Marriage and family counseling-2022

marriage and family counseling is a vital practice to bring peace and security in any dysfunctional family.

1. Wolaita Sodo University College of Education and Behavioral Studies Department of Psychology Course: Marriage and Family Counseling Assegid Negash (Ph.D.) 2022 Psyc 601

2. Description: Examination of the intervention techniques and major theories of Marriage and Family Therapy . cognitive-behavioral , experiential , psychodynamic , solution-focused brief family therapy, strategic family therapy, structural and systemic family therapy Key concepts: role of therapist, goals of treatment, therapeutic techniques, strengths and limitations of each approach. Applications of each theory will be evaluated for cultural appropriateness . Ethical and legal issues related to family therapy will be explored . Research in marriage and family therapy.

3. Contents Chapter One: Introduction Definition of Marriage and Family Therapy Healthy & Dysfunctional Characteristics of Families Differentiation of Family Therapy from Other Psychotherapies Working with Single-Parent Families Working with Blended Families Process of Family Therapy

4. Chapter Two: Theories in Marriage and Family Counseling Structural Family Therapy Strategic Family Therapy Psychodynamic Family Therapy Experiential Family Therapy Cognitive-Behavioral Therapy Solution-focused family therapy Chapter Three: Special Issues in Marriage and Family Therapy Substance Abuse Family Violence/GBV Divorce Child Abuse Sexual Dysfunction and Medical Illness Chapter Four: Ethics in Marriage and Family C ounseling Chapter Five: Research in Marriage and Family Therapy

5. Evaluation Criteria Assignment 1: Interview both of your parents about the family history & note key family dynamics , strategies they have using to improve their relationships , etc. Moreover, ask your parents how they met & about their courtship ( 30%). Assignment 2: Prepare your own family genogram by consulting various members of your nuclear & extended family . Trace at least 2 dynamics or health conditions & discuss the patterns that you see & ways to change the dysfunctional patterns ( 20%). Class work-article review (10%) Final examination (40%) Total mark = 100%

6. Mode of Delivery Lecture Group d iscussion P resentation Recommended Books Wetchler , J. L., & Hecker , L. L. (2015). An introduction to marriage and family therapy (second edition). Routledge . Metcalf, L., & LPC-S, L. S. (2011). Marriage and family therapy: A practice-oriented approach. Springer Publishing Company. Gladding, S. T. (2007). Family therapy: History, theory, and practice. Upper Saddle River, NJ: Pearson, Merrill Prentice Hall. pdfdrive.com/- To download books gen.lib.rus.ec/- To download b ooks sci-hub- To download a rticles

7. There are two different views about what marriage is . 1. Conjugal View: Marriage is the union of a man and a woman who make a permanent and exclusive commitment to each other ( rearing children together). Thus, marriage involves: first, a comprehensive union of spouses; second, a special link to children ; and third, norms of permanence, monogamy , and fidelity . This view is based on religious beliefs. Definition of Marriage

8. 2. Revisionist View : Marriage is the union of two people (whether of the same sex or of opposite sexes ) who commit to romantically loving and caring for each other and to sharing the burdens and benefits of domestic life. Marriage is all about romance, love, and mutual affection . It is essentially a union of hearts and minds , enhanced by whatever forms of sexual intimacy both partners find agreeable. E.g. Gay and lesbians

9. It is a relationship established between two consenting opposite-sex partners with life long commitment. It involves a mutual commitment by each partner. Marriage is more than being together . It is a legally recognized or socially approved arrangement between two or more individuals that carries certain rights and obligations.

10. Monogamy : marriage b/n two partners of the opposite sex (one man with one woman). Polygamy: the concurrent marriage of a person of one sex with two or more members of the opposite sex ( marriage with multiple partners ). Polygamy can take the form of either polygyny or polyandry. Polygyny : the concurrent marriage of one man with two or more women . Polyandry : a marriage of one woman with two or more men or a woman is permitted to marry more than one man at a time . 10 Types of marriage

11. T here are two forms of polyandry : Fraternal polyandry –in which a group of brothers share a wife and sexual access to the wife. Non-fraternal polyandry –it is the one in which a woman’s husbands are not related. Exercised in India , Nepal, Kenya, China etc.

12. Endogamy C ultural norms prescribing that people marry within their own social group or category . T hey marry people who come from the same societal class , ethnic group , religious affiliation , and other categories considered important within their own social group . Exogamy Cultural norms prescribing that people marry outside their own social group or category. 12

13. Marriage provides the creation of relatively stable relationships . Biological functions Means to satisfy sexual desires . Economic functions Social functions Bring happiness Educational functions Marriage educates to be responsible 13 Functions of marriage

14. Factors affecting marital relationship

15. Marriage counseling is a form of therapy in which a clinician sees both spouses together to resolve problems in their relationship. Marital counselling also called ‘marriage counseling’ or ‘marital therapy’, is a form of counselling for married couples or couples who are engaged and are on their path of getting married.

16. Types of marriage counseling Pre-Marital Counselling Pre-marital counselling can be opted by couples who are in a relationship and want to take their relationship to next level, i.e., marriage. T he couple may not have a chance to discuss their ideologies with each other or might find themselves at odd when they realize that their and their partner’s ideas are not compatible.  T he counsellor can help the couple to understand their compatibility, their beliefs and values and many other aspects which will help them to understand the partner in a better way.

17. 2. Post-Marital Counselling T his type of counselling is for couples who are already married . T he couple may have problem in communicating their emotions or thoughts to their spouse, sometimes there can be differences in their parental styles or there can be intimacy issues.

18. Family? Definitions vary across cultures & change over time . 1. People who have interrelated with blood or without. 2. A group of two or more individuals who are related to each other by blood , marriage , or adoption and who usually live together. Family

19. Types of Families Nuclear Families Traditional or n uclear family c onsists of a mother, father, and one or more children . It is a two-generation unit consisting of a husband, wife, and their immediate children—biological, adopted, or both living within one household. Impressions Married men and women are less depressed, anxious , and psychologically distressed than singles, divorced or widowed . Why? 20

20. Single-parent family One parent, either biological or adoptive, who is solely responsible for care of self and child/children. Blended F amily created when two people marry and at least one of them has been married previously and has child/children. What are the challenges?

21. Child-free family C ouples who consciously decide not to have children or remain child-free as a result of chance ( marrying late ) or biology (infertility). Childless c ouples- A growing number of couples are childless, either by choice or by chance. Special-needs-child/children family M any challenges, depending on whether the needs are a result of disabilities. Challenges Faced by families of Autistic Children-153.pdf

22. Grandparent-headed family G randparents taking care of their children’s children ( divorce, substance abuse, teen pregnancy, mental health problems, unemployment ). Gay/lesbian family S ame-sex couples without children or with children from a previous marriage or as a result of artificial insemination. Aging family H eaded by someone 65 years old or older.

23. Adopted Families Families that include children that are not biologically theirs . Extended families/ Multigenerational family A family unit that includes three or more generations such as grand parents , their sons or daughters , and their children . All types of families have challenges.

24. Healthy families are characterized by: Family members communicate and listen to each other respectfully . They support each other. They value each member and his/her contribution. They trust each other. They have a sense of humor . They have a sense of shared and individual responsibility. Functional & Dysfunctional Characteristics of Families

25. They help children understand right and wrong . They realize the importance of healthy interaction among members. They share a belief in the importance of a religious foundation . They believe in contributing to their communities . Dealing with crises in a positive and effective manner.

26. Characteristics of dysfunctional families A dysfunctional family is a family in which conflict , misbehavio r s , and even abuse on the part of individual members of the family occur continually . Unpredictability Denial- d ysfunctional families don't want to face the truth about what is happening, so they deny it. 

27. Unhealthy connections -dysfunctional families are either enmeshed (overly connected) or unattached . Enmeshed  families don't respect the right of each individual member to say no and to choose how he/she wants to live. Disconnected  families  have members that live their own lives so separate from others that each member feels alone . There is no family identity . Dysfunctional families are most often a result of substance abuse, parents' untreated mental illnesses culture

28. A systematic review study results ( Montilla et al., 2017) Main stressful family situations Main family coping strategies Chronic diseases, Autism spectrum disorders, Mental illness, Addictions, Accidents and disability, Family adjustment problem, Financial problems. Positive coping Finding information, Search family, social or spiritual support, Acceptance and Improved self-esteem. Negative coping Denial, Concealment/keep secret, Disconnection, Self-blame, Emotional detachment, Substance use. Stressors among family members

29. Family Counseling Family counseling is a form of treatment that is designed to address specific issues affecting the health and functioning of a family . It can be used to help a family through a difficult period of time, a major transition , or mental or behavioral health problems  in family members. Its aim is the establishment of more satisfying ways of living for the entire family and for individua l family members.

30. Differentiation of Family Therapy from Other Psychotherapies Family therapy differs from individual and group counseling in its emphasis. Individual counseling is more intrapersonal. Group counseling is more interpersonal. Family therapy for the most part focuses on making changes in the family system as a whole . Major emphasis is placed on understanding how the system as a whole remains functional.

31. Individual behavior does not occur in isolation but is embedded in the broader family context . Individual’s symptomatic behavior is seen as an outcome of family interactions and not as the result of individual dynamics. To improve communication. Why marriage and family therapy?

32. Gender issues in marriage and family therapy To be more concrete , there are a number of areas you can interview about to learn more about gender issues . 1. Decision Making Who is responsible for what? W ho is responsible for the “big” decisions and who is responsible for the “small” decisions? W ho makes unilateral decisions? 2. Work/Career W hose career is prioritized ? H ow do you prioritize work with family and relationship?

33. 3. Housework Who works more time in the home? 4 . Money H ow are decisions about spending being made? W ho knows more about finances ? 5. Sex I s there a history of sexual assault or abuse ?

34. Single-Parent Families One parent is primarily responsible for self and child/children . Single-Parent Families are created by divorce , death, abandonment, unwed pregnancy, adoption, imprisonment , & extended temporary assignments. Historically, most resulted from death or divorce . Currently, many single women are choosing to bear & raise children themselves. Why???

35. Single-Parent Families Created by Death Reestablishing one’s life and restructuring of the family are major tasks. Three stages Mourning stage –helps with release of positive and negative feelings and emotions ; “death ends a life, not a relationship” R eadjustment stage –learning to do new tasks , dropping old tasks , reassigning duties to other family members. R enewal and accomplishment stage –engaging in new growth opportunities.

36. Some common reactions towards grief are: Body Thoughts Emotions Nausea Disbelief (it can’t be true) Guilt and self-blame Tightness in the chest Confusion (trouble keeping thoughts straight) Anxiety/Fear Oversensitivity to noise Preoccupation (think very often about him/her) Anger, Loneliness Lack of energy Sense of presence (seems like he is still here) Helplessness Breathlessness Thinking you see or hear him/her Shock Muscle weakness Numbness

37. The five stages of grief Denial -This can’t be happening Anger -Why is this happening to me? Bargaining -I will do anything to change this Depression -Experiencing empty feelings, isolation, crying etc. Acceptance -It’s going to be okay. Accepting the loss of the person. When does grief becomes a problem?

38. Coping with grief Get support A. Turn to friends and family members Do not grieve alone-Effective grief work is not done alone. B. Draw comfort from your faith Praying, or going to church. C. Talk to a counselor

39. Single-Parent Families Created by Temporary Assignments Assignments may include call to military action or transfer by a corporation to overseas duties. These families experience stress due to the sudden and serious nature of the circumstances. Challenges: Immediate task overload . Adjustment to new circumstance

40. Single-Parent Families Created by Divorce Divorce is a legal dissolution of a marriage by a court or other competent body. Contain both custodial & noncustodial parents. Custodial parent - with whom the child resides. S tressors include rebuilding financial resources and social networks . Noncustodial parent is a parent who does not have physical custody of his or her child as the result of a court order . S tressors include: rebuilding of social networks . gaining renewed self-confidence. M ost fathers are much less comfortable in assuming custody of children than are mothers.

41. Effects of Divorce on Children Child’s reaction depends on age at time of divorce & support received in working through feelings. 1. Weakened parent-child relationships Declined relationship between parents and children. 2. Poor performance in academics 3. Loss of interest in social activity 4. Difficulty of adapting to change 5. Emotionally sensitive 6. Feeling of guilt The primary task in helping children of divorce is helping them feel socially, emotionally, & economically secure.

42. Divorce Counseling

43. Couples who have children must find ways to remain connected as parents while separating as partners .

44. Strengths of Single-Parent Families Single-parent families are more democratic . Have more flexible roles & rules . Children mature & take responsibility earlier . They are creative in locating needed resources .

45. Challenges Faced by Single-Parent Families May have unclear or undefined boundaries & roles . Children, esp. boys, may not achieve to the same extent as children from other types of families. This is particularly true of children of divorce. Children may struggle with identity confusion . Often life at or near the poverty level . Must cope with depression & other negative emotional residue.

46. Approaches for Working with Single-Parent Families Prevention approaches P remarital counseling results in couples who are more likely to seek marriage therapy more often had lower levels of stress , and benefited more from marriage therapy than couple without premarital counseling.

47. Educational and Behavioral Approaches Non-theory strategies can also be helpful. Helping family members communicate clearly and frequently . W eekly family conference to talk about concerns, resolve problems and plan for the future . L inking family members to needed sources of social support. A ssisting families with resolving financial matters so they can best utilize their resources. E ducational methods such as reading books .

48. Terms for blended families include stepfamilies reconstituted families recoupled families merged families patched families remarried families r efabricated families Working with Blended Families

49. Issues within Blended Families Prominent issues centered around resolving the past alleviating fears and concerns about stepfamily life establishing or reestablishing trust fostering a realistic attitude becoming emotionally/psychologically attached to others younger children bond more easily with stepparents but are more physically demanding on parents than older children.

50. S tepfamilies are less cohesive , more problematic , and more stressful than first marriage families . Stepparent/child and sibling relationships are less warm and intimate than first marriage families . Interpersonal connectedness and rapport requires much work. 2 to 5 years may be needed to form in-depth relationships with stepchildren and to establish the primary parent role

51. Strengths of Blended Families 1. Life experience A ssists in understanding environments in different and potentially healthy ways. C an increase empathy and influence individual and family resilience. H elp to reduce couple and family isolation and frustration. M ay provide moral support , guidance , or physical comfort

52. 2. Creativity and innovativeness B lended family members can offer new ideas , perceptions , and possibilities for resolution of issues. 3. Appreciation and respect for differences A bility to appreciate and respect differences in people and ways of living. 4. Making the most of situations C oping successfully with difficult situations. I nsights gained can be taught to other families .

53. Challenges of Blended Families Blended families must deal with: t he loss of an important member(s) of the former family . e stablishment of a workable family hierarchy. b oundary difficulties. u nresolved emotions. e conomic concerns & financial difficulties.

54. Approaches for Treating Blended Families 1. Guidance in retaining old loyalties blended family members need not give up old loyalties in order to form new ties . families benefit from learning to be inclusive rather than exclusive . 2. Focus on parental involvement stepparents need to balance their involvement so there is a balance among all family members. 3. Provide education education can help blended families understand differences between blended family and non-blend family systems

55. Role of the counselor in stepparents Therapists must be active , flexible and resourceful in the use of different therapeutic modalities , i.e., wear many hats . Decrease confusion, fear, and depression. Be well informed about legal processes as well as psychological ones. Knowledge of family legal system can help all family members make better decisions . Help stepparents work together to be effective parents. Help family members learn effective communication skills .

56. Process & Outcome As a result of family therapy, blended families are: Better understanding of themselves as systems and subsystems . Increase tolerance for one another and family life events. Decreased projection and distortions. Members find their place in the new family . Family environment becomes cohesive, safe, and open to novel ideas. Fostering of new traditions, celebrations, and rituals . Development of a healthy self-concept of themselves as a family. Development of internal strength to deal with external pressures .

57. Common Problems of Beginning Family Therapists Beginning therapists often : overemphasis on details overemphasis on making everyone happy overemphasis on verbal expression overemphasis on dealing with one member of the family Beginning Therapists often Underemphasize : The establishment of structure Showing care and concern The engagement of family members in the therapeutic process Letting the family work on its problems They may not attend well to nonverbal family dynamics Process in Family Therapy

58. Initial Session Establish rapport & join with the family. Establish initial professional relationship. Collect essential information about the family. Intake information. Form a preliminary diagnosis (e.g., distancing, enmeshment, disengagement, friction, denial, unresolved grief).

59. Ask each member for his/her perception of the family. Observe family patterns ( communication patterns , the family mood, etc.). Assess what needs to be done (e.g., treatment, referral, testing). Engender hope for change and overcome resistance . Make a return appointment and give assignments . Write clinical notes, including impressions of family and progress in the session, immediately after session ends.

60. Middle Phase of Treatment Involve peripheral family members in the therapeutic process (e.g., use circular questioning). Seek to connect family members with appropriate generational interests & concerns . Emphasize progress or change within family system .

61. Reinforce family members for taking risks and trying new behaviors . Stay active as a therapist by continuing to probe, direct, and suggest . Link family members with appropriate outside support systems if needed. Look for evidence of change in the family. Focus on process . Interject humor when appropriate.

62. Termination Plan with the family for a mutually agreed on termination. Consider termination “ open-ended ,” in case family needs to return. Formally bring family therapy to a close (i.e., discuss what was learned and achieved during family therapy ). Celebrate

63. Chapter 2: Theories in Marriage and Family Therapy Theory is a provisional conceptual map that helps therapists understand and treat problems . Causes of problems Symptoms of problems Consequences of problems Treatment strategy Theory is a tool that allows therapists to integrate observation and action in a consistent way.

64. What do theories do? 1. Help us classify problems . 2. Help us understand how and why problems occur. 3. Help us predict as yet unobserved relationship. 4. Serve as a basis for action. 5. Guide research in useful directions . Theoretical and conceptual frameworks In psychology , theories are used to generate hypotheses about human thinking emotions , and behavior

65. Within the context of counseling , a theory needs to; accurately describe, explain, and predict a wide range of therapist and client behaviors. A good theory should clearly explain what causes client problems (psychopathology) and offer ideas or specific strategies for how to alleviate problems. Without a guiding theory the counselor is directionless.

66. Counseling technique The term technique is described as a specific activity and action required to carry out assignment . It is a process of activity through which a counselor gets his counselees to solve their problems during counseling sessions. A counselor can use question, homework, feedback, and positive assertions as his counseling techniques to progressively solve his clients’ problems. Counseling techniques are indispensable tools in counseling relationships.

67. Characteristics of counseling techniques 1. They are structured pathways of achieving counseling goals . 2. They are gender friendly . 3. They are flexible . 4.They are working tools derived from counseling theories . 5. They have no cultural bias . 6 . They are unambiguous and free from technical jargons . 7. They are professional tools . 8.They are observable . 9 .They are logically tested facts . 10.They are activity oriented . 73

68. Working Assumptions of Family Therapy Theories Family relationships are a principal source of mental health and psychopathology for individuals. Family interaction patterns tend to repeat across generations . Family health requires a balance of connection and individuation . Family flexibility is a core trait that prevents family dysfunction . Individuals’ symptoms frequently have meaning within the family's interaction patterns. The triad is the minimum unit for a complex understanding of family interactions .

69. Major Questions Addressed by Family Therapy Theories How do individuals develop psychosocial symptoms within families ? How do families maintain levels of interpersonal connection that allow for emotional bonding and individual autonomy ? How does family conflict become unmanageable ? How can families change dysfunctional patterns ?

70. Structural Family Therapy (SFT) refers to a therapeutic model developed by Salvador Minuchin in the 1960s . Focuses on family organization , rules and boundaries (called “the structure ”) and the ways in which these structures govern interactional patterns. Structural family therapy views families and emotional distress from an organizational perspective : Individual problems are maintained not through personal pathology, but rather through flaws in a family’s organizational design. Interactional dysfunction Structural Family Therapy

71. -+7 Theoretical concept The foundational theoretical concept in SFT is “BOUNDARY.” Boundary is an abstract method of separating parts of a system from each other, such as children from parents or interpersonal boundaries between husband and wife, typically defined by personal rules and roles in a family . The therapy emphasizes the establishment of BOUNDARIES within the family through the decisive and sensitive actions of the therapist. One way to find balance between family and individual identity is to define and clarify the boundaries between the subsystems. 77

72. Boundary types : e nmeshment, disengagement, normal E nmeshed families - families whose members are excessively intrusive. Little autonomy, freedom. D isengaged families -families whose members are excessively unavailable to one another. H ave no emotional attachment but have benefit of self autonomy . Both are abnormal boundaries.

73. In structural family therapy there is a syndrome with enmeshed mother and disengaged father . Family therapy assume family problem occur by dysfunctional and disorganized structural family. Family system must be stable enough to ensure continuity , but flexible enough to accommodate to changed circumstances. The boundaries should be flexible enough to allow external interaction, but strong enough to show rules and principles .

74. Underlying Assumptions Families are competent and capable of solving their own problems. A n attitude derived from the existential-humanistic tradition. All families possess the ability to change dysfunctional structure. Therapists work collaboratively with families, not as experts who can solve problems, but as consultants and coaches who can work to bring the family’s dormant capacities to the surface. Therapists respect the family’s unique culture . The question should be, not “ What’s ideal? ” but “ Does it work for them ?”

75. Concepts and Definitions Structure A n organized pattern in which families interact. Partly universal , partly idiosyncratic/peculiar. Can only be seen when a family is in action , because verbal descriptions rarely convey the true structure. For example, if you ask a family member what the problem is, what they describe is not the problem . All families have a variety of structures to handle different situations.

76. S ubsystems: g rouping of family members to accomplish specific tasks . Spouse subsystem Parental subsystem Sibling subsystem Boundaries: t he rules that govern who is included and excluded from a specific subsystem . Hierarchy refers to a boundary that distinguishes the leadership subsystem from the rest of the family. How problems develop ? Inflexible response to maturational (developmental) and environmental challenges lead to conflict through disengagement or enmeshment .

77. Therapeutic Goals The general goal is creating a new effective structure . Creation of: effective hierarchy executive subsystem …leadership role Structural problems are usually viewed simply as failure to adjust to changes . Problems exist not because of a core dysfunction in the family, but rather because the family is unable to access a structure to solve the problem. Make the boundary clear . Clear boundaries are those that are negotiable. Therapist doesn’t solve problems , that’s the family’s job .

78. Therapists Roles Joins the family in a position of leadership . Act as: Observer Expert (theater director ) A ctive and directive Maps/plot s the family’s underlying structure. The map designates who is in what position with what kind of power. Things to be mapped are: power, role, boundaries, alliance and subsystems.

79. Family assessment typically involves asking questions about how a family attempts to resolve its problems and observing the family members in action . Structural family therapists believe that problems are maintained. Rather than focusing on the history of the problem , structural family therapists are interested in present-centered issues. Does an effective leadership pattern exist in dealing with this problem? Do people talk directly to one another about the problem, or are others inappropriately involved as mediators ?

80. S tructural family therapy breaks families down into various subsystems, or groupings of family members concerning specific tasks. For example, husbands and wives form the spouse subsystem which provides mutual support , sex , and companionship , and they also serve as the parental subsystem in making executive decisions about child rearing , discipline , and nurturance . Children , on the other hand, form the sibling subsystem in which they learn about mutual cooperation , peer problem solving , and how to support one another.

81. Therapeutic Techniques Structural family therapy techniques tend to be action focused rather than insight oriented . 1. Joining: Families are often anxious when they begin therapy. They wonder if their therapist will understand them or blame them for their problems. They ask themselves questions such as, “Will my therapist like me?” “What are we going to talk about?” “Will my therapist think I am crazy ?” “Can therapy really help us?” All of these concerns are valid , and all must be addressed before a therapist can help a family change.

82. Joining is the process in which therapists let their client families know that they understand them and are working to help them . A primary rule of structural family therapy is that therapists should first join with their families and then attempt to restructure them. Joining includes such behaviors as making a family feel comfortable, listening to the concerns of all members, understanding each member’s opinions and feelings, and treating everyone with respect.

83. 2. Accommodation is the manner in which a therapist adapts his or her behavior to fit a specific family. This means that therapists must adjust their language , body posture , and pace to be consistent with a given family’s mode of operating. For example, a therapist might talk more quickly with a fast-talking family and more slowly with a slow-talking family to fit their individual styles. 3. Restructuring refers to helping the family find a more appropriate structure for solving their problems. Changing family structure to make the family more functional.

84. 4. Unbalancing is a technique in which a therapist temporarily sides with a specific individual, or family subsystem, to induce change. “Because you are the parents, I will support your rules ”. Unbalancing techniques could be used in a child case when the therapist supports the parents to take charge of their child.

85. 5. Reframing: c hanging one’s perception by explaining a situation from another point of view . 6. Enactment involves having family members engage in their problematic behaviors in the therapy room. I nvolves requesting a family to move from description to actually showing the problem live in the session . Encouraging people to talk directly to each other rather than through the medium of the social worker .

86. 7. Boundary Marking: Boundary marking is a technique for creating new subsystems within a family. It is through boundary marking that therapists create new structures which enable families to solve problems .

87. 8. Enhancing Family Strengths: Underlying structural family therapy is a core belief in the inherent strength of families. Structural family therapists enhance family strengths when they help the family identify these hidden resources and promote their use in resolving the problem. 9. Homework: Activities or tasks relating to the problem that the therapist asks the client to do between sessions.

88. Class Work (10%) Case study-Structural family therapy.docx

89. Strategic Family Therapy Philosophy Each person is a unique individual . P sychotherapy should be formulated to meet the uniqueness of the individual’s needs. Conduct therapy by paying extreme attention to details of the symptoms clients presented .

90. View of human nature/personality Strategic Family Therapists concentrate on the following dimensions of family life : Family Life: overt and covert rules families use to govern themselves. Family Homeostasis: tendency of the family to remain in its same pattern of functioning unless challenged to do otherwise. Quid Pro Quo: responsiveness of family members to treat others in the way they are treated . Redundancy Principle: the fact that a family interacts within a limited range of repetitive behavioral sequences . Punctuation : the idea that people in a transaction believe that what they say is caused by what others say . Action vs reaction Relationships : the fact that relationships within a family are both among equals (symmetrica l) and un equals (complementary). Circular Causality : Events are interconnected that behaviors are caused by multiple factors.

91. View of the Family and Client In terms of how the family, client, and their contribution to the presenting problem are conceptualized , there are six dimensions to consider when using strategic family therapy : Involuntary versus voluntary behavior : A strategic therapist prefers to think of all symptoms (excluding organic illness) as voluntary and under the control of the individual . Sometimes a problem can be resolved simply by redefining it as the result of voluntary rather than involuntary behavior.

92. 2. Helplessness versus power: The symptom bearer can appear helpless if he or she presents unfortunate and/or involuntary behavior that he or she cannot change even though he or she wants to do so. 3. Metaphorical versus literal sequences: The idea that a symptom may be a metaphor for the problems of another family member may lead the therapist to focus on resolving those other problems instead of focusing directly on the symptoms.

93. 4. Hierarchy versus equality: When the family hierarchy is incongruous , problems arise . Strategic therapy addresses this problem by changing the structure to its proper hierarchy . “An incongruous hierarchy exists in which the adolescent is in charge and more powerful than the parents”. 5. Hostility versus love: Some therapists see family problems in negative terms, such as hostility , jealousy, power, and fear. Other therapists see people as essentially healthy and compassionate. 6. Personal gain versus altruism: If a person is hostile , he or she is being motivated by personal gain or power. If the person is concerned with helping others or receiving more affection, he or she is being motivated by love.

94. Four common p rocedures for ensuring a successful o utcome Defining a problem clearly. Investigating all solutions that have previously been tried . Defining a clear and concrete change to be achieved. Formulating and implementing a strategy for change. Treatment should be pragmatic and short-term .

95. Therapist’s role Therapist is active and flexible . Designs strategies to resolve family problems. Helps family members change from a competitive to a cooperative stance. Gives tasks and homework to help bring about change. Strategic family therapists believe that “action” not “insight ” leads to change. Strategic therapists tend to em­phasize the importance of behavioral change rather than change in feelings or insight. A problem-centered and pragmatic approach that is more interested in creating change in behavior rather than change in “understanding.”

96. Therapeutic goal T o motivate the family to change signature behavioral patterns associated with the identified problem. T o solve the presenting problem by getting clients to do something different rather than getting clients to express their feelings or to understand their problem better. S trategic therapists may also try to get clients to look at their problems differently . This may entail redefining the problem so that it is viewed as simply one of life’s many dif­ficulties. Dysfunction is viewed as a manifestation of an incongruent hierarchy . When people are organized together, they form a status, or power ladder , where each has a place with someone above and someone below.

97. Therapeutic Techniques Reframing: s hifting family member’s perception of a situation by offering a different interpretation . R edefining a problem scenario . Example: a nxiety might be reframed as a strong sense of caring about the outcome of a task. 2. Accepting and emphasizing the positive: b elieving in the power and abilities of each person in the family.

98. 3. Directives: a n encouragement by the therapist to the client to think or act in a certain way . There are two types of directives : straightforward and indirect directives . Straightforward directives are used when the therapist sets rules, boundaries, and structure within the family. Indirect directives- tasks that are not obvious to the client. E.g. restraining/warning. 4. Paradox : g ives client-families permission to do what they are already doing to lower resistance .

99. Paradox is asking for something in order to achieve the opposite result (e.g. you can save money by spending it) For example: (1) the client fears failure, so the therapist asks the client to fail at something; (2) a woman who can’t initiate sex with her husband is advised not to initiate for a month. (3) drink too much until feeling discomfort (satiate). 5. Ordeal: a therapeutic technique in which the therapist asks the client to do a set of tasks that is appropriate for the problem but causes distress that is equal to or greater than the problem. Ordeal technique : a prescription of behavior that causes more distress than the problem itself.

100. 6. Encouraging resistance When clients are not cooperating , the therapist does not engage in a power struggle; rather, he or she accepts and even encourages the resistance . 7. Providing a worse alternative Providing a worse alternative allows the therapist to help clients make decisions by themselves. 8. Causing change by communication in metaphors When clients felt uncomfortable or resistant to talking about their issues, use metaphors without directly mentioning the problem. 9. Encouraging relapse Allows the therapist to maintain in charge of the session and prevents client’s disappointment in the case of relapse. Used to clients to feel as bad as they did prior to the therapy, so counselors could see if there was anything they missed or wanted to recover from that time.

101. Phases of strategic family therapy Phase 1: Joining and Building Rapport During this phase, the strategic family therapist meets with the family, greets each member, and begins to point out the strengths or successes of the family . It is helpful to use empathy and humor during the sessions.

102. Phase 2: Understanding the Presenting Issue In this phase, the clients need to agree on what the specific problem is. T he therapist can inquire about how the clients wish to resolve the presenting problem . Here is a question that a therapist might use during this phase: “ Tell me what you think the problem is? ”

103. Phase 3: Assessment of Family Dynamics By observing the family and taking a brief history , the therapist is able to assess how the problem is maintained or what purpose the problem has . Below are some ideas and question s that are useful for assessing family dynamics : A genogram/family map is helpful in gathering this information about the current family system . Timelines of when the problem first appeared , intensity , and frequency of it are helpful in the assessment of family dynamics . “ How have you tried to solve this problem in the past?” “ What worked? What did not?”

104. Phase 4: Goals The goal of the strategic family therapist is to “solve the presenting problem ”. If the therapist sets clear goals , the therapeutic progress will be less likely to be influenced by distracting issues. Ask each family member what he / she feels are the top three problems he/she wants to be solved . Find common themes , if any. Then ask them to all agree on which ones they want to tackle first, second, third, and so forth .

105. Phase 5: Amplifying Change View on how c hange o ccurs According to strategic family therapy , two types of change can occur within the family system. First-order change occurs when family members attempt to solve a problem repeatedly with the same solution , only by increasing the level of intensity . A short-term, superficial change in the system.

106. Second-order change -allows the system to shift into a new level of homeostasis and allows for permanent rather than temporary change. Strategic family therapists focus on creating second-order change . This is achieved by changing the existing rules within the family system to create new behavioral responses to the identified problem. Phase 6: Termination Once progress has been made, the therapist should slowly begin to disengage and eventually, the clients will terminate.

107. Limitations Strategic family therapy is not a popular model of therapy . C riticized for its paradoxical interventions. O thers criticize is feelings are not the focus.

108. Cognitive-Behavioral Family Therapy It was born from cognitive-behavioral therapy but broader and more extensive . Integrates behaviorism and cognitive approaches and applies them to family systems. C ognitive treatment focus on modifying personal or collective core beliefs (schema). teaching families to think for themselves and to think differently when it is helpful. B ehavioral treatment focus on expressive and listening skills used in communication p roblem-solving skills negotiation and behavior change skills t ime management

109. What is Cognitive Behavioral Family Therapy? It is “a time-sensitive , structured , present-oriented psychotherapy directed toward solving current problems and teaching clients skills to modify dysfunctional thinking and behavior .” CBFT is a psychological treatment that addresses the interactions between how we think, feel, and behave . Thoughts cause Feelings and Behaviors. CBFT is a common type of talk therapy (psychotherapy ).

110. Theoretical A ssumptions

111. Principle of CBFT 1. Ever-evolving formulation of clients ’ problems and an individual conceptualization of each client in cognitive terms . A. Current thinking B. Problematic behaviors C. Triggering factors 2. Requires a sound therapeutic alliance. 3 . Emphasizes collaboration and active participation.

112. 4. Goal oriented and problem focused. 5. Emphasizes the present . 6. Educative , aims to teach the client to be his/her own therapist , and emphasizes relapse prevention. 7. Aims to be time limited. 8. Sessions are structured. 9.Teaches to identify, evaluate, and respond to dysfunctional thoughts and beliefs. 10. Uses a variety of techniques to change thinking , emotion and behavior.

113. Goal of the therapy Cognitive behavioral family therapy recognizes that a change in one person in the system changes the other individuals within the family. The approach does not focus on changing the family’s cultural belief system; rather, it focuses on alleviating the problematic behavior(s ) by altering consequences to the undesirable behavior(s ). To increase self-awareness. To encourage a better self-understanding. To improve self-control through cognitive and behavioural skills. Cognitive behavioral family therapy involves assisting clients with changing their self-defeating or irrational beliefs to change their feelings and behaviors . It assumes that family relationships , cognitions, behaviors, and emotions have a mutual influence on one another.

114. Common cognitive distortions with couples

115. Role of the Therapist The therapist focuses on increasing desired healthy behaviors and eliminating problematic behaviors through accessing the strengths of the family . Therapists concentrate on modifying family members’ cognitions & interactions . Therapist is a teacher, collaborator, coach, & expert, modeling , providing corrective feedback, & learning new behaviors are part of the process. Analyze the problem . Therapists are active in designing & implementing specific strategies .

116. Techniques of CBT 1. Challenging absolutes Statements that include words such as “everyone ”, “never”, and “always ” are usually exaggerations which therapists point out to the client. " Everybody hates me .” 2. Reattribution Helping clients distribute responsibility for an event so as to equally place responsibility for the event . A therapeutic technique in which the client is encouraged to consider possible alternate causes for events .

117. 3. De‐ catastrophizing A “What if” technique, in which the clients are asked, “What if X happened, what would you do?” It is designed to explore actual rather than feared events . 4 . Scaling A technique of turning a dichotomy into a continuum so that individuals do not see things as “all or nothing .” It is used in challenging dichotomous thinking . 5. Cognitive rehearsal The client recalls a problem from the past, and the therapist and the client work together to develop strategies to the problem so that if it occurs in the future , the client has a plan.

118. 6. Cognitive restructuring Cognitive restructuring helps people become aware of their irrational thoughts so that they can correct their thoughts and replace them with more rational ways of thinking . 7. R ational analysis Clients objectively evaluate the facts confirming or disconfirming their hypotheses about each other and craft alternative explanations if their hypotheses are disconfirmed.

119. 8. Interpersonal effectiveness skills . These skills include asking for what one needs, saying no , and coping with interpersonal conflict . 9. Distress tolerance skills. These skills emphasize an ability to accept , in a non-judgmental way, both oneself and one’s current situation. 10. Mindfulness skills. Are psychological and behavioral versions of meditation practices. 11. Emotion regulation skills. It is the application of the mindfulness skills , in particular, a nonjudgmental observation in addition to describing one’s own emotional response.

120. Process and Outcome Family members learn to modify, change, or increase/decrease certain behaviors or thoughts to function more effectively . Teaching parents about positive and negative reinforcement to help parents with difficult child behavior . Clients gain skills in areas such as parenting, interpersonal functioning etc. Family members are able to modify behaviors & cognitions.

121. Psychodynamic and Bowen Family Therapies Both therapies began developing in the 1950s . Nathan Ackerman the founder of psychodynamic family therapy Murray Bowen the founder of Bowen family therapy Similarities B ased on psychoanalysis B elief that changes occur best in the context of family history and development C onscious and unconscious processes are the focus of interventions. “The past is active in the present ” Initial life experiences are relevant. I ntrapersonal and interpersonal processes are intertwined . C hange is gradual and requires a long term investment of time and resources (20 – 40 sessions)

122. Premises of the Psychodynamic Theory Human nature is based on drives (e.g., sexuality and aggression). Conflict is signaled by unpleasant affect such as depression or anxiety. Unconscious processes, called interlocking pathologies , take place among family members that keep them together.

123. Treatment Techniques Transference : The projection of feelings, attitudes, or desires onto the therapist. Dream analysis : helps identify and analyze what needs within the family are not being met and that may need attention. Confrontation : pointing out behavioral contradictions or conflicts with expressed wishes. Focusing on strengths : Therapist helps change the family’s focus by emphasizing strengths of the family. Life history : Assessment of family’s history reveals patterns of interaction.

124. Roles of the Therapist Teacher, g ood enough mother (e.g., nurturing, encouraging), c atalyst (e.g., activates, challenges, confronts, interprets, integrates family processes) and e mphasis on family as well as individual interactions. Unique Aspects The psychodynamic approach emphasizes: f ocus on the importance of the unconscious in influencing human behavior. examines basic defense mechanisms and their influence on family interactions emphasizes the historical origins of dysfunctions and the treatment of persons and families so affected.

125. Bowen Family Systems Therapy Major Theorists: Murray Bowen, Michael Kerr, & Ed Friedman Trained psychoanalytically. Bowen family systems therapy evolved from psychoanalytic principles and practice . According to Bowen, relationship patterns established in one’s family of origin are predictive of relationship patterns in one’s family of formation. Treatment may be long-term (over 20 sessions).

126. Eight Interlocking Concepts of Family Systems Theory 1. Self differentiation 2. Emotional triangle 3. Family projection process 4. M ultigenerational transmission process 5. Emotional cut - off 6. Sibling position 7. Societal emotional process 8. The nuclear family emotional process

127. 1. Self differentiation ( Differentiation of Self) A process of managing one’s individuality and togetherness within a relationship system that involves having the ability to distinguish between feeling and intellectual processes. It is the ability to separate thoughts and feelings; this can be both an interpersonal as well as an inter-psychic process . Differentiation is the ability to take a more neutral position ; with higher differentiation, if a person says something to you, you are able to hold that thought as a cognition and not allow it to turn to a feeling. Parents’ involvement with their families of origin through the mechanism of triangulation initiates and maintains: fusion (f eeling what the group feels) between generations and results in limited differentiation ( the ability to separate thoughts and feelings) in the next generation.

128. Levels of Differentiation

129. Differences Between the Pseudo-Self and the Solid Self

130. 2. Emotional triangle (Triangles ) relationship Is a relationship between three individuals. According to Bowen, the triangle is the smallest stable relationship system because a two-person relationship operates under the constant push–pull forces . Bowen described the triangle as the “basic building block” of the family.

131. 3. Family projection process The family projection process describes the primary way parents transmit their emotional problems to a child . Children inherit many types of problems. The child who is the most emotionally attached to parents is likely to be the object of parental projection and, as a result, have lower levels of differentiation . Result impaired functioning . 4 . Multigenerational transmission process Is the belief that some traits within families are passed down the generations, such as anxiety and some personality traits as well. 5. Emotional cut - off Describes a situation where a person decides to best manage emotional difficulties by emotionally distancing themselves from other members of the family.

132. 6. Sibling position The birth order of children in a family, which influences their personalitie s as well as their interactions with future spouses. Belief that personality characteristics are influenced by sibling position. T he sibling position dynamic suggests that our birth order may influence some important personality characteristics . These characteristics may then influence future relationship stability if children become spouses or parents .

133. 7. Societal emotional process This concept addresses ways that families shape society and society shapes families . The emotional system drives functioning at all levels—families , society, work, social organizations , and other nonfamily groups. Bowen hypothesized that the same principles that apply to the emotional system within the family can be applied to society at large. 8. The nuclear family emotional process D escribes four basic relationship patterns that govern where problems develop in a family. 1. Marital conflict - As family tension increases and the spouses get more anxious, each spouse externalizes his or her anxiety into the marital relationship . 2. Dysfunction in one spouse - One spouse pressures the other to think and act in certain ways and the other yields to the pressure. 3. Impairment of one or more children - The spouses focus their anxieties on one or more of their children . 4. Emotional distance - People distance from each other to reduce the intensity of the relationship, but risk becoming too isolated.

134. To prevent triangulation. To help couples & individuals relate more on a cognitive , as opposed to emotional . To stop dysfunctional , repetitive, intergenerational patterns of family relations . Patterns passed down from previous generations must be examined and changed to avoid repetition in current families. Goals of therapy

135. Therapeutic Techniques 1. Genograms : A visual representation of one’s family tree using geometric shapes and words. Example of genogram below.

136. Example: Genograms

137. 2. Going Home Again : Client is instructed to visit his/her family of origin. 3. Detriangulation : Separating oneself from anxiety in family relationships; resolving anxiety without projecting on others. 4. I position: The ability of a person to calmly state and own a concern and act on convictions and beliefs, without criticizing others’ beliefs and without becoming involved in emotional debate. 5. Differentiation of Self : The degree to which a person is able to distinguish between the subjective feeling process and the more objective intellectual (thinking) process. 6. Asking Questions : helps people to understand the reactions of those in their families better.

138. Role of Therapist Objectivity and neutrality are important therapist characteristics. C oaching and teaching. Setting an example of a reasonable, neutral, self-controlled adult. A ssist with drawing genograms . I nterpret multigenerational patterns of fusion and cut offs.

139. A unique Approach The Bowen approach emphasizes: focus on family history and avoiding replication of past negative patterns of interaction. use of the genogram therapy and theory are consistent and inseparable systemic in nature cognitive orientation

140. Emerged out of the humanistic-existential psychology movement in the 1960s. Influenced heavily by Gestalt therapy, psychodrama, client-centered therapy. Emphasizes affect . A healthy family is one in which people openly experience life with each other in a lively manner. Help individuals achieve more intimacy by increasing their awareness of their inner potential and opening channels for family interaction. Encourage members to be themselves by freely expressing what they are thinking and feeling. Experiential Family Therapy

141. Founding Principles Emotional suppression is the heart of family problems. Dysfunctional families are less tolerant of individualistic emotions. Families will improve if family members get in touch with their real feelings and express them . Family therapy works from the inside out , so it focuses on the private, unexpressed lives of the individual members of the family. Families are not aware of their emotions or, if aware, they suppress them. Lack of emotional awareness and express leads to emotional deadness . Emphasis placed on the present . Humanistic and phenomenological in origin, and also influenced by attachment theory .

142. Denial of impulses and suppression of feeling are the root of family problems. Dysfunctional families: fearful of conflict lack of warmth find children to be annoying/children don’t respect themselves or parents Dishonest ways to communicate: Blaming Being irrelevant Development of behavior Disorder

143. Goals of Therapy Root cause of family problems is emotional suppression . Experiential t herapist believe that the way to emotional health is to uncover deeper levels of experiencing. Therapist attempt to make three changes within the family system First , each member of the family should be able to report congruently (genuinely), completely, and honestly on what he/she sees and hears, feels and thinks, about themselves and others, in the presence of others. Second , each person should be addressed in terms of their uniqueness ( Each person is related to in terms of his or her uniqueness) , so that decisions are made in terms of exploration and negotiation rather than in terms of power. Third , differentness must be openly acknowledged and used for growth .

144. Role of the Therapist Participate actively (less structured). Facilitat e or provide resources (structured ). Assist family members to discover their individuality and find fulfilling rules for themselves. Establish an environment that communicates warmth, acceptance, respect, and hope. Help family members to clarify goals and to use their natural abilities . Likely to behave as real, authentic people.

145. Counseling Techniques Experiential therapists believe that there are no real techniques . Evocative techniques : Family sculpting (forming) technique : a n activity in which family members place themselves in postures symbolic (position….psychodrama) of the family dynamics. - Each person – the mother, father and each child - sculpted how they see the family at that moment . Family puppet interviews technique : a sk a family member to make up a story using puppets. It is useful in determining conflicts and alliances. Animal attribution- A story-telling technique that requires family members to attribute an animal counterpart to each member of the family and then tell a short story about the animal characteristics. Family Art Therapy technique: Art therapy uses the creative process to help improve the mental health of clients. Can be used on children and adults to treat a wide range of emotional issues . Play Therapy : Generally for children ages 3 to 11, although adults can benefit also. Using puppets, playhouses (studios/theaters), finger paints or other media to assist children in expressing their thoughts and emotions. If your mother were an animal, what animal would she be?

146. Process and Outcome F amily members should become more aware of their own needs and feelings and share these impressions with others. M ore capable of autonomy and intimacy . T reatment is designed to promote individual growth without an overriding concern for the needs of the whole family.

147. Pros and Cons of Experiential Family Therapy Pros : Helps individual discover inner thoughts, feelings, and fears . Committed to emotional well-being . Discussing feelings can help family members get pass the defensiveness . Help families re-connect and relate on a more genuine level . Cons: Limited appreciation for role of family structure . May be too advice-oriented and individualistic . The Experiential approach can overemphasize emotion .

148. View of Human Nature Assume that realities are socially constructed . There is no absolute reality . P eople are healthy, competent, resourceful , and have the ability to construct solutions and alternative stories to enhance their lives. Solution-Focused & Narrative Family Therapy

149. This t herapy grounded on a positive orientation. P eople are healthy and competent. Downplay “ past ”, while highlight “ present and future ” View people are healthy, competent , and resourceful , and have the ability to construct solutions to enhance their lives. Therapy is concerned with looking for what is working. People can create their own solutions. Small changes lead to large changes. The client is the expert on his or her own life. The best therapy involves a collaborative partnership. Premises of Theory Solution-Focused Family Therapy

150. Therapeutic Goals Believe family have the ability to define their goals and the resources required to solve their problems. Focus on small, realistic, and achievable changes. Small change leads to big change. Remain goal -directed and future-oriented. E.g., what has changed since last session? Talk about solutions instead of talking about problems .

151. Therapist’s function and Role No knowing position : clients as experts about their own lives. Create a collaborative relationships . Create a climate of mutual respect in which clients are free to create and explore solutions. Help clients recognize their competencies and build on their potential, strengths, and resources . Help clients to use their strengths and resources to construct solutions.

152. Relationship Between Therapist and Client The therapeutic relationship is an important factor for change to occur. Solution-focused brief therapy is designed to be brief , so therapist must shift the focus as soon as possible from talking about problems to exploring solutions.

153. Three Kinds of Relationships in Solution-Focused Therapy Customer-type relationship : client and therapist jointly identify a problem and a solution to work toward. Realize personal efforts is required. Complainant relationship : a client who describes a problem, but is not able or willing to take an active role in constructing a solution. Expect other person to change . Visitors : clients who come to therapy because someone else thinks they have a problem. Disagree they have a problem .

154. Joining : Collaboratively identify a problem with the family. Listening & Accepting: The therapist listens to the family and accepts their situation. Awareness Exercises: Tasks that help families understand situations & look for solutions. Hypothetical Solutions/the Miracle Question: Families imagine solutions by imagining what would be different if problem was better. Making Small Changes: Only a small amount of change can affect larger changes in a family . Task Assignments: Instructions to help family make changes . Scaling: Clients use a scale of 1-10 to rate their progress in reaching goals . Mapping: Planning the course of a successful intervention. Therapeutic Techniques

155. Unlike Bowen or psychoanalytic approaches, no attention is paid to history. Like Strategic Family Therapies, therapy is brief (usually 5-6 sessions). Like Behavioral Therapy, treatment ends when goals are achieved. Comparison with Other Theories

156. Narrative Family Therapy Premises of the Theory Narrative therapy is based on a postmodern and social constructionist perspective. It rejects classification systems based on empiricism . It promotes empowering persons and families through emphasizing their stories. Problems are seen as external to persons and families. Problems should be attacked in a cooperative manner by families who work as teams and utilize their resources .

157. Key Concepts of Narrative Therapy Listen to clients with an open mind . Encourage clients to share their stories . Listen to a problem-saturated story of a client without getting stuck . Therapists demonstrate respectful curiosity and persistence. The person is not the problem , but the problem is the problem .

158. Treatment Techniques Externalization of the Problem: Separation of the problem from the client/family. Influence (Effect) of the Problem on the Person: Therapist helps increase client’s self-awareness by asking how the problem affects his/her life . Influence (Effect) of the Person on the Problem: Asking clients how they influence the problem increases awareness & helps identify personal strengths to better respond to problem. Raising Dilemmas : Therapist gets families to think through problems before they arise.

159. Process & Outcome Individuals and families are challenged to reconstruct and re-author their lives. Problems are externalized and attacked by the whole family. Problems are investigated in terms of meaning rather than causes.

160. Comparison with Other Theories It is postmodern and based on a social constructionist viewpoint , like Solution-Focused Therapy . It was originally developed outside of the United States , like Systemic Therapy . The emphasis of therapy is on the present , as compared with the historical emphasis of Bowen and Psychoanalytic approaches. The focus of the approach is on collaborative effort of families and therapists, like Strategic and Solution-Focused Family Therapies.

161. Chapter Three Special Issues in Marriage and Family Therapy Substance-Related Disorders Domestic Violence Child Abuse Sexual dysfunction

162. Substance-Related Disorders & Families A maladaptive pattern of substance use , leading to clinically signifi­cant impairment or distress . Alcohol is one of the most commonly misused substances . Many families are affected by substance-related disorders . The negative impacts of parental substance use disorder on the family Disruption of attachment Difficulty on social life Economic hardship Conflict Violence or abuse

163. Approaches for Treating Substance-Related Disorders Treatment must address issues of relapse . Using systems and supports in the community can reduce resistance and decrease relapse . Physical, emotional, social, and vocational issues influence each other and must be addressed in therapy . After the substance abusing behavior has stopped , work begins on interactional and activity changes both within and outside the family system. Brief therapies are most of the time recommended.

164. Domestic Violence & Families “ Domestic violence is defined as any incident or pattern of incidents of controlling, coercive, threatening, degrading and violent behaviour, including sexual violence, usually by a partner or ex-partner, but also by a family member or carer ” Violence against spouses (primarily women) takes many forms: physical, sexual, psychological, & economic. Violence in families stems from a power imbalance. Approximately 80% of spouse to spouse violence is alcohol related . How about in Ethiopia?????

165. Child Abuse & Families

166. Bruises, lacerations and abrasions, skeletal injuries, head injuries, and internal injuries from hitting, shaking, twisting, pulling, punching, beating with the hand or an object, biting, force feeding, and kicking. Burns from cigarettes, hot liquids, confinement ropes or irons. PHYSICAL ABUSE…

167. The difference between abuse and neglect is that abuse represents an action against a child while neglect represents a lack of action for the child. A hungry child with a diaper heavy with urine and feces, long past changing time.

168. Unusual sexual behavior or knowledge Eating and/or sleeping pattern changes Change in school performance and relationships with peers Inappropriate touching of others Compulsive behaviors or extreme tantrums Promiscuity , prostitution or substance abuse Suicidal thoughts and/or depression Chronic somatic problems such as stomach aches, vomiting, or headaches. Affectionless or overly affectionate Aggressive behaviors at school or toward siblings, possessions, or pets Destruction of property Withdrawn or social isolated Verbally abusive Angry , hateful, negative attitude May hurt themselves, self destructive activities SYMPTOMS OF ABUSE…

169. Sexual dysfunctions are a heterogeneous group of disorders that are typically characterized by a clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure . Sexual dysfunction involves a complex interaction among biological, sociocultural, and psychological factors . Sexual dysfunction is seldom caused by a psychiatric disorder (although depression and anxiety may often decrease sexual desire). Sexual dysfunction

170. Diagnosis of sexual dysfunction

171. Chapter Four Ethics in marriage and family counseling

172. Ethics is a discipline within philosophy that is concerned with human conduct and moral decision making . Ethics has popularly been named “moral values” or “community standards”. Ethics focus on principles and standards that govern relationships between people, i.e., counselors and clients . Ethics is guidelines or rules that are set for professionals or an organization rather than for an individual. They are created by members of the counseling profession and are interpreted and enforced by ethics committees .

173. Ethical Principles Autonomy - Client’s independence, freedom to choose & direct one’s own actions. The counselor's ethical responsibility to encourage client independent thinking decision-making. Respecting a client’s autonomy includes obtaining informed consent for treatment; facilitating and supporting clients’ choices regarding treatment options.

174. Nonmaleficence - take care to do no harm /doing no harm. The counselor must avoid at all times any activities or situations with the client that could cause a conflict of interest . Beneficence- To Do Good A counselor must accept responsibility for promoting what is good for the client with the expectation that the client will benefit from the counseling sessions.

175. Justice - Fair and Nondiscriminatory The counselor's commitment to provide an equal and fair service to all clients regardless of age, gender, race, ethnicity, culture, disability and socio-economic status. Fidelity - Creating a therapeutic climate in which trust can flourish makes client growth and progress possible. Veracity means that counselors are truthful in their professional actions and conduct with their clients, supervisees, and colleagues.

176. Ethical Decision-Making Professional and ethical issues, problems and dilemmas will arise from time to time and are an unavoidable part of our practice. Ethical decision making is the practical process through which counselors base their actions, behavior and sound judgment. It uses a framework of client rights and professional obligations to make decisions. Ethical decision making is essential to all good counseling practice.

177. Steps in Ethical Decision-Making Identify problem or dilemma Identify potential issues (rights, responsibilities and welfare) Examine codes of ethics Consider applicable laws and regulations Seek consultation Brainstorm possible actions Consider and evaluate consequences Choose best possible course of action Document decision making and follow-up the actions

178. Code of Ethics Ethical codes are guidelines for what therapists can and cannot do. The counseling Code of Ethics is a changeable document. Purposes Educate counseling practitioners about responsibilities of profession. Provide a basis for accountability . Protect clients. Code of Ethics for Marriage and Family Counselors In order for couples and families to receive care and service that acts in their best interest, marriage and family therapists are required to abide by a strict code of ethics.

179. Issues of Law in Family Therapy Malpractice occur through acts of omission and commission . In either case, negligence must be proven. Advertising issues involves representing one’s skills adequately & correctly. Record keeping issues focuses on keeping accurate & professional notes. Liability insurance is necessary for one to be legally protected as a therapist.

180. Chapter 5: Research & Assessment in Family Therapy Family therapy has incorporated research based procedures since the early days of the field. In the initial development of family therapy, research came first and therapy was secondary . Family assessment focuses on dimensions of particular families and is based on theoretical models of family function and dysfunction .

181. Research Findings in Family Therapy Research provides knowledge, confirmation, accountability, practicality, & uniqueness to family therapy. Findings include: Family therapy is as effective as other psychotherapy methods . Deterioration in family therapy is related to a therapist’s poor skills & timing. Brief family therapy is as effective as long-term therapy . Less severe family problems are more successfully treated.

182. Two Types of Family Therapy Research Qualitative Research and Quantitative Research 1. Qualitative Research R ooted in anthropology and sociology . Emphasis on open-ended questions. Often used in theory building. Visual and verbal data reporting rather than numerical data reporting. Used to generate hypothesis

183. 2. Quantitative Research R ooted in scientific traditions of physics, chemistry, and biology. M ost common form of research. E mphasis on closed-ended questions. Uses large sample size to gather information. D ata are gathered in a precise form, frequently using standardized instruments, and reported in a statistical format. R esults are used to “ prove” or “disprove” theories . Used to test hypothesis .

184. Importance of Assessing Families Assessment is the evaluation of a family with specific instruments. Has clinical relevance for treatment. Related to diagnosis, treatment plans, and outcomes. For therapists, assessing families is necessary for responsible practice. It is the basis for accountability with third-party providers.

185. Dimensions of Assessing Families Most assessment is conducted in a systematic manner. Dimensions of assessment: Pressures on the family Family history Family structure Family process Assessment is a continuous process . Informal methods include family assessment forms and observations. Formal methods include over 1,000 assessment instruments available to family therapists.