Lima Model Terapi Keluarga

Terapi Keluarga Bowen

Terapi Keluarga Struktur
Terapi keluarga Strategik
Terapi keluarga Experiential/ Komunikasi
Terapi Keluarga Tingkahlaku dan Tingkahlaku-Kognitif

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

 Masyarakat Malaysia tradisional

 “Biar pecah di perut , jangan pecah di mulut”

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Pengenalan
 Working with family members, all or part, to
bring about change in the family organization.
 It is complex and multifaceted - there is no
simple correct approach
 Makes a shift from an individual to systemic
perspective (menyeluruh)

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Basic Principles
 Focus is on interaction and communication
 An individual influences his context and is
influenced by it
 Changes in organization/structure contribute
to changes in behavior
 http://www.goldentriadfilms.com/films/tapes.ht
m

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Roots
 Psychoanalytic Approach (Freud) and Client-
Centered Therapy (Rogers) – both treated
client in private to maintain purity of
therapeutic relationship

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

 FAMILY VS. INDIVIDUAL
THERAPY:
 Both offer an approach to treatment and a way
of understanding human behavior
 Individual therapy focuses on internalized
influences of family and intrapsychic dynamics
 Family therapy believes the dominate forces in
our lives are located externally – in the family

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

 Therapy focuses on changing the family
organization
 When family organization is transformed, the
lives of every family member are altered
accordingly
 Family therapy exerts change on the entire
family (not just individual in context) –
improvements can be lasting because each
member is changed and continues to exert
change on each other

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

FAMILY THERAPY PROCESS
 Family Assessment:
 Some very formal – with structured questions and genograms;
others conduct little formal evaluation

 Presenting Problem:
 What is family saying, what have they tried to do to solve
problem

 Understanding Referral Source:

 Expectations, agendas, etc

 Identifying Systemic Context:

 Who makes-up the family

 Stage of Life Cycle:

 Transitional issues
Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga
Samb.
 Family Structure:
 Who plays what roles in the family

 Communication:
 Process and content

 Divorce, Domestic Violence, Sexual Abuse, Affairs

 Explore safety issues, secondary issues

 Gender, Cultural Factors, Ethics: Managed

Care:
 Assess to uncover issues, “minefields” Challenges, ethical issues

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Family Therapy Pie

Psychodynamic
and Bowen
Behavioral Experiential

Strategic Structural

Communications

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Bowen-Intergenerational Theory.

 Intergenerational Family Therapy atau Bowen-

Intergenerational Theory.
 Murray Bowen – 1950an, Kehidupan keluarganya
beri impak besar dalam teorinya.
 Ahli terapis yang pertama menggunakan teori sistem
dalam terapi keluarga.
 Bowen percaya sistem emosi wujud dalam keluarga
dan mempengaruhi generasi seterusnya dengan pola
berulangan.
 Corak emosi – emotionally overinvolved (fusion) atau
emotionally cut off pengelakkan fisikal atau
psikologikal)
Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga
Bowen-Intergenerational Theory.
 Elemen penting teori- “that here is a chronic
anxiety in all of life that comes with the
territory of living”. Freidman, 1991, p.139.
 Keluarga bermasalah – anxiety tinggi (kronik)
 stress, sakit fizikal / psikologi (boleh
dijangkakan)

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Bowen-Intergenerational Theory
 8 konsep asas:
 1. Perbezaan Kendiri (Differentiation of Self)
 - keupayaan seseorang membezakan dirinya dari
keluarga asalnya pada tahap emosi dan intelektual.
Kehidupan – “togetherness dan individuality”
 Negatif: Fused atau “undifferentiated family ego mass”.
 Matlamat : Seimbang emosi dan kognitif.
 Contoh: Pelajar kolej yang pulang untuk meraikan
perkahwinan kakaknya dan masa yang sama keluarga
mengalami konflik. Apakah darjah perbezaan
kendirinya?

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Bowen-Intergenerational Theory
 Darjah Differention of Self :
 1. below 50 (Low differentiation)
 - tries to please others, seek others, bergantungan,
avoids conflict, lacks of capacity of autonomy.
 2. 51-75 ( Midrange differentiation)
 - has definite beliefs and values but tends to
overconcerned with the opinions of others.
 3. 76-100 ( high differentiation)
 Jelas nilai dan kepercayaan, goal directed, flexible,
secure, autonomous, can tolerate conflicts and
stress, well defined sense of solid self and less
pseudo self/ pretend self( Roberto, 1992)
Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga
Bowen-Intergenerational Theory
 2. Segi Tiga (Triangles)  interlocking triangles
 3. Sistem emosi keluarga asas ( Nuclear family emotional system)
 4. Proses projeksi keluarga (Family projection process)
 5. Emotional cut-off – pengelakan untuk tidak berhubung, keluarga
yang anxieti
 6. Proses transmisi pelbagai generasi ( multigenerational transmission
process)
 7. Kedudukan adik-beradik ( sibling position- roles and function) e.g.
pasangan berkahwin adalah anak bongsu dalam keluarga  terlalu
terbeban dengan tanggungjawab dan membuat keputusan
 Anak sulong- bersaing
 8. Societal Regression- tahap ‘differentiation’ masyarakat rendah 
lemah keputusan yang manasabah dan lebih kepada perasaan or
Band Aid solutions

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Bowen-Intergenerational Theory.
 Teknik:
 Genogram
 Going home again
 Detriangulation
 Person-to person Relationships
 Differentiation of Self
 Asking Questions


Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Bowen-Intergenerational Theory.
 Aspek Unik:
 1. Sejarah keluarga – elak pengulangan
corak interaksi. Cont: Genogram
 3. Jelas konsep dan intertwined.
 2. Sistemik, berfokus dan amalan
menggunakan strategi kognitif.

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Terapi Keluarga Struktur
 Founder: Salvador Minuchin 1974
 Latar belakang sebagai Child Psychiatry
 Keluarga yang bermasalah ialah tiada struktur
organisasi dan tidak fleksibel dalam menghadapi
kitaran perkembangan keluarga.

 Struktur keluarga yg baik- organisasi kemas dengan

mempunyai hierarki dan ahli mudah berhubungan.
Mudah dan cepat berfungsi kembali setelah
menghadapi tekanan, tekar, dan ‘chaos’. keseluruhan
“wholeness”

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Terapi Keluarga Struktur
 Tesis penting:
 Simptom seseorang di fahami dengan
mengkaji corak interaksi dalam konteks
keluarga.
 Perubahan dalam organisasi atau struktur
perlu diubah dahulu sebelum simptom
diubah.
 Struktur keluarga mempunyai impak terhadap
perubahan terhadap individu.

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Terapi keluarga Struktur
 Pendekatan yang melihat keluarga sebagai satu
organisma yang mengalami perubahan.
 Masalah keluarga berpusat kepada enmeshment
and disengagement, dengan keengganan untuk
berubah
 Peranan terapi adalah aktif, intervensi terapi ialah
mencabar kewujudan "family reality." Strategi
membantu berfokus kepada “joining” dengan
keluarga dan restructure system

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

 Terapi Keluarga Struktur
 Konsep asas:
 1. Struktur keluarga: Setiap keluarga mempunyai struktur dan
dapat dilihat apabila dilaksanakan.
 “Structure is an invisible set of functional demands by which
family members relate to each other( Minuchin, 1974).
 - sebagai jumlah peraturan operasional yang berulang dan
konsisten.contoh: ayah mempunyai autoriti.
 - bersifat tidak statik, komplementari (teamwork)
 - ada struktur, hierarki, perbezaan di antara subsistem,

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Terapi Keluarga Struktur
 2. Subsistem Keluarga
 Ciri- gender, generasi, minat, tugas
 Subsistem pasangan, ibubapa, adik beradik,
 - definisi: interpersonal boundaries dan
peraturan untuk ahli. Tentukan siapa dan
apa peranan dalam subsistem.
 wujud kerana melaksanakan family task

-
Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga
Terapi
. Keluarga Struktur
 3.Boundary Permeability
 Boundaries – how a family is organized. sempadan dalam
keluarga fleksibel ( permeability) dapat menentukan hubungan
bersama ahli keluarga.
 Sempadan yang jelas (“saya”, “kami”, berada di tengah antara
enmeshment dan disengagement)
 Sempadan yang tegar (diengagement)- kurang loyal, kurang
berhubung, tidak melindungi keluarga, kurang “caring”
 Sempadan yang diffuse/berselerak ( enmeshement) – terlalu
terlibat dan ambil tahu, eg. Children may act as parents,
parental control tak berkesan, excessive togetherness

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Terapi Keluarga Struktur
 5. Ketidakfungsian keluarga
 - gagal melaksanakan tujuan membina keluarga yang
sihat (Colapinto, 1991).
 - enmeshed families, disenggaged families, families
with a peripheral (dayus/ tidak berguna) male,
families with juvenile parents.
 Perasan tertekan, tidak berdaya – single parents

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

SIMBOL Peta Keluarga

Boundary Jelas

Boundary kabur
Boundary rigid/tegar

Terlibat

Sangat Terlibat

Konflik
Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga
Terapi Keluarga Struktur
 Teknik:
 Joining
 Reframing
 Unbalancing
 Enactment
 Working with spontaneous interaction
 Boundary formation
 Intensity
 Restructuring
 Shaping competence
 Diagnosing.
Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga
Terapi Keluarga Struktur
 Unik aspek
 1.Versatility –( fleksibiliti) pelbagai jenis keluarga.
 2. Nyah simtom dan menyusun semula organisasi
keluarga.
 3. Pragmatik , penyelesai-masalah.
 Kekurangan
 - tidak sesuai untuk masalah yang kompleks.

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Terapi Keluarga Strategik
 Kenali juga sebagai brief therapy ( ambil masa yang
pendek)
 Hasil kerja Milton Erickson – Matlamat ialah
perubahan dengan menggunakan sumber milik klien
dan merekabentuk “strategi for each specific
problem”
 4 jenis pendekatan:
 a. The mental research institute (MRI)
 b. The Family or Haley-Madanes, Institute
 c. The Milan System Group
 d. the Brief Therapy Center – solution focused
 Tokoh : Jay Haley, Paul Watzlawick, John Weakland,
Cloe Madenes.
Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga
Terapi Keluarga Strategik
 Idea Jay Haley (1973)
 Paling berpengaruh dalam terapi keluarga, mendapat didikan
dari Milton, BatesonGregory, dan Minuchin.
 Tesis:
 Terapi jangka pendek, 10 sesi.
 Mempunyai ciri-ciri brief therapy – “
 what need to be to be changed”
 Fokus kepada matlamat, masalah, bertujuan menjawab
sungutan klien.
 Inervensi ialah mengubah organisasi keluarga agar presenting
problem atau simptom lenyap.
 Perubahan keluarga tidak melalui celik akal tetapi melalui
proses arahan (directives) yang diminta oleh terpais.

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga
Terapi Keluarga Strategik
 In this approach, the therapist considers the therapy in
terms of step-by-step change in the way from one type
of abnormal organisation to another type before a more
normal organisation is finally achieved. For a strategic
therapist two questions are basic: How is the symptom
“helping” the family to maintain a balance or overcome
a crisis? How can the symptom be replaced by a more
effective solution of the problem?

 Memfokuskan kepada mendefinisikan masalah

keluarga, menghubungkannya dan menyelesaikan
 Developed strategies designed to outwit resistance and
provoke families into changing with or without their
cooperation
 Peranan terapi ialah aktif dan interventif.
Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga
Terapi Keluarga Strategik
 Memfokus kepada dimensi keluarga seperti:
 Peraturan keluarga, homeostasis, quid pro
quo, prinsip redundancy, punctuation,
hubungan simetrikal dan komplementari,
sebebaban circular

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Terapi Keluarga Strategik
 Teknik:
 1. Reframing
 2. Directives
 3. Paradox
 4. Ordeals
 5. Pretend
 6. Positioning

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Systemic
 Systemic Family Therapy, atau Milan Model, memfokus pendekatan prescriptive
and paradoxical berdasarkan sistem teori. Mara Selvini-Palazolli and her
associates di Milan, Itali, mencipta keadah ini.
 Fokus: mengalakkan keluarga melihat masalah dengan perspektif yang
berlainan dan bukan hanya mengubah tingkahlaku.
 Milan Systemic Therapy (Boscolo et al, 1987)
 Basic assumption of Milan Systemic Therapy is that mind is social. The
symptomatic behaviour is conceived as a part of the transactional
patterns of the system. Significance of any particular behaviour or event
may be derived from its social context. The therapists consider that the
way to eliminate the symptom which is present in the family is to change
the rules and beliefs. Change is achieved in clarifying the ambiguity in
relationships.
Menggunakan team interview with two members of the team conducting
the interview while other member, of the team observe from behind a two-
way mirror.

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Communications / Experimental
 The work of Virginia Satir, and Carl Whitaker. These two pioneer family
therapists are unique and distinct.
 Conjoint Family Therapy (Satir, 1967)
 Conjoint family therapy works with personal experiences and helps
experiencing the value of the individual within the family system.
Therapists use all levels of communication to express the relational
qualities present in the family to achieve change in family system. This
approach uses many feeling and communication exercises and games,
for example family sculpture.
 Masalah keluarga berpunca daripada tekanan perasaan, kurang
kesedaran, tidak ada perasaan (emotioanl deadness), penafian,
penggunaan mekanisma bela diri yang terlampau. mechanisms
 Fokus: Komunikasi dalam keluarga dan menekankan rawatan yang
berbentuk experiential .

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

 Matlamat terapi : fokus kepda sensitiviti dan
luahan perasaan , verbal dan nonverbal (role
play, mime (act out),

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Behavioral, cognitive FT
 Behavioral, cognitive, and affective common factors in MFT.
Behavioral regulation occurs in MFF when therapists facilitate
change in clients through, for example, changing interactional
patterns, modifying boundaries, changing family structures, and
helping clients to learn new skills. Cognitive mastery occurs in
MFT when therapists, for instance, help clients to gain insight
about interactional processes within themselves, the family,
between the family and other systems, and across generations
(Wampler, 1997). An example of affective regulation or
experiencing is when therapists facilitate the emotional
connections that clients make with themselves, the therapist,
and (most importantly) with each other.

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

Teknik Asas Terapi Keluarga
 Genogram
 The Family Floor Plan
 Reframing
 Tracking
 Communication skill-building
 Family Sculpting
 Family photos
 Special days, mini vacations, special outings

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga

 The Empty chair
 Family Choreography (step designs ,lakunan)
 Family Council meeting
 Strategic Alliances
 Prescribing Indecision
 Putting the client in control of the symptom

Fauziah Hanim Jalal Ph.D KKT 2013 Kaunseling Keluarga