Psychoanalytic Family Therapy LOGAN WINDER DIXIE STATE UNIVERSITY History and major founders Key concepts View of health/dysfunction Role of the therapist Overview Assessment Common interventions/exercise Critique Research (effectiveness) Recommended books & articles Major Founders & History Psychoanalytic has a long history that stems from the works of Freud; the handout will provide a more detailed history Pioneers of family therapy who were psychoanalytically trained: Nathan Ackerman, Murray Bowen, Ivan BoszormenyiNagy, Carl Whitaker, Don Jackson, Salvador Minuchin 1960’s and 70’s, most family therapists rejected psychoanalytic thinking; however, in the 1980’s, the psychology of the individual returned Freud (1909) introduced major psychoanalytic concepts, but overall ignored the role of the family Leading Figures and Contributions Erikson (1930) expanded ego psychology to consider sociological factors Cohen (1953) led the family schizophrenia research at NIMH Ryckoff and Wynne (1960) introduced family dynamics courses at Washington School of Psychiatry Scharff (1975) helps the school become a leading center in psychoanalytic family therapy History Continued: Theoretical Underpinnings 1) Freudian Drive Psychology Libidinal and aggressive energy 2) Self Psychology (Kohut, 1971, 1977) Every human longs to be appreciated 3) Object Relations Theory (Klein, Fairbairn, & Winnicott, 1965) Mental images of self and others built up from experience and expectation The bridge between psychoanalysis (individual therapy) and family therapy Formation of early mental representations can create patterns of interaction in the future (like attachment theory) Object = person, relations = the relationship with the person Defense Mechanisms: Splitting = maintains the all good or all bad dichotomies that children have of their parents Introjection = repression of negative attributes of an object, person becomes more susceptible Example: pg. 152 Object Relations Theory Pseudomutuality: a family relationship that has the superficial appearance of openness; however, it is rigid and depersonalizing Delineations: express a need within the parents; usually affects adolescents in the way they maintain behavior to address the parental need, (engaging in misbehavior because the parent needs to discipline) Projective Identification: unconscious act of projecting a (usually) unwanted emotion or attribute onto someone else Key Concepts: NIMH Research Key Concepts: Self Psychology Two things are deemed essential for the development of a secure and cohesive self: 1) Mirroring: understanding plus acceptance Example: attentive parents conveying a deep appreciation for how their children feel 2) Idealization: when children can believe their parents are terrific, and they are part of them This helps create a firm base of self-esteem There are many ways a family can experience dysfunction: When families and individuals experience overtaxing stress, they may become stuck in dysfunctional patterns Dysfunction Fixation occurs when they repeat unsuccessful attempts Regression occurs when they revert to previous levels of development Invisible loyalties: unconscious commitments children take on to help their families to the detriment of their own wellbeing (scapegoat) A “Healthy” Family Parents who do not project their anxieties onto their children Individuals within the family are differentiated; they do not react from unresolved dependency needs Avoiding the “false self” (pretending to be what you’re not) Mirroring and idealization help foster self-esteem “An average expectable environment with good-enough mothering is sufficient” (Winnicott, 1965) Create the container (trust, empathy, connection) Empathy helps create a “holding environment” where the family feels safe to be vulnerable Role of the Therapist The therapist remains focused on process Goal of the therapist is to free family members of unconscious constraints so they can interact as healthy, differentiated individuals He/she will help clients identify how their present difficulties emerged from unconscious perpetuation of conflict in their own families Assessment Create a climate of trust and proceed slowly Assessment is continual, and a practitioner will not postpone treatment until they’ve “figured it out” Five Important Questions: Bentovim & Kinston, 1991 1) How does the family interact around the symptom? 2) What is the function of the current symptom? 3) What disaster is feared in the family that keeps them from facing their conflicts? 4) How is the current situation linked to past trauma? 5) How would the therapist summarize the focal conflict in a short, memorable statement? Assessment The signal of intrapsychic conflict is affect Analytic therapists key in on strong feelings and use them as a starting point for a detailed inquiry into its origins Example: “when have you felt that way before?” Takeaway: psychoanalytic family therapists form an initial hypothesis, then refine it through exploration over the course of treatment Common Interventions Four Basic Techniques: 1) listening Let go of the desire to “do something” 2) empathy Express empathy in order to help the family open up 3) interpretations Used to illuminate hidden aspects of experience 4) analytic neutrality Helps establish a climate of exploration; suspends therapist’s anxious involvement in problem solving Psychoanalytic therapists organize their explorations along four channels: 1) internal experience Common Interventions 2) the history of that experience 3) how family members trigger that experience 4) how the context of the session and the therapist’s input might contribute to what’s going on between family members Critique (Strengths & Limitations) Limitations: Psychoanalysts have been criticized that their theories absolve individuals of responsibility Very focused on mother-child relationship Strengths: The psychoanalytic approach is very process-oriented, and can help the “individual” within the relationship Insight driven for cognitive clients Research & Support Psychoanalytic therapists have generally resisted empirical attempts to validate their work, as symptom reduction is not their goal However, the following case studies have provided evidence for dealing with various emotional and behavioral problems: Childhood trauma (Mackay, 2002; Paris, 2013) Adolescent depression (Christogiorgos et al., 2010) Schizophrenia (Morey, 2008) Borderline Personality Disorder (Allen, 2001) Parent-Infant Relationships (Cutner, 2014; Diaz Bonino, 2013) Recommended Books & Articles Books Attachment in Psychotherapy, by David J. Wallin Attachment Theory and Psychoanalysis, by Peter Fonagy Object Relations in Family Therapy, by David and Jill Scharff Self in the System: Expanding the Limits of Family Therapy, by Michael Nichols Articles A full circle: psycho-dynamic understanding and systems theory, by Arnon Bentovim Connection between object-relations theory and attachment theory, by Alan Challoner Additional Resources Video of David Scharff explaining the psychoanalytic process with an 11-year-old client https://www.psychotherapy.net/video/scharffchild-object-relations References Heard, D. H. (1978). From object-relations to attachment theory: a basis for family therapy. British Journal of Medical Psychology, 51(1), 67-76. Mackay, J. L. (2010). A psychodynamic understanding of trauma and adolescence—a case study. Southern African Journal of Child and Adolescent Mental Health, 14(1), 24-36. Nichols, M. P., & Davis, S. D. (2017). Family therapy: Concepts and methods. Hoboken: Pearson.
