Objects
Chapter 5
1. Four seemingly independent scientific and clinical developments during the decade following
WWII helped set the stage for the emergence of family therapy:
a. The investigation of the family’s role in the development of schizophrenia in one of its
members.
b. The evolution of the fields of marital and premarital counseling.
c. The growth of the child guidance movement.
d. Advances in group dynamics and group therapy.
2. Fromm-Reichmann and the Schizophrenogenic Mother
a. Maternal rejection postulated from Fromm-Reichmann for the development of male
schizophrenia
b. Schizophrenogenic Mother denotes a domineering, cold, rejecting, possessive, guilt-
producing person who, in combination with a passive, detached, and ineffectual father,
causes her male offspring to feel confused and inadequate and ultimately to become
schizophrenic.
c. Viewed schizophrenia as a intrapsychic disorder, residing within the individual patient.
d. Saw the clinicians role as freeing the patient from the parents’ noxious influences.
e. NO patient was beyond the reach of psychotherapy.
3. Bateson and the Double Bind
a. 1950’s major impetus for family research in schizophrenia
b. 1954 Bateson and Don Jackson with the grant of the Macy Foundation studied
schizophrenic communication patterns further.
c. Hypothesized that the family, when upset and threatened, seeks a homeostatic state
through feedback mechanisms that monitor the family’s behavior in an effort to achieve
balance and stability.
d. Challenged the idea that schizophrenia was an intrapsychic disorder that subsequently
damaged interpersonal relationships. More specifically, they hypothesized that the
family might have shaped the strange and irrational behavior of schizophrenic by means
of its contradictory and thus impossible communication requirements.
e. Double bind situation occurs when an individual receives repeated conflicting
injunctions from the same person with whom the child has an important ongoing
relationship. In their exchange, a primary negative injunction by the adult is followed by
a conflicting secondary injunction at a more abstract level, again with the threat of
punishment if the child disobeys. As a tertiary injuction, the adult demands a response
but forbids the child to comment on the contradiction, thus forbidding escape from the
confusing situation.
4. Lidz: Marital Schism and Marital Skew
a. Lidz who was trained in psychoanalysis, starting publishing his findings on the family’s
role in schizophrenic development of one or more of its children.
b. He rejected the Fromm-Reichmann theory and argued that a family-oriented perspective
could contribute to a needed overhauling of psychoanalytic theory.
c. He called attention to the possibly destructive role of the father. He described five
patterns of pathological fathering of schizophrenics: rigid and domineering, hostile.
Paranoid, of little or no consequence at home, passive and sumbmissive.
d. Schizophrenia was a “deficiency disease” resulting from the failure of both parents to
play supportive and complementary roles with one another.
e. Two patterns of chronic marital discord that are particularly characteristic of families and
schizophrenics: marital schism and marital skew
f. Marital schism refers to the disharmonious situation in which each parent, preoccupied
with his or her own problems, fails to create a satisfactory role in the family that is
compatible with and reciprocal to the other spouse’s role.
g. Marital skew, which the researchers observed in families with schizophrenic offspring,
the marriage is not threatened, but mutually destructive patterns nevertheless exist.
h. Lidz and associates concluded that male schizophrenics usually came from skewed
families in which there is a dominant, emotionally disturbed mother, impervious to the
needs of other family members but nevertheless intrusive to her child’s life.
i. Lidz searched for family dysfunction as the locus of pathology in schizophrenics.
5. Bowen, Wynne, and NIMH Studies
a. Murray Bowen, a psychiatrist broke new ground in the study of schizophrenia in the
early 1950’s.
b. He was interested in identifying unresolved symbiotic mother-child interactions.
c. Bowen reported that families of schizophrenics often demonstrate interaction patterns
resembling Lidz findings about marital schism.
d. Bowen termed the striking emotional distance between parents in such a situation as
emotional divorce. He described relationships of this kind as vacillating between periods
of over-closeness and over-distance.
e. Bowen proposed that schizophrenia is a process that spans at least three generations
before it manifests in the behavior of a family member.
f. Wynne helped organize a family therapy training program which emphasized how
disordered styles of communication, what he terms communication deviance, are
transmitted in schizophrenic families provides an interactional vehicle for understanding
the development of a thought disorder, the defining characteristic of young
schizophrenic adults.
g. Wynne offered the term pseudomutuality- giving the appearance of a mutal, open, and
understanding relationship without really having one—to describe how such families
cover up conflict and conceal an underlying distance and lack of intimacy between their
members.
h. Families with pseudohostility maintain a relationship by engaging in continuous
superficial bickering, masking their deeper need for tenderness, and affection.
i. A rubber fence, a changeable situation in which the specific boundaries of the family
may shift, as though made of rubber, allowing in certain acceptable information but
unpredictably or arbitrarily closing in order to keep unacceptable information out.
6. Marriage and Premarriage Counseling
a. Based on the concept that psychological disturbances arise as much from conflicts
between persons as from conflict with a person.
b. In 1929 Abraham and Hannah Stone opened the Marriage Consultation Center in New
York
c. A year later Paul Popenoe founded the American Institute of Family Relations in Los
Angeles, offering premarital guidance as well as aid in promoting marital adjustment.
d. Emily Mudd started the Marriage Council of Philadelphia in The fist1932
e. In 1941 the American Association of Marriage Counselor (AAMC) was formed largely
from Mudd’s prodding
f. The first documented premarital intervention program was offered by Ernest Groves
(later the first president of AAMC) in 1924 in a family life preparation course at Boston
University.
g. In 1970 Olson, among others urged the integration of marriage counseling and the
emerging field of family therapy which in turn the AAMC wanted to increase interest by
its members in family therapy, which changed its name to the American Association of
Marriage and Family Counselors
h. Many people who seek help for their marriage are attempting to cope with a crisis such
as infidelity, threat of divorce, disagreements regarding child rearing, money problems,
sexual incompatibilities, ineffective communication patterns, conflict over power and
control that has caused an imbalance in the family equilibrium.
i. Conjoint therapy, a couple works with the same therapist together in the same room and
at the same time, replaced earlier efforts to counsel each partner separately.
7. The Child Guidance Movement
a. Emerging early in the 20th century, was based on the assumption that if emotional
problems did indeed begin in childhood then early identification and treatment of
children could prevent later pschopathology.
b. Adler helped found the child guidance movement in Vienna in the 1900’s
c. Influenced by Adler, Rudolf Dreikurs expanded child guidance centers into family
counseling centers
d. Child guidance centers continue to function on the principle of early intervention in a
child’s family’s emotional problems in order to avert the later development of more
serious disabilities.
8. Group Dynamics and Group Therapy
a. Group dynamics and the behavior of small groups served as models of family
functioning for some early family therapists such as John Bell which he called his
approach family group therapy.
b. The earliest use of group process in psychotherapy can be credited to the Austrian
psychiatrist Jacob Moreno, who around 1910 combined dramatic and therapeutic
techniques to create psychodrama.
c. Pyschodrama is recreated in the therapeutic process the various interpersonal situations
that may have led to the patient’s psychological difficulties. At certain junctures, the
director might instruct the patient to reverse roles with one of the players so the patient
could gain a greater awareness of how another person saw him or her.
d. Wilfred Bion and Melanie Klein whose theories developed considerable interest in group
processes developed during the 1930’s- group intervention techniques began to be
experimented with
e. Samuel Slavson began to do group work and created the activity group therapy
technique in which a group setting encourages disturbed children or adolescents to
interact, thereby acting out their conflicts, impulses, and typical behavior patterns.
f. Slavsons efforts influenced the American Group Psychotherapy Association in 1943
g. In the 1960’s the encounter group made a dramatic impact on the therapy scene and
attracted large numbers of people, mostly from the upper middle class
9. The Evolution of Family Therapy
a. Family therapy owes its legitimacy to the following facts it was carried out for
scientifically defensible research purposes and the research being done on clinical
problems such as schizophrenia that did not respond well to the established
psychotherapies of that time.
b. Nathan Ackerman, a child psychoanalyst in the child guidance movement, is generally
credited with haven written the first paper dealing specifically with treating an entire
family. Ackerman began seeing entire families together at least a decade before other
therapists joined him in this approach.
c. John Bell was another major architect of family therapy. He recalled that a casual
remark overheard while he was visiting the Tavistock Clinic—to the effect that John
Bowlby, a prominent psychoanalyst, was experimenting with group therapy with entire
families---stimulated his interest in applying the technique to treat behavior problems in
children.
d. Murray Bowen—theoretical proposals and his innovative technique of hospitalizing
families with a schizophrenic member in order to study mother-child symbiotic
influences
e. Carl Whitaker began working with families and used co therapies and included
intergenerational family members in a patient’s therapy
f. In 1962 Ackerman and Jackson founded the first journal in the field Family Process
g. Minuchin’s Wiltwyck School Project, a pioneering study of urban slum families.
Minuchin subsequently developed appropriate clinical techniques for successful
intervention with male juvenile delinquents.
h. Minuchin developed an approach he called structural family therapy that was pragmatic
and oriented toward problem resolution, always mindful of the social context in which
the family problems emerged and were maintained.
i. Behavior family therapy first appeared in the late 1960’s
j. Robin Skynner contributed a brief version of psychodynamic family therapy
k. John Howells instituted family diagnosis as a necessary step in planning interventions.
l. Helm Stierlin called attention to patterns of separation in adolescence and related them
to family characteristics.
m.
n. Multiple family therapy is treating several families with hospitalized schizophrenic
mothers in groups.
o. Multiple impact therapy brings families together for an intensive, crisis focused 2 day
period of continuing interaction with a team of mental health professionals
p. Network therapy working in the home with an extended family group including friends,
neighbors, and employers.
q. Family crisis therapy treats a family on an outpatient basis instead of hospitalizing a
distrurbed, scapegoated family member.
r. Beels and Ferber distinguished two types of family therapists based on the therapists
relationship to the family: conductors and reactors. Conductor therapists are active,
aggressive, and colorful leaders who place themselves in the center of the family. They
are likely to initiate rather than respond to propound ideas vigorously to make their
value systems explicit. Reactors are less theoretical personalities, more subtle and
indirect. They observe and clarify the family process, responding to what the family
presents, negotiating differences among family members.
10. Professionalism, Multiculturalism, and a New Epistemology (1980;s)
P 127 lists the associations
a. Family therapy became an international phenomenon in the 1980’s, with active training
programs and congresses.
b. Medical family therapy emerged as a subspeciality, and the journal of family systems
medicine was founded.
c. Doherty and Baird published a landmark book, Family Therapy and Family Medicine, in
which they argued for the application of a systems approach to treating illness in which
both disciplines cooperatively act as providers for patients with a variety of medical
conditions.
d. Wynne, Shields, and Sirkin reminded therapists that illness was more than a personal
experience, it was transactional and communicative with fellow family members.
e. Family psychoeducation (1) reduces relapse rates, (2) improves patient functioning, (3)
improves family dynamics
11. Constructivists believe objectivity is impossible and that the therapist, presumably an outside
observer of a family, in actuality participates in constructing what is observed.
12. Tom Andersen employs an egalitarian technique he calls a reflecting team, in which a clinical
team first watches a family and therapist behind a one-way mirror, then reverses roles and holds
an open forum regarding what they have just seen while the family observes their discussion
behind the one-way mirror.
13. The Core Competency Movement (2000-present)
a. The core competency movement emerged as a way to define the knowledge, skills, and
attitudes needed for responsible practice in healthcare disciplines.
b. Competency in family therapy steps for growth over time
1. Learn the core information of their field
2. Experience the ongoing evaluation of their absorptions of the material, with tested
aimed at assessing overall retention.
3. Apply academic knowledge to the professional field. In family therapy, this means
the application of coursework to clinical practice.
4. Undergo a period of mentorship and supervision that provides a source of direct
observation, evaluation, and feedback.
5. Experience a capstone event that demonstrates overall professional ability
Chapter 7
1. Psychodynamic models emphasize insight, motivation, unconscious conflict, early infant-
caregiver attachments, unconscious intrapsychic object relations and , more recently, actual
relationships and their impact on inner experience.
2. Transgenerational models accent how current family patterns, alliances, and boundaries are
embedded in unresolved issues from the families of origin.
3. Experiential-humanistic models address emotional engagement, self-growth, and self-
determination through present-day experience, encounter, confrontation, intuition, spontaneity,
and action.
4. Structural models emphasize the context of the family and use spatial and organizational
metaphors to describe problems and identify solutions.
5. Strategic models privilege directive or task-oriented interventions over understanding the
meaning of symptoms. The Milan systemic model questions family belief systems including
thoughts and the meanings attached to behaviors.
6. Behavioral and cognitive models emphasize skills and behavioral change.
7. The Place of Theory
a. Patterson argues that a clear theoretical position provides the structural underpinnings for
assessment and treatment planning to occur. He maintains that a therapist must accurately
identify the major theoretical orientation from which he or she operates before untilizing
congruent intervention methods within it.
b. The criteria of a sound theory is it comprehensive, parsimonious, is it verifiable, is it precise,
is it empirically valid, is it stimulating (p160)
8. Psychodynamic Models
a. Psychoanalysis plays the central role in establishing and defining the nature of
psychotherapy. Traditionally, psychoanalysis focused on treating neurotic individuals by
examining and reconstructing childhood conflicts generated by the colliding forces of inner
drives and external experiences.
b. Sigmund Freud, founder of psychoanalysis recognized that the family provided the early
environment or context in which neurotic fears and anxieties developed.
c. Alfred Adler helped found the child guidance movement in the early 1900’s. He began to
speicialize in nuerology and psychiatry, especially in treating childhood disorders.
1. Adlers awareness of key role of family experiences in influencing adult behavior
concepts such as sibling rivalry, consetellation, birth order, and style of life.
2. The goal of Adlerian family therapy is to promote changes in both indiividuals and the
family as a whole. While some principles vary, basic principles include the promotion of
a new understanding and insight about purposes, goals, and behaviors: the
enhancement of skills and knowledge in such areas as communication, problem solving,
and conflict resolutuion: increase of social interests and positive connections with
others: and the encouragement of commitment to ongoing growth and change.
Encouragement, the most important concept in working with families as a means to
promote changes in both individuals and the family as a whole.
d. Harry Stack Sullivan, was influenced by sociology and social psychology. He stressed the role
of interpersonal relationships, within the family and with outsiders, in personality
development. He argued that people are essentially products of their social interactions; to
understand how people function, he urged the study of their “relatively enduring patterns of
recurrent interpersonal interactions.”
e. Techniques of Adlerian Family therapy table on page 163
f. Sullivan described the participant observer is a second-order cybernetic idea of the therapist
as part o the ongoing therapeutic system. It recognizes the impact of her or his own
subjective experience during therapy.
9. The Psychodynamic Outlook (164)
a. Classical Psychoanalytical Theory- Freud’s psychoanalytic theories focus on what he believed
were biologically determined forces, or drives, within a person as the basis for
understanding motivation, conflicts, and symptomology. Drives motivate behavior by means
of bodily demands that take the form of unconscious wishes and impulses seeking
satisfaction.
1. Each drive has four components:an aim or release of sexual or aggressive tension,
hunger or the bodily need for nourishment, an impetus or the pressure or urgency
of the drive, and an object or the person or thing or condition that will satisfy the
drive, food, sexual intercourse etc.
2. Freudian concepts. Transference refers to a clients unconscious transfer of feelings,
wishes, and reactions related to important people from childhood onto the
therapist. Countertransference refers to the therapist’s unconscious experiences
that emerge during the analytic process; these may interfere with the therapists
ability to positively interact with the client. Resistance refers to an unconscious
impediment experienced by the client to the unfolding of the therapy.
i. Interpretation of the resistances and transferences of individual family
members ofr the family of the whole will lead to psychic healing.
3. Focal family therapy (Bentovim) this approach is developmentally oriented and
looks for family disturbances, espically traumatic event to family members that have
led to intrapsychic and interpersonal disturbance with the family.
4. Samuel Slipp-object relations theory
5. Ackerman was seen as the grandfather of family therapy (167)
a. A “failure of complementarity” occurs when change and growth within the
system become constricted. Rules become rigid, Narrowly defined or
stereotyped or shift rapidly, causing confusion. The family in which this occurs
must be helped to quote accommodate to new experiences, to cultivate new
levels of complementary and family role relationships, flexibility, and
adaptability of roles are essential allowing for maturing children to gain
appropriate autonomy
b. Interlocking pathology in family relationships notes the impact of the family
environment on the development of childhood disorders.. Any single members
behavior can be a symptomatic reflection of confusion and distortion occurring
in the entire family.
6. Object relations theory views the infants experience and relationship to the mother
or primary caregiver as the main determinant of adult personality formation.
According to this theory the infants need for attachment to the mother is the
foundation for the development of the self the unique psychic organization that
creates A person's sense of identity.
A. Melanie Klein provided much of the foundation of objects relations
theory. Her insights into the pre verbal, inner world of the child's object
relations are often considered the start of the movement. Klein argued
that drives parentheses urges, instincts) are relational and inherently
directed objects
7. WRD Fairbairns worked therapeutically with schizoid adults. His innovative theory
of personality development was based strictly on the consideration of object
relations, and those objects inevitably are people.
a. . Splitting -the child within the first year of life internalizes an image of the
mother into a good object (the satisfying and love loving mother) and a bad
object (the inaccessible and frustrating mother) The former becomes an
idealized object and allows the child to feel loved, the latter a rejecting object
that leads to anger, a feeling being unlived, and a longing to regain that love.
Part of mother is loved, another part hated , because she is not seen yet as a
whole person, one of the other part dominates at different times.
8. Henry Dicks expanded fairbairns conceptualization by proposing that marriages
were inevitably influenced by each spouses infantile experiences
. While two people make conscious marital choices based upon many factors including
emotional compatibility, physical and intellectual attraction background similarities and so
forth
9. Identification refers to an interactive mental process in which marital partners
unconsciously defend against anxiety by projecting or externalizing certain split off
or unwanted parts of themselves onto their partners, who in turn are unconsciously
manipulated to behave in accordance with this projection
a. When a person who feels herself ( and wants other people to know her) to be
thoughtful and kind believes that a perfect stranger is cruel
10. Object relations therapy is when individuals therapy can be enhanced by exploring
the objects projected by the client onto more people than just the person of the
therapist
a. Holding environment, a phrase attributed to DW Winnicott, refers to the safe
and nurturing environment provided by the mother to her infant that supports
good-enough psychological development. The term also refers to a comparable
environment that the therapist seeks to create for the patient. In this shared
holding space the child or individual or family may interact with the therapist for
the sake of growth and or healing.
11. James Framo stressed the relationship between the intrapsychic and the
interpersonal offering an amalgam of psychodynamic and systems concepts. He
developed a set of intervention techniques that helped couples in marital therapy
deal with unresolved issues each partner brings to the marriage from his or her
family of origin. Framo believed that these intrapsychic conflicts continue to be
acted out or replicated with current intimates, such as a spouse or children.
12. Objectj relations family therapy includes many concepts from psychoanalysis comes
from the collaboration of David Scharff and Jill Scharff. The Scharffs therapeutic
approach, unconscious themes expressed in dreams and fantasies are evoked and
investigated, family histories are explored as they relate to current relationships,,
interpretations are made to the family, insight is sought, and transference and
countertransference feelings are explored in an effort to arrive at greater
understanding and growth.
13. Kohut and Self Psychology
Heinz Kohut was responsible for another major development in psychoanalysis.
Kohuts disavowal of drive the theory represents a more radical departure from
Fruedian theory than the original objects relations theorists, many of whom retained
in their reformulations.
a. Self-psychology, a theory of psychoanalysis that emphasizes the relationship
between the self and outside objects as the defining organizational pricinciple of
human life. From his viewpoint , conflict within the person arises early in life
from a compromised sense of self rather than from insticnctual conflict.
b. Selfobject refers to a sense of oneself in relation to an other that is needed for
the sustenance or enhancement of the self.
c. Selfobject transference is the transference formed by the patient within which
current narcissistic needs are experienced and explored vis a vis the therapist. It
is to be understood so that developmental needs can be met and goals
achieved.
Chapter 8
1. bowen’s Family theory
2. a. Bowen, the developer of family systems theory, conceptualized the family as an emotional
unit, a network of interlocking relationships, best understood when analyzed within a
multigenerational or historical framework. Bowen hoped to help the partners hear each other
out without deafening passions, accusations, or blame and to learn what each must do to reduce
anxiety and build their relationship.
3. b. He believed that the driving force underlying all human behavior came from the submerged
ebb and flow of family life, the simultaneous push and pull between family members for both
distance and togetherness (Wylie, 1990b). This at- tempt to balance two life forces—family
togetherness and individual autonomy—was for Bowen the core issue for all humans.
Successfully balanced, such persons are able to maintain intimacy with loved ones while
differentiating themselves sufficiently as individuals.
C Bowen became particularly interested in researching the possible transgenerational impact of
a mother–child symbiosis, or intense enmeshment, in the development and maintenance of
schizophrenia. Extrapolating from the psychoana- lytic concept that schizophrenia might result
from an unresolved symbiotic attachment to the mother, herself immature and in need of the
child to fulfill her own emotional needs, , Bowen began studying the emotional fusion between
schizophrenic patients and their mothers.
D. the family emotional system—a kind of family guidance system shaped by evolution that
governs its behavior. The conceptual shift proved to be a turning point in his thinking, as Bowen
increasingly viewed human emotional functioning as part of a natural system that followed the
same laws that govern other systems in nature, such as the laws of gravity. Bowen began to
study human emotional functioning in a more rigorously scientific way. In so doing, Bowen was
beginning to formulate nothing less than a new
theory of human behavior.
e. Family systems theory (sometimes referred to as natural systems theory to differentiate it
Murray Bowen, M.D.from cybernetically based family systems theories) is derived from the
biological view of the human family as one type of living system.
2. eight interlocking theoretical concepts
The eight concepts are tied together by the underlying premise that chronic anxiety is omnipresent in
life. While it may manifest itself differently, and with different degrees of intensity depending on specific
family situations and differing cultural considerations, chronic anxiety is an inevitable part of nature.
a. Bowen viewed chronic anxiety as a biological phenomenon that humans have in common with all
forms of life
b. Anxiety is inevitably aroused as families struggle to balance the pressures toward togetherness as well
as toward individ- uation. If greater togetherness prevails, imbalance results and the family moves
toward in- creased emotional functioning and less individual autonomy, leading the person to experience
increased chronic anxiety.
4. According to Family Systems Theory, Eight Forces Shape Family Functioning:
1. Differentiation of self 2. Triangles 3. Nuclear family emotional system 4. Family projection process 5.
Emotional cutoff 6. Multigenerational transmission process 7. Sibling position 8. Societal regression
5. Differentiation of Self-- Differentiation of self, says Bowen, reflects the extent to which a person is able
to distinguish between the intellectual process and the feeling process of what he or she is expe-
riencing. Differentiation of self is demonstrated by the degree to which a person can think, plan, and
follow his or her own values or convictions, particularly around anxiety-provoking issues, without having
behavior automatically driven by the emotional cues from others
a. One way people can demonstrate (especially to therapists) their degree of relative differenti-
ation is through speaking in I-statements (reflective of I-positions), that is, statements that verbalize the
degree of separation an individual feels vis-S-vis others.
b. The degree to which one separates emotionally from parents in growing up is key to
differentiation. In extreme cases, the attachment becomes a symbiosis in which parents and child cannot
survive without one another. Such unresolved emotional attachment is equiv- alent to a high degree of
undifferentiation in a person and in a family
c. Individuals with the greatest fusion between their thoughts and feelings (e.g., schizophrenics
dealing with their families) function most poorly; they are likely to be at the mercy of automatic or
involuntary emotional reactions and tend to become dysfunctional even under low levels of anxiety.
d. Bowen (1966) early on introduced the concept of undifferentiated family ego mass, a term derived
from psychoanalysis. The term conveys the idea of a family emotionally “stuck together,” one in which “a
conglomerate emotional oneness . . . exists in all levels of intensity”
e. Bowen family systems theory assumes that an instinctively rooted life force in every human propels
the developing child to grow up to be an emotionally separate person, able to think, feel, and act as an
individual. At the same time, a corresponding life force propels the child and family to remain
emotionally connected. Because of these counterbalancing forces, no one ever achieves complete
emotional separation from the family of origin.
6. Triangles
a. Bowen family systems theory also emphasizes the emotional tension within an individual or in that
person’s relationships. For example, the greater the fusion in a couple, the more difficult it is to find a
stable balance satisfying to both. One way to defuse such an anxious two-person relationship, according
to Bowen (1978), is to triangulate—draw in a significant family member to form a three-person
interaction. Triangulation is a common way that two-person systems under stress attempt to achieve
stability
b. Think of a couple in therapy that are considering divorce. After weeks of hostility and mutual blaming,
the therapist invited the couple to bring in their 16-year-old son and asks the young man, “What do you
think of your parents getting a divorce?” The young man, looking very sad, says, “Finally, someone has
asked me for my opinion.” Each parent looks at each other and realizes that in their fused state of rage
and anxiety, they have both neglected their son. They both take deep breaths and for the first time start
talking more honestly about all their thoughts and feelings. As this example suggests, the basic building
block in a family’s emotional or relational system is the triangle
c. The least-well-differentiated person in the family is particularly vulnerable to being drawn in to reduce
tension. Often this person winds up being the identified patient.
d. Kerr and Bowen (1988; Kerr, 2003) point out that triangulation has at least four pos- sible outcomes:
(a) a stable twosome can be destabilized by the addition of a third person (e.g., the birth of a child brings
conflict to a harmonious marriage); (b) a stable twosome can be destabilized by the removal of a third
person (a child leaves home and thus is no longer available to be triangulated into parental conflict); (c)
an unstable twosome can be stabilized by the addition of a third person (a conflictual marriage becomes
more harmonious after the birth of a child); and (d) an unstable twosome can be stabilized by the
removal of a third per- son (conflict is reduced by getting a third person, say a mother-in-law who has
consistently taken sides, out of the picture).
7. Nuclear Family Emotional System
Bowen (1978) contends that people choose mates with levels of differentiation equivalent to their own.
The relatively undifferentiated person will be attracted to a person who is equally fused to his or her
family of origin. These poorly differentiated people, now married, likely will become highly fused and
produce a family with the same characteristics. Bowen indicates that the resulting nuclear family
emotional system will be unstable and will seek to reduce tension and maintain stability. The greater the
nuclear family’s fusion, the increased likelihood of anxiety and potential instability, and the greater the
family’s propensity to seek resolution through fighting, distancing, exploiting the compromised
functioning of one partner, or banding together over concern for a child (
a. Kerr and Bowen (1988) note three possible symptomatic patterns in a nuclear family when
partners are intensely fused1. Physical or emotional dysfunction in a spouse, sometimes chronic, an
alternative to dealing directly with family conflict; the anxiety generated by the undifferentiated
functioning of every family member is absorbed disproportionately by a symptomatic parent.
2. Overt, chronic, unresolved marital conflict, in which cycles of emotional distance and over closeness
occur; both the negative feelings during conflict and the positive feelings for one another during close
periods are likely to be equally intense in roller-coaster fashion; the family anxiety is being absorbed by
the husband and wife.
3. Psychological impairment in a child, enabling the parents to focus on the child and ignore or deny
their own lack of differentiation; as the child becomes the focal point of the family problem, the intensity
of the parental relationship is diminished. Thus the family anxiety is absorbed in the child’s impaired
functioning; the lower a child’s level of differen- tiation, the greater his or her vulnerability to increases
in family anxiety and dysfunction. Furthermore, dysfunction in one spouse may take the form of an
overadequate-underadequate reciprocity, in which one partner takes on most or even all family
responsibilities (earning a living, caring for the children, cooking, shopping, arranging a social life, and so
on) while the other plays the counterpart role of being under-responsible (can’t drive without anxiety,
can’t choose clothes, can’t have friends to the house). Fused together, the two pseudo selves develop an
arrangement in which one partner increasingly underfunctions while the other
takes up the slack by assuming responsibility for them both. When the tilt gets too great, according to
Singleton (1982), the one giving up more pseudo self for the sake of family harmony becomes vulnerable
to physical or emotional dysfunction.
4. Family Projection Process
Bowen (1976) believed that poorly differentiated parents, themselves immature, select as the object of
their attention the most infantile of all their children, regardless of his or her birth order in the family.
This child receives the parents’ own low levels of differentiation and becomes that way him- or herself.
Bowen calls this transmission experience the family projection process
a. The intensity of the family projection process is related to two factors: the degree of
immaturity or undifferentiation of the parents and the level of stress or anxiety the family experiences.
5. Emotional Cutoff
Bowen (1976) considers such supposed freedom an emotional cutoff—a flight of extreme emotional
distancing in order to break emotional ties—and not true emancipation. Kerr (1981) contends that
emotional cutoff reflects a problem (underlying fusion between generations), solves a problem (reducing
anxiety associ- ated with making contact), and creates a problem (isolating people who might benefit
from closer contact).
a. Cutoffs occur most often in families in which there is a high level of anxiety and emotional
dependence
6. Multigenerational Transmission Process
In perhaps his most intriguing formulation, Bowen (1976) proposed the concept of a multigenerational
transmission process, in which severe dysfunction is conceptualized as the result of chronic anxiety
transmitted over several generations. Two earlier concepts are crucial here: (1) the selection of a spouse
with a similar differentiation level and (2) the family projection process that results in lower levels of self-
differentiation for the targeted offspring, who is often particularly sensitive to parental emotional
patterns.
7. Sibling Position
Bowen credits Toman’s (1961, 1993) research on the relationship between birth order and personality
with clarifying his own thinking regarding the influence of sibling position in the nuclear family emotional
process. Toman hypothesized that children develop certain fixed personality characteristics based on
their birth order in the family
8. Societal Regression
beliefs, behavior patterns, and the transmission of family values over generations. As we empha- size
throughout this text, those factors are at the forefront of contemporary family psychology and family
therapy. In the final, least well developed of his theoretical formulations, societal regression, Bowen
argued that society, like the family, contains within it opposing forces toward undifferentia- tion and
toward individuation. Under chronic stress (population growth, depletion of natural resources) and an
anxious social climate, there emerges an emphasis on short-term solutions based on self-interest rather
than community interest (Kerr, 2003).
9. Bowen Family Systems Therapy
Family systems therapy occurs in stages. Adopting a neutral and objective role in order to remain
untriangled into the family, the therapist first attempts to assess the family’s emo- tional system, past
and present, through a series of evaluation interviews and measurement techniques before intervening
therapeutically.
a. The Evaluation Interview
The appraisal of a symptomatic family begins with the initial telephone contact. Kerr and Bowen (1988)
caution the therapist against being drawn into the family emotional system by overresponding to the
caller’s forceful, charming, or theatrical presentation of the fami- ly’s problem.
b. Family evaluation interviews are carried out with any combination of family members: a
parent, husband and wife, the nuclear family, perhaps including extended family members
c. Family evaluation interviews begin with a history of the presenting problem, focusing
especially on the symptoms (physical, emotional, social) and their impact on the symptom- atic person
or relationship. If more than one person is present, the therapist is interested in each member’s
perception of what created and what sustains the problem for which they seek relief, why they seek such
help now, and what each hopes to get from the experience. Through a series of such process questions,
the therapist attempts to assess the pattern of emotional functioning as well as the intensity of the
emotional process in the nuclear family of the symptomatic person.
The initial interview, which may extend over several sessions, seeks information to assess the degree of
family dysfunction associated with the presenting symptoms, which may appear in one or more family
members history can affect the quality of a marriage.
The final part of the evaluation interview attempts to understand the nuclear family in the context of the
maternal and paternal extended family systems. The therapist is interested in multigenerational patterns
of fusion, the nature of the nuclear family’s relationship with the extended families, and the degree of
emotional cutoff of each spouse
10. Since Bowen believed multigenerational patterns and influences are crucial determinants of nuclear
family functioning, he developed a graphic way of investigating the genesis of the presenting problem by
diagramming the family over at least three generations in a family genogram. Worked out with the family
in early sessions, it provides a useful tool for therapist and family members alike to examine the nuclear
and extended family structure and emotional processes and patterns in the system
11. Therapeutic Goals
Bowen family systems therapy, no matter the presenting clinical problem, is governed by two basic goals:
(a) management of anxiety and relief from symptoms and (b) an increase in each participant’s level of
differentiation in order to improve adaptiveness
12. contextual therapy
Ivan Boszormenyi-Nagy was the primary pioneer of contextual therapy. A psychiatrist with psy-
choanalytic training who immigrated to the United States from Hungary in 1948, he founded the Eastern
Pennsylvania Psychiatric Institute (EPPI) in Philadelphia in 1957 as a research center for studying
schizophrenia (
a. Contextual therapy, as elaborated in a collection of papers spanning 30 years by Boszormenyi-
Nagy (1987), is heavily influenced by Fairbairn’s (1952) object relations theory, existential philosophy,
and Sullivan’s interpersonal psychiatry (1953), to which he added an ethical perspective—trust, loyalty,
transgenerational indebtedness, and entitlements, as well as fairness in relationships between family
members.
b. To function effectively, family members must be held ethically accountable for their behavior
with one another and must learn to balance entitlement (what one is due or has come to merit) and
indebtedness (what one owes to whom). This balance provides the relational foundation or context for
all potential relationships
c. A core concept in contextual theory, relational ethics focuses attention on the long-term,
oscillating balance of fairness among members within a family, whereby the welfare interests of each
participant are taken into account by the others. Relational ethics encompasses both individual
psychology (what transpires within the person) and systems characteristics (roles, power alignments, and
communication sequences within the family).
d. theory based upon invisible loyalty within a family, in which children unconsciously take on
responsibilities to aid their parents, often to their own detriment (e.g., become a failure to
confirm parental forecasts).
13. Family Ledger, Legacies, Debts, and Entitlements
In addition, Boszormenyi-Nagy and Spark proposed a set of therapeutic techniques designed to uncover
and resolve family “obligations” and “debts” incurred over time, using the met- aphor of a family ledger
on which these “accounts” are kept. This multigenerational accounting system tracks what has been
given and who, psychologically speaking, still owes what to whom.
a. family legacy, expectations handed down from previous generations concerning what is
expected, say, of men and women, and family loyalty, referring to allegiances in children based on
parental fairness in order to emphasize that family members inevitably acquire a set of expectations and
responsibilities toward each other
a. 9
b. Experiential Models
c. Experience, encounter, confrontation, intuition, process, growth, existence, spontaneity, action,
here-and-now—this is the vocabulary of experiential family therapists. These ther- apists tend to
minimize theory (and especially theorizing) as a therapeutic hindrance and argue that change
resides in a nonrational therapeutic experience that establishes the con- ditions for personal
growth and unblocks family interaction. Phenomenological psychother- apy is concerned with
the experience or subjectivity of an individual’s (or family’s) unique life circumstances. Expanding
experiences, unblocking suppressed impulses and feelings, developing greater sensitivity, gaining
greater access to one’s self, learning to recognize and express emotions, achieving in- timacy
with a partner—these are some of the phenomenologi- cal humanistic goals for experientialists.
d. Today, a new experiential wave is represented by, among others, Susan Johnson and Leslie
Greenberg, whose emotionally focused therapy (EFT) with couple and family applications
emphasizes emotional engagement between family members and partners, identifying feel- ings
that define the quality of their relationship, and helping create secure attachment bonds.
LO 1A Shared Philosophical Commitment
Experiential interventions are, by definition, uniquely fitted to the individual client or family by
a personally involved therapist.
the experiential Model
Experiential family practitioners tailor their approach to the unique conflicts and behavior
patterns of each family with whom they work. The work of some experiential therapists such as
Carl Whitaker (1976) clearly reflects the psychodynamic orientation of their training,1 though
they are careful, as far as possible, not to impose any preconceived theoretical suppo- sitions or
techniques upon families
Virginia Satir, a warm, intuitive, highly empathic therapist, utilized her humanistic outlook and
creative techniques to draw out the positive growth potential in each family member with whom
she worked.
David Kantor, Fred Duhl, and Bunny Duhl, represent other early influential experiential family
therapists. They cofounded the Boston Family Institute in 1969 and developed expressive
techniques, such as family sculpting, a nonverbal communication method whereby a family
member can physically place other members in a spatial relationship with one another,
symbolizing his or her perception of the family members’ differences in power or degrees of
intimacy with one another
carl Whitaker and symbolic-experiential
Family therapy
Symbolic-experiential family therapy (S-EFT), pioneered by Carl Whitaker, is a multigenerational
approach that uses therapy to address both individual and family relational patterns (see Box
9.1). Oriented toward personal growth and family connectedness, the therapist assumes a
pivotal role in helping family members dislodge rigid and repetitive ways of interacting by
substituting more spontaneous and flexible ways of accepting and dealing with their impulses.
Why symbolic? Keith and Whitaker (1982) explain it this way:
We presume it is experience, not education that changes families. The main function of the
cerebral cortex is inhibition. Thus, most of our experience goes on outside of our consciousness.
We gain best access to it symbolically. For us “symbolic” implies that some thing or some process
has more than one meaning. While education can be immensely helpful, the covert process of
the family is the one that contains the most power for potential changing. (
Symbolic-Experiential Therapy’s Distinguishing Features
• A pragmatic, nontheoretical approach to • A commitment to client self-
access, self- psychotherapy fulfillment, expanded experiences, and family
• A steadfast effort to depathologize human experience •
• The replacement of preplanned therapeutic technique with the therapist’s spontaneous
creativity •
• An emphasis on emotional experience and affectively engaging families •
cohesiveness The use of self by the therapist (drawing upon
images, fantasies, and personal metaphors from one’s own life) The use of symbolic, nonverbal
methods or play
The use of co-therapy
STUDY GUIDE – EXAM 2
COUN 601 – Goldenberg et al. 9th edition
Chapters 5, 7, 8, and 9
Develop an understanding of conjoint therapy.
a. Conjoint therapy, a couple works with the same therapist together in the same room and
at the same time, replaced earlier efforts to counsel each partner separately.
What do marital schisms and marital skews look like?
a. Marital schism refers to the disharmonious situation in which each parent, preoccupied
with his or her own problems, fails to create a satisfactory role in the family that is
compatible with and reciprocal to the other spouse’s role.
b. Marital skew, which the researchers observed in families with schizophrenic offspring,
the marriage is not threatened, but mutually destructive patterns nevertheless exist.
c. Lidz and associates concluded that male schizophrenics usually came from skewed
families in which there is a dominant, emotionally disturbed mother, impervious to the
needs of other family members but nevertheless intrusive to her child’s life.
Be able to explain pseudomutuality, pseudohostility, and the rubber fence.
a. Wynne offered the term pseudomutuality- giving the appearance of a mutal, open, and
understanding relationship without really having one—to describe how such families
cover up conflict and conceal an underlying distance and lack of intimacy between their
members.
b. Families with pseudohostility maintain a relationship by engaging in continuous
superficial bickering, masking their deeper need for tenderness, and affection.
c. A rubber fence, a changeable situation in which the specific boundaries of the family
may shift, as though made of rubber, allowing in certain acceptable information but
unpredictably or arbitrarily closing in order to keep unacceptable information out.
Who coined the term “double-bind” and what does it mean?
Termed by Gregory baetson
a. Emotional cutoff
b. e bind situation occurs when an individual receives repeated conflicting injunctions from
the same person with whom the child has an important ongoing relationship. In their
exchange, a primary negative injunction by the adult is followed by a conflicting
secondary injunction at a more abstract level, again with the threat of punishment if the
child disobeys. As a tertiary injuction, the adult demands a response but forbids the
child to comment on the contradiction, thus forbidding escape from the confusing
situation.
Know information on Fromm-Reichmann and the Schizophrenogenic Mother.
1. Fromm-Reichmann and the Schizophrenogenic Mother
a. Maternal rejection postulated from Fromm-Reichmann for the development of male
schizophrenia
b. Schizophrenogenic Mother denotes a domineering, cold, rejecting, possessive, guilt-
producing person who, in combination with a passive, detached, and ineffectual father,
causes her male offspring to feel confused and inadequate and ultimately to become
schizophrenic.
c. Viewed schizophrenia as a intrapsychic disorder, residing within the individual patient.
d. Saw the clinicians role as freeing the patient from the parents’ noxious influences.
e. NO patient was beyond the reach of psychotherapy.
Develop a working knowledge of Object Relations Family Therapy.
1. Object relations therapy is when individuals therapy
can be enhanced by exploring the objects projected by
the client onto more people than just the person of the
therapist
b. Holding environment, a phrase attributed to DW
Winnicott, refers to the safe and nurturing
environment provided by the mother to her infant
that supports good-enough psychological
development. The term also refers to a comparable
environment that the therapist seeks to create for
the patient. In this shared holding space the child or
individual or family may interact with the therapist
for the sake of growth and or healing.
Understand Framo’s approach to marriage and family therapy.
James Framo stressed the relationship between the intrapsychic and
the interpersonal offering an amalgam of psychodynamic and systems
concepts. He developed a set of intervention techniques that helped couples
in marital therapy deal with unresolved issues each partner brings to the
marriage from his or her family of origin. Framo believed that these
intrapsychic conflicts continue to be acted out or replicated with current
intimates, such as a spouse or children
Be familiar with Object Relations Theory.
1. Object relations theory views the infants experience
and relationship to the mother or primary caregiver as
the main determinant of adult personality formation.
According to this theory the infants need for
attachment to the mother is the foundation for the
development of the self the unique psychic
organization that creates A person's sense of identity.
B. Melanie Klein provided much of the foundation
of objects relations theory. Her insights into the
pre verbal, inner world of the child's object
relations are often considered the start of the
movement. Klein argued that drives
parentheses urges, instincts) are relational and
inherently directed objects
4.
What does “self object” refer to? Selfobject refers to a sense of oneself
in relation to an other that is needed for the sustencance or
enhancement of the self.
a.
What constitutes a “sound” theory? Be able to list trends of family
therapy today. The criteria of a sound theory is it comprehensive, parsimonious, is it
verifiable, is it precise, is it empirically valid, is it stimulating (p160)
Be familiar with Ackerman, Psychoanalysis, and Family Dynamics.
What does Ackermann mean by “interlocking pathology”?
In an early paper, Ackerman (1956) presented a conceptual
model of interlocking pa- thology in family relationships. Noting the
impact of the family environment on the devel- opment of childhood
disorders, he was one of the first to see the constant interchange of
unconscious processes taking place between family members as
they are bound together in a particular interpersonal pattern.
Accordingly, any single member’s behavior can be a symp- tomatic
reflection of confusion and distortion occurring in the entire family.
With notions such as “interlocking pathology,” Ackerman was able to
wed psychoanalytic concepts of intra- psychic dynamics to the
psychosocial dynamics of family life. See Box 7.3 for an example of
Ackerman’s intervention style.
What are the foundational concepts of Experiential Therapy?
What is family sculpting?
Be familiar with the experiential model and S-EFT.
Be familiar with Satir’s Human Validation Process Model.
Know information on symbiosis.
C Bowen became particularly interested in researching the possible
transgenerational impact of a mother–child symbiosis, or intense
enmeshment, in the development and maintenance of schizophrenia.
Extrapolating from the psychoana- lytic concept that schizophrenia might
result from an unresolved symbiotic attachment to the mother, herself
immature and in need of the child to fulfill her own emotional needs, , Bowen
began studying the emotional fusion between schizophrenic patients and their
mothers.
Know the family life facts chronology by Satir.
Be familiar with Emotionally Focused Couple Therapy.
Be familiar with undifferentiated family ego mass and triangles.
. Bowen (1966) early on introduced the concept of undifferentiated
family ego mass, a term derived from psychoanalysis. The term conveys the
idea of a family emotionally “stuck together,” one in which “a conglomerate
emotional oneness . . . exists in all levels of intensity”
Understand the multi-generational transmission process, genograms, and
Bowenian
therapy techniques.
Know the differentiation of self, undifferentiated family ego mass, symbiosis,
triangles,
birth order, emotional cut offs, and all of the Bowenian terms.
Pay attention to “bold print” terms. You may see them again.
What did the use of a “one-way” mirror do for research and clinical practice
in Marriage
and Family therapy?
Carefully read the text boxes, clinical notes, cases studies, etc.
