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6/1/2018
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W19 Contemporary Applications of Family Systems Theory
Joseph A. Micucci, PhD, ABPP
Scott Browning, PhD, ABPP
Jeffrey M. Alpart, MA, MS, CCC‐SLP
Overview of Couple and Family Psychology
Jeffrey M. Alpart, MA, MS, CCC‐SLP
Year VI Doctoral Candidate
Chestnut Hill College
A shift in perspective (Sexton & Lebow, J., 2015)
Exploring systemics requires a profound shift…
• A shift in understanding a person
• A shift in understanding a presenting issue
• A shift in understanding communication
• A shift in understanding yourself
Family Systems Perspective (Stanton & Welsh, 2011)
• Individuals are best understood through assessing the interactions within an entire family/system
• A system is an interactional unit and a change in one member effects all members
• A systems orientation broadens the traditional emphasis on individual internal dynamics
CFP View of Symptoms (Stanton & Welsh, 2011)
• Symptoms are viewed as an expression of a dysfunction within a family
• Problematic behaviors:
• Serve a purpose for the family
• Are unintentionally maintained by family processes
• Reflect the family’s inability to operate productively
• Are symptomatic patterns handed down across generations
Adlerian Family Therapy
• Based on an educational model that emphasizes family atmosphere and family constellation
• Therapists are collaborators who seek to join the family
• Parent interviews yield hunches about the purposes underlying children’s misbehavior (Corey, 2017)
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Multigenerational Family Therapy
• A theoretical and clinical model developed by Murray Bowen that evolved from psychoanalytic principles and practices (Bowen, 1966)
• The family is viewed as an emotional unit• Unresolved emotional reactivity to one’s family must be addressed if one hopes to achieve a mature personality
• Differentiation of the self• A psychological separation from others
• Triangulation• A third party is recruited to reduce anxiety and stabilize a couples’ relationship
Structural Family Therapy
• Created by Salvador Minuchin, this approach focuses on family interactions
to understand the structure, or organization of the family
• Symptoms are a byproduct of structural failings
• Structural changes must occur in a family before an individual’s symptoms
can be reduced
• Techniques are active, directive, and well thought out (Minuchin & Fishman, 1981)
Strategic Family Therapy
• Presenting problems are accepted as “real” and not a symptom of system
dysfunction
• Therapy is brief, process‐focused, and solution‐oriented
• Change results when the family follows the therapist’s directions and
change transactions (Szapocznik & Williams, 2000)
Clinical Intervention geared to Contemporary Families
Scott Browning, Ph.D., ABPP
Professor
Department of Professional Psychology
Chestnut Hill College
Evidence Based Practice is appropriate for contemporary families
• Four ingredients are necessary for an Evidence Based Practice (EBP)• Knowledge of the basic research on the family type (e.g. stepfamilies, families of adoption…)
• Clinical Theory specific to the family type
• Regular outcome assessment (Genogram Based Interaction Measure, SRS and ORS)
• Ongoing attention to Common Factors of successful psychotherapy (e.g.empathy, alliance, clear goals…
Combined approaches
• Most cases have some use for a specific EST.
• Family cases frequently have some individual concerns that clearly benefit from an EST. Someone will have a panic disorder, anxiety or depression. These three are so well research
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The Way We Never Were
• Dr. Judith Stacey• Sociologist
• The two parent, two child American family was a post World War II anomaly
• War
• Disease• Maternal death in childbirth
• Immigration
TWO BOOKS: Source of Material
• Browning, S. & Pasley, K. (2015). Contemporary families: Translating research into practice. New York: Routledge Press.
• Browning, S. & van Eeden‐Moorefield, B. (2017). Contemporary families at the nexus of research and practice. New York: Routledge Press.
Two Books 7 family types First Seven
• Adoption
• Families on the Autism Spectrum
• LGB
• Chronic Illness
• Foster Families
• Intergenerational
• Interracial
Two books 7 family types Second Seven
• Families of Divorce
• Stepfamilies
• Families of Addiction
• Families of Homicide
• “Fragile Families”
• The Returning Citizen Family (Post Imprisonment)
• Cyberbullied Families
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The effects of psychotherapy are noted in the research as follows:
•The general or average effects of psychotherapy are widely accepted to be significant and large, (Chorpita et al., 2011; Smith, Glass, & Miller, 1980; Wampold, 2001).
These large effects of psychotherapy
• are quite constant across most diagnostic conditions, …variations in outcome are more heavily influenced by patient characteristics, e.g., chronicity, complexity, social support, and intensity – and by clinician and context factors than by particular diagnoses or specific treatment “brands”
• (Beutler, 2009; Beutler & Malik, 2002a, 2002b, Malik & Beutler, 2002; Wampold, 2001)
All Competent Therapy
• “In contrast to large differences in outcome between those treated with psychotherapy and those not treated, different forms of psychotherapy typically produce relatively similar outcomes.”
• APA Proclamation on Evidence Supported Treatment, Aug. 2012
Adoption
• Grotevant, Dunbar, Kohler, & Esau, 2000
• Openness (structurally and communicative)
• Both forms of openness benefit all members of the adoptive triad (i.e., provides knowledge about genetic history, prenatal concerns, adjustment)
Families of Adoption
• Respect absent bio‐parents. Although the adopted person may have mixed feelings about his or her biological parents, the therapist should hold the biological parents in respect. They remain the people who provided the genetic material that created the adopted individual.
• Correct an inaccurate story (if possible). Because the reason a person choses to relinquish a child may never be known, a therapist can present the possibility that the decision was not necessarily motivated only by selfishness.
• Normalize the desire to Search.” To search for one’s birth parents is an individual’s decision for which no universal advice is possible; however, the question of whether to search is normal.
Families with a member on the Autism Spectrum
• Russell & Norwich, 2012
• Tendency for parents to manage the possibility of an ASD diagnosis
• Avoidance‐ to retain “normal” status of child, label of ASD represents a loss of normality for them
• Pursuing a diagnosis and remediation‐ being proactive, normalizing the child by identification of ASD and seeking intervention.
• Research shows that early identification and enrollment in intervention optimizes tx outcomes (Wetherby et al., 2004; Guthrie et al., 2012)
• Clinically‐ helping avoidant parents recognize the ramifications, exploring fears and feelings related to loss of normalcy, and increase sense of urgency
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Autism• Families on the Spectrum have more in common than not.
• These families need community, yet many are pushed toward isolation.
• Etiology of the disorder is mainly helpful if planning more children.
• Marriages can survive and thrive, but they need attention.
• No one treatment is the answer‐shifts as the child develops
• Connection is possible• Obsessions need not to be understood.
Families on the Spectrum (FotS)
• Each member has “a voice.” Because the family member on the spectrum may use spoken language in a manner that creates strained communication, efforts must insure that his or her perspective is recognized.
• Obsessions need not to be understood. The topic of an obsession may be random, so pursuing specific analysis may be unhelpful. Instead, proceed to “thought stopping.”
• View oneself as part of a therapeutic team. Support services of some type are available to most people who have a family member on the spectrum, but parent(s) should be the quarterback of clinical team. This intervention was true for families with medical concerns and foster families, as well.
Family of Addiction‐Smock
• The addicted person may not be part of treatment
• Solution‐Focused Treatment is considered most helpful due to the emphasis on “Preferred Future.”
• Women have more co‐occurring diagnoses than men, yet, they receive less clinical and research attention.
• Family Strengths need to be identified and highlighted.
Research on Chronic Medical Illness
• Kitzman‐Ulrich and colleagues (2010) concluded that family‐based interventions that attempt to change the way family members interact with each other about the health condition requiring management are more effective than those using a psycho‐educational approach
• Direct clinical implication‐ supporting family members in facilitating behavior changes in how they interact with each other is superior to just teaching about the issues at play.
Clinical Basics for Chronic Medical
• Commitment to clear communication among all systems (family and professional)
• Personal control is accented at all possibilities
• Secrets are unhealthy
• Strengths are nourished
• The “illness” is fully understood (as much as possible)
• Shifting roles and expectations need to clarified
Families of Divorce—Wagner & Silverman
• Treatment is improved if the therapist has an alliance with both parents.
• Putting a child in the middle has been identified in longitudinal studies as one of the most damaging aspects of divorce on children—thus—work to assist adults to communicate directly with each other.
• Transitions are difficult for all children—time is needed when transitioning.
• The Bi‐Nuclear Model of Connie Ahrons (We Are Still Family) is a helpful template.
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“Fragile Families” – Jones
• Multiple dimensions‐support, assistance, therapy, practical concerns
• All members in the home are included in treatment
• Stabilization is paramount
• Family Based services must find a way to re‐empower the person representing the highest position in the family hierarchy
Families of Homicide‐Hayes & Browning
• Communication patterns are permanently changed and new patterns must be established.
• Grief/Trauma/Legal‐all three issues are occurring simultaneously, and the therapist needs to shift between these issues.
• Language of co‐victim
• Non‐Judgmental and Play Therapy
Research findings regarding LGB Families
• Extensive research (Patterson; Green) find that child outcome is not significantly different.
• There is not a higher proclivity to become LGB
• These relationships are generally egalitarian
• Social pressures are difficult on many adolescents
• Stepfamily issues may exist
LGBT Family
• (Weston, 1991)‐ often create own kinship networks/families of choice, perhaps after rejection from family of origin post‐disclosure
• Clinically‐ help couple recognize this as a sign of strength/resilience, a way of coping/adapting, thriving in a marginalized world (Meyer, 2003)
LGBTQ+ Families
• Accept one’s own limited expertise. The LGBTQ family is always the expert of their own situation and identity.
• Assess the effect of stigma. Being aware of likely stigma assists in countering the devastating effect of ongoing stigmatization. Certainly, stigma is connected with many family types that are perceived as outside the norm.
• Create an affirming environment. Photos, posters and toys should match the world as experienced by these families.
• Overtly avoid “pathologizing”. A history of implied or stated pathology for these families demands that therapists need to be careful to avoid replicating that historical mistake.
• 5. Use intersectionality exercise. Creating a list of roles held in one’s life is used to highlight the effect of being asked to abandon any aspects of one’s identity.
Research on Straight parents reacting to LGBTQ children
• Families who reject their queer child often do so with the intention of doing what they believe is guided by love (Ryan, 2010).
• Clinical‐ exploring parental reactions and meaning behind their initial rejection
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Families with an LGB Adolescent “Coming Out”‐Micucci
• Parallel processes occur. Both the parents and adolescent are trying to reconcile identity issues.
• “Expand the field of vision.” Rather than concentrate only on the disclosure, some attention shifts back to the former relationship that existed.
• Avoid “rescuing the LGB adolescent.” Therapist and adolescent should not form a coalition against the rest of the family.
• People are more than their sexual orientation. Assist parents, and potentially siblings, in seeing the “coming out” adolescent in her or his entirety.
• Be hyper‐vigilant about depression and suicide. The LGBT adolescent is at a higher risk, and therapists should be watchful.
Foster Care
• Foster parents, engaged in caregiving, may increase family and marital conflict (Brown & Calder, 1999)
• Conflict increases especially when there is serial caregiving, as this is disruptive, due to reconfiguring daily routines to account for constant newcomers (Seaberg & Harrigan, 1997, 1999)
Basic Issues in Foster Families
• Determine the likely goal: 1) birth mother (father) will regain the child; 2) the foster parent will be involved for as long as the child is in need; 3) this is a temporary “safe” placement; 4) the foster parent will be seeking the rights to adopt the child
• As multiple possibilities of miscommunication and misinterpretation are likely, engaging all parties is helpful.
• Bureaucratic complexity hinders success
• Work to reduce confusion for children
Clinical Interventions: Foster Care Families
1. Determine the likelihood of reunification. The “reality” of reunification needs to be clarified for all parties to function securely.
2. Assess motivation for treatment. These families may be required or advised to seek assistance, so the role of the therapist must be determined, that of coach or therapist.
3. Acknowledge the effect of uncertainty. When one does not know if a member will return, the uncertainty shows up in depression, tension, or acting out.
4. Carefully assess the foster child’s vulnerabilities. This child is often removed because of child maltreatment which needs to be part of assessment and treatment.
5. Reduce the guilt of loyalty binds. By addressing loyalty binds as normal, anxiety over the topic is reduced.
Grandparents raising grandchildren
• (Smith & Dolbin‐MacNab, 2013)‐ custodial GRG who were mentally healthy resulted in children exhibiting less behavioral problems and demonstrating better adaptation
• Clinically‐ supporting the emotional well‐being of GRG may promote positive parenting and better outcomes for child.
Intergenerational Family Basics
• All involved adults must have an agreement about the “chain of command.”
• Past relational issues should not be dictating current interactions.
• In parenting, people from any relationship should be permitted some time with people of their age group.
• The child has the right to form a relationship with a parent, even an addict or convict, if such a relationship is sought after. And one has the right to not have a relationship.
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Grandparent‐headed Families
• Determine permanency of arrangement. Relationship building demands clarity to create an environment of mutual respect. When children feels that relationships are temporary, acting out and anxiety are more difficult to address.
• Support, don’t replace, the grandparent. Therapist need to avoid rushing in and becoming the authority, as it weakens the grandparent.
• Recognize the likely presence of grief and trauma. Some life event has caused the parent to be unavailable, so the child has experienced loss.
• Discuss age differences openly. The child and often the therapist are younger than the grandparent, so age is a factor for discussion.
• Increase the grandparental support system. Grandparents often are not embedded in a like community, so; social support is less available, but still necessary
Interracial families
• Couples‐ when they have divergent orientations (individualist/collectivist), boundaries may be problematic
• Ex. Partners’ ideas about who is in/outside of the family
• Without agreement on who is considered family, conflict may ensure (Negy & Snyder, 2000)
• Clinical‐ helping interracial couples acculturate to each other’s cultural views, role expectations, and beliefs
Interracial
• People tend to go through stages of racial and cultural identity. One cannot dictate what stage the person should be on at any one time.
• One has the right to accept an identity to incorporates all of the heritages that comprise one’s background.
• One may select to embrace only one part of their heritage, if they wish (although it is likely not to continue through life)
• In‐Law acceptance is not a given.
• Where to live is a large issue
Families Post‐Imprisonment
• Language of “Returning Citizens”
• Intergenerational issues need to be a focus
• “Prisonization” is real and should be explained• Don’t show weakness
• Be hypervigilant
• Emotions can be manipulated
• Mediation precedes therapy
Stepfamilies
• Stepfamilies usually have dynamics that are distinct from first union families.
• Stepfamilies often go through a transition period (3‐5 years) that is more difficult than they expected.
• Stepparents and stepchildren may not love each other, particularly at first.
• After a period, stepfamilies may be loving and satisfied families.
• Adults who are able to communicate, serve the children in stepfamilies well.
THE END, Thank you
• Scott Browning, Ph.D., ABPP
• Professor of Psychology
• Chestnut Hill College
• Philadelphia, Pennsylvania
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Applying Family Systems Theory to Individual Psychotherapy
Joseph A. Micucci, Ph.D., ABPP
Pennsylvania Psychological Association
June 14, 2018
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Overview
• Step 1. Reframing the presenting problem
• Step 2. Obtaining a picture of the social system
• Step 3. Identifying desired changes
• Step 4. Exploring options for intervention
• Step 5. Following up on interventions and revising hypotheses
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Systems Theories Applied to Individuals• Murray Bowen’s “coaching”
• One‐person Family Therapy (Szapocznik et al.)
• Family games (Selvin‐Palazzoli & Viaro)
• Systemic/Constructivist Approach (Boscolo & Bertrando)
• Working with the “complainant” (MRI)
• Solution‐focused therapies
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Positioning Theory(Davies & Harre, 1990; Harre & van Langenhove, 1991)
• Positions vs. roles• Positioning through “discursive practices”
• Explicit or implicit positioning
• Positions as organizers of experience
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Similarities to Other Concepts
•Complementarity
•Report and Command Function of Communication
•Multifaceted Self
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Harre & Gillett (1994)
• Emotions (feelings) vs. emotional displays
• Emotional displays are discursive acts aimed to accomplishing social ends
• Have more “illocutionary force” (social impact) than verbal acts
• Thus, emotional displays can be utilized in positioning
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Paolo Bertrando on Emotions
• “Emotions are not purely individual phenomena but rather …complex events embedded in an interpersonal systemic matrix” (Bertrando, 2014)
• “Emotions should be considered as processes, rather than things; they are aspects of relating” (Bertrando & Arcelloni, 2009)
• “[An emotion] is a function of one’s position in the system”
• What is the relational meaning of an emotional expression at a specific moment?
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Emotions as “Ecosystemic Adaptations” (Pocock, 2009, 2010)
• Emotions and how they are handled are “systemically organized” strategies that are designed to elicit certain responses from others”
• “Emotional expression in one person is a non‐consciously organized adaptation to an emotional ecosystem”
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Power(Guilfoyle, 2003)
• “Power is made available to different people on the basis of their positioning within discourses that are culturally and socially – not individually – constructed … power is not something that a therapist can simply choose to avoid”
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Power (Knudson‐Martin & Heunergardt, 2015)
• “Power [is] the ability to influence the other. It is a dynamic, fluid process between people”
• “People in powerful positions may not be aware of how others accommodate and do not necessarily feel powerful”
• “When influence is relatively equal, each partner feels free to express their needs, goals, and interests, and each attends to and accommodates to the other”
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Applications(Guilfoyle, 2015)
• Dominant narratives situate (i.e., position) people relative to others in their lives
• Advocates “empathic positioning” to determine what position the client occupies within their dominant narrative –Who are you in this story?
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Positioning and Family Structure
• Positions in a social system define where one is in relation to others ‐‐ alignments, boundaries, coalitions.
• Complementary or opposing positions
• Opinions, beliefs, feelings are a function of one’s position
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Applications to Individual Therapy
• Step 1. Reframing the presenting problem
• Embed problem in relational network
• Resolution entails changing the network
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Applications to Individual Therapy
• Step 1. Reframing the presenting problem
• Embed problem in relational network
• Resolution entails changing the network
• Step 2. Obtaining a picture of the social system• Circular Questions (Selvini‐Palazzoli, et al.)• Client’s position vis a vis other significant people in their life
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Applications to Individual Therapy
• Step 3. Identifying desired changes• Help clients become aware of the positions s/he occupies
• Assess client’s satisfaction with these position
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Applications to Individual Therapy
• Step 4. Exploring options for intervention• Strategize ways client can re‐position self• Advantages/Disadvantages of change• Implementing interventions and keeping records
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Applications to Individual Therapy
• Step 5. Following up on interventions and revising hypotheses• Revising hypotheses• Tracking change in presenting problem• Therapist is conscious of his/her position within the therapeutic system
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Applications to Individual Therapy
• Step 1. Reframing the presenting problem
• Step 2. Obtaining a picture of the social system
• Step 3. Identifying desired changes
• Step 4. Exploring options for intervention
• Step 5. Following up on interventions and revising hypotheses
66
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Couple & Family Psychology Training
“Seeing The System” (Stanton & Welsh, 2012).
Cartesian View
• 2D view
• Cause and Effect
Cyclical View
• 3D view
• Interconnected patterns
CFP Immersion Learning
•Reflection •Observation (Hodgson, et al., 2005)•Created Family (Browning, Collins & Nelson, 2006)
Beyond graduate school…
• Psychology requires an ongoing education (Fairburn & Cooper, 2011)
• CEUs
• Conferences
• Research
The Philadelphia Association for Couple & Family Psychology
www.phillyCFP.org
Our Mission
1. Provide a community of support and education for providers of Couple and Family Psychology in the greater Philadelphia area,
2. Provide a resource for professionals and laypeople looking to find a qualified provider of Couple and Family Psychology &
3. Provide a richer understanding of the importance of systemic thinking and the clinical impacts of systemic psychotherapy.
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Membership
1. CEU events
2. Social Events
3. Peer‐mentoring training and groups
4. Therapy Resources
5. “Provider Network”
6. Informative newsletter including events calendar, articles related to CFP research and practice
Thank you
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