Family Psychotherapy Modalities and Methods

Abstract

This is a paper about family psychotherapy. The paper examines two types of family psychotherapy methods, that is to say, systemic therapies and social construction therapies. There are various types of models which fall under systemic therapy. They include Multi-generational family therapy (Murray Bowen), Adlerian family therapy (Alfred Adler), Human Validation Process model (Virginia Satir), Experiential symbolic family therapy (Carl Whitaker), Structural family therapy (Salvador Minuchin) and Strategic family therapy (Jay Haley, Chloe Madanes).

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Social construction models include: Solution Focused or Solution Focused Brief therapy (Steve de Shazer, lnsoo Kim Berg) and Narrative approach (Michael White, David Epston) model.This work looks through the explanation as given in each model and also applies the theories in Stan’s case borrowed from Gerald Corey’s book; Theory and Practice of Counseling and Psychotherapy, the theories

Introduction

Psychotherapy involves talking with a trained mental health professional such as a psychiatrist, psychologist, social worker or counselor. The professionals assist their clients to gain insight into their feelings, change behaviors, resolve problems or learn how to deal with feelings like stress, grief, loss, fear and sadness. Family psychotherapy refers to a variety of techniques and methods used to help family groups who are experiencing difficulties with their emotions or behavior (http://www.healthatoz.com).

System therapy seeks to address people not as an individual but as a people in relationships. It has its roots in family therapy which later came to be called family systems therapy. Examples of family systems therapy are discussed below.

Multi-generational family therapy (Murray Bowen therapy): This therapy was started by Murray Bowen. He studied schizophrenia and the mother to child symbiosis and resulting anxiety attachment. His theory was based in the balance or imbalance of two forces, that is to say, togetherness and individuality. Bowen introduced eighty interlocking concepts to family theory which include: differentiation of self, triangulation, nuclear family emotional processes, family projection process, multi-general transmission process, sibling position, emotional cut off and societal emotional processes. According to him family therapy lies on a continuum.

The goals of multi generational family therapy include ending generation to generation transmission of problems by resolving emotional attachments, to increase family members’ level of differentiation, to less anxiety and relive symptoms and to change an individual within the context of the system. Differentiation of self is the ability to separate feelings and thinking. Differentiation frees one from family thinking enabling one to realize his/her involvement in a problem rather than blaming others. Triangulation involves introducing a third party normally a therapist who will help in reducing anxiety and stabilize relationships.

Nuclear family emotional processes refer to emotional patterns that exist in a family over years and passed to each generation. Family projection processes are passed on from one generation to the next. This affects interaction with spouse or siblings.

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Multi general transmission process is the Process by which family emotional process are transferred and maintained over generations. Sibling position: each child has a give position in family thus less likely to fit some projections Emotional cut off involves emotional or physical separation from family origin. Person cut off may look/feel independent from the family but is not. Societal emotional processes are expectations about rules, classes, ethnic groups, gender and so forth and their effect on family (http://www.thebowencenter.org)

Adlerian family therapy: Adlerian family therapy uses an educational model to counsel families. It emphasized family atmosphere and family constellation. In the model, therapists function as collaborators who seek to join the family. Adlerian therapy stresses a positive view of human nature and that a person is in control of his/her fate and not a victim of it. A person begins early in creating own unique style of life and stays relatively constant in life. It emphasizes that motivation is due to setting of goals on how one could deal with the tasks he/she faces in life and ones social interest.

Therapists using adlerian theory gather information about the family as much as possible. Using the data they set goals and to get past the history of the client. Those are used to make one feel free and equal to other people. The goals of Adlerian therapy are to unlock mistaken goals and interaction patterns, to engage parents in claiming experience and collaborative assessment and to emphasize family’s motivational patterns. It also initiates reorientation of the family. Adlerian therapy assists the family to have social equality; the sense that everyone has an equal right to be valued and respected in the family (www.adler-maps.com).

Human Validation Process Model (Satir Model). The Satir change model describes the major stages of a change; transition between stages, effects of each state, effects of each stage on feelings, thinking, performance and psychology and harmful and helpful interventions during each stage. Satir categorizes people into five groups. The placator, the blamer, the computer, the distracter and the leveler.

The placator is normally afraid that other people will become angry, go away and never to come back again. The blamer uses verbal patterns intended to demonstrate that they are in charge, the boss and powerful. The computer (super reasonable) is normally terrified that someone will find out their feelings. They normally avoid using “I” they normally prefer using “one”. The distracter continually switches from one category to another due to underlying feeling of panic. It is normally useful in lifting the energy level. The levelers say exactly what they feel. They give frank information which at times people are not ready to receive.

It is normally useful when one wants to end questions and to give factual information. Placatory is useful if one wants to gain sympathy for a point of view. The Blamer is useful in emergencies. The computer is useful when one has been asked a question and wants to buy time.

Satir model aims at improving relationships and communication within the family unit. It encourages people to live an inner joy and to have a peace of mind.

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Experiential symbolic family therapy: The therapy is used in the treatment of problems presented by young people living with their parents. The problems are often related to difficulties in communication between members of the family or role problems. It is normally combined with anti-depressant medication for a depressive disorder. The model unmasks pretense, creates new meaning and liberates family members to be themselves. It focuses on the needs of the family members. The therapy assumes that family members have a right to be themselves. It also assumes that family needs could be suppressing rights of the individual.

The model aims at facilitating individuals’ autonomy and sense of belonging in the family to help individual achieve more intimacy by increasing awareness and experience, to encourage members to be themselves and to freely express what they are thinking. The model also supports spontaneity, creativity, the ability to play and the willingness to be “crazy” (http://www.hksatir.org/counselingservices.html)

Structural family therapy: The therapy focuses on family interactions to understand the structure of organization of the family. The therapy argues that a family has a structure that is revealed when a family is in action. The structure influences for better or for worse and the structure emphasizes the family as a whole as well as between subunits. A person has symptoms understood and rooted in the context of family transaction patterns.

Symptoms are bi-products of structural failings. The therapy argues that structural changes must occur in a family before an individual’s symptoms can be reduced. Structural family therapy focuses on how, when and to whom family members relate. It also emphasizes that the family has subsystems which include, spousal: wife and husband, parental: mother and father, sibling who include children, extended which include grandparents and other relatives. Family members play a different role in each of the subsystems they belong. Structural difficulty occurs when one subsystem takes over or intrudes another.

Structural family therapy aims to reduce symptoms of dysfunction and bring about structural change by modifying family’s transactional rules, develop appropriate boundaries, create effectiveness hierarchical structure. In addition to structure, subsystems and boundaries, structural family therapy is based on roles, rules and power.

Strategic family therapy: It is referred to as strategic because it is a therapy where the therapist initiates what happens during therapy, designs a specific approach for each person’s presenting problem and where the therapist takes responsibility for directly influencing a person. (www.mri.org/strategic.family-therapy.html)

Strategic family therapy focuses on solving problems in the present. Problems are accepted as a real not as symptoms. The therapy is brief, process focused and solution oriented. The involved therapist would design a strategy for change. Change results when the family follows given directions and for change.

Its goals include resolving problems by focusing on behavioral sequences, getting people to behave differently and moving the family toward the appropriate stage of family development.

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A therapist employing strategic theory must identify solvable problems, set goals, design interventions to achieve those goals, examine the responses and examine the outcome of the therapy.

Stan’s case indicates that Stan has strained relationship with his parents and siblings. He also has problems with drinking and relating to women. He wants to feel better, relate better with women on equal basis and also wants to love and trust himself and other people. Each of the systemic therapies is unique in dealing with Stan’s case. As indicated some of Stan’s emotional feelings are influenced by the relations he has with his family members. Multi-generational therapy can be effective to handle such a case. Through the model his feeling will be rediscovered. He would be made to understand his problems rather that blame other people about the same. The eight feature of multi-generational theory can be used here to solve Stan’s case.

Adlerian model provides for the use of a questionnaire. The questionnaire would be used to determine some of the features that might have originated from Stan’s childhood. Listening about his past would provide clues to what could be unfinished in his life so that they could address. Adlerian model is keen on where someone is going. The model therefore will enable realization of what Stan wants for himself. In understanding what he wants he would be able to evaluate the present and be able to think ahead and actualize his aspirations. Adlerian model would also be used to develop a plan of action that would greatly determine his future.

The model provides for interaction with the family giving his feeling a wider picture. Adlerian therapy would assist Stan and the family achieves social equality; the sense that everyone has an equal right to be valued and respected in the family and that way, Stan would be accommodated in the set up

Satir model is unique in that it could be adapted to help improve Stan’s relationships and communication within the family unit. The case says that part of Stan’s problems is strained relations with his parents and sibling. Therefore using the model he would be assisted to improve relationships and communication that would give him inner joy and a peace of mind.

Experiential symbolic family therapy is unique because it can be used to address problems with his parents. The model would enable Stan to realize his autonomy and sense of belonging in the family. That would also help him achieve more intimacy by increasing awareness and to freely express what he could be thinking

Structural family therapy model would be used to help Stan focus on family interactions to understand the structure of organization of the family. That would have the effect of reducing conflicts with the various units of the family. The mode would help Stan understand that a family structure influences a person for better or for worse. He would also understand that his symptoms are rooted in the context of family transaction patterns. There his symptoms could be symptoms could be bi-products his family’s structural failings. In addressing his symptoms the structural failings of the family could also be rectified in this model.

Strategic family therapy model allows a therapist to chat the way forward for Stan. The therapist would focus on solving his problems in the present. In that way appropriate ways would be drafted to help Stan be able to stop drinking, relate with women equally, be able to love and to trust other people. In the model Stan’s problems would be addressed not as symptoms. The involved therapist would design a strategy for change and it would be for Stan implement or follows given directions for change. The therapist in this model would identify for Stan problems that are solvable, set for him goals, design interventions to help him achieve those goals, examine his responses and the outcome of the therapy for him

Social construction therapies. They include solution focused brief therapy and narrative approach therapy. Solution focused brief therapy: It is a short term goal focused approach which helps to change a client by constructing solutions rather than dwelling on problems. Elements of desired solution (present in client’s life) are normally the basis for change. Articulating how change is expected to be is more important than the problem.

It is based on using things that relate to how change happens rather than concentrating on how problems develop. The cause of a problem is not normally important in finding solution. The focus is on how the client wants things to be different and what it takes to get that happen. SFBT visions of how things shall be created hopes and expectations. It even makes solution possible. SFBT focuses on the future and sets elaborative and clear goals. Goals help in directing the process and make it remain focused and brief. It also focuses on client’s strength and resources and their use in bringing change.

It does not set out a limit on the number of sessions. A therapist would not focus on limiting sessions. Time setting goals and developing strategies is what is important.

It is widely used from minor problems to major ones. It addresses conditions and problems such as anger, sleeping difficulties, anxiety and work-related problems .

Narrative approach: Narrative approach therapy focuses on the stories of people’s lives. It is based on the ideas that stories are manufactured in social, cultural and political contexts. Person involved produces meaning of his/her life from stories available in those contexts. The therapy is based on “postmodernism” believe which says that there is no one objective “truth” and that there are many possible interpretations of any event. One story is seen as true as another story and ones life seen as multi-storied.

Stories are made up of events in this narrative context and linked by a theme. The stories as retold describe and shape people’s perspectives on their lives, histories and futures. By the time an individual sees a therapist their lives are completely dominated by problems that work to oppress them. The stories are commonly referred to as problem saturated stories. Those stories invite a powerful negative way a person sees his/her life and capabilities.

Therapists help people step out of problem saturated stories to discovering the untold story about their lives. While listening to problem stories counselors get clues to enable them assist the person to live by his/her preferred way of life.

Solution focused brief therapy can be used in constructing solutions to Stan’s problems rather than focusing on the problems alone. Stan has already indicated that he wants to stop drinking, would want to feel better, wants to relate with women equally and wants to learn loving and trusting other people. Those desires would be used in SFBT model as a basis for change for Stan. It would be the work of the therapist to come up with how Stan can get to where he wants to go.

In the case it is indicated that Stan is already experiencing problems of alcoholism. The model will also be used to treat those symptoms. Stan would be made to see that alcohol is a drug and should make an honest evaluation of his behaviors and how drinking is interfering in his living (Corey, pp 502-524, 2005)

In the narrative approach, Stan would be required to tell his story time and again. In those sessions, the therapist will focus on the story more deeply. In the event, the therapist will identify which areas of the problem saturated story need to be addressed. In the model Stan is taken as the author of his life. Stan would be assisted in identifying, clarifying and achieving goals and preferences. It is believed that Stan has external and internal resources that would facilitate the kind of changes he would want. A therapist would construct questions that would assist Stan to discover choices and goals that would eventually help him to re-author the story of his life.

Counseling session in narrative model would be guided by the choices Stan makes. The therapist listens and emphasizes is on his behavior, including his doing, thinking, feeling, and physiology. Stan is made to concentrate on what he is doing and thinking. Change occurs on those levels consequently changing his feelings and physiology. After he evaluates his present behavior, it is left to him to decide the degree to which the change is working for him. Incase identifies areas that are not meeting his needs, they are explored with the therapist. Much of therapy consists of creating specific, realistic, and attainable plans. Once Stan agrees to a plan of action, he is assisted to commit in following it.

References

Health A to Z (2007): Web.

Bitter, J., & Christensen, O., (2004): A guide to Aldlerian family theory. Web.

Brief therapy institute of Sydney (2008). Web.

Counseling Satir method. Web.

Corey,G. (2005): Theory and practices of counseling and psychology.(7th edition) Brooks- Cole:Pacific Grove, CA pp. 502- 524.

Narrative Therapy center of Toronto (2008). Web.

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