Psychonlyticl Fmily Therpy - Essay Example

Ides from psychonlyticl fmily therpy cn be useful for socil workers working with fmilies where the prents re hving reltionship problems [Nme of the School] [Nme of the Student] Introduction Psychonlyticl fmily therpy (further fmily therpy in this pper) is more thn collection of techniques used by prctitioners who work with the whole fmily s the medium of chnge. It lso provides different perspective on the problems presented to members of the helping professions. In fmily therpy, problems re viewed s prts of repetitive sequences of interction which mintin nd re mintined by the problem. Such sequences my be observed in the present or identified s recurring themes throughout fmily's history. These repetitive behviorl ptterns nd enduring beliefs re interconnected into wht might be clled fmily system. Socil workers, iming to ssist fmilies with the prents tht hve reltionships problems, cn use lot of good ide from fmily therpy. Some techniques tht cn be useful re described in the following pper. Through theoreticl overview of reltionships problems tht tke plce in fmilies, some dvices to socil workers' prctices re proposed to fce these problems. The lnguge of reltionships: dyds nd trids The wy we describe situtions reflects our thoughts nd influences our ctions with respect to those situtions. description of problem in terms of individuls will led to our seeking solutions imed t chnging individuls. If we re to tke seriously the ide of chnging reltionships rther thn individuls, then we need to be competent in describing humn dilemms in terms of reltionships. It is no longer sufficient to ssess fmily in terms of its members' individul chrcteristics. For exmple, sying tht the fther is wek, peripherl person nd the mother is domineering nd controlling describes two individuls rther thn their reltionship. n interctionl description needs to encpsulte the pttern of their reltionship, which in this cse would be complementry. The bsic unit of nlysis, description, nd then intervention must become the reltionship. Reltionship style nd the development of rules When there re reltionships problems between prents, socil worker should first set up negotitions with the fmily. During this formtive phse of reltionship the prticipnts negotite, explicitly nd implicitly, style or definition of the reltionship. People then relte s if there were certin rules 'governing' the vrious spects of their reltionship. These rules pply to such issues s who mkes the morning te nd to more subtle spects such s how ffection is displyed in socil situtions. These initil negotitions nd the rules tht develop will depend on mny fctors including: 1. Resons why people live together, for exmple: romnce, reproduction, necessity, convenience, ethnic custom. 2. Belief systems of the prticipnts. No reltionship strts off with 'blnk sheet'. Ech of the prticipnts will bring to the reltionship vlues, stndrds, nd expecttions of how life should be lived, how people should behve towrds ech other, nd whose job it is to put the rubbish out. In study tht included over thousnd fmilies, Reiss (1981) shows how prtners dopt vrious spects of one nother's functioning nd beliefs, so creting blnce. The effects of contrsting belief systems cn be seen most strikingly in interethnic mrriges. 3. Environmentl circumstnces such s the finncil nd mteril constrints within which the people in the reltionship exist; size nd vilbility of ccommodtion; imminence of wr; reltive vilbility of work; thret of redundncy; choice of vilble mtes. 4. Culturl mores. Public opinion nd ttitudes my influence couple's choice bout number of fctors ffecting their reltionship, including whether to cohbit or mrry, nd whether to hve children; nd if so how mny. couple my be ffected by tboos bout blck person living with white person, or working-clss boy mrrying middle-clss girl. ccording to Crter nd McGoldrick ethnicity is 'mjor determinnt of our fmily ptterns nd belief systems' (1998). THE PROCESS ND CONTENT OF NEGOTITION Through process of negotition, reltionships estblish wht Lederer nd Jckson (1998) term the quid pro quo. This is n greement or collection of rules which my be sid to constitute the mutul definition of their reltionship. In the nlysis of reltionships it is extremely importnt to distinguish between the process nd content of negotition. Process is term used to describe the ptterns of negotiting tht develop grdully through tril nd error. Content refers to the issue under discussion. n interctionl therpist is usully interested in chnging the fmily process rther thn the content. Process becomes identifible s repetitive behviourl sequences bsed upon shred belief system, For instnce, n observble process in some fmilies my be tht whenever the welfre of the children forms the content of discussion, the mother is cknowledged by the other fmily members s the spokesperson. This rule my be bsed on the belief tht 'mothers know best'. The development of process nd pttern tkes plce vi verbl nd non-verbl communiction. Some rules bout pttern my be consciously nd explicitly decided through open discussion. Other ptterns of coexistence re implicit nd re tken for grnted. The content of negotition my t times be issues which the prticipnts regrd s crucil such s: in which prtner's home town shll the couple live which child will give up his or her bedroom when Grnny comes to live with the fmily nd who will tht child shre with More often content consists of the ordinry, dy-to-dy prcticlities of living such s housework, bby-sitting rrngements, tking the cr for its service, mking the mels, nd visiting reltives. Through negotitions bout mjor nd minor issues the style of reltionship will be formed. Hley (1993) clled this 'the struggle to define the reltionship'. In trditionl ethnic groups the rules governing wys of living my be universlly prescribed nd ccepted by the members of the culture. In such society little or no negotition my be felt necessry. In contrst, in society where old vlues nd rituls re breking down, people re freer to be innovtive in how they orgnize their reltionships. Exmples of this freedom might be: deciding to cohbit rther thn mrry; deciding not to hve children; or choosing to hve joint custody of children fter divorce. consequence of greter freedom is tht more negotition is required to estblish ech seprte reltionship. This implies greter potentil for the conflict tht usully ccompnies such brgining. From n interctionl stndpoint, people who live together my be sid to develop reciprocl ptterns of relting which re more or less mutully stisfying. These ptterns my be described s conforming to the rules of tht reltionship. Reltionship ptterns Interctionl ptterns my be understood in vriety of wys. The serch for stisfctory typology of reltionships hs lwys been mjor issue in the field of fmily therpy. Some uthorities describe the reltionship ccording to the problem ttched to the identified member: hence the lcoholic couple, or the norectic fmily. No universlly ccepted clssifiction hs emerged. However, there re some descriptions tht re used more frequently thn others nd which re defined here. Problems in reltionships ll reltionships hve phses which re chrcterized by one wy of relting more thn nother. The question is whether the fmily hs sufficient flexibility in its rules. This would enble its structure to dpt to chnging circumstnces by dopting different nd more workble orgniztion. Fmily systems tht present with reltionship problems my be viewed s operting in n outmoded style which prevents them from deling with certin tsks in the next stge of development. If prticipnts in reltionship hold tenciously to their reltive positions when chnge is required, then escltion or 'more of the sme' occurs. Neither person seems ble to shift from his or her stnce. If one of them tries to chnge the other responds in such wy tht the previous definition of the reltionship is restored. Hley (1993) clls this phenomenon the first lw of reltionships. For exmple, in symmetricl escltion of insulting behviour, in which ech prticipnt continully disqulifies the other, one of them my ttempt to chnge the pttern by ccepting defet nd sying 'Yes, you re probbly right, I m lousy lover', tht is tking complementry (one-down) position. The other my respond, 'Tht's the lest of your fults, it's your cooking tht I cn't stnd'. This is likely to provoke nother round of symmetry. Such chronic escltions my go on for yers with only temporry respite to llow the prticipnts to 'get their breth bck'; they re often described s the 'gme without end'. n excellent exmple of this is given in n nlysis of Who's frid of Virgini Woolf in The Prgmtics of Humn Communiction (Wtzlwick, Jckson, nd Bevin 1997: Chpter 5). Complementrity cn lso become rigidified, s when one person is lwys seen s the overdequte prtner nd the other s the underdequte one. Levels of reltionships: overt nd covert Socil workers often ssess reltionships in fmilies tht t the overt level pper to be one type but t the covert level re nother. We my discover tht silence does not represent complince but is son's wy of fighting his fther. Therefore it could be sid tht the reltionship while being overtly complementry is covertly symmetricl. This ide of two-level reltionship is extremely useful in therpy s symptoms cn be viewed s one wy of tking fight underground. It often emerges in therpy tht mnifesting problems is person's wy of fighting bck in reltionship struggle, lbeit covertly. Conflict tht is not overt is more difficult to resolve. n im of therpy in such cse my therefore be to bring the conflict into the open so tht prticipnts need no longer produce symptoms in their ttempts to del with it. For exmple, n norexic womn's not eting might be covert tctic in the fight over independence in n enmeshed fmily. One im of therpy might be to enble negotitions bout independence to be more open so tht such self-destruction is not required. The descriptions bove re essentilly bi-polr terms useful when nlysing dydic reltionships: individul to individul, fmily to gency, ntion to ntion, nd so on. They re useful but not sufficient in work with fmilies. The next stge is to look t reltionships in terms of trids, nd the problems produced in three-prty interctions. Trids The use of 'pecemker' to medite between two dversries cn be seen throughout history nd t mny levels of socil interction. ('Blessed re the pecemkers for they shll be the children of God'). However, the pecemker's role or rewrd is not lwys s ttrctive s it first ppers. Prudent use of the influence of n outsider to ssist reltionship cn be beneficil. However, the over-involvement of third person in dydic reltionship cn be problemtic. Tringultion is the process whereby the conflict between two people is detoured through third prty; this diffuses but does not resolve the originl problem. Exmples of this re: child becoming 'cught up' in prentl conflict, mother cting s the 'bridge' between her husbnd nd her children, or fther stepping in between wrring children. The 'go between' my perform his or her tsk in mny wys: sometimes openly, e.g. 'I wish you would both stop this constnt fighting nd be friends'; or this role cn be performed in covert wy through symptomtic behviour. The following exmple illustrtes this process. Two prents begin to rgue (symmetry). s their voices rise nd their fces look ngrier one of their children my develop hedche or strt to cry. lterntively, two of their children my begin to fight. t this 'signl' from the children, the prents my cese their rgument to ttend to the child(ren). This is n exmple of tringultion; it hppens in most fmilies. Tken to the extreme, however, e.g. where child is repetedly required to use symptomtic behviour to regulte the distnce between the prents, it becomes problemtic. The bove exmple might continue thus: fter the prents hve comforted the child they my begin to blme ech other for upsetting it. The conflict thus begins gin nd so the child hs hedche nd so the prents stop to comfort the child nd so on (more of the sme). The term tringultion cn be pplied to ny sitution where third prty gets repetitively cught up in the disgreements between two others, e.g. prent between two fighting children, therpist between two sides of fmily in conflict, worker between school nd fmily in disgreement over who is to blme for child's lck of progress. When such fmily seeks help, it is often the 'pecemker' who is mnifesting the problem. For exmple 15-yer-old girl presented s seeing ghosts. During the first interview it cme to light tht the prents, who were seprted, never met directly but crried on ll their finncil nd emotionl negotitions vi this prticulr dughter. fter she begn to hve these problems she ws unble to ct s the prents' 'go between' nd consequently they begn to meet regulrly. Byng-Hll hs referred to this process in his pper 'The Symptom Berer s Mritl Distnce Regultor' (2000). different exmple of this phenomenon ws seen in fmily where three people were lwys involved in rguments. No mtter which dyd begn to rgue third prty would inevitbly intervene. n im of therpy in such cses is to detringulte the third prty, enbling the dyd to resolve their difficulty nd llow the 'go between' to give up their symptom. PROCESSES IN TRIDS The following terms re used to describe three-prty interctions. llince This indictes sitution where two prties hve mde n greement to shre common interest or project, for exmple, when two fmily members join together to shre n interest in fishing, cooking, or plnning surprise for nother person. Figure 1 Colition This indictes joining of forces ginst nother. Such colitions re often rrnged covertly. For exmple, where mother nd child plot together in order to deceive nother fmily member. mother my know tht child hs been in trouble t school nd gree not to tell the fther if the child does not tell bout something tht she hs done. This exmple would be noted s crossing hierrchicl or genertionl boundries. Hierrchy This refers to the orgniztion of fmily round the notion of executive power in decision-mking processes. The power to decide my be relted to ge, sttus, knowledge, strength, gender, etc. For exmple, prents re generlly seen s hving the power to mke decisions for their children nd would thus be seen in hierrchiclly superior position. n dolescent my be given hierrchicl power over younger siblings when prents re bsent. Women in fmily my trditionlly ssume more powerful position thn men over issues concerning the emotionl welfre of the children. Some therpeutic schools (Minuchin nd Fishmn 2001, 1991; Hley 2003) ttribute most of the problems tht occur in fmilies to the fct tht hierrchicl boundries re either too diffuse or too rigid. Hence their therpeutic endevours re devoted to the restortion nd Figure 2 mintennce of n pproprite hierrchy with the prents united nd in chrge. In the cse of the mother-child colition described bove, the therpists might direct their energies towrds inducing the prents to mke n open llince for the ske of their child's success, thus breking the cross-genertionl colition. n incestuous reltionship between fther nd dughter would be viewed in hierrchicl terms s breking the pproprite sexul boundry. Work would be directed towrds clrifying the intergenertionl boundries nd possibly physiclly seprting the fther from the fmily s first stge in emotionl disenggement. Boundries This is wy of circumscribing the sptil, temporl, nd emotionl territory of reltionships. For exmple, decision by two dolescents to go on holidy without their prents cn be seen s the cretion of boundry. If the rest of the fmily ccept this 'sttement' or even help them finncilly, then the boundry is vlidted. This concept cn be pplied to ny ctivity crried out by n individul or group of individuls. The mking nd breking of boundries is centrl feture of mny therpists' interventions. Enmeshed fmilies re seen s hving diffuse boundries, represented thus: ..........., while disengged fmilies tend to hve rigid boundries, represented so:---. Helth lies in hving cler yet permeble boundries: - - - - - -. This llows for distnce to be estblished without losing contct, nd for contct to be mintined without losing individulity. Belief systems Behviourl nd emotionl styles of reltionships ptterns exist within conceptul frmework known s fmily's belief system. belief system is fmily's wy of knowing nd understnding its world. It cn be likened to 'filter' or lens through which events re pssed nd interpreted. The work of Reiss (1991) shows tht fmilies operte within conceptul nd behviourl frmework which regultes nd mintins fmily blnce. This frmework is n mlgm of trditions, myths, legends, shred ssumptions, expecttions, nd prejudices. The belief system of fmily is formed by, nd in turn sustins, its ptterns of behviour. For instnce, tke fmily tht throughout the genertions hs mintined its blnce during crisis by clling upon socil work gency to temporrily remove one of its members. This fmily my well be seen s conforming to belief tht the expulsion of member is the only solution to crisis. The more the fmily believes tht expulsion is the only solution, the more it will use expulsion s solution, the more the fmily uses expulsion, the more it will believe tht expulsion is the only solution, nd so on throughout the genertions. In such fmily the person who is expelled cn be regrded s the content nd expulsion s the process of crisis resolution. Some fmilies proclim their belief system in the form of n officil fmily motto. Beliefs re mnifest in ctch-phrses. For exmple, 'Once children rech thirteen they're nothing but trouble', 'Fther is lwys right', ' house without children is n empty shell'. The ctch-phrse of fmily whose members constntly rgued mongst themselves, nd with people t work, school, nd in the neighbourhood, ws 'If you re worthwhile person, then you will be right every single time'. Gining ccess to these beliefs cn help the therpist to understnd nd chnge ptterns of behviour. Byng-Hll (2004), building on the trnsctionl nlysis concept of n individul's life script, hs coined the term 'fmily script' to describe how the members of fmily repet sequences of behviour just s ctors follow the script of ply. Fmily scripts re estblished nd hnded down through the genertions vi fmily customs. They my be ltered ccording to current circumstnces. In n er of gret socil chnge it is likely tht these scripts will need to be chnged or even bndoned in fvour of new version. Work with the fmily might include re-editing the script so tht people cn ply different prts. This is similr to Whitker's ide (2005) of helping fmily to hve rotting scpegot insted of one person plying the prt ll the time. Plzzoli et l. (1998) intervened in prticulrly rigid fmily system nd likened their interction to the production of gth Christie's Mousetrp ( ply tht hd been running for mny yers) where the ctors lwys plyed the sme prt. The wy in which behviourl chnge cn be chieved by ffecting system of beliefs will be illustrted in Prt II. Erlier models of fmily therpy tended to concentrte on either the current behviourl ptterns of the fmily or the historicl legcies mnifested in the form of the fmily's belief system. Knowledge of the wy in which they re intertwined is now thought to offer more options for successful intervention. MULTIPLE LEVELS OF CONTEXT The wy in which the bove ides cn be seen s series of lyers connected through reflexive, circulr process is discussed by Cronen, Johnson nd Lnnmn (1992) nd Cronen nd Perce (1995). The concept of reflexivity emphsizes the mutul nd simultneous effect of the different levels of reltionships on one nother. Figure 3 (. simplified nd dpted version of Perce nd Cronen's work) shows how the 'expelling' fmily cn be represented digrmmticlly. Figure 1 provides frmework ccording to which behviour, to be understood in n interctionl sense, must be seen in the context of the episode in which it occurs; the episode must be viewed in the context of the reltionship between those involved; the reltionship must be understood in the context of the previling fmily script tht governs tht reltionship; nd so on in scending degrees of influence. Ech level is influenced by those bove. lthough Perce nd Cronen consider this influence from higher to lower which they cll contextul force to be the strongest, the process is not one-wy. They lso note the implictive or upwrd influence from the lower to the higher levels. Behviour t lower level cn hve fr-reching consequences on reltionships over time. For exmple, if fmily is helped to resolve crisis episode without using expulsion s the only vible solution then tht episode my in time influence future episodes, reltionships, fmily scripts, nd culture. Tht is, behviour t time cn become the context for behviour t time B. Figure 3 The prents of n 8-yer-old boy were sked why he ws not llowed out to ply unless one of them ws with him. They nswered tht since he hd been in fight with n older boy two yers go, they hd not thought it sfe to let him out on his own. Not surprisingly this fmily's script ws 'better sfe thn sorry'. The episode of the ttck influenced other levels over time, producing n enmeshed reltionship between prents nd child, nd the child's disenggement from peers. This two-wy (though not equl) interchnge of influence is known s reflexivity or recursiveness. Summry This pper inevitbly gives somewht sttic picture of psychonlyticl fmily therpy usefulness to socil workers' prctice with fmilies where prents hve reltionships problems. ccount hs to be tken of fluctutions nd vrition over time nd the fmily's bility to evolve through developmentl stges. The ptterns of relting in fmily re estblished over period of time, through negotitions tht re both explicit nd implicit. The formtion of these ptterns will be influenced by the culturl mores of the time nd by the prticulr fmily's unique process of tril nd error. The definition of the reltionship will hve been reched through the process of brgining over mny content issues. greements re reched for combintion of resons including obligtion, necessity, plesure, nd usefulness t ny prticulr time in the fmily's development. Fmilies tend towrds prticulr behviourl nd emotionl styles which re bsed on the definition of the reltionships. The repertoire of behviours will reflect nd support conceptul frmework within which the fmily opertes. These mny fcets of fmily's life cn be usefully orgnized schemticlly s multiple levels of context. t some future dte these ptterns will need to be renegotited either incrementlly or trnsformtionlly when they re no longer sufficiently functionl or emotionlly stisfying. Such times of renegotition re known s trnsitionl stges nd re of prticulr interest nd utility to n interctionl therpist. The next chpter goes on to look t reltionships over time using the ides of trnsitionl stges nd the fmily tree. Bibliogrphy: 1. Burke, B. L., Vssilev, G., Kntchelov, . nd Zweben, . Motivtionl interviewing with couples. Chp. 23, pp. 347-361. In: Miller, W. R. nd Rollnick, S. Motivtionl interviewing: prepring people for chnge. 2d ed. xx + 428 pp. New York; Guilford Press; 2002. 2. Byng-Hll, J. (2000) The Symptom Berer s Mritl Distnce Regultor: clinicl implictions. Fmily Process 19:355-65. 3. Byng-Hll, J. (2004) Personl communiction.. Fmily Process 19:355-65. 4. Crter, B., & McGoldrick, M. (Eds.). (1998). The expnded fmily life cycle: Individul, fmily, nd socil perspectives (3rd ed.). Boston: llyn & Bcon. 5. Collins, C. C., Grell, C. E. nd Hser, Y-I. Effects of gender nd level of prentl involvement mong prents in drug tretment. mericn Journl of Drug nd lcohol buse 29(2): 237-261, 2003. 6. Cronen, V. nd Perce, B.W. (1995) Towrd n Explntion of How the Miln Method Works: n Invittion to Systemic Epistemology nd the Evolution of Fmily Systems. In D. Cmpbell nd R. Drper, pplictions of Systemic Fmily Therpy: The Miln pproch. London: Grune Strtton. 7. Cronen, V., Johnson, K.M., nd Lnnmn, J.W. (1992) Prdoxes, Double Binds nd Reflexive Loops: n lterntive Theoreticl Perspective. Fmily Process 21:91-112. 8. De Jong, P., & Berg, I. K. (2002). Interviewing for solutions (2nd ed.). Pcific Grove, C: Brooks/Cole. 9. Dishion, T. J. nd Kvngh, K. n ecologicl pproch to fmily intervention for dolescent substnce use. Chp. 6, pp. 127-142. In: Wgner, E. F. nd Wldron, H. B., eds. Innovtions in dolescent substnce buse interventions. xii + 394 pp. msterdm; Pergmon; 2001. 10. Epstein, E. E. nd McCrdy, B. S. Couple therpy in the tretment of lcohol problems. Chp. 23, pp. 597-628. In: Gurmn, . S. nd Jcobson, N. S., eds. Clinicl hndbook of couple therpy. 3d ed. xix + 731 pp. New York; Guilford Press; 2002. 11. Freemn, E. M. Substnce buse intervention, prevention, rehbilittion, nd systems chnge strtegies: helping individuls, fmilies, nd groups to empower themselves. xix + 487 pp. New York; Columbi University Press; 2001. 12. Gingerich, W. J., & Eisengrt, S. (2000). Solution-focused brief therpy: review of the outcome reserch. Fmily Process, 39, 477-498. 13. Gingerich, W. J., & Wbeke, T. (2001). solution-focused pproch to mentl helth intervention in school settings. Children & Schools, 23, 33-47. 14. Hley, J. 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Selekmn, M. (1999). The solution-oriented prenting group revisited. Journl of Systemic Therpies, 18, 5-23. 24. Wtzlwick, P., Bevin, J., nd Jckson, D.D. (1997) Prgmtics of Humn Communiction: Study of Interctionl Ptterns Pthologies nd Prdoxes. New York: W.W. Norton. 25. Weiner-Dvis, M. (1992). Divorce busting. New York: Summit Books. 26. Weiner-Dvis, M. (2001). The divorce remedy: The proven 7-step progrm for sving your mrrige. New York: Simon & Schuster. 27. Whitker, C. (2005) The Hindrnce of Theory in Clinicl Work. In P.J. Guerin (Jr) (ed.) Fmily Therpy: Theory nd Prctice. New York: Grdner Press. Read More