Compare and contrast Systemic Therapies: MRI and Milan. Which therapy do you believe the most efficacious and why? Support your answer by referencing the text. Do no use direct quotes.
Readings
Gehart Chp. 4, 5
“Through time, you learn how to look at a system and appreciate it for what
it is. Never expect the system to be different. It’s important… to train
themselves to see the system, to be interested in it, to appreciate this kind of
a system without wanting to change it.”—Boscolo, Cecchin, Hoffman, &
Penn, 1987, p. 152
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Theory and Treatment Planning in Family Therapy
Chapter 5:
MRI and Milan Systemic
Therapies
• Milan Systemic Therapy
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• Mental Research Institute (MRI; a.k.a. The
Palo Alto Group)
Theory and Treatment Planning in Family Therapy
Lay of the Land
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Theory and Treatment Planning in Family Therapy
MENTAL RESEARCH INSTITUTE (MRI)
SYSTEMIC THERAPY
• Introduce small, yet meaningful alterations to family
interactions; allow the family to naturally reorganize
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Overview
• Conceptualizes symptoms of individuals within
larger network of family and social systems
• Therapists tap into systemic dynamics to effect
change
Theory and Treatment Planning in Family Therapy
In a Nutshell: The Least You Need to Know
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Theory and Treatment Planning in Family Therapy
THE JUICE: SIGNIFICANT
CONTRIBUTIONS TO THE FIELD
• Reframe is an alternative yet equally plausible
explanation of same facts
• Considers symptom in relational system: how it
helps maintain homeostasis
• Clients not expected to adopt proposed reframe;
it’s “news that makes a difference”
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How it works
Theory and Treatment Planning in Family Therapy
Systemic Reframing
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• Don Jackson
• John Weakland
• Richard Fisch
• Paul Watzlawick
• Art Bodin
• William Fry
• Jules Riskin
• Wendel Ray
• Barbara Anger-Diaz and Karin Schlanger
• Giorgio Nardone
Theory and Treatment Planning in Family Therapy
Rumor Has It: The People and Their Stories
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Theory and Treatment Planning in Family Therapy
THE BIG PICTURE: OVERVIEW OF
TREATMENT
• The presenting problem is a relational one,
specifically an interactional one
• The problem is part of interactional behavior sequence
• Attempted solution: prior unsuccessful problem solving
done by client
• Interventions are used to interrupt (not fix)
behavioral sequences
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Overview
Theory and Treatment Planning in Family Therapy
Process of Systemic Therapy
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Theory and Treatment Planning in Family Therapy
MAKING CONNECTIONS: THE
THERAPEUTIC RELATIONSHIP
• Respect and trust the system
• Adapt to client language and viewpoint
• Practice maneuverability
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The therapeutic relationship is built by the
therapist ability to:
Theory and Treatment Planning in Family Therapy
The Therapeutic Relationship
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Theory and Treatment Planning in Family Therapy
THE VIEWING: CASE CONCEPTUALIZATION
AND ASSESSMENT
1. Things being normal (homeostasis)
2. Tensions escalating (early positive feedback)
3. The symptomatic feelings and behaviors (positive
feedback)
4. Self correction w/ultimate return to normal
(homeostasis)
• Focus
• Less on content of conversation
• More on metacommunication and
interactions
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• Assess problem interaction cycle
Theory and Treatment Planning in Family Therapy
Interaction Patterns
• The specific form and expression of a given individual
symptom is a form of communication within the
system.
• “Individual pathology” conforms to, is shaped by, and
shapes the relational systems in which they are
expressed
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Systemic view of individual pathology:
Theory and Treatment Planning in Family Therapy
Interactional/Systemic View of Problems
• Solutions that the family has tried and did
not work
• Instead they perpetuate the problem
• Common Forms of More-of-the-Same
Solutions:
1. Terrible simplifications (action necessary, but none is
taken)
2. The Utopian syndrome (action taken when none is
necessary)
3. Paradox (action taken at the wrong level)
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• “More of the same” solutions
Theory and Treatment Planning in Family Therapy
“More of the Same” Solutions
• Nonverbal clues to interpret verbal messages
• Typically a comment on the relationships
• Forms of metacommunication
• Voice tone, gestures, eye glances, or smirks
• May reinforce verbal message (congruent)
• May satirize the verbal message (openly contradict)
• May create a double bind (contradiction that can’t be
directly commented on)
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• Communication about communication
• Attend to command aspect of
conversation
Theory and Treatment Planning in Family Therapy
Metacommunication
• Pursuer/distancer
• Logical one/emotional one
• Helpless one/rescuer
• Overfunctioner/underfunctioner
• Good parent (friend)/bad parent (disciplinarian)
• Social/recluse
• Oversexed/undersexed
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Common complementary patterns:
Theory and Treatment Planning in Family Therapy
Complementary & Symmetrical Patterns
• Typically involves a change in roles within the system
example: pursuer becomes a withdrawer
• The basic interactional pattern stays the same
example: one pursuer and one withdrawer; level of intimacy
maintained
• Second order change
• Fundamentally changes rules for relating in the system
• This is the type of change necessary for problems to be
resolved
• Changes tracked week to week to assess type of change
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• First order change
Theory and Treatment Planning in Family Therapy
Type of Change
• Hallmark of MRI systemic viewing
• Teams would sit behind one-way mirror to
observe sessions
• Team could see systemic dance more
rapidly/completely than therapist
• Reason therapists still train with a mirror is to
develop ability to see system’s dynamics
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What the observation team does:
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The Observation Team
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Theory and Treatment Planning in Family Therapy
TARGETING CHANGE: GOAL SETTING
• Homeostasis that is problem-free/doesn’t
involve facing same problem over and over
• The problem is the attempted solution:
• Define the problem
• Identify attempted solutions
• Describe the desired behavioral change
• Develop a plan:
• Target of change is the attempted solution
• Tactic of change is using the client’s own language
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• Symptom-free interaction patterns
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Goals of MRI Systemic Therapy
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Theory and Treatment Planning in Family Therapy
THE DOING: INTERVENTIONS
• Key technique in the MRI approach to facilitate
second-order change
• Less-of-the-same behavior prescription
• Identify alternative behavior that will alter the pattern
• “Prescribe” behavior; clients leave sessions with
behavioral prescriptions
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• Reframing
Theory and Treatment Planning in Family Therapy
Reframing and Less-of-Same
• Undo double-bind message in a family or relationship
• Therapeutic form: no matter what you do, it’s different
• Example: A wife demands her husband spontaneously be romantic.
If he does what she asks, it’s not spontaneous; if he does nothing,
he doesn’t care.
• Therapeutic double bind has him show his romantic side in
any way other than the way his wife demands
• If he follows directive, he initiates new romantic behavior; if he
doesn’t and uses wife’s suggestions, he does so without command.
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More-of-the-same behavior prescription:
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Therapeutic Double Bind
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• Dangers of improvement involves asking
clients to identify potential problems that
might arise if the problem were resolved
Theory and Treatment Planning in Family Therapy
Dangers of Improvement
• The directive to go slow; another paradoxical
intervention
• “Restrain” or tell clients to “go slow;” warn
clients to avoid changing too fast
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Restraining
Theory and Treatment Planning in Family Therapy
Restraining, Going Slow
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Theory and Treatment Planning in Family Therapy
MILAN SYSTEMIC THERAPY
• Uses more language-based interventions, such
as reframing and circular questions
• Interaction patterns are “family games”
• Positive connotation to reframe symptoms
• Shift family interactions by shifting family’s
epistemology and view of problem
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The Milan approach:
Theory and Treatment Planning in Family Therapy
In a Nutshell: The Least You Need to Know
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Theory and Treatment Planning in Family Therapy
THE JUICE: SIGNIFICANT
CONTRIBUTIONS TO THE FIELD
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• Useful techniques when working with more
than one person in room
• Helps assess and make overt overall dynamics
in the system
• Reframes problem for all without therapist
verbally providing reframe
Theory and Treatment Planning in Family Therapy
Circular Questions
• Behavioral sequence questions
• Behavioral difference questions
• Comparison and ranking questions
• Before-and-after questions
• Hypothetical circular questions
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Forms of circular questions:
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Circular Questions (cont.)
• Mara Selvini Palazzoli
• Gianfranco Cecchin
• Luigi Boscolo
• Guiliana Prata
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The Milan team:
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Rumor Has It: The People and Their Stories
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Theory and Treatment Planning in Family Therapy
THE BIG PICTURE: OVERVIEW OF
TREATMENT
• Pre-session
• Session
• Intersession
• Intervention
• Discussion
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Structure of the session
Theory and Treatment Planning in Family Therapy
Long-Term Brief Therapy
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Theory and Treatment Planning in Family Therapy
MAKING CONNECTIONS: THE
THERAPEUTIC RELATIONSHIP
• Non-partiality toward family members/problems
• Multipartiality
• Willingness to honor all perspectives, even if they
conflict
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• Neutrality
Theory and Treatment Planning in Family Therapy
Neutrality and Multipartiality
• Therapeutic curiosity: sincere interest in hearing
multiple voices within system
• No singular truth; rather an esthetic curiosity
about emerging patterns
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Therapeutic stance is of curiosity:
Theory and Treatment Planning in Family Therapy
Curiosity and Esthetics
• Captures the therapist’s relationship to problem
(not the relationship to the client)
• Doesn’t acknowledge “personality flaw,” “illness,”
“unresolved childhood issue”
• Systems are inherently self-correcting; the
therapist maintains an openness, creativity, and
flexibility
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Irreverence
Theory and Treatment Planning in Family Therapy
Irreverence
• Actively monitor therapist influence on the client
system
• Hypothesis about the family is abandoned if it’s
incorrect/unhelpful
• Even theoretical notions to be abandoned if not
serving purpose
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Role of the therapist
Theory and Treatment Planning in Family Therapy
Therapist Unavoidable Influence
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Theory and Treatment Planning in Family Therapy
THE VIEWING: CASE CONCEPTUALIZATION
AND ASSESSMENT
• Refers to relational rules for how a family
interacts
• Rules not consciously created; emerge from
family interaction pattern
• Therapists also ask circular questions to
assess the interactional sequence
• Can be used with individuals, couples, or families
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• “Game”
Theory and Treatment Planning in Family Therapy
Family Games (Interactional Sequences)
• Example: “I am depressed” or “He’s an angry person”
are global labels that suppress times in the day when
other feelings/identities are experienced.
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• How language, particularly descriptions of
self and others, shape reality
Theory and Treatment Planning in Family Therapy
The Tyranny of Linguistics
• How family punctuates events
• How events are described in terms of
cause, effects, ordering, etc.
• Example:
• Husband says, “Because she nags, I withdraw.” Wife
responds, “It’s because you won’t engage that I have to
nag.”
• Both fail to capture the systemic interaction that is going
on.
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• Family Epistemology
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Family Epistemology and Epistemological Errors
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Theory and Treatment Planning in Family Therapy
TARGETING CHANGE: GOAL SETTING
• Generate new meanings (punctuations) that change
the “games” (interactional behavior sequences) in
the family
• Milan therapists don’t linearly “fix” family
interactions
• Therapists can only perturb the system encouraging
it to self correct
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Achieving new meaning:
Theory and Treatment Planning in Family Therapy
New Meaning
• Goals are simply:
• Symptom reduction by means of new systemic
interaction patterns
• Family integrates new information and alters “rules” of
family game so no member has symptoms
• Family is able to maintain stability and cohesion as a
system
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There are no predefined goals-
Theory and Treatment Planning in Family Therapy
Goals
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Theory and Treatment Planning in Family Therapy
THE DOING: INTERVENTIONS
• Hypothesizing for conceptualization
• Hypothesizing as intervention
• Three common types of hypotheses
• Hypotheses about alliances
• Hypotheses about myths and premises
• Hypotheses that analyze communication
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Two phases of the process:
Theory and Treatment Planning in Family Therapy
The Hypothesizing Process
How the reframe is used:
• Interpret the behavior of each family member
positively, with underlying benevolent
motivation
• Example: reframing a child’s problematic behavior as a way to
keep the parents together.
• The therapist views family members less
judgmentally and with greater hope
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(Milan-Style Reframe)
Theory and Treatment Planning in Family Therapy
Positive Connotation
• Often very effective in revealing structure of the system
to the family in a that it often makes other reframes
unnecessary
Counterparadox
• The therapeutic response to family created paradoxes
• Request that the family not change; amplifies the
problem so that the family spontaneously gives it up
• Particularly appropriate with uncooperative families
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Circular Questions
Theory and Treatment Planning in Family Therapy
Circular Questions and Counterparadox
• Behavioral assignments addressing double-binds
• Helps shift meanings
• Later, create more subtle ritual by putting
conflicting directives in sequence
• Example: A woman caught in a triangle with her husband and child
is asked to be a wife on odd days, a mother on even days, and
spontaneous on 7th day.
• The family response is new information; refines
working hypothesis/interventions
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Rituals
Theory and Treatment Planning in Family Therapy
Rituals
• Intervention that is not varied across families
• Severs covert coalitions between parent and child
• Example: parents arrange date (or other outing) and don’t tell the
children where/why.
• Creates secret between parents
• Ends inappropriate coalitions
• Creates clear boundary between unified parents and
child
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Invariant prescription:
Theory and Treatment Planning in Family Therapy
Invariant Prescriptions
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Theory and Treatment Planning in Family Therapy
TAPESTRY WEAVING: DIVERSITY
CONSIDERATIONS
• Multisystemic family therapy
• Brief strategic family therapy
• Ecosystemic structural therapy
• Multidimensional family therapy
• Functional family therapy
• Emotionally focused couples therapy
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• Growing research on the effectiveness of
evidence-based systemic therapies
• EBTs incorporating elements of systemic/strategic
therapies:
Theory and Treatment Planning in Family Therapy
Research and the Evidence Base
• “Since in strategic family therapy a specific therapeutic
plan is designed for each problem, there are no
contraindications in terms of patientselection and
suitability” (Madanes, 1991, p. 396)
• Works from within client’s worldview
• Adapts language and interventions to client’s values and
beliefs
• Does not impose theory of “health” (i.e. appropriate
behaviors)
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Systemic therapy readily adaptable:
Theory and Treatment Planning in Family Therapy
Ethnic, Racial, and Cultural Diversity
• Understanding heterosexism
• Therapist self-reflectivity
• Locating your position, transparency, and self
disclosure
• Client as expert, and therapist as curious
• Connecting to wider systems
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5 principles for adapting systemic therapy to
GLBTQ:
Theory and Treatment Planning in Family Therapy
Sexual Identity Diversity
• LGBT youth have higher rates of suicidal ideation,
substance abuse, self-harm, depression, anxiety,
and school issues; important to monitor safety
• Most adolescents are able to predict parents
response based on prior comments about sexuality
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Considerations:
Theory and Treatment Planning in Family Therapy
Adolescents Coming Out to Family
• Interrupt the interactional pattern to achieve change
• Target the attempted solution
• Milan systemic therapy
• Identify interactional pattern/s or the “family game”
and associated epistemological errors
• Change family interactions through language-based
interventions
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• Mental Research Institute (MRI; a.k.a. The Palo
Alto Group)
Theory and Treatment Planning in Family Therapy
In Conclusion
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• Brief Strategic and Systemic World Network:
www.bsst.org
• Mental Research Institute: www.mri.org
• Multisystemic Therapy: www.mstservices.com
Theory and Treatment Planning in Family Therapy
Online Resources
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Theory and Treatment Planning in Family Therapy
Chapter 4:
Philosophical
Foundations of Family
Therapy Theories
• Systems theory
• Social constructionism/Postmodernism
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• Two Philosophical traditions inform
family therapy:
Theory and Treatment Planning in Family Therapy
Lay of the Land
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Theory and Treatment Planning in Family Therapy
Systemic Foundations
• A group of scholars and researchers met to
discuss how groups of things operate to
form a “system”
• The group included study of human,
ecological, and mechanical systems
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• The Macy Conferences (1940s)
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Systemic Foundations
•
•
•
•
Gregory Bateson
Heinz von Foerster
Milton Erickson
Bradford Keeney
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• Some of the contributors to
systemic theory:
Theory and Treatment Planning in Family Therapy
Foundational Systemic Thinkers
General systems theory
•
•
Systems operate using the same basic
principles
Cybernetic systems theory
•
•
Closely related to general systems but
more focused on social systems
Emphasizes that systems are selfcorrecting, moving towards dynamic
homeostasis
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•
Theory and Treatment Planning in Family Therapy
Systemic Assumptions
• In families: unique set of behavioral, emotional,
and interactional norms that create stability for
the family or other social group.
• Family system homeostasis is not static but dynamic
• The key to maintaining stability is the ability to selfcorrect, which requires feedback
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• Homeostasis
Theory and Treatment Planning in Family Therapy
Homeostasis and Self-Correction
Negative feedback
• No new information, the system remains the
same (homeostasis)
• Behavior is within expected parameters
•
Positive feedback
• New information is coming in, system is changing
• Typically experienced as crisis
• First response to positive feedback is to try to
return to homeostasis
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•
Theory and Treatment Planning in Family Therapy
Negative and Positive Feedback
First-order change
•
•
•
Members of the system change roles but
basic structure of the family the same
Can feel very different to persons in
system
Second-order change
•
•
New structure created; new homeostasis
Typically required at each stage of family
life cycle
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•
Theory and Treatment Planning in Family Therapy
First- and Second-Order Change and
Communication
• Foundational premise
• All behavior is a form of communication
• Example
•
Not sharing personal information may
communicate a person does not feel
emotionally safe in the relationship.
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• “One cannot not communicate”
Theory and Treatment Planning in Family Therapy
Communication
Symmetrical relationships
•
•
Each party has symmetrical or evenly distributed
abilities in the system
Complementary relationships
•
Each party has a distinct role that complements the
other, often resulting in a form of hierarchy
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•
Theory and Treatment Planning in Family Therapy
Relationships: Symmetrical &
Complementary
Report
•
•
Context, the literal meaning of the
statement
Command
•
The metacommunication – how to
interpret the communication; serves to
define the relationship
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•
Theory and Treatment Planning in Family Therapy
Communication: Report and
Command
Two people in an intense relationship with high
degree of survival value
Within the relationship, a message is given that is
structured with
•
•
•
•
A) primary injunction (request or order) and
B) a simultaneous secondary injunction that contradicts the first
The receiver senses that he/she cannot escape
and is always in the wrong
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•
Theory and Treatment Planning in Family Therapy
Double Binds
•
The therapist can no longer assume to
be a neutral, unbiased observer
Therapist must remain aware of how
therapeutic behavior shapes that of
the client
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•
Theory and Treatment Planning in Family Therapy
Second-Order Cybernetics
•
•
•
No single person orchestrates the
interaction patterns
All behavior makes sense in context
No single person can be blamed for
family distress
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The defining feature of systemic
approaches to family therapy is viewing
the family as a system
Theory and Treatment Planning in Family Therapy
Family as a System
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Theory and Treatment Planning in Family Therapy
POSTMODERN AND SOCIAL
CONSTRUCTIONIST THEORIES
Most influential in development of new
psychotherapy models
Textual metaphor
•
•
•
People create meaning from the way they
construct their life story
Relational focus
•
Maintains an emphasis on relationships and
relational construction of reality
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•
Theory and Treatment Planning in Family Therapy
Social Constructivist Foundations
•
•
•
•
Kenneth Gergen
Sheila McNamee
John Shotter
Michel Foucault
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Foundational social constructivist
theorists include:
Theory and Treatment Planning in Family Therapy
Social Constructivist Theorists
“Truths” &“realities” are
constructed – language and
consciousness develop meanings
Different levels of reality construction
•
•
•
•
•
Linguistic level
Person level
Relational level
Societal level
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•
Theory and Treatment Planning in Family Therapy
Postmodern Assumptions
•
words fashion our identities, identify what is and is not
a problem
Reality is negotiated through relationships
•
meanings a person gives are always embedded in a
web of relationships
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Reality is constructed through language
Theory and Treatment Planning in Family Therapy
Postmodern Assumptions
•
•
•
Culture provides a set of values that its members
use to interpret their lives
Selecting certain goods and values over others
creates labels of judgment
Cultural oppressiveness is directly correlated with
reflexivity
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Tradition, culture, and oppression:
Theory and Treatment Planning in Family Therapy
Postmodern Assumptions
•
•
A culture remains humane to the extent that it is
reflexive, able to examine the effects of itself on
others and to question and doubt its values and
meanings
Within any group there are some people for whom the
dominant cultural norms“fit” and those for whom
they do not
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Diane R. Gehart
Reflexivity and humanity
Theory and Treatment Planning in Family Therapy
Postmodern Assumptions
•
•
•
Suspiciousness about singular“truths” has affected
the practice of most therapies
Norms of human behavior are relative because they
are established by one group
Focus on how specific cultural groups construct
meaning and identify acceptable behaviors to
coordinate their activities
© 2016. Cengage Learning. All rights reserved. For classroom use only.
Diane R. Gehart
Social constructionism, postmodernism, and
diversity
Theory and Treatment Planning in Family Therapy
Postmodern Assumptions
4 School of Family Therapy Theories
•
•
•
•
Modernism
Humanism
Systemic
Postmodern
© 2016. Cengage Learning. All rights reserved. For classroom use only.
Diane R. Gehart
•
Theory and Treatment Planning in Family Therapy
How to Choose a Theory
Belief of an external “truth”
Therapist is an expert, assuming role of
teacher or mentor
Two family therapy schools (modernism)
•
•
•
Psychodynamic
Cognitive-behavioral therapies
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Diane R. Gehart
•
•
Theory and Treatment Planning in Family Therapy
Modernism
Prioritizes the individual’s subjective truth
Supportive, nurturing environments
promote therapeutic change
Includes:
•
•
•
•
Carl Roger’s client-centered therapy
Fritz Perl’s gestalt therapy
Virginia Satir’s communications approach
•
•
Sue Johnson’s Emotionally Focused Therapy
Carl Whitaker’s Symbolic Experiential Approach
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Diane R. Gehart
•
•
Theory and Treatment Planning in Family Therapy
Humanism
•
Emphasizes ‘contextual’ truth
One cannot not communicate; all behavior
is a form of communication
An individual’s behavior and symptoms
always make sense in the person’s broader
relational contexts
© 2016. Cengage Learning. All rights reserved. For classroom use only.
Diane R. Gehart
•
•
Theory and Treatment Planning in Family Therapy
Systemic
Belief that objective truth can never be
fully known
Language and words greatly affect how
one’s identity is shaped/experienced
Three influential schools:
•
•
•
•
•
Constructivism
Social constructivism
Structuralism/poststructuralism
© 2016. Cengage Learning. All rights reserved. For classroom use only.
Diane R. Gehart
•
Theory and Treatment Planning in Family Therapy
Postmodern
• Systems theory
• Families work as a system, people behave in certain
ways to maintain homeostasis
• Social constructivism
• People construct their reality based on the meaning
they create from their relationships
© 2016. Cengage Learning. All rights reserved. For classroom use only.
Diane R. Gehart
Theories developed from these philosophical
foundations:
Theory and Treatment Planning in Family Therapy
In Conclusion
© 2016. Cengage Learning. All rights reserved. For classroom use only.
Diane R. Gehart
• Brief Strategic and Systemic Therapy Network: www.bsst.org
• Ken Gergen’s Web Page:
www.swarthmore.edu/SocSci/kgergen1/web/page.phtml?st=
home&id=home
• Mental Research Institute: www.mri.org
• John Shotter’s Web Page: www.pubpages.unh.edu/~jds/
• The Taos Institute: explores social constructionist practices in a
wide range of disciplines: www.taosinstitute.org
Theory and Treatment Planning in Family Therapy
Online Resources
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