Loyola University of Chicago School of Social Work Family Therapy Models Overview of Selected Models

Dr. J.M. Rasheed

A. Psychodynamic (psychoanalysis as theoretical underpinning) 1. Chief theorists and practitioners a. Nathan Ackerman (Father of Family Therapy), Framo, (contextual) Ivan Boszormenyi-Nagy, (Invisible Loyalties) William Meissner, Norman Paul (operational mourning) and Helen Stierlin. 2. Theory of dysfunction a. Unresolved conflicts from the past, largely outside of awareness, continue to attach themselves to current objects and situations. b. Family projection process stemming from unresolved issues and losses from the past supports the development of symptoms. 3. Theory of Change a. Insight leads to understanding, conflict reduction and eventually intrapsychic and interpersonal change; working through old conflicts. 4. Goal of therapy a. Develop insight, psychosexual maturity, strengthening of ego functions, reduction in interlocking pathologies, and more satisfying object relations, redressing family debts. 5. Role of therapist a. neutral party making interpretations of individual and family behavior patterns, provocateur. 6. Therapeutic techniques a. interpretation; looking for connections with the past, helping family members identify and explore those connections and mourn the old lost objects. B. Communications/Experiential/Humanistic 1. Chief theorists and practitioners a. Don Jackson, Milton Erickson, Paul Watzlawick, John Weakland, Fisch, (Haley, Satir), Whitaker 2. Theory of dysfunction

a. Conflicting messages are sent via different levels of communication (w o r d s incongruent w/behavior) e.g., double-bind. b. Symptoms are viewed as a form of non-verbal behavior that communicates on one level that the person has no control of illness (i.e., without power) and on another level is very powerful and controlling of others who respond to and organize around symptom. Low self-esteem contributes to symptom formation and dysfunctional communication. 3. Theory of Change a. Change occurs by correcting discrepancies in communication both on verbal and non-verbal levels. b. Improving self-esteem; addressing power issues in family system. 4. Goal of Therapy a. Develop or restore clear, direct unambiguous communication. b. Each person better able to take responsibility for feelings, thought, behavior. 5. Role of Therapist a. Governor of communications; role model for congruent communication b. Builder of self-esteem and validate strengths c. Provocateur d. To change communication of family 6. Therapeutic techniques a. role play b. paradox (MRI) c. communication skills training d. Use of relationship/emphatic use of self disclosure (emotional display) e. Touching C. Structural family therapy 1. Chief theorists and practitioners a. Minuchin b. Montalvo-Supervision c. Fishman-Skills and techniques d. Aponte 2. Theory of dysfunction a. dysfunctional boundaries b. cross generational coalitions c. symptom maintained by dysfunctional system, malfunctioning hierarchical arrangements.

3. Theory of change a. change by doing b. change happens in the session c. realities are challenged (symptom, structure, world view) d. new relational alternatives are found from changed context 4. Goal of Therapy a. clarify boundaries b. reorganize family structure (hierarchy and proximity) 5. Role of the therapist a. join the system (purposeful use of self) b. therapist is in charge of session and of change (Director) 6. Therapeutic techniques a. enactment b. boundary making c. working with complementarity d. unbalancing e. creating intensity (repetition, prolong interaction, increasing affective component of transaction) D. Strategic therapy 1. Chief theorists and practitioners a. Haley b. Madanes c. Papp/Hoffman (Paradoxical) d. Milan Group (Systematic) e. Palo Alto Group f. solution-hyphened models (smile!!!) as off-springs of the strategic model i.e. solution oriented, solution-focused, brief solution therapy (MRI Group)Chief theorists and practitioners: Steve DeShazar, Michele Weiner-Davis, Jane Peller and John Walters g. Narrative Family therapy techniquesnote that I have classified this area as techniques, as I feel this area very much still evolving and yet to be developed into a model per se 2. Theory of dysfunction a. dysfunctional hierarchies b. symptom maintains the system c. dysfunctional behavior sequences d. unsuccessful problem-solving techniques e. Inability to adjust to life cycle transition (Haley) 3. Theory of Change a. change the meaning of events around the symptom b. symptom as point of entry to address power and control

c. removal of the symptom changes the family pattern 4. Goal of Therapy a. Change the presenting problem only b. Symptom as point of entry to address power and control c. Realign dysfunctional hierarchy around presenting problem d. Utilize family resistances to create change 5. Role of the therapist a. track sequence of interaction b. to be determined to cure, but have less investment than the family (family maintains responsibility for change) c. observer d. provocateur 6. Therapeutic Techniques a. tracking b. reframing c. task prescription, directives d. paradox (indirect techniques) injunctions e. family sculpting and choreography f. Greek chorus g. Use of metaphors to see new solutions to old problems E. Intergenerational Therapy/Family Systems/Family of Origin 1. Chief theorists and practitioners a. Bowen b. Papero (not really an architect of this model, but continued Bowens work, after Bowens death, I predict to be the heir-apparent 2. Theory of dysfunction a. unresolved family of origin issues which interfere with successful functioning of the current family b. fusion among family members, inadequate individuation. c. family projection process, triangulation 3. Theory of change a. learn ways to break the fusion or detriagulate b. decrease family projection process 4. Goals of therapy a. functioning impaired by relationships w/family of origin b. increase differentiation of family members and decrease emotional reactivity c. detriagulate and strive toward individuation d. family projection process, repair cutoffs

5. Role of Therapists a. coach b. facilitator c. expert/teacher 6. Therapeutic Techniques a. letters b. family visits c. genograms d. work w/one person F. Behavioral 1. Chief theorists and practitioners a. Patterson b. Stuart c. Alexander d. Gambrill e. Liberman 2. Theory of dysfunction a. Maladaptive symptomatic behavior reinforced by family attention and reward b. Communication deficit c. Deficit reward exchanges 3. Theory of Change a. Change contingencies of social reinforcement b. Create clearer communication and reward adaptive behavior 4. Goals of therapy a. to change patterns of mutual reinforcement 5. Role of therapist a. problem-solver b. active teacher 6. Therapeutic techniques a. contracting b. parent-education c. other adaptations of traditional Behavior Modification (i.e. positive reinforcement, aversive conditioning, extinction, relaxation, systematic desensitization, etc.)