Family therapy also covers the topic of marital and couple therapy, and there are 2 theoretical models. General systems theory states that the interactions between the members of the family are attempting to achieve homeostasis. Cybernetics is based on feedback loops, negative feedback loops attempt to decrease change and maintain consistency, positive feedback loops are incidents and behaviors that increase change. This post will cover Bowenian family Systems, Cognitive Behavioral Family Therapy, Communications Approaches, Milan Systemic Family Therapy, Narrative Therapy, Object Relations Therapy, Psychoanalytic Family Therapy, Solution Focused Therapy, Strategic Therapy and Structural Family Therapy. The information is best used in collaboration with your own knowledge and what you have already been taught, your previous notes or textbooks, and research if you need more information on a particular topic. Or you can check out the product reviews page.
You can expect for the EPPP to have at least a few questions on family therapy, and you will be expected to have a knowledge of a variety of different techniques. Treatment, Intervention, Prevention, and Supervision covers 14% of the exam, and this study guides mentions a few of them. There are many different family therapy types, and this post will cover some of the more popular ones.
Bowenian Family Therapy
Created by Murray Bowen in the 1950’s, also called Intergenerational Family Therapy. Based on the assumption that healthy family have members that identify independently and differently from each other which creates balance. This is as opposed to unhealthy families who function as a single unit, and the pathological client is a part of the larger family symptoms where the symptoms are expressed as a unit. The term “undifferentiated family ego mass” is used to describe the collective emotional experience of the family, and the “multigenerational transmission process” refers to emotional disturbances that are passed down through several generations. A tool created by Bowen which is commonly used in practice is the genogram, which has the ability to capture several generations.
Treatment focuses on supporting the client to be themselves and to learn how to manage any negative family backlash by doing this, also by becoming conscious of the family system and differentiating from the family of origin. Another important concept is the Emotional Triangle, which is basically two individuals or entities becoming close and excluding the third. Identifying this and working with each member (starting with the most psychologically stable) to diffuse any hot spots and avoid future triangles is important.
Cognitive Behavioral Family Therapy
There are number of individuals who have influenced Cognitive Behavioral Family Therapy such as John Gottman, Albert Ellis, Alberta Bandura and more. The Behavioral Family Therapy Model is based on the concepts of reinforcement, and believe that healthy behavior is repeated if reinforced but maladaptive behavior also increase if reinforced, which can often be unintentional. With Cognitive Behavioral Family Therapy the cognitions of the family members are examined, specifically in relation to other members of the family. Therapeutic interventions include therapeutic contracts, modeling, systematic desensitization, shaping, charting, and examining irrational beliefs.
Family therapy is primarily attributed to Virginia Satir, but influenced by many others including Paul Watzlawick, Gregory Bateson, Don Jackson, Jay Haley, John Banmen, Jane Gerber, and Maria Gomori. It is based on the assumption that communication, both verbal and non-verbal, has a significant impact on the family unit. Individuals in the family take on a survival stance in order to protect themselves ant their self-worth from family members, specifically the words threats communicated.
Therapeutic techniques include equality, modeling communication, family life chronology, family sculpting, metaphors, family reconstruction. One term coined by the Mental Research Institute is the “double bind” which is an impossible dilemma which involves: 1) Telling the person they are wrong or will be punished 2.) simultaneously relaying the opposite message, typically through non-verbal communication 3) Not allowing the individual the opportunity to escape the dilemma (for example not listening if the individual protests or points out the inconsistency). Another specific intervention is “paradoxical interventions” which is an indirect strategy of prescribing the symptom, for example telling a bickering couple that they must fight for 2 hours everyday.
Milan Systemic Therapy
The Milan group included Luigi Boscolo, Gianfranco Checchin, Mara Selvini Palazzoli, and Giuliana Prata and is based on the concepts of feedback loops. It was noted that in family systems typically one member was trying to establish dominance in the family and control the other members, “Circular Questioning” was a technique that simultaneously gathers information from each member of the family while simultaneously taking the opportunity to introduce new concepts or information to teach the family. Other important techniques used in Milan Systemic Therapy are hypothesizing, neutrality, counterparadox, and prescription of rituals.
Developed by Michael White with contributions from David Epston, its based on the assumption that psychological symptoms oppress people and they come from the stories that the clients tell about themselves, particularly when the individual uses problem focused language to describe themselves. In order for people to create an identity or make sense of what they encounter, they use stories based on their knowledge and social constructs filled with descriptive language.
One key therapeutic tool is externalizing the problem. For example instead of being an individual with anxiety the therapist discusses the anxiety as if it is it own entity, using language to describe how the anxiety affected the individual or how the individual overcame the anxiety rather than describing the client as an anxious individual. Other common tools used in narrative therapy include deconstruction, mapping, and asking permission.
Object Relations Therapy
Significant contributors include Hazan & Shaver, David Scharff & Jill Scharff, and James Framo, and based on the assumption that individuals unconsciously project the elements that cause them to be insecure about themselves onto other members in their family. Another part of the theory believes that childhood experiences and attachments influence who that individual chooses to be in future relationships with. Occasionally the negative pattern of childhood experiences created by the parents can be unconsciously projected onto the individuals partner in a relationship. Projections in a relationship are an attempt to change another person as a result of their own feelings of distress or dissatisfaction. The goal of therapy is to bring awareness to these unconscious projections, and for each individual in the family unit to work on these elements they are projecting within themselves. One of the therapeutic techniques utilized by Framo is Family of Origin Therapy, where a couple completes a session with one individuals family of origin and then completes another session with the other individuals family of origin. Other interventions utilized in Object Relations Therapy include detriangulation, co-therapy, psychoanalysis, and holding environment.
Psychodynamic Family Therapy
The goal of psychodynamic family therapy is to bring consciousness to neurosis, projections, and defense mechanisms in the relationship which are the result of past experiences and childhood development. To do this the therapist must support members of the family in communicating with each other and open and honest about their true feelings. Theodore Lidz identified 2 problematic marriages. 1) Marital schism describes a marriage where fighting leads to common threats of separation or divorce. If children are in the family unit often parents try to get the children to side with them, and will put down the other parent to the children. 2) Marital skew does not typically have the threat of separation, but often one member’s needs take higher priority at the expense of the others needs. In both there is a lack of reciprocity (acceptance and understanding of each others values, roles and goals), and one technique used involves family sculpting which involves the therapist interpreting and suggesting new roles for the family. Other interventions include psychoanalysis, authenticity, joining, and confrontation.
Solution Focused Therapy
Developed by Steve de Shazer and Insoo Kim Berg, with significant contrubutions from William O’Hanlon, Michelle Weiner Davis, and Paul Watzlawick. It is based on the assumption that expectations and goals are very powerful, and the client has the ability to know what they want and need (goals) as well as how to achieve it with proper guidance and exploration. Therapy is typically very brief with as little as 3-4 sessions, and focused on the present and future rather than dwelling or in depth exploration of the past. It is believed that the therapist only needs to facilitate very small change and the client is able to accomplish the rest on their own outside of therapy.
Therapeutic techniques involve the miracle question, asking the client “If a miracle happened and this problem was solved…” followed by How would you know? What would be different? What would you be doing? Exception questions ask the client to explore times that the problem wasn’t occurring and what they were doing instead. Scaling question simply have the client rate the problem from 0 to 10, then exploring any slight movement in the scale or focusing on positivity to reduce all or nothing thinking. Other techniques include being future focused, beginner’s mind, and goal setting.
Developed by Jay Haley, and based on the assumptions that in order for a family to function normally it needs clear rules, a family hierarchy to pass down those rules, flexibility, and a variety of different tools used to problem solve through family transitions and difficult behaviors. If the hierarchy is not functioning at optimal level or there are unstable relationship triangulation then the family can become pathological. Rather than trying to resolve underlying conflicts in therapy, the focus is just the present problem which often involves a lack of flexibility or unclear hierarchy. Common interventions utilized include directives, positioning, restraining, paradoxical injunctions, and metaphoric tasks.
Structural Family Therapy
Developed by Salvador Minuchin with significant contributions from Harry Aponte, Charles Fishman, and Braulio Montalvo, and based on the assumption that problems in the family are a result of poor boundaries, rules, and ineffective family hierarchy. In the model the family is one system, and a healthy family is made up of a strong and united parental unit at the top of the hierarchy. There are clear expectations and boundaries, yest flexibility enough for each member to have their own autonomy and growth, and these expectations and boundaries are constantly being adapted as the other members mature and develop. On the other hand an unhealthy family system is comprised of a lopsided hierarchical arrangement with either too rigid or too flexible boundaries.
There are 3 boundary problems: 1) Triangulation involves the parents trying to encourage the child to take their side. 2) Detouring is when the parents typically blame the child for their problems. 3) Stable Coalition is when a parent and child unite against the other parent. The therapeutic intervention involves reorganizing the family into a more functional unit. Specific techniques include joining, family mapping, hypothesizing, reenactments, re-framing, unbalancing.
***There are many other forms of intervention and treatment such as marital behavior therapy, Adlerian family therapy, attachment theory, collaborative language systems, contextual therapy, emotion-focused therapy, experiential family therapy, family mode deactivation therapy, feminist family therapy, MRI brief therapy. Comment with any other therapy interventions or treatments you know of that may be helpful to be aware of for the EPPP, or let people know of any study tips or tricks you use for exam preparation.
You may find the information on this site is not enough to help you feel confident about your ability to pass the exam, That is OK and only you can be the judge of what you need. If this information seems overwhelming to you it does NOT mean you will fail the exam, but you may require a little more in depth material than is offered here That is why there is a Product Reviews page which will give you a variety of additional options, as well as practice exam questions which I highly recommend as explained on the Study Tips page.