Counseling and Psychotherapy Theory · Counseling and Psychotherapy Theory . Major Concepts and...

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Week 8. Family/System Approach Counseling and Psychotherapy Theory

Transcript of Counseling and Psychotherapy Theory · Counseling and Psychotherapy Theory . Major Concepts and...

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Week 8. Family/System Approach

Counseling and

Psychotherapy Theory

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Major Concepts and Propositions

Overview

Major Concepts and Propositions I

Major Concepts and Propositions II

Change Mechanisms & Intervention Methods

Moving from the Problem State to the Changed State

Strategies and Techniques

Theory’s Current State and Prospect

Current State and Prospect

Implications

Contents

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Overview

Main Assumptions

Characteristics by Subtype Approach

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Ⅰ. Major Concepts and Propositions

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Individual counseling theories

Main Assumptions

Acknowledges that family affects an individual's well-being

However, the target of the intervention is the individual individual & family are changed

Family counseling

Acknowledges that family affects an individual's well-being.

But the intervention is on the family system individual & family are changed

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‘Intervene in the family system’?

Main Assumptions

intervene in the family structure

• Hierarchy within family

• Boundaries between members

• Subsystems within family

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‘Intervene in the family system’?

intervene in interactions

• Dual, triangular interaction style

A B

Main Assumptions

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4 subtype approaches

Characteristics by Subtype Approach

Structural approach

Strategic approach

Experiential approach

Psychoanalytic multigenerational approach

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Psychoanalytic multigenerational approach (M. Bowen)

Assumptions

• Parents' inappropriate nurturing style triggers problems • Dysfunctional interactions within the original family are transferred throughout

generations.

Problems Interventions

• Maladaptive defense mechanisms (not genuine interactions)

interaction between defense mechanisms • Parents function as good/bad objects • Triggers/worsens children’s splitting [ex] splitting, projective identification, various defensive interactions

• Understanding & insight • Preventing dysfunctional interaction • Insight on dysfunctional family

dynamics • Insight on multi-generational

dysfunctional family dynamics • Holding, containing • Integration of splitting

Characteristics by Subtype Approach

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Structural approach (S. Minuchin)

Assumptions

family structure and system determines an individual's well-being

Problems Interventions

• inappropriate family structure and system

• family hierarchy, subsystems, within-family boundaries, within-family alliance, etc.

• modifying incorrect structures and systems

Characteristics by Subtype Approach

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Strategic approach (J. Haley)

Assumptions

The purpose of every interaction within a family is acquisition of power

Problems Interventions

• Implicit strategy taken when making explicit efforts to acquire power and secure control within a relationship seems impossible

• Counterstrategy to disempower the implicit strategy

• Making the implicit strategy explicit

• Paradoxical intervention, etc.

Jay Haley

Characteristics by Subtype Approach

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Experiential approach (V. Satir)

Assumptions

Family is a system that seeks to maintain balance and homeostasis

Problems Interventions

• Individual’s cost of maintaining balance and homeostasis

• Hinders individual’s growth

• Breaking the family’s balance and homeostasis that stayed as a symptom

• Recognizing and explicitly expressing/conveying individual’s inner experience

V. Satir

Characteristics by Subtype Approach

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Problems Interventions

Communication pattern

Indirect, ambiguous Direct

Family rules Rigid, absolute Flexible

Family function Emotional shutdown,

defensive Emotional openness, not

defensive

Individual’s value

Neglect of positive self or value

Identify self worth

Characteristics by Subtype Approach

Experiential approach (V. Satir)

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Major Concepts and Propositions I

Systems Theory Related

Family Genogram

Classical Concepts

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Ⅰ. Major Concepts and Propositions

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Feedback loop

Systems Theory Related

an automatic control process where an input results in an output, which again affects the input.

Input Process Output …

Feedback

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Feedback loop

Systems Theory Related

Positive Feedback Negative Feedback

• the output goes through the loop in the same direction as the initial input.

• Sharp increase in the nonlinear distortion

• the output goes through the loop in the opposite direction as the initial input.

• Decrease in the nonlinear distortion

• Microphone

• Arguments within family

• Thermostat

• Parent’s homeostatic function

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Cyclical interaction

Systems Theory Related

Change in one member affects other member and the family as a whole, and such influence affects that one member again

Oppressive parent

Child’s defiance

Parent becomes more oppressive

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Homeostasis

Systems Theory Related

Tendency of the system to stay in the original, familiar state and function Thus, systems tend to resist change.

A child’s behavior that is about to bring change to

the system

Parents’ control gets stronger due to the anxiety that the family system

might collapse

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Family Genogram

Family Genogram

• Expresses family structure, relationship, dynamics

• Includes 3 generations

• Age, job, education level must be included

80 co unemp

(reporter)

85ms unemp

57hs housewife

55 co entrepre

neur

53gr professor

47gr doctor

50co doctor

24 stude

nt

27 co business

man

18 hs

59co unemp

83gr unemp (lawyer)

Ms: middle school grad Hs: high school grad Co: college grad Gr: graduate school grad Unemp: unemployed

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Double bind

Classical Concepts

Two contradictory messages

No satisfactory conclusion either way

- A nonverbal message signaling ‘go away’

- A verbal message saying, ‘Come here. You need my love.’

- ‘You interpreted my message wrong’

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Double bind

[Ex] A young man was recovering from schizophrenia

• Situation: His mother visited him at the hospital, and he was glad to see her. Mother appears tense, so he backs off.

Mother : ‘You don’t love me anymore.’

Son : (blushes)

Mother : ‘Son, you shouldn’t get so easily embarrassed or fearful of your emotions.’

Classical Concepts

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Marital schism

Broken marital relationship

Marital skew

One spouse overwhelms the other in a marital relationship

Classical Concepts

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Major Concepts and Propositions II

Multigenerational Approach Related

Structural Approach Related

Experiential Approach Related

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Ⅰ. Major Concepts and Propositions

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Multigenerational Approach Related

• A state in which one has accepted that one’s thoughts, feelings, or language can be different from that of other family members.

• A state in which emotion and thought process are differentiated from each other within an individual buried in emotions

• When one cannot accept that one can be different from other members, one is restricted about what to think and feel.

• [Ex] A client who has difficulty making choices freely based on his thought and emotions

Self-differentiation

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• Bringing in a third person in order to reduce a conflict, anxiety or tension between two other members within a family.

• Typically, a person with low self differentiation is taken in as the third person.

• [Ex] Mother who complains to her son after fighting with her husband

Triangulation

Multigenerational Approach Related

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• Parents projecting their own stress to their children

• [Ex] A parent who gets angry at his child because of his own anxiety

Family projection

Multigenerational Approach Related

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• When a child is overly stressed due to excessive meddling from family, she separates herself emotionally from the family

• [Ex] A son who never visits his parents

Emotional cut-off

Multigenerational Approach Related

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Structural Approach Related

The spousal subsystem or sibling subsystem within a family system

Are sometimes formed based on emotional proximity

[Ex ] - Parent/child system

- Father/daughter vs. mother/son subsystem

Family subsystems

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Structural Approach Related

Boundaries are set between members or between subsystems

Boundaries are established through certain rules regarding information influx shared by individuals or subsystems or rules regarding participation.

Boundary

Clear boundary ___ . . ___ . . ___ . . ___

Diffuse boundary ……………………………

Rigid boundary ____________________

Alliance/Over-involvement

=================

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Structural Approach Related

Two people teaming up against a third member

Coalition

• Stable coalition

• Detouring coalition

• Triangulation

• Cross-generational coalition

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Experiential Approach Related

Internalized behaviors, attitudes, relationship responses that were experienced among family members

[Ex] Taboo topics within the family

Family rules

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Experiential Approach Related

Communication

• Every interaction people use to exchange messages including implications and symbols

• Reveals the relationship level of the interactions as well as individual characteristics

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Experiential Approach Related

Communication

Communication types

Placater Blamer Computer Distractor Leveler

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Experiential Approach Related

Communication

Placater

• Conveys to others that one is not so important by denying oneself

• Tries to please others

Blamer • Self-centered, self-righteous, dominant, and slighting others

• Aggressive, controlling, easily angered

Computer

• Cool-headed; regards being rational, objective, and logical important

• Self and others don’t matter; logic and situation are considered important

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Experiential Approach Related

Communication

Distractor

• The opposite of the ‘computer’ type

• Talks and acts inappropriately to particular topic or situation

• Interferes with deep communication

Leveler

• Internal emotions and thoughts are consistent with what are externally expressed

• Sensitively aware of and expresses one’s own thoughts, emotions, and desires

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ⅠI. Change Mechanisms & Intervention Methods

Moving from the Problem State

to the Changed State

Problem State vs. Changed State

Change Facilitating Factor

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Approach type Problem state Changed state

Psychoanalytic multi-

generational

• Maladaptive dynamics repeated within and between generations

• Dysfunctional dynamics or defense mechanisms incapacitated

Structural • Inappropriate family structure,

system • Appropriate family structure,

system

Strategic

• Implicit strategies for exercising power and control are fixated and are shown through different symptoms

• Explicit strategies and clear communication

Experiential

• Pursuing family balance to the point of blocking individual members' experiences and communication

• A new dimension of family balance that reflects individual members’ experiences and communication

Problem State vs. Changed State

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Change Facilitating Factor

Approach type Change Facilitating Factor

Psychoanalytic multi-

generational

• Gaining awareness/insight into maladaptive dynamics and defense mechanisms within and between generations

• Contacting internal experiences

• Choosing new method

• Practicing and solidifying new behavioral style

Structural

• Gaining awareness/insight into inappropriate family structure

• Modifying into appropriate, functional family structure

• Choosing new method

• Familiarizing with the new structure

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Approach type Change Facilitating Factor

Strategic

• Weakening the implicit strategies through explicit communication

• Taking root in clear communication

Experiential

• Becoming aware of private experiences that had been blocked

• Directly communicating about experiences

• Taking risks and choosing direct communication

• Practicing and familiarizing with direct communication

Change Facilitating Factor

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Recognizing inappropriate family

structure

• Recognizing defense mechanisms

• Recognizing cross-generational patterns

Awareness, understanding,

insight

Recognizing implicit strategies

• Recognizing that personal experiences are blocked for family balance

• Recognizing individual member’s experiences

Change Facilitating Factor

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Reenact/practice/solidify behavioral style within

an appropriate structure

Reenact/practice/solidify a new behavioral style

Reenact/ practice/ solidify

Reenact/practice/solidify direct/explicit

communication method

Solidify behavioral style that

expresses personal experiences

Change Facilitating Factor

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Strategies and Techniques

Overview

Specific Strategies and Techniques

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ⅠI. Change Mechanisms & Intervention Methods

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Overview

Purpose of techniques and strategies

Bringing about change in an individual through transforming family structure and within-family communication

Approach type Change in the individual

dimension Change in the family

dimension

Psychoanalytic multi-

generational

• Insight into individual’s inner dynamics and structure

• Insight into family dynamics and structure • Insight into repeated patterns across generations

Structural • Insight into individual’s inner dynamics and structure and modifying them

• Awareness/insight into inappropriate family structure and modifying it

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Overview

Purpose of techniques and strategies

Bringing about change in an individual through transforming family structure and within-family communication

Approach type

Change in the individual dimension

Change in the family dimension

Strategic • Change in the individual through explicit communication (not symptoms)

•Change in the communication within through explicit communication (not symptoms)

Experiential

• Change in the individual through awareness and communication of personal experiences

•Moving to a new level of family balance through awareness and communication of personal experiences

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Specific Strategies and Techniques

Psychoanalytic multigenerational approach

Explain and interpret (family genogram)

Empathize and hold

Contain

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Structural approach

Changing boundaries

• Rearrange seating

• Empower

• Reconstruct the way family members agree or make alliances

Specific Strategies and Techniques

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Strategic approach

Instructing

Paradoxical intervention

Ordeal therapy

[Ex] instruct a child to use honorifics (in Korean) to her parents.

[Ex] tell the father to become more demanding to the son who has run away from home

[Ex] tell a client with insomnia to wipe the floor instead of trying to sleep

Specific Strategies and Techniques

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Strategic approach

Restructuring

Exaggerating

Metaphorical task

[Ex] label anorexia not as a disorder but as stubbornness

[Ex] tell a child who frequently throws a fit to act like a Hulk in front of his mother.

[Ex] When a client has a hard time talking about sexual issues, ask her to metaphorically talk in terms of eating food.

Specific Strategies and Techniques

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Experiential approach

Family sculpting

Role play Family picture

Specific Strategies and Techniques

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Current State and Prospect

Current State and Prospect

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ⅠII. Theory’s Current State and Prospect

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Mix of various value systems

- from familyism to individualism

- from paternalism to gender equality

- values of men and women are in conflict family problems are increasing

Characteristics of Korean families

Current State and Prospect

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Adequate individuation between parent and child is difficult

From extended families to nuclear families.

Indirect and nonverbal communication method

- Children are still thought to be face-savers for parents.

Characteristics of Korean families

- Both cultures and value systems coexist.

- Indirectness or nonverbal communication due to hierarchies

- Expressing emotions is not valued; it’s indirectly done.

Current State and Prospect

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International marriages

between a Korean and a foreigner are reported to be 7% or 10%.

Increasing multicultural families

Foreign women Foreign men

China, Vietnam, Philippines

China, Japan, U.S.A.

Current State and Prospect

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Inflow of North Korean defectors

Currently, about 28,000 North Korean defectors live in Korea.

Similar language and looks, but culturally different.

Increasing multicultural families

Current State and Prospect

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Implications

Create insight/understanding/narrative : dynamics, patterns

- Ex: “I now realize that our family had such and such dynamics and patterns. This is why I felt so suffocated.

Recognize/contact/familiarize : needs, emotions

- Ex: Getting in contact with the needs and emotions within the family and getting used to them

Intervening in family systems, structures, and interactions

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Choose: new behavior

- Ex : Taking the risk of trying out a new behavior

Practice/solidify: thoughts, behaviors

- Ex : having honest conversations; engaging in interactions without using symptoms or being defensive

Intervening in family systems, structures, and interactions

Implications

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