CONTAINS VARIOUS OBJECTIVES, TECHNIQUES UNDER FAMILY THERAPY.

1. PRESENTED BY : RITIKA SONI
FAMILY THERAPY

2. Introduction
• Family therapy is often thought of as
therapeutic modality
– To be employed when overt conflict is recognized
in members of the same family and
psychotherapeutic interventions are required .
– Is an essential intervention in a family system to
change the family.
– Family is the unit which is being treated for better
interactions among each other.
– Can be conducted at hospital or during home visit
– Maximum 20 sessions are planned and by the end
of 10th session changes can be seen.

3. DEFINITION
• “A psychotherapeutic approach that focuses on
interactions between a couple with in nuclear family
or its members in extended family or between the
family and other interpersonal system with the goal
of alleviating problems initially presented by
individual family members , family subsystems , the
family as a whole or other referral sources.”
Wynne, 1988

4. How many sessions will we need?
• Wherever possible, decisions about the
number of sessions and the intervals
between appointments are made
collaboratively between the therapist and
family.
• The number of appointments offered will
depend on the service setting and family
members’ needs.
 Most sessions last between 45 minutes and
one and a half hours.

5. Do family therapists only work
with families?
• No.
• They may see children and adults individually and/or in family
member groups. They may work with couples, or with other groups
and communities.
• When a family is involved with several different agencies, family
therapists may work with the network of professionals as well as
with family members
– to ensure their input is coordinated and helpful.
– Some systemic psychotherapists use their understandings of
relationships to work with organizations.
– Many use their skills in family sensitive working to supervise other
professionals

6. What’s meant by ‘family’?
• Family therapists recognize that different
cultures and groups have different ideas of what
‘family’ means.
• They take ‘family’ to describe any group of
people who care about each other and define
themselves as such. As well as parents and
children of all ages, they may work with
grandparents, siblings, uncles and aunts, cousins,
friends, carers, other professionals
• whoever people identify as important to their
lives

7. TYPES
1.FAMILY SYSTEM THERAPY :
o To clarify and distinguish thinking and feeling
process in the family members which leads to
undifferentiated family ego
2. FAMILY STRUCTURE THERAPY :
o Based on a normative concept of a healthy
family , emphasizing the boundaries between
family subsystem and the establishment ,
maintenance of a clear hierarchy based on
parental competence.

8. Functional
Family Therapy
• Functional Family Therapy (FFT) is a :
family-based prevention and intervention
program to treat a range of these high-risk
youth and their families.
• As such, FFT is a good example of the current
generation of family-based treatments for
adolescent behavior problems
(Mendel, 2000; Sexton and Alexander, 1999)

9. FFT may include :
 diversion, probation, alternatives to
incarceration, or reentry programs for youth
returning to the community following release
from a high-security, severely restrictive
institutional setting.

10. • FFT is a short-term intervention
— including, on average, 8 to 12 sessions for
mild cases and up to 30 hours of direct service
(e.g., clinical sessions, telephone calls, and
meetings involving community resources)
- for more difficult cases.
 In most cases, sessions are spread over a 3-
month period.

11. Core Principles, Goals,
and Techniques
• To identify the primary focus of intervention (the
family)
• reflect an understanding that positive and negative
behaviors both influence and are influenced by
multiple relational systems (i.e., are functional).
• FFT is a multisystem prevention program,
 meaning that it focuses on the multiple domains and
systems within which adolescents and their families
live.
 FFT is also focuses on the treatment system, family and
individual functioning, and the therapist as major
components.

12. • FFT works first to develop family members’
inner strengths and sense of being able to
improve their situation.
• These characteristics provide the family with
a platform for change and future functioning
that extends beyond the direct support of the
therapist and other social systems.
• In the long run, the FFT philosophy leads to
greater self-sufficiency, fewer total treatment
needs, and considerably lower costs.

13. Functional Family Therapy Clinical
Model: Intervention Phases Across
Time
Assessment…………………………………………………………………
Intervention…………………………………………………………………
Early Middle Late
Engagement
And Motivation
Behavior
Change Generalization

14. 1.Engagement and Motivation
Phase goals
Develop alliances.
Reduce negativity, resistance.
communication .
Minimize hopelessness.
Reduce dropout potential .
Develop family focus.
Increase motivation for
change.
2.Behavior Change
Phase goals
• Develop and implement
• individualized change plans.
• Change presenting
• delinquency behavior.
• Build relational skills (e.g.,
• communication and
• parenting).
• 3.Generalization
Phase goals
• Maintain/generalize
change.
• Prevent relapses.
• Provide community
resources
• necessary to support
change.

15. 1.Risk and protective
Factors addressed
• Negativity and blaming (risk).
• Hopelessness (risk).
• Lack of motivation (risk).
• Credibility (protective).
• Alliance (protective).
• Treatment availability
2.Risk and protective
Factors addressed
• Poor parenting skills (risk).
• Negativity and blaming (risk).
• Poor communication (risk).
• Positive parenting skills
• (protective).
• Supportive communication
• (protective).
• Interpersonal needs
• Parental pathology (depends
on context).
• Developmental level (depends on
context
3. Risk and protective
Factors addressed
• Poor relationships with school/
community (risk).
• Low level of social support
(risk).
• Positive relationships
with school/community
(protective).

16. 1.Assessment focus
• Behavior (e.g., presenting
• problem and risk and protective
• factors).
• Relational problems sequence
• (e.g., needs/functions).
• Context (risk and protective
• factors).
2.Assessment focus
• Quality of relational skills
• (communication, parenting).
• Compliance with behavior
• change plan.
• Relational problem sequence
3. Assessment focus
• Identification of community
• resources needed.
• Maintenance of change.

17. 1.Therapist/
Interventionist skills
• Interpersonal skills (validation,
• positive interpretation,
• reattribution, reframing, and
• sequencing).
• High availability to provide
• services.
2.Therapist/ Interventionist
skills
• Structure (session focusing).
• Change plan implementation.
• Modeling/focusing/directing/
• training.
2.Therapist/
Interventionist skills
• Family case manager.
• Resource help.
• Relapse prevention
• interventions

18. Structural Family Therapy
• Salvador Minuchin’s Background :
Born in 1921 to Russian Jewish emigrants in Argentina
 In 1948 he joined the Israeli army as a doctor
 In 1950, Minuchin came to United States with the
intention of studying with Bruno Bettelheim in
Chicago
1. Met Nathan Ackerman in New York and
chose to stay there
2. In 1954 Minuchin began studying
psychoanalysis .

19. Minuchin Became Director of Philadelphia
Child Guidance Clinic (1967)
 He transformed the clinic into a family therapy center
 Gained a reputation as a tough and demanding
administrator
 Developed many innovative ideas at the Clinic
Example: Institute for Family Counseling, a training
program for community paraprofessionals that was
effective in providing mental health services to
the poor
 Minuchin published Families and Family Therapy in1974
 Most clearly written and popular books in field of family
therapy
 In 1975 Minuchin stepped down as director of clinic, but
remained head of training until 1981

20. Key Concepts of Structural Family Therapy
• Focus is on family interactions to understand
the structure/organization of the family
• Symptoms/presenting problem viewed as by-
product of structural failings
• Structural changes must occur in a family
before an individual’s symptoms can be
reduced

21. Structural Goals
– To the extent permitted by the hypotheses, the therapist
determines immediate goals for the intervention that is to
follow
• Reduce symptoms of dysfunction
• Bring about structural change because it is assumed that faulty
family structures have:
– Boundaries that are rigid or diffuse
– Subsystems that have inappropriate tasks and functions

22. Structural Family Therapist’s Function
• The therapeutic task is to help move family
from a dysfunctional stage to a new stage
(evolved different structures have more
stable levels of functioning)
• Actively engage family unit to initiate
structural change by joining and
accommodating.

23. Understanding the Problem
 The therapist determines the issues around
which to explore and intervene in the session.
• Joining the family in a position of leadership
entering their reality and becoming part that
family’s patterns of relating/structure

24. Collecting Data
The therapist tracks content and learns about the family
issue and draws together all data relevant to the issue
as gathered from prior information
– Mapping family’s underlying structure
observe family to see structure, focusing on the how,
when, and to whom family members relate
– who says what to whom
– in what way
– with what result

25. Formulating Hypotheses
On the basis of the data, the therapist commits to
hypotheses about the significance of the current
transactional sequence of the nature of the problem, its
locus, and sustaining structure.
– Conducts experiments through probes and challenges to
assess the flexibility of family patterns

26. Intervening
– Intervening in ways designed to transform an ineffective structure
– The therapist:
(a) to facilitates change in patterns of transactional sequences among
family members and/or between self and family members
(b) to controls for variables in the transaction so that the effects of the
intervention can be assessed
– Challenging family rules, fostering boundary reorganization,
prompting conflict resolution, creating an effective hierarchical
structure, increasing degree of flexibility in family interactions,
modifying dysfunctional family structures, and supporting greater
individuation of family members.
Feedback
– On the basis of the reactions of the family members to the
intervention, the therapist restarts the cycle from the second step.

27. Family Structure
• Invisible set of functional demands or rules that
organize way family members relate to one
another
• Family Subsystems :
• Spousal: wife & husband
• Parental: mother & father
• Sibling: children
• Extended: grandparents, other relatives
• Family member play a different role in each of
the subsystems they belong
• Structural difficulty when one subsystem takes
over or intrude another

28. Seven stages of family life cycle :
1. Pairing/Marriage Fusion Leaving family of origin (emotionally and
physically) Readiness for intimacy (psychological and sexual) Agreeing
roles, goals and values Complementarities /symmetry of marital
relationship
2. Childbearing :
Childbearing Sharing each other Role ambiguity - wife, woman or mother?
Two's company, three's a crowd Pairing off
3. School-age-Children :
School-age-Children Providing security (emotional and
environmental)How to be a parent Separation anxiety Involvement with
community Mother with more time again Differences between children
4. Family with adolescent children :
Family with adolescent children Control versus freedom Power struggle
and rebellion Individuation Social and sexual exploration

29. 5. Family as a launching ground :
Family as a launching ground Changing roles of children still
at home The empty nest - loss or opportunity? Parents
rediscover each other Latent marital conflict
6. Middle Years :
Middle Years Mid-life crisis Fulfillment /disappointment
Accepting limitations Changing self-image Anticipating
retirement ? Death of parents
7. Old Age :
Old Age Aging, illness and death Closing-in of boundaries
Achieving serenity Religion and philosophy
Isolation/dependency Bereavement

30. Family Therapy Techniques :
1.Family Systems Approach
e.g. : husband's depression can affect the wife and
children just as a child's eating disorder can be both a
result of familial expectations and a pressure on the
family dynamic.
 Effective family therapy techniques involve the entire
family in the diagnosis of problems as well as the
short-term and long-term treatment options.

31. 2. Observation :
• A clinical psychologist is trained to observe the family
dynamic and monitor both verbal and non-verbal cues.
• During the assessment phase and initial interviews, the
family systems psychologist will monitor how the parents
interact with each other and how their children react to
them.
• He or she will compare his or her observations with testing
data offered in both subjective and objective forms.
– The subjective test data is gathered during the interview
– the objective test data is gathered via clinical tests that family
members are requested to fill out and return to the
psychologist.

32. 3. Effective Communication
• Effective communication is an important lessons
that family systems psychologist incorporate into
group and individual family therapy sessions.
– To create an effective solution to any dysfunction or
problem in the group dynamic requires effective
communication so that all members of the group or
family are in touch with each other.
• Effective Communication allows a family to
dialogue on their problems, concerns and feeling
obligated to resolve the problems being shared.
• A large portion of effective communication
resides in active listening, a skill that must be
learned.

33. 4. Problem Solving :
4. Problem solving is an effective therapy
technique not because it teaches the family
how to resolve the issues
 but it teaches them how to identify,
develop plans and create resolutions for
future problems.
 Problem solving may seem like a common
sense resolution, but it requires a willingness
on the parts of all parties to contribute to the
solution

34. 5.Psycho education:
 Psycho education refers to the education offered to people
who live with a psychological disturbance.
 Frequently psycho education training involves patients with
schizophrenia, clinical depression, anxiety disorders, psychotic
illnesses, eating disorders, and personality disorders, as well
as patient training courses in the treatment of physical
illnesses.
 Family members are also included.
 A goal is for the patient to understand and be better able to
deal with the presented illness.
 Also, the patient's own strengths, resources and coping skills
are reinforced,
 in order to avoid relapse and contribute to their own health
and wellness on a long-term basis.

35. Indications
• No improvement in individual therapy
• Problem lies in the family rather than an
individual
• Family facing transactional stage in the family life
cycle
• Facing communication problems
• Substance abuse
• Schizophrenia
• Childhood psychiatric disorder
• Psychosis
• Anxiety disorder
• Bipolar disorder

36. AIMS
• To change the relationships which produced
pain in the members
• To establish good communication pattern
• To improve integration of family system in to
societal system
• To assist ,to locate the community resources
• To reduce anxiety , stress and establish
balance in the family.

37. PRINCIPLES
1. is based on principle that “change your behavior
and you will change your relationship”
• Making the use of emotional closeness ,
differentiating the self from ‘we’ relieves the
person from uncomfortable closeness , hostile
rejection which increases emotional closeness
without fusion.
2. the family system itself is more influential than
individual conflicts in producing abnormal
behavior
• It holds that the family system has contributed to
the chronic behaviors which an individual has
developed.

38. 3. In the structured family therapy , change the
origin of the family in such a way that family
members behave more positively and
supportively towards each other.

39. Points to be kept in mind during
therapy
• Always go along with therapy process ,ways of
working and their walks of life , as their mood ,
communication pattern ,and beliefs.
• Give ear to their words
• Respect their culture , values etc.
• Give weight age for the weakness and strength
• Know about available resources
• Respect the supporting family subsystem by
which problem arises or helps to resolve it.

40. Role of nurse
• The nurse plays a vital role in in assisting the therapist,
apart from this she also act as a co-therapist..
– Assess the type of family as functional or dysfunctional
– Assess family for :
 homeostasis ,
 problem solving approach
 attitude about other family members
 relationship among family members
 With neighbor
 Care o child such as overprotection ,distance keeping
parents.

41. • Assist the therapist in selection of type therapy
based on the assessments
• Develop a clear contact with family members
regarding time , sessions , procedures to be
followed
• Encourage the family members to take
responsibility for the self and not try to change
others
• Nurse must limit her action and avoid becoming
involved
• Set up norms , values and rules to be followed
• Help the family to find out their own problem
solving approach.