Family Systems Therapy

The "Systems" Perspective

The individual is best understood through assessing interactions between and among family members and the living systems that the client is connected to. The family is a functioning unit that is more than the sum of its various members.

The actions of one influence all the others...

Development of Family Systems Therapy

Alderian Family Therapy 

 

Alfred Adler (1870-1937)

Key Concepts and Techniques

• Family constellations (or systems)
• Purposeful behaviors
• Birth positions within the family
• Both parents and children become locked in repetitive , negative interactions based on mistaken goals

Multigenerational Family Therapy 

Dr. Murray Bowen (1913-1990)

Key Concepts and Techniques

• Focus on patterns across multiple generations
• Triangulation - development of triads in a two against one experience between family members
• Differentiation of self - The psychological separation of intellect, emotion, and independence of the self from others.

Human Validation Process Model

 Virginia Satir (1916-1988)

Key Concepts and Techniques

• Emphasis on family connection
• Development of a nurturing triad ~ two people working together for the well being of another
• The importance of connection and meta-connections
• Four communication stances: Blaming, Placating, Super Reasonable, Irrelevance
• A strong belief in congruence or emotional honesty, in which one speaks for oneself.

Experiential Family Therapy

Carl Whitaker (1912-1995)

Key Concepts and Techniques

• Application of existential therapy to family systems therapy
• A focus on choice, freedom, self-determination, growth, and actualization
• Importance of the relationship between the family and therapist
• Maintenance and enhancement of anxiety to use as a motivator for change
• The involvement of the therapist makes a difference
• Utilization of a therapist and co-therapist

  

Structural-Strategic Family Therapy

Salvador Minuchin (b.1921)

Key Concepts and Techniques

• Symptoms are understood from interactional patterns and sequences within a family
• Changes must occur within the family before the individual symptoms can be eliminated
• Reduce symptoms of dysfunction
• Structural change through modification of family rules and development of more appropriate boundaries
• Interventions include joining, boundary setting, re-framing, unbalancing, enactments, and ordeals.

 

 

The "Movements" of Family Therapy

1. Forming a relationship between the therapist and family.
2. Conducting as assessment using genograms and/or circular or relational questioning.
3. Hypothesizing and sharing of meanings.
4. Facilitating change through planning, techniques, interventions, enactments, or assignments of tasks.

References:
 Corey, Gerald (2012). Theory and Practice of Counseling and Psychotherapy. 9th ed.
      Belmont,California: Brooks/Cole. (pp. 433-458).
  

  

  

 
 

 

  

Postmodern Therapies

Social Constructionism

The psychological expression of the postmodern worldview which values the client's reality without disputing its rationality or accuracy in addition to focusing on a collaborative partnership over assessments or techniques.

Solution-Focused Brief Therapy (SFBT)

Steve deShazer

(1940-2005)

 Insoo Kim Berg

(1935-2007)

Concepts of SFBT 

• Clients want to change, can change, and are doing their best to make change happen.
• No problem is constant ~ Change IS inevitable.
• Positive psychology ~ a focus on what is right and working rather than dwelling on weaknesses and deficits.
• Positive orientation that clients are competent and accepted as they are.
• Present and future focused.
• Goal oriented.
• Clients choose the goals they wish to accomplish.
• Behavior change is the most effective approach to enhancing one's life.

Goals of SFBT

• Goals are unique to each client and are constructed by the client to create a fuller future.
• The client should express what they want to achieve in therapy.
• Small, realistic, achievable changes that can lead to additional positive outcomes.
• To talk about change produces change.
• The therapist assists the client in creating well defined goals that are:

1. Stated positively in the clients language
2. Process or action oriented
3. Structured in the here and now
4. Attainable, concrete, specific, and measurable
5. Controlled by the client

   

Techniques of SFBT

• Pre-therapy change or events that are set into motion by simply scheduling the initial appointment.
• Exceptions and exception questions
• Scaling questions - Scales of 0 through 10
• The Miracle Question - "If a miracle happened and this problem was solved, what would be different?"
• Change focused questions
• Formula First Session Taste - homework that occurs between the 1st and 2nd visit that places emphasis on future solutions over past problems.
• Therapist feedback to clients
• Termination focus

  

 Narrative Therapy

Michael White

(1949-2008)

David Epston

(b. 1944)

 

Concepts of Narrative Therapy

• Listening to the clients' stories without judgement or blame while affirming and valuing them.
• Separation of the person from the problem in their mind.
• The client is the primary interpreter of their own experiences and is the expert on what they want.

Goals of Narrative Therapy

• To invite people to describe their experience in a new and fresh language so that they may discover what is possible.
• To enlarge perspective and focus and to facilitate discovery or creation of new options that are unique to the client.

 

 

Techniques of Narrative Therapy

• Narrative therapy is not technique driven and has no set agenda or specific formula.
• The therapists creation of an encouraging climate to see the clients stories from different perspectives.
• Circular, relational questions designed to empower clients in new ways and to discover the clients experience.
• Externalization - The person is NOT the problem, the PROBLEM is the PROBLEM.
• Alternative stories and re-authoring of stories.
• A search for unique outcomes and assisting clients in finding new meanings and outcomes.

     

   

References:
 Corey, Gerald (2012). Theory and Practice of Counseling and Psychotherapy. 9th ed.
      Belmont,California: Brooks/Cole. (pp. 396-426).

 

Feminist Therapy

Concepts

Feminist therapy focuses on the importance of understanding and acknowledging the psychological oppression of women and the constraints imposed by sociopolitical status to which women have been relegated.

Therapy is viewed as a partnership between equals, incorporates strategies from many other therapeutic models, and seeks to understand the forces of social, political, and cultural change that damage and constrain girls and women, as well as boys and men.

Principles of Feminist Therapy

1. The personal is political in that problems originate in a political and social context.
2. Commitment to social change in additional to individual change.
3. Women's and girl's voices and ways of knowing are valued and their experiences are honored.
4. The counseling relationship is egalitarian in which the client is the expert in their own life and power is shared between the client and therapist.
5. Focus on strengths and a reformulated definition of psychological distress with attention placed on communication rather that a disease model of mental illness.
6. All types of oppression are recognized.

Key Figures in Feminist Therapy

Jean Baker Miller, MD

Carolyn Zerbe Enns, PhD

Olivia M. Espin, PhD

Laura Brown, PhD

Goals of Therapy

• To EMPOWER all people to create a world of equality that is reflected on individual, interpersonal, institutional, national, and global levels.
• Viewing oneself as an active agent on behalf of themselves and on behalf of others.
• Valuing and affirming diversity
• Striving for change rather than adjustment
• Equality
• Balancing independence and interdependence
• Social change
• Self nurturance
• Transformation for both the individual and society as a whole.

Techniques

• EMPOWERMENT of the client
• Self disclosure
• Gender-role analysis
• Gender-role intervention
• Power analysis
• Bibliotherapy
• Assertiveness training 
• Reframing
• Relabeling
• Social action
• Group work

  

References:
 Corey, Gerald (2012). Theory and Practice of Counseling and Psychotherapy. 9th ed.
      Belmont,California: Brooks/Cole. (pp. 361-387).


 

Reality Therapy

CHOICE THEORY

Five genetically encoded needs which serve as the theoretical basis for reality therapy

REALITY THERAPY

• A focus on unsatisfying relationships or lack of relationships, which is often a cause of problems.
• Prioritizing wants and uncovering what is most important
• Understanding total behavior which is made up of acting, thinking, feeling, and physiology

CHARACTERISTICS OF REALITY THERAPY

• Emphasis on choice and responsibility
• Rejection of transference
• Keeping therapy in the present
• Avoiding a focus on symptoms
• Challenging traditional views of mental illness
• Understanding our "quality world" or our file of wants which lies at the core of our lives and consists of people, activities, events, beliefs, possessions, and situations that fulfill our needs 

KEY FIGURES

Dr. William Glasser 

Robert E. Wubbolding, EdD

 

GOALS OF REALITY THERAPY

• To assist clients in getting connected or reconnected with the people they have chosen to put in their quality world.
• To help the client learn better ways of fulfilling all of their needs
• Assisting clients in making more effective and responsible choices related to their wants and needs
• Behavioral change
• Better decision making
• Improvement of significant relationships
• Enhanced living
• More effective satisfaction of all psychological needs

TECHNIQUES

• Creation of a supportive and challenging environment to allow clients to begin making life changes
• Implementation of specific procedures that will lead to changes in behavior
• Wubbolding's WDEP System - Strategies which assist clients in satisfying and exploring their basic needs.

1. Wants, 
2. Doing and Direction
3. Evaluation of Self
4. Planning and Action

References:
 Corey, Gerald (2012). Theory and Practice of Counseling and Psychotherapy. 9th ed.
      Belmont,California: Brooks/Cole. (pp. 334-356).
 
 

Cognitive Behavior Therapy

Concepts of Cognitive Behavioral Therapy

• A collaborative relationship between the therapist and client
• Psychological distress is a function of disturbances in thinking processes
• A focus on changing thoughts to produce desired changes in affect and behavior
• A present centered and time-limited focus
• An active and directive stance by the therapist
• An educational treatment that focuses on specific and structured target problems
• The client must play an active role in the therapeutic process
• Strong emphasis on "homework"

Important Figures

Albert Ellis (1913-2007)

Founder of Rational Emotive Behavior Therapy 

Aaron Beck (1921- present)

Founder of Cognitive Therapy

Donald Meichenbaum (1940 - present)

Founder of Cognitive Behavior Modification

Goals Of Each Approach

  Rational Emotive Behavior Therapy 

• To teach clients how to change their dysfunctional emotions and behaviors into healthy ones.
• To assist in the process of achieving unconditional self acceptance (USA) and unconditional other acceptance (UOA) and how these are interrelated.
• Utilization of the A-B-C framework to understand the client's feelings, thoughts, events, and behavior.

 

Cognitive Therapy

• To provide symptom relief
• Providing assistance in resolving the client's most pressing problems
• Teaching clients relapse prevention strategies

Cognitive Behavior Modification

• Focus on changing the clients self-verbalizations
• Helping clients become aware of their self-talk and the stories they tell about themselves
• The client must notice how they think, feel, and behave and the impact that this has on others before their behavior can change.

Techniques of Each Approach

 

Rational Emotive Behavior Therapy 

Cognitive Methods 

• Disputing irrational beliefs
• Doing cognitive homework
• Bibliotherapy 
• Changing one's language
• Psychoeducational methods

Emotive Techniques

• Rational emotive imagery
• Humor
• Role playing
• Shame attacking exercises

Behavioral Techniques

• Operant conditioning
• Self-management principles
• Systematic desensitization
• Relaxation techniques
• Modeling
• Behavioral homework assignments

Cognitive Therapy

• Focus on identifying and examining beliefs, the origin of the beliefs, and modification of these beliefs if the client can not support them.
• Activity scheduing
• Behavioral experiments
• Skills training
• Role playing
• Behavioral rehearsal
• Exposure therapy
• Examination of automatic thoughts
• Education on the process of magnification and minimization of thinking

Cognitive Behavior Modification

• Self observation
• Starting a new internal dialogue
• Learning new skills
• Stress Inoculation Training
• Incorporation of the constructivist narrative perspective

References:

 Corey, Gerald (2012). Theory and Practice of Counseling and Psychotherapy. 9th ed.

      Belmont,California: Brooks/Cole. (pp.288-324).

 

 

Gestalt Therapy

"THE POWER IS IN THE PRESENT"

Goals of Gestalt Therapy:

Self Acceptance

Responsibility for choices

Contact within interrelationships

Experience of the here & now

Focus on the present instead of the past or future

Increased awareness

Contact with our external and internal environments 

Quality of contact with ourselves and others

Important Figures in Gestalt Theory

Frederick S. "Fritz" Perls, MD, PhD

1893 - 1970

 Laura Posner Perls, PhD.

1905 - 1990

Paradoxical Theory of Change 

Authentic change occurs when we are being who we are rather than when we are attempting to be who we are not. 

"BE" in your current condition, rather than striving to become what you "SHOULD BE".

Key Concepts of Gestalt Therapy Theory

• Holism - Focus on the whole person to include thoughts, feelings, behaviors, the body, memories, and dreams
•  The Figure - The foreground or aspect that are considered most relevant to our experience at the moment.
• The Ground - The background, or aspects that are out of our immediate awareness. 
• Field Theory -  Everything is relational and must be seen in its environment.
• Figure-Formation Process - How an individual organizes experiences from moment to moment.
• Organismic Self-Regulation - Actions and contacts that will restore one's balance after our equilibrium is disrupted by a need, sensation, or interest.
• The NOW - Emphasis on learning to appreciate and fully experience the present moment.
• Resolution of unfinished business which may muddle our present awareness.
• Attention to energy and avoidance of behaviors that may block our energy.  

TECHNIQUES

EXERCISES:

Internal Dialogue Exercise

Empty Chair Technique
"Making the Rounds" Exercise
The Reversal Exercise
The Rehearsal Exercise
Exaggeration Exercise
"Staying with the Feeling" Exercise
Dream Work


THE EXPERIMENT 
A method that is crafted to fit the individual as they exist in the here and now and is utilized to assist the client in active self exploration. 


CONFRONTATION
An invitation for the client to examine their thoughts, attitudes, and behaviors and how they may be blocking their strengths.  

 References:
 Corey, Gerald (2012). Theory and Practice of Counseling and Psychotherapy. 9th ed.
      Belmont,California: Brooks/Cole. (pp. 211-239).

 
 

 

 

 

Behavior Therapy

A Current View of Behavior Therapy

"The person is the producer and the product of his or her environment." (Corey, 2009)

Seven Key Characteristics of Behavior Therapy

1. Based on the principles and procedures of the scientific method.
2. Behavior includes actions as well as internal processes such as thoughts, images, beliefs, and emotions and can be operationally defined.
3. Dealing with current problems and the factors that influence present functioning through functional assessment and behavioral analysis.
4. Clients must assume an active role in dealing with their problems. DO something to bring about change.
5. Changes in behavior can occur prior to or simultaneously with understanding of oneself.
6. Assessment informs the treatment process and is an ongoing process of observation and self-monitoring.
7. Behavioral treatments are tailored to specific problems experienced by each individual client.

 

Important Figures in Behavioral Therapy

B.F. Skinner (1904 - 1990)

Albert Bandura (1925 - )

Arnold A. Lazarus (1932 - )

Goals of Behavior Therapy

To increase personal choice and create new conditions for learning.

Behavior therapy is a goal oriented procedure in which the client and the therapist define clear, concrete, understood, and agreed upon objectives that result in a negotiable contract that guides the course of therapy. 

Techniques

• Classical Conditioning 
• Operant Conditioning - Positive/Negative Reinforcement, Positive/Negative Punishment, and Extinction
• Progressive Muscle Relaxation
• Systematic Desensitization
• Exposure Therapies & Flooding - Imagined and In Vivo
• Eye Movement Desensitization and Reprocessing (EMDR)
• Social Skills Training 
• Assertion Training
• Self-Management Programs
• Multimodal Therapy 
• Mindfulness and Acceptance Based Cognitive Behavioral Therapy

 

References:

Corey, Gerald (2012). Theory and Practice of Counseling and Psychotherapy. 9th ed. 

      Belmont,California: Brooks/Cole. (pp. 245-281).

VPlatform. (2009, Sep 17). Window to an EMDR Session [Video file]. Retrieved from 

       http://www.youtube.com/watch?v=bqbFIj5vwmA&feature=related