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STUDY GUIDE – EXAM 3
Goldenberg et al. 9th edition
Chapters 10–12
●Be familiar with family coalitions. p 271
Figure 10.2 The effect of stress on the subsystem boundaries of a family. In the top diagram, a father (F)
and mother (M) both stressed at work come home and criticize each other but then detour their conflict by
attacking the child (C). In the bottom diagram, the husband criticizes the wife, who seeks a coalition with
the child against the father. Note the rigid cross-generational subsystem of mother and child; their
coalition has the effect of excluding the father. Minuchin refers to this as a cross-generational
dysfunctional pattern.
●Understand the emphasis of structural therapists. p255
The primary role of structural therapists is the facilitation of organizational changes in the dysfunctional
family, assuming that individual behavioral changes and symptom reduction will follow as the context for
the family’s transactions changes. When the family’s structure is transformed, the positions of its
members are altered, and each person experiences change. As an instrument of change, the therapist
actively engages the whole family to introduce challenges 1 that force adaptive changes, supporting and
coaching family members as they attempt to cope with the consequences (Colapinto, 1991).
●Know characteristics and interventions of psychosomatic families. p 257 - 258
psychosomatic families (with particular attention to families of anorexia nervosa patients), p124
(p257) At the Philadelphia Child Guidance Clinic, Minuchin turned his attention to the role of family context
in psychosomatic conditions, especially such urgent medical problems as diabetes and anorexia. More
specifically, no medical explanations could be found for the unusually large number of diabetic children who
required emergency hospitalization for acidosis (a depletion of alkali in the body), nor would they respond to
individual psychotherapy
(p. 258)As noted in Psychosomatic Families (Minuchin, Rosman, & Baker, 1978), families of children who
manifest severe psychosomatic symptoms are characterized by transactional problems that encourage
somatization. Enmeshment is common, subsystems function poorly, and boundaries between family members
are too diffuse to allow individual autonomy. A psychosomatic family was found to be overprotective,
inhibiting the child from developing a sense of independence, competence, or interest in activities outside the
safety of the family. The physiologically vulnerable child, in turn, feels great responsibility for protecting the
family. The manifestation of symptoms typically occurs when stress overloads the family’s already
dysfunctional coping mechanisms. Thus, the symptoms are regarded as having a regulating effect on the
family system, the sick child acting as a family conflict defuser by diverting family attention from more basic
but less easily resolved family conflicts.
Side Note: Wiltwyck families
In the Wiltwyck families (Minuchin et al., 1967), typically burdened by severe external stressors brought
about by poverty, five dysfunctional family structures were differentiated: (a) enmeshed families, (b)
disengaged families, (c) families with a peripheral male, (d) families with noninvolved parents, and (e)
families with juvenile parents. A sense of feeling overwhelmed and helpless was common to these families,
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often led by single mothers, who struggled to control or guide their delinquent children.
●Know boundaries and characteristics of disengaged and enmeshed families. p262
Disengagement or enmeshment—avoiding contact with one another or continuous bickering—are both
directed at circumventing change, thus failing to achieve conflict resolution. Overprotection of the sick
child by the entire family helped cover up underlying family conflicts and tended to discourage the
development of a sense of competence, maturity, or self-reliance on the part of the symptomatic child.
Goldenberg, Irene. Family Therapy: An Overview (p. 262). Cengage Learning. Kindle Edition.
Most family systems fall somewhere along the continuum between enmeshment (diffuse boundaries) and
disengagement (rigid boundaries; Minuchin et al., 1967), although they may contain enmeshed or
disengaged subsystems.
Side Note: The therapeutic efforts of structuralists p267
For structuralists, the most effective way to alter dysfunctional behavior and eliminate symptoms is to
change the family’s transactional patterns that maintain them.
Although they are not always so neatly separated in practice, the therapeutic efforts of structuralists
typically follow this order:
1. Joining and accommodating
2. Assessing family interactions
3. Monitoring family dysfunctional sets
4. Restructuring transactional patterns
Goldenberg, Irene. Family Therapy: An Overview (p. 267). Cengage Learning. Kindle Edition.
●Know information on monitoring family dysfunctional sets. p 271 & 274
Monitoring and helping modify troubled or problematic transaction patterns is the crux of the structural
intervention process. Once structuralists join the family, they begin to probe the family structure, looking
for areas of flexibility and possible change.
● Understand alignments, boundary making, unbalancing, and tracking.
1. Boundary making - represents an effort to create greater psychological distance between the
enmeshed mother and daughter, and, by bringing the marginalized father closer, begins to modify the
family’s customary transactional patterns.
2. unbalancing - attempting to change the hierarchical relationship between
members of the parental subsystem by having the father take on an expanded role in the family.
3. tracking - the structural therapist adopts symbols of the family’s life gathered from members’
communication (such as life themes, values, significant family events) and deliberately uses them in
conversation with the family.
4. enactment - a staged effort by the therapist to bring an outside family conflict into the session so that
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family members can demonstrate how they deal with it. The therapist can observe the conflict
sequence and begin mapping a way to modify the members’ interaction and create structural changes.
5. alignments are defined by the way family members unite or oppose one another in carrying out a
family activity. p 264
●Have an understanding of family mapping p270 and mimesis p267.
Family mapping helps provide an organizing schema for understanding complex family interactive patterns
—especially which particular subsystem is involved in perpetuating a problem—and as such may be
invaluable in therapeutic planning. As Minuchin and Fishman point out:
The family map indicates the position of family members vis-à-vis one another. It reveals coalitions,
affiliations, explicit and implicit conflicts, and the ways family members group themselves in conflict
resolution. It identifies family members who operate as detourers of conflict and family members who
function as switchboards. The map charts the nurturers, healers, and scapegoaters. Its delineation of
the boundaries between subsystems indicates what movement there is and suggests possible areas of
strength or dysfunction. (p. 69)
Goldenberg, Irene. Family Therapy: An Overview (p. 270). Cengage Learning. Kindle Edition.
Mimesis (Greek for “copy”) refers to the process of joining the family by imitating the manner, style,
affective range, or content of its communications in order to solidify the therapeutic alliance with them. The
therapist might tell of personal experiences (“I have an uncle like that”) or mimic a family member’s
behavior (taking off his coat, sitting in a particular position, playing with the baby). These efforts are
sometimes spontaneous, sometimes planned; whatever the case, they often have the effect of increasing
kinship with the family and building trust as the therapist becomes part of the system.
●Understand the focus of strategic therapies. p283
Strategic therapies offer active and straightforward therapeutic interventions aimed at reducing or
eliminating the presenting family problems or behavioral symptoms. Less focused on the meaning of the
symptom or its origins, strategists typically issue a series of directives or tasks to the family.
●Know information on developing a communication paradigm. p285
Watzlawick, Beavin, and Jackson’s (1967) Pragmatics of Human Communication is considered the
classic pioneering text in communication. It encourages the simultaneous study of semantics (the clarity of
meaning between what is said and received), syntax (the pattern as well as manner or style in which
information is transmitted), and pragmatics (the behavioral effects or consequences of communication),
using a series of axioms regarding interpersonal communication:
●Develop an understanding of reframing. p. 271
- relabeled as a problem with a larger focus
- changes the original meaning of an event or situation by placing it in a new context in which an equally
plausible explanation is possible. The idea is to relabel what occurs in order to provide a more
constructive perspective, thereby altering the way the event or situation is viewed.
●Know about response of a person receiving a double-bind message. P 287
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A double-bind message is a particularly destructive form of paradoxical injunction. A double-bind
message occurs when one person, especially someone in a powerful position, issues an injunction to
another that simultaneously contains two levels of messages or demands that are logically inconsistent
and contradictory, producing a paradoxical situation for the recipient.
●Have a working knowledge of first-order p 289 and second-order changes p290
First-order changes are superficial behavioral changes within a system that do not change the structure
of the system itself. These changes are apt to be linear and little more than cosmetic or simply a reflection
of a family’s good intentions—for example, the therapist might suggest to Holly and her family that they
agree to end all screaming at each other. First-order changes are likely to be short lived.
Second-order changes require a fundamental revision of the system’s structure and function. Here the
therapist moves beyond merely helping to remove the symptom, but strives to help the family alter its
systemic interaction pattern and reorganize the system so that it reaches a different level of functioning.
●Be familiar with “prescribing the symptom.” p 290
strategic therapists try to produce a runaway system by urging or coaching the client to engage in or practice
his or her symptoms, at least for the present time.
●Know what Haley believes about every relationship. (p. 297)
Power and control are at the very core of Haley’s thinking about family functioning. Jockeying for control
occurs in all families and in every relationship between two or more people.
●Be familiar with the use of directives in strategic therapy. (p. 290)
therapeutic tasks aimed at extinguishing ineffective interactional sequences. These are maneuvers
designed to subtly gain control over the presenting symptoms and force families to attempt different
solutions. To the family, these directives appear to fly in the face of common sense.
●Develop an understanding of paradoxical interventions. (p. 303)
represent a particularly ingenious way of maneuvering a person or family into abandoning dysfunctional
behavior. Similar to “prescribing the symptom,” this technique is particularly appropriate for strategists
because they assume that families who come for help are also frightened and therefore resistant to the
help being offered.
●Be familiar with techniques introduced by Milan and systemic therapists. (p. 305)
the work of this group shifted the focus of treatment away from the observation of interactive sequences
and patterns toward questioning family belief systems. Families were helped to become aware of
repetitive belief and behavioral patterns and to see themselves within a relational context (i.e., from the
perspective of fellow family members) in order to examine various perspectives with which to address
problems.
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●Understand positive connotation, counterparadoxes, reflexive questioning, and rituals.
Positive connotation - reframes the family’s problem-maintaining behavior so that symptoms are seen as
positive or good because they help maintain the system’s balance and thus facilitate family cohesion and
well-being. Instead of being considered “bad” or “sick” or “out of control,” a symptomatic child, for
example, is considered to be well intentioned and to be behaving volitionally.
counterparadoxes—essentially therapeutic double binds—the family was warned against premature
change, allowing the members to feel more acceptable and unblamed for how they were, as the team
attempted to discover and counter the family’s paradoxical patterns to disrupt repetitive, unproductive
games.
Rituals - address aspects of family relationships that the therapist or team hypothesizes as significant for
family functioning regarding the current difficulty. Generally, they are ceremonial acts proposed by the
therapist as temporary experiments.
Reflexive questions - Tomm (1987b) refers to reflexive questions, which are designed to help families
reflect on the meaning they extract from their current perceptions, actions, and belief systems, stimulating
them to consider alternative constructive cognitions and behavior. Tomm differentiates eight groups of
reflexive questions: (p. 309)
●Develop an understanding of “paradoxical interventions.” (p. 303)
represent a particularly ingenious way of maneuvering a person or family into abandoning dysfunctional
behavior. Similar to “prescribing the symptom,” this technique is particularly appropriate for strategists
because they assume that families who come for help are also frightened and therefore resistant to the
help being offered.
●Be familiar with “rules of the game.”
●Have a working knowledge of the Milan techniques. (p. 305-307)
The Milan group employs many strategic techniques but adds the unique contributions of positive
connotations, rituals, and circular questioning (an especially provocative and effective intervention that
may allow the system to heal itself). Milan therapists make frequent
Goldenberg, Irene. Family Therapy: An Overview (p. 452). Cengage Learning. Kindle Edition.
●Know information on circular questioning. (p. 308)
involves asking each family member questions that address a difference or define a relationship between
two other members of the family. These differences are intended to reveal the multiple perspectives of
different family members and to expose recursive family patterns. The therapist maps the interconnections
among family members, assuming that asking questions about differences in perception is the most
effective way of creating such a map
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●Be familiar with “family rituals.”
●Be familiar with hypothesizing from a Milan perspective. (p. 307).
a continual interactive process of speculating and making assumptions about the family situation, guides
the systemic interview. It is not true or false but rather a starting point, open to revision or abandonment
by the family as well as the therapist as new data accumulate. The technique allows the therapist to search
for new information, identify the connecting patterns that sustain family behavior, and speculate on how
each participant in the family contributes to systemic functioning.
●Have a working knowledge of behavior therapy. (p. 315)
Three pioneers in behavior therapy came from related disciplines—social worker Richard Stuart (1969),
psychologist Gerald Patterson (1971), and psychiatrist Robert Liberman (1970). They addressed specific
behavioral problems in families (poor communication between spouses, acting-out behavior in children
and adolescents), identified in a family assessment process, not comprehensive family dynamics (Sanders
& Dadds, 1993). Limiting their therapeutic efforts to observable behavior, without inferring intrapsychic
or interpersonal causality, these therapists attempted to extinguish or otherwise manipulate certain
targeted behaviors by means of reinforcements.
●Know information on Albert Ellis. (p. 317)
A-B-C theory of dysfunctional behavior, it is not the activating events (A) of people’s lives that have
disturbing consequences (C), but the unrealistic interpretation they give to the events, or the irrational
beliefs (B) about what has taken place that cause them trouble.
●Have a working knowledge of cognitive-behavioral therapist assessment purposes and working levels.
(p. 319)
include a functional analysis of inner experiences—thoughts, attitudes, expectations, beliefs. More
systemic, they see individuals as interactive participants, interpreting, judging, and influencing each
other’s behaviors. Typically, they gather such data using three main forms of clinical assessment: self-
report questionnaires, individual and joint interviews, and direct behavioral observations of family
interaction (Epstein & Baucom, 2002).
●Understand “cognitive restructuring.” (p. 317)
help the client modify her perceptions and allow her to produce new self-statements
●Be familiar with therapeutic contracts. (p. 393)
contract: explore perceptions of the eating problem; disinterest in identifying causes; assess severity;
medical evaluation; externalize the problem; provide information; engage problem solving with the
family.
●Know information on Gottman’s research. (p. 327)
opinion, it is not anger that predicts divorce but rather four forms of negativity that Gottman calls “The
Four Horsemen of the Apocalypse”—criticism (attacking a spouse’s character), defensiveness (denying
responsibility for certain behavior), contempt (insulting, abusive attitudes toward a spouse), and
stonewalling (a withdrawal and unwillingness to listen to one’s partner). In a typical demand-withdrawal
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transaction, women were found more likely to criticize, while men were likelier than women to stonewall.
●Know information about family management skills. p 329-330
●Be familiar with “contingency contracting.” (p. 315)
a written schedule describing the terms for the exchange of mutually reinforcing behaviors between
individuals in a family, aimed at reducing undesired
●Know the beliefs of functional family therapists and their approaches. (p. 336)
all behavior is adaptive. Rather than being thought of as “good” or “bad,” individual behavior is viewed
as serving a function, representing an effort to create a specific outcome in relationships.
●Know information on “sensate focus.” (p. 340)
learning to touch and explore each other’s bodies and to discover more about each other’s sensate areas
but without feeling any pressure for sexual performance or orgasm. Sensate focus exercises are designed
to offer both partners pleasure in place of the anxiety previously accompanying a demand for sexual
arousal or intercourse, a technique based on classical conditioning procedures for dealing with phobic
objects and situations.
●Understand the constructivist perspective in cognitive therapy (p. 342)
Constructivists argue that reality is invented, a product of the personal meanings each individual creates.
From a narrative perspective, the traumatized person constructs stories to explain his or her situations
●Carefully read all clinical notes, case studies, text boxes, etc. (highlighted box texts).
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