Family Therapy

Fundamentals Of Theory And Practice

William A. Griffin

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9780876307199
• eBook ISBN:
  9781135063689
• Topic: Psychology
• Subtopic: Education in Psychology
• Index: Psychology

First published in 1993. should be used as opposed to focusing on the techniques-with-theories­attached approach of other books in the same genre. The first volume in the Basic Principles Into Practice Series, this book provides an easy to under­stand, basic approach that eschews the latest treatment trends and buzzwords in family therapy to focus on a new way of thinking about using family relation­ships in treating behavioral disorders. Throughout, Dr. Griffin stresses the importance of learning to view and treat the family as a whole, often requiring a difficult conceptual shift in one's view of aberrant behavior. Readers will be rewarded with a core, rudimentary understanding of family therapy that will serve them well regardless of which family therapy models they later use in practice.

1

FAMILY THERAPY

A Shift in Perspective

FAMILY THERAPY: MODALITY VS PERSPECTIVE

Family therapy, done correctly, requires you to see the family as a single dynamic system. All parts interact with all other parts. No single action can have an isolated effect. Similarly, no single aberrant behavioral act can be thought of in isolation, nor is it simply a consequence of a string of behaviors. This act reflects a dynamic system internally configured to allow the behavior to be manifest. This idea of systems and interconnectedness is expanded later, although its introduction points to a unique feature of family therapy—specifically, family therapy is not a modality of psychotherapy, but rather a fundamental shift in perspective about the etiology of normal and aberrant behavior.

This chapter introduces to the reader the concept that family therapy requires the therapist to conceive of behavior as contextually based. Logically extended, this concept implies that treatment is also contextually based. Here context refers to the immediate environmental influences. Among these influences, interpersonal relationships, especially those in the family, are considered the primary vehicle for changing behavior—hence the rationale for family therapy.

ASSUMPTIONS ABOUT BEHAVIOR

Several assumptions about people, behavior, and change must be kept in mind as one makes the shift from an individual pathology model to a dynamic systems (i.e., interpersonal or interactional) model.

Most Behavior Is Nonpathological

First, very little of the behavior seen by most psychotherapists is pathological. As Torrey (1974) points out, most of the behaviors that therapists are asked to fix are simply problems of living. At any given moment the manifest behavior reflects the system's condition and, in general, how well the system is adapting to forces impinging on it. Most people come from families that adapt well, and produce only transitory adjustment problems.

Most Behavior Is Environmentally Driven

This perspective shift clearly moves the focus from the individual to the individual's context. With few exceptions, behavior is assumed to reflect environmental dynamics (see Contraindications, this chapter). How, when, and where a behavior occurs is determined by the history of the relationship between the behavior (or some variant of that behavior) and the environment.

When you adopt the position that environmental and contextual information drive behavior, then it follows that treatment implies altering the environment. This environment includes both the physical (behavioral sequences) and the perceptual (cognition; beliefs) aspects. More formally, you must assume that the behavior is a consequence of genetic composition coupled with current family patterns and history. In turn, this composite is coupled with, and reacts to, the larger social environment.

Families and Relationships Are Powerful Change Agents

Finally, arching above the assumptions about context, perception, behavioral sequences, and change is the fundamental assumption that families and relationships are the most potent change agents in an environment. (Colloquially referred to as the Mother of All Assumptions.) Hence, therapy occurs at the point of greatest therapeutic leverage—the family. Unlike demographers and census takers, therapists are not interested in whether the family is composed of individuals related by blood, marriage, or adoption. Instead, they focus on which relationships in the immediate environment affect the expression of behavior. Depending on the school of family therapy, this can include long dead grandparents or the 2nd grade school teacher (see Chapter IV: Family Therapy Orientations ).

A CONCEPTUAL SHIFT

The pragmatic need to fix families inevitably leads to a single unifying concept of treatment: All therapeutic efforts should be directed toward the relationship among individuals, and not toward the individuals themselves. As family members interact, the composite of their interaction uniquely embodies the family. This composite is the object of therapy. This concept is shown in Figure 1.

This relationship among individuals refers to the processes that simultaneously reflect and dictate behavioral interactions. Key concepts are relationship and processes. Processes determine the relationship, and the relationship determines how processes occur. This is not a tautology. Relationship is a concept about quality, while processes are behavioral, cognitive, and affective patterns. Both occur simultaneously (i.e., processes reflect relationship), and their symbiotic relationship dynamically reconfigures as the system evolves over time. Family therapy is done with the relationship(s), and the therapist uses processes as the handles needed to affect and reshape the relationship.

Figure 1: Viewing family members and their interactions as the unit of treatment.

To appreciate the processes necessary for a family to function well or badly, a conceptual shift must occur—moving from the individual deficit model to the interpersonal model. This shift allows the therapist to move away from the notion that the individual possesses the disorder, and to assume that the behavior reflects family interaction, history, and context. If this shift does not occur, the therapist is merely doing individual therapy with multiple people in the room.

The astute reader may be asking: If the individual is simply fulfilling an obligation within the system, is he or she responsible for the behavior that occurs? Yes. Irrespective of the assumed etiology, at the societal level the individual must be held responsible for any actions taken to fulfill the system obligation (Boszormenyi-Nagy, 1987).

Even if the individual is held responsible for the aberrant, abusive, or violent behavior, the therapist must separate the behavior from the function. Doing so allows you a better opportunity to observe current relationship features that endorse the behavior. If the child's behavior results from inadequate parenting or ongoing marital conflict, do not blame the mother; instead try to appreciate what permits the behavior to occur and what needs to change in order for the behavior to be unnecessary. Remember, that if you can discern what relationship or contextual features drive the dysfunctional behavior, then the behavior can be conceptualized as functional, making it easier to develop therapeutic strategies.

Therapy with the Relationship

From an interpersonal model, therapy involves a minimum of two entities: the therapist and a relationship. Initially, the most important question is, “Who or what is involved in the relationship?” Despite the implications of the term, family therapy does not need the entire family, but only those members necessary to alter the processes postulated to be influencing the presenting problem. Remember, only one person is absolutely needed, since the theory postulates that interactional changes reverberate throughout the system. Perspective is more important than the number of people in session.

In many cases, at least initially, having multiple family members present is helpful because the therapist has more opportunity to see relevant and nonrelevant patterns. It is analogous to the old football adage: First you tackle everybody, and then, one by one, throw bodies from the pile until you find the ball carrier. In the case of family therapy, instead of a ball carrier, you are looking for those interactional patterns that allow you the most leverage with the relationship. Each family member gives a slightly different perspective. In composite, the family brings multiple perspectives; the therapists must select one that is concrete, yet malleable, and fixable. This dilemma is portrayed in Figure 2.

Intangible relationships

Now let's extend the definition of a relationship beyond processes between two or more people to include processes between an individual and anything that can be interacted with or against. In other words, the interaction may be with some person(s) or with some intangible object. This would include, for example, the way an individual interacts with a family myth (Bagarozzi & Anderson, 1989; Reiss, 1981), some preconceived notion of ideal family behavior, or history in the relationship (e.g., the proverbial, “He has always been like that!”) or an attribution set (see Fincham & Bradbury 1990).

Figure 2: Finding the relevant pattern among many.

Stated differently, an individual does not necessarily need another living, breathing person to form a relationship with that produces dysfunctional behavior; a simple family myth is sufficient (see, e.g., Reiss, 1981). Note here that the individual is still not seen as having a deficit, even if the behavior is in reaction to a family myth. Instead, the focus is on the functionality of the behavior within the context of the myth. Hence, therapy is guided toward altering the relationship between the individual and the myth in order to allow the behavior to be unnecessary.

Conversely, you should also consider the situation where the individual conveniently maintains a myth in order to justify the behavior. Usually, this takes the form of, “I can't because…” For example, a mother with an acting-out adolescent 14-year-old daughter reported that she could not be expected to set and follow through on parenting guidelines because of her temper. In her words, “If I tell her once and she doesn't do it—I just lose it! It's my temper, I can't control it, and I've always had it.” In this case, the mother did not want the responsibility of being a parent. Her temper was selective; it was uncontrollable only around parenting. By failing to parent, the mother insured that the girl's dysfunctional behavior would accelerate, guaranteeing that she would be sent back to residential treatment, which had been her home for the previous four years.

Behavioral Repertoire

In general, the behavioral acts that constitute the presenting problem are irrelevant. That is, it does not matter if Johnny's presenting problem is starting fights, engaging in oppositional behavior, or pulling out his hair. Only the assumption that the behavior represents a dysfunctional system is important. Moreover, whether the behavior reflects poor parenting skills or failed solutions, or is a metaphor for the system dysfunction is less important than is the assumption that the behavior reflects interpersonal dysfunction somewhere in the system. In short, for the family therapist, the behavioral act is secondary to the processes that generate it. This is not to suggest that the behavior may not be hurtful, or dangerous to self and others, but rather that its function, and not the behavioral act itself, interests the family therapist.

Behavior brought to therapy as the presenting problem represents end-stage phenomena. You should assume that there had been smaller, less extreme unsuccessful behaviors occurring prior to the point of referral. Only after the less extreme behaviors fail does the behavior escalate sufficiently to warrant attention. In general, the behavior selected by a child or adolescent depends on the efficacy of the behavior relative to its function within the system. To truly appreciate the role of a behavior, it is better to see it as necessary than to see it as abnormal. In essence, kids use what works, and what works depends on what gets noticed by those in the immediate environment.

Behaviors representing a dysfunctional system can be crudely assessed across two dimensions: age appropriateness and degree of persistence. Age appropriate means that the child and the adolescent typically do what most kids that age do. If the adolescent acts like a younger child, or a younger child engages in adolescent behavior, then assume greater system dysfunction. Similarly, if the behavior is age appropriate, but the degree is extreme, assume greater system dysfunction.

Furthermore, any singular behavioral act is meaningless. It is only after a sustained pattern that the behavior warrants consideration as an indicator of system dysfunction.

Otherwise, assume the child is learning how to accommodate to social rules. For example, normal behaviors include defiant acts like saying no, or attention-getting behaviors in public (e.g., a three-year-old strategically flinging himself on the floor of the grocery store in front of the candy section). Also included is age-appropriate acting out, such as classroom behavior that is disruptive, or out-of-seat behavior. If such behavior becomes too disruptive or, as the child gets older, you see exaggerated risk-taking behavior, it may reflect system dysfunction. In boys, for example, normal adolescent fighting might become too frequent. For both boys and girls, normal adolescent experimentation of the big three (drugs, alcohol, sex) might exceed the experimentation levels. Conversely, lack of any experimentation probably means that the system lacks flexibility to allow age-appropriate individuation. The qualitative nature of deviant behaviors changes with age; saying no as a child is metamorphosed into refusing to eat in an anorectic adolescent. This evolution of this skill is illustrated in Figure 3.

FAMILY THERAPY

What Is Family Therapy?

Family therapy is any attempt to modify salient environmental features, most importantly interpersonal contacts or beliefs about those contacts, that alters interaction patterns, allowing the presenting problem to be unnecessary. Notice that this definition of family therapy does not necessarily exclude nonfamily members, nor does it necessitate that all family members be present in therapy (see Torgenrud & Storm, 1989).

Family therapy occurs through social negotiation. It involves determining what the family wants, how they see the problem, how they want it fixed relative to what you think is wrong, and what is within your capacity to alter.

Once an agreement has been negotiated, the therapist allows the prese...

Table of contents

• Front Cover
• Half Title
• Title Page
• Copyrights
• Contents
• Preface
• Acknowledgments
• 1. Family Therapy: A Shift in Perspective
• 2. Intrapersonal vs Interpersonal Models
• 3. Theory and Technique
• 4. Family Therapy Orientations
• 5. The Therapist
• 6. Questions
• 7. Therapy Implementation
• 8. Miscellaneous Topics: Supervision, Ethics, and Organizations
• 9. Recommended Readings
• References
• Index