Many psychologists and psychotherapists note that working with people’s problems is much easier if there is a clear vision of their environment. Moreover, colleagues, friends, acquaintances, neighbors do not play such a significant role in shaping a person’s internal state as members of his family. According to statistics, in 85% of cases it is they who directly or indirectly, intentionally or involuntarily, in the past or present, become the cause of all kinds of personality disorders and behavior. Therefore, it is not surprising that family psychotherapy has become so popular and, with systematic work, produces excellent results.
What it is
In simple terms, family psychotherapy is the work of a psychotherapist with the entire family or some of its members in order to identify and eliminate existing psychological problems. It’s worth mentioning right away that it’s not just about interpersonal conflicts (quarrels between spouses, misunderstandings between parents and teenagers, difficulties in raising adopted children). It is often necessary to call close relatives of a person suffering from a serious disorder to sessions and consultations in order to help him overcome the disease.
For many years, one of the main problems of family psychotherapy was the lack of demand. Some family members (most often men) considered it something shameful to go to sessions with a “shrink”, because they are absolutely healthy. However, in recent times, such inert views are gradually being eradicated. In the West, it has become not only commonplace, but almost mandatory to have your own psychologist or psychotherapist. They take an active part in raising children, divorce proceedings and many other key issues.
This is a very useful trend when the same specialist leads the same family for many years. He better understands the problems that arise, knowing exactly how and what kind of relationships developed between its members over time.
From the history
Family psychotherapy as a separate direction has been formed for almost two centuries. Back in 1817, professor of pathology and therapy Friedrich Houdin first expressed the idea that the reasons for a child’s hysteria should be sought primarily in his upbringing and relationships with his parents. By the end of the 19th century, consultations were already being held with relatives of mentally ill patients.
At the beginning of the 20th century, psychiatrists, clinical and social psychologists, and sociologists began to conduct systematic studies of the family. Moreover, they covered a variety of aspects: the process of raising children, relationships between generations, leadership of individual members, interpersonal conflicts between spouses, communications with the environment, cultural and spiritual values, material status.
The need for family psychotherapy has increased in many countries since the end of World War II (after 1945). There were a huge number of orphaned children on the street, whose parents were killed. Every second family had losses, some did not return from the front. At the same time, I had to somehow move on with my life. All these difficulties were helped to overcome not only by social workers, but also by family psychotherapists.
Since then, family psychotherapy has begun to develop by leaps and bounds. Many trends have emerged that examine the main problems and conflicts between relatives from different angles, using different methods and techniques to eliminate them.
Systemic family psychotherapy
Eidemiller once made his own amendments to the concept of “family psychotherapy,” thereby expanding the scope of this method. From his point of view, this technique is not only an influence on a specific individual, but a way of influencing the family as an open living system in order to improve and optimize its functioning. The methodology itself was formed and developed relatively recently, along with cybernetics, which determines its systematic approach. Along with other narrowly focused techniques in psychiatry, systemic family psychotherapy is the “youngest”. This technique, being aimed at working with internal connections in a team and resolving emerging interpersonal conflicts, considers as a basis the systemic structure of the family as a team and the characteristics of family relationships for this particular case.
The family system is in very close contact with the outside world, constantly carrying out certain actions in it that can also influence the internal state of the family. Thus, the family as a system is an open system. At the same time, its main feature is the fact that the generator, that is, the “core” of the direction of action, is, as it were, located inside the system. From this it is easy to conclude that the behavior of all family members does not directly depend on external factors. but on their personal ideas, motives, and needs. And if we consider the hierarchical system of the position of elements, then in relation to the individual, as an element that makes up the family system, this system is primary. Thus, within the framework of psychotherapy, it is wiser to influence not a specific person, but the system itself.
The family system, as a rule, is understood as a group of people who are united by a common place of residence, way of life, ideas and goals, and, above all, relationships. The phenomenon of “totality of the system” is very common. It means a situation where what happens in the family practically does not depend on the individual motivation, plans and intentions of a certain subject, since the state of the family is regulated only by the system itself. If we talk about various approaches and techniques, the most popular nowadays is the Varga method. This specialist studied in great depth and accuracy the features of the family structure, its emotional states, stages of formation and changes in the structure. Moreover, he considers all these elements within the framework of the Russian family, which is very important, since the family system largely depends on mentality.
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Goals and objectives
The main goal of family psychotherapy is the correction of interpersonal relationships within the family, aimed at eliminating emotional disorders that are pronounced in one of its members or several at once.
Main directions and tasks:
- identify the conflict and its participants;
- change the family’s ideas about the conflict situation that has arisen;
- transformation of views from individual-personal to system-collective;
- improve relationships between different groups of relatives and in general;
- create alternative conflict resolution models to give everyone a choice;
- increase tolerance, especially towards a sick or simply problematic relative;
- build new hierarchical relationships;
- teach the family to independently find resources to resolve conflict situations and successfully resolve them on their own, without outside help;
- eliminate dysfunctional behavior patterns that stem from childhood;
- reveal secrets, establish trusting relationships.
If the conflict concerns only two family members, work is usually carried out only in this pair and the task is set to normalize their relationships with each other. If a psychotherapist is working with a problematic (mentally ill) relative, the direction changes radically - everyone who lives with him is invited to the sessions.
Other directions
Family communication therapy emerged from the Palo Alto area. Its leading representatives are P. Vaclavik, D. Jackson and others. The goal of family communication therapy is to change communication patterns, or “consciously act to change dysfunctional patterns of interaction.” At first, representatives of this trend, for example, Virginia Satir, aimed simply at improving communication in the family, then this idea narrowed to changing precisely those methods of communication that support the symptom. The main groups of family communication therapy techniques are: teaching family members the rules of clear communication; analysis and interpretation of communication methods in the family; manipulation of communication in the family using various techniques and rules. This type of family psychotherapy has not been able to establish itself as a highly effective method.
Among the representatives of the field of experiential family psychotherapy, the most famous are Carl Whitaker and August Napier. This method is based “on experience and common sense” (Eidemiller, Justitskis, “Psychology and Psychotherapy of the Family”, 1999).
Basics
To achieve more effective results, three basic principles have been developed.
Principle 1. Circulation
All events occurring in the family are subject to circular rather than linear causality.
Example. Tensed relations between spouses → lack of attention to children → problems in learning → intrafamily conflicts (who is to blame) → deterioration of relations between spouses (the circle is closed).
Principle 2. Hypothetical
The psychotherapist has to conduct several sessions blindly, based only on his own hypotheses of what is happening between relatives, until they reveal their secrets and confirm one of his hypotheses.
Principle 3. Neutrality
On the part of the psychotherapist - a sympathetic, calm, friendly attitude towards each relative equally. He cannot take sides or condemn anyone. He must see the suffering of the individual. During the session, everyone should be able to speak and be heard.
These principles are used in all areas of modern family psychotherapy.
Main directions
Initially, two areas emerged within family psychotherapy.
Direction 1. Psychogenetic
In the formation of personal and behavioral anomalies, clinical psychoses, the main role is played by the relationships that a person develops with relatives. At the same time, insufficient attention was often paid to biological factors (the same hereditary predisposition, genetic syndromes, past diseases).
Direction 2. Clinical and genetic
The causes of disorders can be both intra-family conflicts and childhood psychotraumas, as well as genetic characteristics passed on from generation to generation. In this regard, within the framework of this direction, both elderly family members and their parents were examined for heredity in order to exclude the role of biological factors in the development of anomalies and psychoses.
Subsequently, both of these directions were combined. In most modern schools of family psychotherapy, any disorder is viewed as the result of complex interactions between relatives and biological factors.
In modern family psychotherapy, the following areas are distinguished.
Systemic family psychotherapy (SSP)
The youngest, most promising and successful direction in the USA and the West. The main feature that distinguishes it from other schools is its systematic approach to solving all problems.
Family as a system
Firstly, representatives of the SSP consider each family as a separate system in which all elements (its members) are interconnected and work towards a single goal (comfortable coexistence). If problems arise in one person, the whole model invariably collapses. Therefore, in systemic family psychotherapy they will not work with an isolated couple (spouses, for example, or only with a stepfather and stepdaughter). Everyone who lives in the house under the same roof is invited to the sessions, even if one of the distant relatives happens to be there.
Personality as a system
Secondly, systemic family psychotherapy considers each member of a social unit as a separate system. It functions thanks to the close relationship of such structural components as physiology, psyche, behavioral patterns, worldviews, and values. And they all depend on each other in one way or another.
Methods used:
- circular and scale questions;
- reframing;
- paradoxical interference;
- hometasks;
- sculptures;
- sociogram;
- group reflection.
Systemic psychotherapy of family relationships is officially recognized at the state level as a treatment method for various types of disorders in the USA, Finland, Italy, Switzerland, Austria, Germany, Poland, Hungary and the UK. To date, there are results of 80 random studies confirming that BSC is a really working method that provides long-term effects. Since 2009, specialists have been trained in the field of systemic family psychotherapy for adults, and since 2010 - for children and adolescents.
She also has disadvantages. Firstly, it is too eclectic: there is no main base that could unite all views within this direction. The second disadvantage follows from the first - in different SSP schools they have different views on resolving some intra-family conflicts and treating disorders. Thirdly, they focus too much on personal relationships between relatives and often lose sight of biological factors.
Intensive family psychotherapy (IFP)
Intensive family psychotherapy is a form of socio-psychological rehabilitation aimed at children who are on the verge of being removed from their parents and placed in government institutions (orphanages and boarding schools). The goal is to prevent such developments, help the family overcome difficulties and reduce the risk of negative consequences.
The focus of COI is usually on difficult teenagers who exhibit deviant behavior and conflict with the majority of those around them. The main method is for a mobile team of specialists to visit your home. It includes not only a psychotherapist, but also a social worker, lawyer, psychologist, and district police officer. Sessions, as a rule, take place in an environment familiar to all relatives.
ISP tasks:
- mobilize family resources;
- strengthen family ties;
- improve the climate in the family;
- restore positive contacts of the minor and eliminate negative ones;
- increase the child’s interest in learning;
- develop skills for independently solving conflicts and problems;
- constantly monitor everything that happens.
The model is based on a team approach and interdepartmental interaction. All relatives are involved in the planning and implementation of the program for their own rehabilitation. The internal resources of the family are reanimated, capable of triggering positive changes that lead to a way out of a difficult situation.
It is used primarily in psychosocial work with difficult teenagers and socially dangerous families.
Behavioral family psychotherapy (BFP)
Discussed in detail in the works of Skinner, Bandura, Rotter, Ziegler. She does not study the past. Its goal is to analyze the sequence of actions of relatives in the present. The normal development of a family, from their point of view, is when all its members behave pleasantly towards each other. Distorted - if they irritate each other and create conflict situations.
Unlike systemic SP, behavioral SP works with couples: for example, husband - wife or child - parent. The task is to improve their interpersonal relationships. One of the advantages of this direction is a well-developed system of techniques.
Operant conditioning techniques:
- shaping;
- tokens;
- contracts;
- exchange of changes for a fee;
- time-out.
Response conditioning techniques:
- systematic desensitization;
- self-affirmation training;
- obverses;
- sex therapy.
Cognitive-affective techniques:
- stopping thoughts;
- rational-emotive therapy;
- rational emotive behavior therapy;
- modeling;
- reattribution.
PSP achieves its goals, but does not improve the functioning of the entire family system, and the results are most often short-term in nature.
Crisis family psychotherapy (CFP)
Deals directly with conflicts. Goals: to unite the family, improve the adaptation of relatives to crisis situations, and develop a constructive style of communication between them. Two psychological turning points are most often considered:
- Discord between spouses when the risk of divorce becomes critical.
- Child-parents are on the verge of the child escaping from the family.
Possible outputs offered by KSP:
- restoration of pre-crisis relations;
- concluding a compromise, maintaining an unstable, but still equilibrium;
- the final break in relations, which is the only way out of the current situation.
A distinctive feature of CSP: the psychotherapist acts as a mediator, not a judge, without taking sides. The main methods are genogram and timeline.
Playful family psychotherapy (GFP)
A non-directive practice that focuses primarily on emotions and works with families with young children. After all, it is games that reflect the system of their relationships with adults, in particular with parents. The main thing here is to choose the right conditions for the role-playing game, which will allow you to open up and show your true colors to all participants.
Advantages of ISP:
- simplicity and naturalness of the process;
- quickly establishing contact with a psychotherapist;
- active inclusion in the process of young children who are not able to clearly verbalize their feelings, emotions, sensations;
- the ability to identify unconscious or hidden problems that relatives are not ready to discuss openly;
- demonstrating relationships in symbolic form;
- the ability to shorten the long course of treatment.
The main concept in COI is transference, when relatives project their interpersonal relationships onto the game. Sometimes decoding their statements and actions is quite complex and requires high professionalism from the psychotherapist.
Positive family therapy
A direction that works with a whole system of relationships, which includes:
- psychotherapist;
- separate personality;
- family;
- society.
The main efforts, of course, are aimed at the family. But the work doesn't stop there. The goal is to create conditions for productive interaction of all members with the people around them: colleagues at work, neighbors, friends, classmates at school. Intrafamily, individual, socioecological and cultural resources are involved. The options for resolving conflicts here are more expanded than in other areas. To eliminate the problem, the psychotherapist actively involves those who make up the family environment.
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Sherman R., Fredman N. Structured family therapy techniques: A manual . - M., 2001, 336 p.
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CONTENT
PREFACE………………………………………… 1 CHAPTER 1: CONSTRUCTION AND USE OF TECHNIQUES………….. 4 CHAPTER 2: FANTASY AND IMAGERY……………………………. 14 INTRODUCTION……………………………………………………………. 14 2-1."MEMORIES" ………………………………….. 20 2-2. FAMILY PHOTOS…………………………………… 24 2-3 FAMILY PUPPET INTERVIEW……………………….. 31 2-4. POETRY AND SONG LYRICS IN MARRIED GROUPS……… 35 2-5. "IF I WERE"…………………………………. 39 2-6 CREATION OF SIMILAR SITUATIONS……………………… 44 2-7 COMPLETION OF A SENTENCE……………………………. 47 2-8 CLARIFYING VALUES “MOM ALWAYS SAYS...DADDY ALWAYS SAYS”…………………………….. 51 2-9 COMPARING VALUES……………………………. 57 2-10 USE OF DREAMS IN FAMILY THERAPY……………… 60 2-11 DRAW THE DREAM…………………………………….. 64 2-12 ROLE OF DREAMS IN SEXUAL THERAPY………… …… — 2-13 THE ROLE OF IMAGINATION IN SEXUAL THERAPY…………….. — 2-14 IMAGERY: EVENTS IN THE PARENTAL FAMILY………………. 68 2-15 GUIDING IMAGE: INTERNAL ADVISOR……………. 72 2-16 MARITAL IMAGES……………………………………. 78 2-17 AN EMPTY CHAIR IN FAMILY THERAPY………………………. 81 Chapter 3: SOCIOMETRIC TECHNIQUES……………………… 87 INTRODUCTION……………………………………………………………. 87 3-18 FAMILY SCULPTURE……………………………… 91 5-19 FAMILY CHOREOGRAPHY…………………………….. 98 5-20 GENOGRAM……………… ………………… 102 3-21 ROLE-PLAYING CARD GAME…………………………… 110 3-22 ECO MAP: MAPPING THE FAMILY SYSTEM……………. 117 3-23 THE STRAW TOWER………………………………… 124 3-24 FAMILY SPACE…………………………… - 3-25 FAMILY SOCIOGRAM…………………… ……….. — Chapter 4: STRUCTURAL MOVEMENTS…………………………….. 130 INTRODUCTION………………………………………………………. 130 4-26 TRACKING………………………………………….. - 4-27 SUPPORTING INTERGENERATIONAL BOUNDARIES………………………. 136 4-28 JOINING THE SUBSYSTEM……………………….. 141 4-29 STRATEGIC ALLIANCES…………………………… 147 4-30 FAMILY RITUAL……………………… …………. 151 4-31 VACATION……………………………………………………………. — 4-32 EXCHANGE OF ROLES………………………………………………………. 156 4-33 CHALLENGE OF COMPLEMENTARITY…………………………… 160 Chapter 5: BEHAVIORAL TASKS………………………….. 167 INTRODUCTION…………………………………… ………. 167 5-34. MARITAL CONFERENCE AND FAMILY COUNCIL………….. 171 5-35 “MARITAL CONTRACT” GAME………………………. — 5-36 DAYS OF CARE…………………………………….. 178 5-37 STRUCTURED TASKS DURING THE SESSION………….. — 5-38 POSITIVE EXCHANGES………………… …………….. 183 5-39 READING OUT LOUD IN MARITAL THERAPY………………… 189 5-40 TEACHING AWARENESS OF CHOICE……………………….. 194 5-41 SYMBOLISM AND GIFTS…… ………………………… — 5-42 STRUCTURED COMMUNICATION TRAINING…………………. — CHAPTER 6: PARADOX………………………………………………………. 200 INTRODUCTION……………………………………………. 200 6-44 REFRAMING……………………………………………………… 210 6-45 SIMULATION OF SYMPTOMS……………………………………. 215 6-46 THE ILLUSION OF ALTERNATIVES……………………………… 218 6-47 PARADOXICAL LETTER: HOW TO GET A RESISTANT FAMILY MEMBER INTO THERAPY…………… 221 6-48 CONTAMINATION OF SUICIDAL FANTASIES……………… …. 225 6-49 PSYCHOTHERAPIST AS DIRECTOR OF A FAMILY DRAMA………….. 230 6-50 PRESCRIBED NON-RESOLVATION OF PROBLEMS…………………. — 6-51 BETS WITH TEENAGERS………………………………. 236 6-52 JOINING THE OPPOSITION: APPLYING THE PARADOX IN THE CASE OF A DEVIANT CLIENT AND HIS COMPLIANT FAMILY… 239 6-53 MAKING THE CLIENT RESPONSIBLE FOR THE SYMPTOM…………….. - CHAPTER 7: ALTERNATIVE MODELS…………………… …… 246 INTRODUCTION……………………………………………. 246 7-54. CO-THERAPY…………………………………….. 247 5-55. VCR PLAY……………………… 252 7-56. PHONE CALLS DURING THE SESSION………………… 256 7-57. HOME VISITS………………………………… 259 7-58. FAMILY THERAPY MARATHON………………….. – 7-59. WORKING WITH SIMULATED FAMILIES…………………. — Chapter 8: EPILOGUE……………………………………… 263 Literature………………………………………….. 269
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