Family Therapy
http://www.youtube.com/watch?v=9PUhTdkzg8
Two Focuses
• The first is togetherness and the second is
individuality.
• Too much togetherness creates fusion and
prevents individuality, or developing one's
own sense of self.
• Too much individuality results in a distant
and estranged family.
Differentiation of Self
• The first concept is Differentiation of Self, or the ability to
separate feelings and thoughts. Undifferentiated people can
not separate feelings and thoughts; when asked to think, they
are flooded with feelings, and have difficulty thinking logically
and basing their responses on that. Further, they have
difficulty separating their own from other's feelings; they look
to family to define how they think about issues, feel about
people, and interpret their experiences.
Differentiation is the process of freeing yourself from your
family's processes to define yourself. This means being able
to have different opinions and values than your family
members, but being able to stay emotionally connected to
them. It means being able to calmly reflect on a conflicted
interaction afterward, realizing your own role in it, and then
choosing a different response for the future.
Triangles
• Triangles are the basic units of systems. Dyads
are inherently unstable, as two people will
vacillate between closeness and distance. When
distressed or feeling intense emotions, they will
seek a third person to triangulate.
• Think about a couple who has an argument, and
afterward, one of the partners calls their parent
or best friend to talk about the fight. The third
person helps them reduce their anxiety and take
action, or calm their strong emotions and reflect,
or bolster their beliefs and make a decision.
• This is a healthy triangulation!
Triangles
• People who are more undifferentiated are likely to
triangulate others and be triangulated. People who are
differentiated cope well with life and relationship stress,
and thus are less likely to triangulate others or be
triangulated.
• Think of the person who can listen to the best friend's
relationship problems without telling the friend what to do
or only validating the friend's view. Instead, the
differentiated person can tell the best friend "You know,
you can be intimidating at those times..." or "I agree with
you but you won't change your partner; you either have
to learn to accept this about them, or have to call this
relationship quits...“
• http://www.youtube.com/watch?v=nAvspf49UTE
The Nuclear Family Emotional
Processes
• These are the emotional patterns in a family that
continue over the generations.
• Think about a mother who lived through The Great
Depression, and taught her daughter to always prepare
for the worst case scenario and be happy simply if things
are not that bad. The daughter thinks her mother is wise,
and so adopts this way of thinking. She grows up, has a
son, and without realizing it, models this way of thinking.
He may follow or reject it, and whether he has a happy
or distressed relationship may depend on the kind of
partner he finds.
• http://www.youtube.com/watch?v=4fC6x8paqpc
Emotional Process
• Likewise, think of a daughter who goes to work
for her father, who built his own father's small
struggling business into a thriving company. He
is seen in the family as a great business person
as he did this by taking risks in a time of great
economic opportunity. He teaches his daughter
to take risks, "spend money to make money,"
and assume a great idea will always be
profitable. His daughter may follow or reject her
father's advice, and her success will depend on
whether she faces an economic boom or
recession.
Emotional Process
• In both cases, the parent passes on an emotional view of
the world (the emotional process), which is taught each
generation from parent to child, the smallest possible
"unit" of family (the nuclear unit). Reactions to this
process can range from open conflict, to physical or
emotional problems in one family member, to reactive
distancing (see below). Problems with family members
may include things like substance abuse, irresponsibility,
depression....
• http://www.youtube.com/watch?v=0Bgshe4S3_s
The Family Projection Process
• This is an extension of The Nuclear Family
Emotional Process in many ways.
• The family member who "has" the
"problem" is triangulated and serves to
stabilize a dyad in the family.
Family Projection Process
• Thus, the son who rejects his mother's pessimistic view may
find his mother and sister become closer, as they agree that
he is immature and irresponsible. The more they share this
view with him, the more it makes him feel excluded and
shapes how he sees himself. He may act in accord with this
view and behave more and more irresponsibly. He may reject
it, constantly trying to "prove" himself to be mature and
responsible, but failing to gain his family's approval because
they do not attribute his successes to his own abilities ("He
was so lucky that his company had a job opening when he
applied..." or "It's a good thing the loan officer felt sorry for him
because he couldn't have managed it without that loan..."). He
might turn to substance abuse as he becomes more and more
irresponsible, or as he struggles with never meeting his
family's expectations.
Family Projection Process
• Similarly, the daughter who faces harsh
economic times and is more fiscally conservative
than her father is seen by the parents as too
rigid and dull. They join together to worry that
she'll never be happily married. She might
accept this role and become a workaholic who
has only superficial relationships, or reject it and
take wild risks that fail. In the end, she may
become depressed as she works more and
more, or as she fails to live up to her father's
reputation as a creative and successful business
person.
Family Projection Process
• The family member who serves as the
"screen" upon which the family "projects"
this story will have great trouble
differentiating. It will be hard for the son or
daughter above to hold their own opinions
and values, maintain their emotional
strength, and make their own choices
freely despite the family's view of them.
The Multigenerational Transmission
Process
• This process entails the way family emotional
processes are transferred and maintained over
the generations. This captures how the whole
family joins in The Family Projection Process, for
example, by reinforcing the beliefs of the family.
As the family continues this pattern over
generations, they also refer back to previous
generations ("He's just like his Uncle Albert - he
was always irresponsible too" or "She's just like
your cousin Jenny - she was divorced four
times.").
Sibling Position
• sibling order, believing that each child had a place in the
family hierarchy, and thus was more or less likely to fit some
projections. The oldest sibling was more likely to be seen as
overly responsible and mature, and the youngest as overly
irresponsible and immature for example.
• Think of the oldest sibling who grows up and partners with a
person who was also an oldest sibling. They may be drawn to
each other because both believe the other is mature and
responsible.
• Alternately, an oldest sibling might have a relationship with
someone who was a youngest sibling. When one partner
behaves a certain way, the other might think "This is exactly
how my older/younger sibling used to act."
Emotional Cutoff
• This refers to an extreme response to The
Family Projection Process. This entails a
complete or almost-complete separation
from the family. The person will have little,
if any, contact, and may look and feel
completely independent from the family.
However, people who cut off their family
are more likely to repeat the emotional and
behavioral patterns they were taught.
• In some cases, they model the same values and
coping patterns in their adult family that they
were taught in their childhood family without
realizing it. They do not have another internal
model for how families live, and so it is very hard
to "do something different." Thus, some parents
from emotionally constrained families may
resent how they were raised, but they do not
know how to be "emotionally free" and raise a
family as they believe other families would.
• In other cases, they consciously attempt to be very
different as parents and partners; however, they fail to
realize the adaptive characteristics of their family and
role models, as well as the compensatory roles played in
a complex family. Thus, some parents from emotionally
constrained childhood families might discover ways to be
"emotionally unrestrained" in their adult families, but may
not recognize some of the problems associated with
being so emotionally unrestrained, or the benefits of
being emotionally constrained in some cases. Because
of this, Bowen believed that people tend to seek out
partners who are at about the same level of
individuation.
Normal Family Development
• optimal family development occurs when
family members are differentiated, feel
little anxiety regarding the family, and
maintain a rewarding and healthy
emotional contact with each other.
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are balanced in terms of their togetherness and separateness, and can adapt to
changes in the environment
view emotional problems as coming largely from the greater system but as having
some components in the individual member
are connected across generations to extended family
have little emotional fusion and distance
have dyads that can deal with problems between them without pulling others into their
difficulties
tolerate and support members who have different values and feelings, and thus can
support differentiation
are aware of influences from outside the family (such as Societal Emotional
Processes) as well as from within the family
allow each member to have their own emptiness and periods of pain, without rushing
to resolve or protect them from the pain and thus prohibit growth
preserve a positive emotional climate, and thus have members who believe the family
is a good one
have members who use each other for feedback and support rather than for
emotional crutches
Family Disorders
• family problems result from emotional fusion, or from an
increase in the level of anxiety in the family. Typically, the
member with "the symptom" is the least differentiated
member of the family, and thus the one who has the
least ability to resist the pull to become fused with
another member, or who has the least ability to separate
their own thoughts and feelings from those of the larger
family. The member "absorbs" the anxiety and worries of
the whole family and becomes the most debilitated by
these feelings. Families face two kinds of problems.
• Vertical problems are "passed down" from parent to child. Thus,
adults who had cold and distant relationships with their parents do
not know how to have warm and close relationships with their
children, and so pass down their own problems to their children.
• Horizontal problems are caused by environmental stressors or
transition points in the family development. This may result from
traumas such as a chronic illness, the loss of the family home, or the
death of a family member. However, horizontal stress may also
result from Social Emotional Processes, such as when a minority
family moves from a like-minority neighborhood to a very different
neighborhood, or when a family with traditional gender roles
immigrates to a culture with very different views, and must raise their
children there. The worst case for the family is when vertical and
horizontal problems happen at once.
• The basic roles which I list below apply to
American culture specifically, and Western
Civilization generally - but with a few changes in
details could be made to fit most any culture.
• There are four basic roles that children adopt in
order to survive growing up in emotionally
dishonest, shame-based, dysfunctional family
systems. Some children maintain one role into
adulthood while others switch from one role to
another as the family dynamic changes (i.e.
when the oldest leaves home, etc.) An only child
may play all of the roles at one time or another.
"Responsible Child" - "Family Hero"
• This is the child who is "9 going on 40." This child takes over the
parent role at a very young age, becoming very responsible and
self-sufficient. They give the family self-worth because they look
good on the outside. They are the good students, the sports stars,
the prom queens. The parents look to this child to prove that they
are good parents and good people. As an adult the Family Hero is
rigid, controlling, and extremely judgmental (although perhaps very
subtle about it) - of others and secretly of themselves. They achieve
"success" on the outside and get lots of positive attention but are cut
off from their inner emotional life, from their True Self. They are
compulsive and driven as adults because deep inside they feel
inadequate and insecure.
• The family hero, because of their "success" in conforming to
dysfunctional cultural definitions of what constitutes doing life "right",
is often the child in the family who as an adult has the hardest time
even admitting that there is anything within themselves that needs to
be healed.
"Acting out child" - "Scapegoat"
• This is the child that the family feels ashamed of - and
the most emotionally honest child in the family. He/she
acts out the tension and anger the family ignores. This
child provides distraction from the real issues in the
family. The scapegoat usually has trouble in school
because they get attention the only way they know how which is negatively. They often become pregnant or
addicted as teenagers. These children are usually the
most sensitive and caring which is why they feel such
tremendous hurt. They are romantics who become very
cynical and distrustful. They have a lot of self-hatred
and can be very self-destructive. This often results in
this child becoming the first person in the family to get
into some kind of recovery.
"Placater" - "Mascot" - "Caretaker"
• This child takes responsibility for the emotional wellbeing of the family. They become the families 'social
director' and/or clown, diverting the family's attention
from the pain and anger. This child becomes an adult
who is valued for their kind heart, generosity, and ability
to listen to others. Their whole self-definition is centered
on others and they don't know how to get their own
needs met. They become adults who cannot receive
love, only give it. They often have case loads rather
than friendships - and get involved in abusive
relationships in an attempt to "save" the other
person. They go into the helping professions and
become nurses, and social workers, and
therapists. They have very low self-worth and feel a lot
of guilt that they work very hard to overcome by being
really "nice" (i.e. people pleasing, classically
codependent) people.
"Adjuster" - "Lost Child"
• This child escapes by attempting to be invisible. They
daydream, fantasize, read a lot of books or watch a lot of
TV. They deal with reality by withdrawing from it. They
deny that they have any feelings and "don't bother
getting upset." These children grow up to be adults who
find themselves unable to feel and suffer very low selfesteem. They are terrified of intimacy and often have
relationship phobia. They are very withdrawn and shy
and become socially isolated because that is the only
way they know to be safe from being hurt. A lot of actors
and writers are 'lost children' who have found a way to
express emotions while hiding behind their characters.
• It is important to note that we adapt the roles
that are best suited to our personalities. We are,
of course, born with a certain personality. What
happens with the roles we adapt in our family
dynamic is that we get a twisted, distorted view
of who we are as a result of our personality
melding with the roles. This is dysfunctional
because it causes us to not be able to see
ourselves clearly. As long as we are still
reacting to our childhood wounding and old
tapes then we cannot get in touch clearly with
who we really are.
• The false self that we develop to survive is never totally
false - there is always some Truth in it. For example,
people who go into the helping professions do truly care
and are not doing what they do simply out of
Codependence. Nothing is black and white - everything
in life involves various shades of gray. Recovery is
about getting honest with ourselves and finding some
balance in our life. Recovery is about seeing ourselves
more clearly and honestly so that we can start being
True to who we really are instead of to who our parents
wanted us to be. (Reacting to the other extreme by
rebelling against who they wanted us to be is still living
life in reaction to our childhoods. It is still giving power
over how we live our life to the past instead of seeing
clearly so that we can own our choices today.) The
clearer we can see our self the easier it becomes to find
some balance in our life - to find some happiness,
fulfillment, and serenity.
Goals of Therapy
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reframing the presenting problem as a multigenerational problem that is
caused by factors beyond the individual
lowering anxiety and the "emotional turmoil" that floods the family so they
can reflect and act more calmly
increasing differentiation (individuality), especially of the co-dependent, so
as to increase their ability to manage their own anxiety, transition more
effectively into a healthy relationship with the addict, and thus fortify
(strengthen) the entire family unit's emotional wellbeing
using the therapist as part of a "healthy triangle" where the therapist
teaches the family to manage their own anxiety, create distance and
closeness in healthy ways
focusing away from "the problem" and including the overall health and
happiness of the family. Thus creating positive habits and interests
evaluating the progress of the family in terms of how they function now
compared to when they started, as well as how adaptive they can be to
future changes
addressing the power differential in families such as economic power and
gender role socialization.
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In general, the therapist accomplishes this by giving less attention to
specific problem they present with, and more attention to family patterns of
emotions and relationships, as well as family structures of dyads and
triangles.
tries to lower anxiety to promote understanding, which is the critical factor in
change; open conflict is prohibited as it raises the family members' anxiety
during future sessions
remains neutral and detriangulated, and in effect models for the parents
some of what they must do for the family
promotes separation of members, as often a single member can cause
changes in the larger family; using "I" statements is one way to help family
members separate their own emotions and thoughts from those of the rest
of the family
develops a personal relationships with each member of the family and
encourages family members to form stronger relationships too
encourages cut off members to return to the family
may use descriptive labels like "pursuer (co-dependent)-distancer (addict),"
and help members see the dynamics occurring; following distancers only
causes them to run further away, while working with the pursuer to create a
safe place in the relationship invites the distancer back.
coaches and consults with the family, interrupts arguments, and models
skills..
Techniques
Getting the environment right
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Counseling techniques
• create a space to talk which is private and quiet and where you
know you will be free from interruptions (always seek the advice of a
colleague about the safety and appropriateness of this
action). Where possible, make sure the seating is comfortable and
make sure that there is appropriate heating and ventilation.
• Get the message across that you have time to attend to the issue
that you want to address. Get the message across that the
conversation is private and that you will not be passing on what the
family says to any third party*.
• * You have to also make it clear that if the family gives you
information that suggests that they or others are in danger (for
example a disclosure of abuse or threat of self-harm) you cannot
keep this confidential. Make sure that you are fully aware of your
organisation’s child protection policies
Getting the listening right
• One way of encouraging a person/persons to talk is to make
sure that they know you are listening.
• You can do this by just being attentive and by showing with
your body language that you are listening.
• Sometimes this will be by facing the person and making good
eye contact.
• Sometimes sitting side by side will be less threatening. Try
not to interrupt when the person is talking.
• By occasionally nodding or quietly saying "yes" or "aha" the
person should be encouraged to open up.
• Reporting back to the person/family a short summary of what
they have just said and asking them if you have got it right is
another way of doing this.
• Make sure you look and sound calm, unhurried and caring.
Reflective Listening
• S: "I'm very depressed today, Doctor."
D: "You're very depressed, Mr. Smith."
S: "Yes. I haven't been this depressed in a long time."
D: "You haven't been this depressed in a long time."
S: "I'm so depressed that I'm thinking about killing myself."
D: "You're thinking about killing yourself."
S: "I'd like to kill myself right now."
D: "You'd like to kill yourself right now."
S: "Yes, I'm so desperate that I think I'll open this window and jump
out."
D: "You're thinking of jumping out that window."
S: "I'm gonna do it. See? I'm opening the window.... and I'm gonna
jump."
D: "You're going to jump out the window."
S: "Bye, doc. Here I go........ aaaaaaaaaaaaaaaaaaaaah" (splat)
D: "Aaaaaaaaaaaaaaaaaaaaaah, splat."
Asking the right questions
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Try to ask more open questions than closed questions.
An open question is one which cannot be answered with yes or no and
which encourages a more detailed answer, for example:
“What are your feelings about this?”
“What are the advantages of doing things the way you have suggested?”
“What are the disadvantages?”
Avoid closed questions such as:
“Are you sad?”
“Are you looking forward to the holidays?”
Another disadvantage of closed questioning is that the desired answer
might be implied within the question and you might inadvertently steer the
person to give an answer that they wouldn’t otherwise have given. An
example of this would be:
“Are you going to stop obsessing about your addicted family member
because it is upsetting you so much?”
The implied expected answer here is quite clearly “yes”.
Being affirming
• To encourage the flow of conversation it is
important that you show respect by taking an
accepting attitude.
• The message you are trying to get across is "I
have respect for your opinions and your view of
the world at this present time".
• This is not the same as saying that you agree
with the client’s opinions or actions and it is okay
for you to make it clear that your opinions and
moral view are different, as long as this is done
in a respectful way.
How to make it work
• Do not turn your conversation into an
interrogation.
• However good you are at counseling some
people will not be ready to talk to you or want to
talk to you.
• This does not mean that you have failed. It
might be that they will talk later or that they will
talk to a colleague of yours who they know better
or a colleague of the opposite sex.
• http://www.youtube.com/watch?v=AQ4Pkt
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• http://www.youtube.com/watch?v=81L5WclNTg
• http://www.youtube.com/watch?v=iB1ZZ6
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• http://www.youtube.com/watch?v=fF11ulCPTE