Dating a Family Therapy Model

I am going to start seeing clients in a few weeks in the clinic at the University of Oregon. Part of that process is beginning to “date a model.” That means I have to choose one of the many styles of family therapy and try it out to see if it’s really my thing. I’m a born generalist and integrator, so this is a difficult choice to make. Below, I typed up the “In a Nutshell: The Least You Need to Know” sections for each family therapy model in Diane Gehart’s excellent book, Mastering Competencies in Family Therapy. (Actually, I’ve left out one–collaborative therapy–because I know almost nothing about it, so it’s not one of my active choices.)

Those of you who know me (and I believe that’s pretty much all of you, readers) and have the stamina to read these eleven paragraphs, I would love to know which of these models you think sounds the most like me.

Systemic and Strategic Therapies: Using what most therapists consider the classic family therapy method, systemic family therapists conceptualize the symptoms of individuals within the larger network of their family and social systems while maintaining a nonblaming, nonpathologizing stance toward all members of the family. Systemic therapies are based ongeneral systems and cybernetics systems theories,  which propose that families are living systems characterized by certain principles, including homeostasis, the tendency to maintain a particular range of behaviors and norms, and self-correction, the ability to identify when the system has gone too far from its homeostatic norm and then to self-correct to maintain balance. Systemic therapists rarely attempt linear, logical solutions to “educate” a family on better ways to communicate–this is almost never successful–but instead tap into the systemic dynamics to effect change. They introduce small, innocuous, yet highly meaningful alterations to the family’s interactions, allowing the family to naturally reorganize in response to the new information. Because this method effects change quickly, systemic therapies were the original brief therapies.

Structural Therapy: As the name implies, structural therapists map family structure–boundaries, hierarchies, and subsystems–to help clients resolve individual mental health symptoms and relational problems. After assessing family functioning, therapists aim to restructure the family, realigning boundaries and hierarchies to promote growth and resolve problems. They are active in sessions, staging enactments, realigning chairs, and questioning family assumptions. Structural family therapy focuses on strengths, never seeing families as dysfunctional but rather as people who need assistance in expanding their repertoire of interaction patterns to adjust to their ever-changing developmental and contextual demands.

The Satir Growth Model: One of the first prominent women in the field, Virginia Satir began her career in family therapy at the Mental Research Institute working alongside Jay Haley, Paul Watzlawick, Richard Fisch, and the other leading family therpists in Palo Alto. [These were the folks who came up with the “systemic and strategic therapies,” above.] She eventually left the MRI to develop her own ideas, which can broadly be described as infusing humanistic values into a system approach. She brought a warmth and enthusiasm for human potential that is unparalleled in the field of family therapy. Her therapy focused on fostering individual growth as well as improving family interactions. She used experiential exercises (e.g., family sculpting), metaphors, coaching, and the self of the therapist to facilitate change. Her work is practiced extensively internationally, with Satir practitioners connecting through the Satir Global Network.

Symbolic-Experiential Therapy: Symbolic-experiential therapy is an experiential therapy model developed by Carl Whitaker. Whitaker referred to his work as “therapy of the absurd,” highlighting the unconventional and playful wisdom he used to help transorm family. Relying almost entirely on emotinal logic rahter than cognitive logic, his work is often misunderstood as nonsense, but it is more accurate to say that he worked with “heart sense.” Rather than intervene on behavrioral sequences like strtegic-systemic therapists, Whitaker focused on teh emotional process and family structure. He intervened directly at the emotional level of the system, relying heavily on “symbolism” and real life experiences as well as humor, play, and affective controntation.

For the astute observer, Whitaker’s work embodied a deep and profound understanding of families’ emotional lives; to the casual observer, he often seemed rude or inappropriate. When he was “inappropriate,” it was always for the purpose of confronting or otherwise intervening on emotional dynamics that he wanted to expose, challenge, and transform. He was adamant about balancing strong emotional confrontation with warmth and support from the therapist. In many ways, he encouraged therapists to move beyond the rules of polite society and invite them selves and clients to be genuine and real enough to speak the whole truth.

Bowen Intergenerational Therapy: Bowen intergenerational theory is more about the nature of being human than it is about families or family therapy. The Bowen approach requires therapists to work from a broad perspective that considers the evolution of the human species and the characteristics of all living systems. Therapists use this broad perspective to conceptualize client problems and then rely primarily on the therapist’s use of self to effect change. As a part of this broad perspective, therapists routinely consider the three-generational emotional process to better understand the current presenting symptoms. The process of therapy involves increasing clients’ awareness of how their current behavior is connected to multigenerational processes and the resulting family dynamics. The therapist’s primary tool for promoting client change is the therapist’s personal level of differentiation, the ability to distinguish self from other and manage interpersonal anxiety.

Psychoanalytic Family Therapies: These therapies use traditional psychoanalytic and psychodynamic principles that describe inner conflicts and extend these  principles to external relationships. In contrast to individual psychoanalysts, psychoanalytic family therapists focus on the family as a nexus of relationships that either support or impede the development and functioning of it’s members. As in traditional psychoanalytic approaches, the process of therapy involves analyzing intrapsychic and interpersonal dynamics, promoting client insight, and working through these insights to develop new ways of relating to self and others. Some of the more influential approaches are contextual therapy, family -of-origin therapy, and object relations family therapy.

Behavioral and Cognitive-Behavioral Family Therapies: In the general mental health field, cognitive-behavioral therapies (CBTs) are some of the most commonly used therapeutic approaches. They have their roots in behaviorism–Pavlov’s research on stimulus-response pairings with dogs and Skinner’s research on rewards and punishments with cats–the premises of which are still widely used with phobias, anxiety, and parenting. Until the 1980s, most of the cognitive-behavioral family therapies were primarily behavioral: behavioral family therapy and behavioral couples therapy. In recent years, approaches that more directly incorporate cognitive components have developed: cognitive-behavioral family therapy and Gottman method couples therapy approach.

Cognitive-behavioral family therapies integrate systemic concepts into standard cognitive-behavioral techniques by examining how family members–or any two people in a relationship–reinforce one another’s behaviors to maintain symptoms and relational pattern. Therapists generally assume a directive, “teaching,” or “coaching” relationship with clients, which is quite different from other approaches of “joining” or “empathizing” with clients to form a relationship. Because this approach is rooted in experimental psychology, research is central to its practice and evolution, resulting in a substantial evidence base.

Solution-Based Therapies: Solution-based therapies are brief therapy approaches that grew out of the work of the Mental Research Institute in Palo Alto (MRI) and Milton Erickson’s brief therapy and trance work. The first and leading “strength-based” therapies, solution-based therapies are increasingly popular with clients, insurance companies, and county mental health agencies because they are efficient and respectful of clients. AS the name suggests, solution-based therapists work with the client to envision potential solutions based on the client’s experience and values. Once the client has selected a desirable outcome, the therapist assists the client in identifying small, incremental steps toward realizing this goal. The therapist does notsolve problems or offer solutions but instead collaborates with clients to develop aspirations and plans that they then translate into real-world action.

Narrative Therapy: Developed by Michael White and David Epston in Australia and New Zealand, narrative therapy is based on the premise that we “story” and create the meaning of life events using available dominant discourses–broad societal stories, sociocultural practices, assumptions, and expectations about how we should live. People experience “problems” when their personal life does not fit with these dominant societal discourses and expectations. The process of narrative therapy involves separating the person from the problem, critically examining the assumptions that inform how the person evaluates himself/herself and his/her life. Through this process, clients identify alternative ways to view, act, and interact in daily life. Narrative therapists assume that all people are resourceful and have strengths, and they do not see “people” as having problems but rather see problems as being imposed upon people by unhelpful or harmful societal cultural practices.

[First posted on Nathen’s Miraculous Escape, May 22, 2010.]

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