Counseling Methods: Family Systems Therapy - Coursework Example

COUNSELING METHODS 2007 COUNSELING METHODS Family Systems Therapy Family Systems Therapy (FST), also referred to as Family Therapy and Couple and Family Therapy, is a relatively new psychotherapeutic strategy that is used to treat psychological problems in the family context. The earliest forms of FST can be traced back to the mid 1950's, but the concepts and ideas underlying modern forms of this therapy emerged several decades earlier. Family therapy evolved out of the psychoanalytic theories, which had dominated the psychological science in the beginning of 20th century, and the medical forms of psychiatric treatment. Development of FST is associated with the increasingly broad views on the patient's needs instead of focusing on individual symptoms and behaviors as traditional psychoanalysis embodied by Sigmund Freud and Carl Rogers postulated (Nichols & Schwartz, 1998). FST perspective relies upon the assumption that psychological issues are developed and maintained in the social context of families. Such view implies that the therapist should pay attention to the entire family of the patient instead of focusing almost exclusively on the individual needs and symptoms of the patient. Modern forms of FST employ a wide range of methods and techniques from the field of psychotherapy, systems theory, systemic coaching, and communication theory and tend to incorporate several psychotherapeutic approaches including cognitive therapy, narrative perspectives, social constructionist approach, intergenerational theory, etc. (Nichols & Schwartz, 1998). Such variety of paradigms incorporated in FST is due to exceptionally complex, multilateral and multilevel nature of human interactions within the family setting. There are at least four major approaches within contemporary family therapy: 1. Experiential: this approach, also termed Symbolic-Experiential Family therapy, was founded by Carl Whitaker in the 1960's. The experiential approach, as its name suggested, emphasized the role of immediate ongoing experience, required the therapist conducting treatment to be active and directive, and stressed the importance of going beyond the tenets of traditional theory. Virginia Satir was another recognized contributor and proponent of the experiential approach (Fraenkel, 1997). 2. Family Systems: this approach founded by Murray Bowen revolves around eight basic concepts, namely Emotional Triangles (three-person relationship system considered the smallest building block of a wider network), Differentiation of Self (psychological liberation of intellect and emotion from the family influences, independence of the self from others), Nuclear Family Emotional System (encompasses 4 primary patterns of relations that affect development of problems in the family context), Family Projection Process (the basic way in which parents transmit their psychological problems to their children), Multigenerational Transmission Process (the way in which smaller dysfunctional patterns are accumulated and passed from one generation to another, which eventually leads to serious psychological problems), Emotional Cutoff (the way of managing emotional problems that emerge in the family by cutting off any emotional contacts with other members), Sibling Position (this concept relies on the research of Walter Toman and explains the mechanism of how position of the sibling affects behavior and psychological development of other family members), and Societal Emotional Process (explains how the emotional system influences an individual's behavior on a broader societal level). These concepts fully clarify the basic goals of treatment and role of therapist in the Family Systems approach: The person should be detriangulated from the emotional setting within her family context; The system of relations between the spouses or members of family must be adequately defined and clarified to the fullest extent possible; The person must be fully aware of the function of emotional systems; The person must demonstrating differentiation from the family context by taking strongly "I position" (Comella, 1995). 3. Strategic Family Therapy: this approach was developed by Jay Haley and Cloe Madanes whom proposed to focus directly on the symptoms taking measures to alleviate them. This approach is considered to be more straightforward than other kinds of family therapy (Fraenkel, 1997). 4. Structural Family Therapy: founded by Salvador Minuchin, this approach postulates that each family has invisible barriers that isolate its members from non-members of the family and predictable patterns of interaction within its context, and also each family can be divided into several smaller subsystems. Consequently, the task of therapist conducting the treatment consists of four steps: join the family context, observing the interactions within it, diagnose the problem, and modify the observed patterns and family boundaries in such a way to rectify the diagnosed problem/problems (Colapinto, 1991). Evidently, among the four approaches within the family therapy Bowen's Family System Therapy is the only one that pays serious attention to theoretical underpinnings of treatment and seeks for a deep insight while other perspectives focus primarily on action and technique adopting a more behaviorist stance. One possible explanation for such situation may be the dominant positions of behaviorist paradigm in American psychology during the time when the basics of family therapy were developed. Various types of family therapy are effectively used to treat serious psychological disorders (e.g. schizophrenia, anorexia nervosa, bulimia, etc.) and substance addiction, overcome different crises in a family (divorce, loss), and support or amplify the effect of pharmacological interventions and/or other psychotherapeutic strategies. However, family therapy is not considered an adequate option in several cases: when family members, one or both, have serious mental disorder; physical or life-related limitations that does not allow to regularly take part in family therapy; when excessively rigid structure of personality is observed in one or both members of the family, when cultural/religious background of the family does not allow conducting any kind of psychotherapeutic intervention; unstable families (Nichols & Schwartz, 1998). Family therapy provides the researchers with an alternative way of analyzing human being in terms of interactional patterns of behavior thus paving the way for a new perspective on the origins and mechanisms of serious psychological problems. The traditional psychoanalytic and the earlier medical model leaned toward a simplified linear view of human illness, which largely failed to adequately consider the external interactional component of human life, but focused on the internal set of symptoms and dysfunctions. The FST approach avoided this essential drawback by viewing psychological issues from a broader perspective that focused on the mutually influential and interpersonal context in which these issues developed (Nichols & Schwartz, 1998). Adlerian therapy Adlerian Therapy (AT) is distinct psychotherapeutic model which places specific emphasis on the positive view of human nature. The originator of this therapy, Alfred Adler, was one of the many scholars whom built their theories on the fundamental ideas suggested by Freud. This list includes Anna Freud, Carl Jung, Karen Horney, Erik Erikson, Melanie Klein, and Alfred Adler whom also formed his own systems of psychotherapy. Therefore, Adler's theory is also termed under the umbrella label 'psychodynamic', which means he admitted conscious and unconscious influence on social relationships and the self. However, Adler managed to avoid many pitfalls of pure Freudism, including splitting the personality into separate pieces, and himself became the precursor of the revolutionary doctrine in psychological science, namely humanistic psychology, proponents of which adopted a holistic approach to human personality viewing the human condition as one integrate unity, something more than a mere sum of physical, social, and psychological characteristics (Vander-Zanden, 1993; Gleitman et al, 2000). The core principles of Adlerian psychology were first explained in his book The Neurotic Character published in 1912. The psychologist claims that human personality can be explained in terms of the guiding purpose of the individual's unconscious perception of the ideal self to convert feelings of inferiority to superiority. However, the desires of the self-ideal are typically countered by ethical and/or social requirements and obligations, and if the corrective opportunities are left without adequate consideration, then an inferiority complex will inevitable develop. This complex is likely to increase the risk of the person turning egocentric, aggressive, or developing other psychological problems (Carlson, Watts & Maniacci, 2005). Although Adler sticks to the Freudian view about the psychodynamic nature of human psychology he, apparently, does not accept Freud's emphasis on instinctual demands holding the view that human psychology is goal-driven and fuelled by a yet unknown force that is creative in nature. Similarly to Freud, Adler believes in the unconscious nature of these goals, and claims they have the so-called 'teleological' function. Normally, there is a fictional final goal which can be uncoded alongside of multiple smaller goals or sub-goals. The dynamics of inferiority/superiority is constantly at work through various forms of compensation and over-compensation (Carlson, Watts & Maniacci, 2005). For example, in substance abuse the fictive final goal is to get rid of emotional problems (overcompensation on the basis of a feeling of inferiority). This goal is fictive because it can never be subjectively achieved: the problems will emerge again after the substance's effect disappears. The theory of personality developed by Adler formed the basis for a distinct system of psychotherapy: his ideas have gradually and persistently permeated the whole of contemporary psychology (Ellenberger, 1970). Adler's concept of the style of life is reflected in his works. In particular, Adler believes in the fundamental creative power of individuals and their freedom to choose and change their direction in life; this is very similar to the biological process called autopoesis which is the autonomous, self-renewing, and self-directing nature of all life forms (Nelson, 1991). Adlerian theory represents a value-based, fully-integrated, theory of personality, model of psychopathology, philosophy of living, strategy for preventative education, and technique of psychotherapy (Carlson, Watts & Maniacci, 2005). In particular, Adler emphasizes the needs for an individual's optimal development and social responsibility, which is probably one of the key reasons why the Adlerian perspective can be effectively used for treatment and prevention of numerous psychological problems. Consequently, Adlerian Therapy relies upon the assumption that human being creates its unique style of life early in life, and the create style remains relatively stable and constant as the person enters adolescents and adulthood. The life style affect the process of goal setting, coping with different tasks throughout life cycle, social and private interests, etc. Therefore, the therapist within the Adlerian framework is supposed to collect as much information and family history about the patient as possible, and eventually use this information to set adequate goals for the patient avoiding excessively high or too low goals. Setting and encouraging socially useful goals that facilitate the patient's adjustment to the environment is the primary purpose of Adlerian Therapy (Carlson, Watts & Maniacci, 2005). The list of such goals may include variety of items, but AT is especially effective in treatment and prevention of psychological problems which are associated with socially negative consequences, such as substance abuse and addiction. Thus, the popular 12-step model of substance abuse treatment strongly relies on the notions and concepts proposed by Alfred Adler. The relationship between the key concepts and ideas of the Adlerian perspective has been explored and verified by credible research. Thus, Carroll (1999) argues that, "tenets of Adlerian theory and practice are compatible with the philosophy and practices of Alcoholics Anonymous. Counselors can expect treatment approaches based on Adlerian counseling theory to be congruent with 12-step practices of individuals who are in recovery from alcohol dependence" (p. 50). This relationship is multiple and difficult to remain unnoticed. Improvement in self-acceptance and self-esteem of the patients is the core goal and idea of the 12-step model, which clearly shows that this therapy is, in fact, built on the foundations of Adlerian teaching. Similarly to Freud and other representatives of the psychodynamic paradigm, Adlerian psychology implies excavation of the patient's past and using the results to modify his or her future in the positive direction: improving the self-worth, restoring or increasing the patient's integration into community, etc. Yet, the key feature of the Adlerian perspective should be clearly emphasized: it distinguishes his theory from the rest. Adler argues that people are motivated by a striving for superiority and self-worth rather than by unconscious coming from ID impulses as Freud postulates or the desire to achieve the remote self-actualization as Maslow believes. Therefore, Adlerian philosophy focuses on encouraging and empowering people to remember situations and events that occurred in the past when their unconscious need for self-worth remained unmet, and using these memories to improve their self-worth through putting changed values and beliefs into their unconscious. Gestalt Therapy Gestalt Therapy (GT) is a holistic approach in treatment of psychological problems which seeks to integrate the whole variety of factors that relate to human mind, body and spirit: integration of feelings, behaviors, and thinking is the main purpose in this approach. GT is commonly associated with Fritz and Laura Perls and Paul Goodman and similarly to the family therapy has its roots in several psychological theories, namely: Psychoanalysis: increased attention to the inner aspects of psychological processes; Humanistic psychology: holistic perspective on human being, importance of direct personal experience and everyday life; Gestalt psychology: focus on interactive aspects of human life and experimental observations (Latner, 1990). Although GT represents a significant extension and often modification of the traditional Gestalt psychology, the latter is undoubtedly the major contributor among the three. In particular, the originators of GT relied heavily on the field theory in social action (Kurt Lewin), the body awareness theory (Wilhelm Reich), and humanistic approach to psychotherapeutic treatment proposed by Martin Buber (Latner, 1990). However, there is a strong disagreement between GT researchers and practitioners as for the importance of the theoretical precursors of this therapy. Thus, Enright (1975) claims that Gestalt psychology is perhaps the least contributing paradigm which has affected Perls: the name 'Gestalt' was chosen for a mere reason of being up to date with the scientific developments of those days" (Enright, 1975: 127). On the contrary, Yontef (1979) adopts a different view claiming that the influence of Gestalt psychology on the originators of GT was serious: " the underlying holistic and phenomenological structure of Gestalt therapy is a clinical derivative of Gestalt psychology" (p.27). However, it can hardly be put in question that many concepts developed by representatives of the then powerful Gestalt school formed the foundations of GT. Methodologically and in terms of practical application, GS is a 'present-centered' approach: it stresses the value present subjective experiencing, the therapeutic relationship, personal responsibility and autonomy (O'Leary, 1997). Therefore, the two central concepts of GT, which are awareness and the field, are taken into consideration by the therapist only in terms of the present moment - this essential feature is common for the whole range of methods and techniques GT encompasses. Holism, another contribution of Gestalt psychology, is the logical outcome of the present-moment focus: it is hardly possible to conceive a phenomenon from the holistic perspective without its present-center focus (Latner, 1992). Similarly, a holistic perspective is the key element of field theory, another important element of Gestalt psychology incorporated in GT: the person is viewed in relation to the social world, culture, environment, and the social world. Field theory helps to perceive individuals and groups as a part of their life situations and surroundings. Evidently, such task - explaining reasoning of individuals with reference to so numerous factors - can hardly be viewed as an ordinary theory: the latter normally deals with narrower subjects. For this reason Kurt Lewin, one of the most prominent scholars within the Gestalt paradigm, viewed field theory rather as an overall approach or a set of general principles in psychological and sociological studies than as a theory: "Field theory can hardly be called a theory in the usual sense" (Lewin 1952: 45). Field theory is a method of thinking explaining the interconnectedness between a wide variety of factors and the situations in which these factors affect an individual or a group. This is probably the most important thing about field theory: it is not a theory in the traditional sense, but a general theoretical outlook or way of perceiving and assessing the reality. The concept of awareness was initially emphasized by Perls (1969) whom claimed that awareness was curative and believed it to be the major change agent within GT. O'Leary (1997) three types of awareness: affective which involves accentuating present experience and listening to feelings; bodily awareness which involves noticing the various sensations occurring in the body; and cognitive awareness which involves understanding how individuals prevent themselves from feeling, thinking and doing. Patients within GT perspective are viewed as potentially empowered to recognize how their previous experiences may have affected their lives and are made aware of personal responsibility, how to avoid problems, to finish things which must be finished, to experience life issues in a positive light, and in the awareness of the present moment. The basic goal of the therapist is to make the patient accept this awareness and the responsibility of taking care of him instead of trying to find the empowerment outside. The arsenal of methods and techniques the therapist may employ to achieve this goal - either individually or in groups - ranges from dimple dialogue to role plays and dream analysis, while the problems that can be treated using GT are multiple too: deviant behavior in children and adolescents, psychosomatic disorders, and couples and family problems (Latner, 1992). Psychoanalytic therapy Psychoanalytic Theory (PT) is fully based on the epoch-making theory of the father of modern psychology Sigmund Freud. The key postulate of Freud's theory is that human being passes through a series of psychosexual stages over the course of maturation. Each stage is dominated by the development of sensitivity in a particular erogenous or pleasure-giving zone of the body. Each stage poses for individuals a unique conflict they must cope with before passing over to the next stage of development. In case the conflict is not resolved it will result in a long-lasting frustration. Such frustrations become chronic and in future shape the behavior of personality. Moreover, people may stop at a given stage when they become extremely addicted to its pleasures. But whatever the cause is the result is the same: it leads to fixation of an individual at some certain stage of development (Gleitman et al, 2000). Freud identified five stages of psychosexual development: the oral, anal, phallic, latent and genital. The oral phase starts from the moment of birth, when both needs and their fulfillment involve participation of child's tongue, lips and teeth. Mouth is the first zone of body the child can control and due to this the most part of his sexual energy is focused on it. Later, when the child can control other parts of his body, a certain part of his energy still remains "cathected" to his mouth. Therefore it is natural to have a moderate interest to oral pleasures (Frager & Fadiman, 2000). As the child grows up new zones of pleasure appear. At age between two and four years the child is learning how to control the anal sphincter and bladder, they obtain much of his attention. The process of toilet training excites the child's interest to self-discovery. Since parents interfere with elimination pleasures, the child develops ambivalent attitudes toward them. As children resolve the conflict between their needs for parental love and instinctual gratification they evolve lifelong attitudes toward cleanliness, orderliness, punctuality, submissiveness, and defiance (Gleitman et al, 2000). At the age of tree years the child enters the phallic stage of development: he focuses on his genitals. This phase is called phallic because the child starts to realize whether he has penis or not. At that point children understand the difference between two sexes. During phallic stage of development children treat their parents as a potential threat to fulfillment of their needs (Frager & Fadiman, 2000). This stage of development often leads to Oedipal complex in boys (they feel sexual love for the mother and rivalry to the father), and Electra complex in girls (they feel sexual love for the father and rivalry to the mother) (Vander-Zanden, 1993). Two other stages of development are less important to the development of the basic personality structure if compared with the earlier stages. The latent stage is characterized by relative calmness: this is the period of formation of Ego-structure, including such concepts as shame, disgust, and moral values. This is the period of preparation for puberty. And finally, the last stage of biological and psychological development is the genital phase. It takes place during puberty when the sexual energy (libido) goes back to genitals. Girls and boys finally understand their sexual difference and search for adequate ways of fulfilling their sexual needs (Frager & Fadiman, 2000). Consequently, the major task of the therapist whom provides PT is to make repressed unconscious conflicts conscious. Once the conflict enters the realm of conscious the patient can start his attempts to deal with them. Evidently, this process requires very good professional skills and takes much time. Freud's theory human development has repeatedly been criticized since the moment of its emergence. The main concern of critics was purely biological explanation of social behavior. Like Pluto who lived in the world of great Ideas, Freud lost himself in finding sexual reason of any human's action simply neglecting the importance of situational factors in human's behavior. The main drawback of Freud's theory is that it is evidently contemplative: he tried to create a holistic theory of human development observing a limited number of his mentally ill patients. Children or healthy people rarely fell in the scope of his interest (Gleitman et al, 2000). But at the same time we should not forget about the evident strengths of Freud's theory. Thus, he was the first who embarked on the road of exploring the problem of unconscious in the context of integrate personality. He also provided the science of psychology with the concept of defense mechanisms, explained and proved their role in determining human behavior and development of personality (Vander-Zanden, 1993). References Carlson, J., Watts, R. E. & Maniacci, M. (2005). Adlerian Therapy: Theory and Practice. Washington, DC: American Psychological Association Carroll, J. J. (1999). Compatibility of Adlerian Theory and Practice with the Philosophy and Practices of Alcoholics Anonymous. Journal of Addictions & Offender Counseling 19(2), 50-61. Colapinto, J. (1991). Structural Family Therapy. In Gurman, A. & Kniskern, D, (Eds), Handbook of Family Therapy, Vol. II, NY: Brunner-Mazel, 417-434. Comella, P. A. (1995). A Brief Summary of Bowen Family Systems Theory. In Comella, P. A., Bader, J., Ball, J. S., Wiseman, K. K. & Sagar, R. R. (Eds), The Emotional Side of Organizations Applications of Bowen Family Systems Theory, Bowen Center for the Study of the Family, 2-16. Ellenberger, H. (1970). The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. New York: Basic Books. Enright, J.B. (1975). An introduction to Gestalt Therapy. In Stephenson, F.D. (Ed), Gestalt Therapy Primer, Springfield, Illinois: Thomas. Fraenkel, P. (1997). Systems Approaches to Couple Therapy. In Halford, W. K. & Markman, H. (Eds), Clinical Handbook of Marriage and Couples Interventions, New York: Wiley. Frager, R. & Fadiman, J. (2000). Personality and Personal Growth. Longman. Gleitman, H., Friedlund, A. & Reisberg, D. (2000). Basic Psychology. W.W. Norton and Co. Latner, J. (1992). The Theory of Gestalt Therapy. In Nevis, E. C. (Ed), Gestalt Therapy Perspectives and Applications, Gestalt Institute of Cleveland (GIC) Press. O'Leary, E. (1997). Towards Integrating Personcentered and Gestalt Therapies. The Person-Centered Journal, 4, 14-21. Lewin, K. (1952). Field Theory in Social Science, Tavistock, London. Nelson, A. (1991). The Application of Chaos Theory to the Understanding of Psychological Transformation. Pepperdine University. Nichols, M. P. & Schwartz, R. C. (1998). Family Therapy: Concepts and Methods, 4th edition. Allyn & Bacon Vander-Zanden, J. W. & Wilfrid, J. (1993). Human development, 5th edition. McGraw-Hill Inc. Yontef, G. (1979). Gestalt Therapy: Clinical phenomenology. The Gestalt Journal, 11(1), 27-45. Read More