Couple and Family Therapy A Case Approach, 1st edition by Nancy L Murdock Solution Manual

Instructor's Manual D. Robert Casares, Jr., Wake Forest University

Couples and Family Therapy: A Case Approach 1st Edition

Nancy L. Murdock University of Missouri–Kansas City

Table of Contents CHAPTER ONE: INTRODUCTION

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CHAPTER TWO: STRATEGIC FAMILY THERAPY

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CHAPTER THREE: STRUCTURAL FAMILY THERAPY

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CHAPTER FOUR: EXPERIENTIAL FAMILY THERAPY

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CHAPTER FIVE: BOWEN FAMILY SYSTEMS THEORY

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CHAPTER SIX: COGNITIVE BEHAVIOR THERAPY

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CHAPTER SEVEN: SOLUTION-FOCUSED THERAPY

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CHAPTER EIGHT: NARRATIVE THERAPY

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CHAPTER NINE: EMOTION-FOCUSED THERAPY

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CHAPTER TEN: THE GOTTMAN APPROACH

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CHAPTER ELEVEN: CONCLUSION

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Chapter 1: Introduction

CHAPTER ONE: INTRODUCTION CHAPTER OUTLINE What is family?

“The family is a social system that supports survival and welfare of its members.”

However, what constitutes a family is varied, complicated, and expansive Counselors should approach couples and family counseling with respectful curiosity and an awareness of personal biases What is couple and family therapy? Why do I use the term couple?

In couple and family counseling, the relationship—rather than an individual—is the client A Brief History Family therapy began in the 1940s and 1950s British anthropologist Gregory Bateson introduced systems thinking and cybernetics to the profession of CFT The Palo Alto Group eventually established the Mental Research Institute, which explored and advanced early theory in CFT Notable early CFT figures included Jay Haley, Don Jackson, John Weakland, John Fry, Virginia Satir, Murray Bowen, and Salvador Minuchin 1970–1985: Strategic, Structural, Bowen, and Experiential theories were developed 1980s and 1990s: Increased emphasis on social constructivism and cultural diversity Basic Systemic Constructs The family is a system The family is interconnected—each part affects other parts of the system Systems therapists are more interested in the process (how things happen in a family) than the content (the what) of the happenings There are too many theories!

Review major theories before selecting one It is valuable to learn about and practice a single theory during early efforts to become a CFT Key considerations for selecting a theory: research support and how a particular theory fits with your assumptions about world and style of relating to others Research Research indicates that CFT approaches produce desired client change 1 .

Chapter 1: Introduction

Types of research: outcome research and theory testing research Choosing a Theory Avoid trying to be integrative early in your career The Theories I Chose The CFT approaches presented represent traditional, postmodern/constructivist, and couples-focused theories Conclusion—A Word About My Case-Based Approach Each chapter starts with a case After each construct, principle, or technique associated with a theory is introduced, it is applied to the chapter’s case

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Chapter 2: Strategic Family Therapy

CHAPTER TWO: STRATEGIC FAMILY THERAPY CHAPTER OUTLINE Overview and Background Evolved from the work of early systems theorists, primarily the Palo Alto Group at the Mental Research Institute (MRI) MRI researchers: Gregory Bateson, Jay Haley, Don Jackson, and John Weakland Famously described the concept of double-bind communication Basic Philosophy Goal: Solving the problem as quickly as possible Therapy focuses on the present and emphasizes action over insight Central Constructs Communication Interested in repetitive sequences of interaction that are seen in families and dyads Symptoms are viewed as attempted solutions to problems, although not satisfactory ones Two levels of communication: report (or content) and command (or relationship) aspects Hierarchies Families, like any organization, involve power Those at the top of the family are in charge and those lower in the hierarchy must obey Hierarchies are only to be changed when necessary to change symptoms Typical task for strategic therapists is to get parents back in charge Theory of Development Important life stages for strategic therapists: courting period, early marriage, childbirth and dealing with the young, middle marriage, weaning parents from children, and retirement and old age Health and Dysfunction Dysfunction is rigid, repetitive interactive behavior Problematic hierarchies produce symptoms 3 .

Chapter 2: Strategic Family Therapy

Confused and distorted hierarchies can even reside in healthy families Nonpathological orientation: no problem exists unless the clients identify one Healthy families have clear hierarchies that are consistent with the family’s cultural context Nature of Therapy Assessment No formal assessment or diagnosis is used Observation of interactions provides information about hierarchies and where they might be dysfunctional Overview of Therapeutic Atmosphere Therapist assumes responsibility for the structure of the counseling process Flexibility with use of locations (homes, schools, traditional office space) and time frames for therapy (sessions can last 50 minutes to several hours) Roles of Clients and Counselor Few expectations for client roles Strategic therapists are very active and directive Shoulder total responsibility for the outcome of therapy Closely observe, but typically do not interpret, the family’s ways of interacting Invites cooperation and strives to establish a productive alliance with families Goals Resolve the presenting problem Help clients navigate transitions between life stages Help clients learn more complex ways of communicating and interacting with their systems Process of Therapy Formulate a problem that is solvable Five stages: social, problem, interaction, goal setting, and task setting Therapeutic Techniques Directives Reframing Working with Hierarchical Problems Pretend Directives

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Chapter 2: Strategic Family Therapy

Evaluation of the Theory Research Support Outcome Research Theory-Testing Research Issues of Diversity Family systems approaches are generally susceptible to the charge of cultural bias However, this theory was not based on the traditional White family model This approach is applicable with Black and Hispanic families, and its general predictions about triangulation mostly hold up in Chinese culture Summary Strategic family systems therapists focus on communication, interaction patterns, and hierarchies Interventions are intended to change problematic hierarchical patterns to alleviate undesired symptoms

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Chapter 3: Structural Family Therapy

CHAPTER THREE: STRUCTURAL FAMILY THERAPY CHAPTER OUTLINE Overview and Background Most commonly associated with Salvador Minuchin Minuchin developed the structural approach in partnership with Jay Haley and Braulio Montalvo SFT influenced the later development of Multisystemic Therapy Basic Philosophy Rooted in systemic thinking Individuals experience the twin pulls of belonging and being separate Families are constantly balancing the tension between belonging and autonomy Central Constructs Family Structure “The invisible set of functional demands that organize the ways in which family members interact” Repeated patterns of interaction are the family structure Subsystems Families differentiate into smaller groupings that have different functions (e.g., parental, partner, sibling, etc.)

Boundaries Rules that specify who participates in a system or subsystem When boundaries are too rigid, the system is said to be disengaged When boundaries are unclear, or diffuse, it is said to be emmeshed Power and Hierarchy Typically, parent figures have the most power, placing them at the highest level with children in subsystems below Sometimes deviations in this hierarchy signify disfunction Theory of Development Four stages of family development: couple formation, families with young children, families with school-age or adolescent children, and families with grown children

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Chapter 3: Structural Family Therapy

Becoming a couple requires partners to shift loyalties from their families of origin to their new entity, the partnership The arrival of children requires the system to undergo serious realignment Health and Dysfunction Something about the structure is not working; the problem can typically be seen in the ways in which the family relates Families tend to experience difficulties when old patterns of interaction stop working Dysfunction is discussed as enmeshment or disengagement Healthy families are those whose structures are clearly defined and flexible and up to the task at hand A healthy individual can maintain a good balance between individuation and belonging to the family Nature of Therapy Assessment No formal assessment; rather, a series of questions are considered Some contemporary structural therapists use genograms to explore and document a family’s history Overview of Therapeutic Atmosphere Structural therapists strive to “modify the present, not to explore or interpret the past” No one individual may be viewed as the problem Roles of Clients and Counselor Therapist is the expert—joins with the family but maintains a stance as a leader in the counseling process Goals Changing the structure of the family Solve the presenting problem Impede old patterns of thinking and relating Build on strengths to generate new patterns that lead to results Process of Therapy Therapist is both a leader and a member of the system Four steps: Opening Up the Presenting Complaint, Highlight Problem-Maintaining Interactions, Structurally Focused Exploration of the Past, Exploration of Alternative Ways of Relating Recognizing and acknowledging family strengths is critical 7 .

Chapter 3: Structural Family Therapy

Therapeutic Techniques Reframing Enactment Focusing Achieving Intensity Boundary Making Unbalancing Teaching Complementarity Directives Cognitive Intervention Evaluation of the Theory Research Support Outcome Research Theory-Testing Research Issues of Diversity Has been criticized for offering a traditional family structure Implementing this approach with diverse families requires flexibility and thoughtful consideration of contextual issues Summary SFT is recognized as one of the major theories of couples and family counseling SFT therapists help families change how they see family problems, and therefore to behave differently Very little research has tested the efficacy of this approach

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Chapter 4: Experiential Family Therapy

CHAPTER FOUR: EXPERIENTIAL FAMILY THERAPY CHAPTER OUTLINE Overview and Background Virginia Satir’s human validation process and Carl Whittaker’s symbolic-experiential family therapy are foundational approaches within this tradition Basic Philosophy Humanistic approach, which sees humans as agentic, positive beings with potential to grow if in the right circumstances According to Satir, there are two ways to see people and the workings of the world: the threat and reward model and the seed model Satir agreed with Freud: humans are motivated to love and work Central Constructs Self-Esteem Defined as the degree to which individuals value themselves regardless of the opinions of others One’s level of self-esteem is a product of early family experience Self Mandala Concept of wholeness, used to illustrate the eight aspects of human existence, according to Satir: physical, intellectual, emotional, sensual, interactional, nutritional, contextual, and spiritual The self is at the middle of the mandala Communication The process and outcome of communication is critical to family life At the most basic level, communication between two individuals is a request for validation of one by the other Four problematic patterns of communication: placating, blaming, computing, and being irrelevant Primary Triad A grouping of three family members, or any three people The nature of triangles often leads an individual to feel excluded from the relationship of the other two A child’s idea about personal power are formed in relation to the primary triad

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Chapter 4: Experiential Family Therapy

The power of triangles can be both negative and positive Family Rules Can be overt or covert Should be doable Flexibility and age-appropriateness are also important Should allow family members to share feelings and opinions freely The Iceberg Metaphor This model emphasizes that behavior is the only part of the iceberg that sticks out above the water Below the water is the largest part of the iceberg: feelings, perceptions, expectations, yearnings, and the true, core self Theory of Development Five basic life stages: conception to birth, birth to puberty, puberty to adulthood, adulthood to senior status, and senior status to death The most important forces in development are the people around us when we are young Four important dimensions of family: individual self-esteem of members, communication patterns, rules of the family, and its relation to society Seven processes are essential to becoming fully human: differentiation, relationships, autonomy, self-esteem, power, productivity, and loving Health and Dysfunction According to Satir, “All human beings carry with them all the resources they need to flourish” Behavior is motivated by good intentions and represents the best that the individual knows Satir believed that evil did not exist within people but, instead, in the process between people Healthy people are honest with themselves and others The problem is not the problem; coping is the problem Nature of Therapy Assessment Therapist observes the relationships among family members to gauge communication patterns Self-presentations of family members give information about self-esteem 10 .

Chapter 4: Experiential Family Therapy

Interactions among family members can yield information about covert and overt family rules Overview of Therapeutic Atmosphere Therapists approach families with optimism, warmth, and positivity No prescribed treatments—the therapist strives to tailor treatment to each family’s situation and needs Roles of Clients and Counselor Help people unlock their potential Therapists serve as a resource and an expert, teaching families what they need to learn to communicate more effectively Therapists must be in touch with themselves and nonjudgmental Effectively working with families also requires the therapist to be humble, authentic, and genuine Goals Releasing the blocked potential of families Engaging the healing power of clients Enhancing self-esteem of family members Helping family members become more aware of themselves and others Process of Therapy Three stages of therapy: (1) Contact: family members come to therapy in pain; (2) Chaos: One family member ventures into risky territory, revealing hurt, pain, and/or anger; (3) Integration: The family develops new ways of being and some closure is gained Therapeutic Techniques Family Sculping Communication Analysis Therapist Communications Family Therapeutic Reading Parts Party Evaluation of the Theory Research Support Outcome Research Theory-Testing Research

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Chapter 4: Experiential Family Therapy

Issues of Diversity Useful for working with clients and families from diverse cultural backgrounds Might be inconsistent with the norms of some cultures that hold collectivistic values Summary Therapists working from the Satir model should create a safe, trusting environment for clients and families Family members need to be able to express, experience, and love themselves and others

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Chapter 5: Bowen Family Systems Theory

CHAPTER FIVE: BOWEN FAMILY SYSTEMS THEORY CHAPTER OUTLINE Overview and Background Bowen Family Systems Theory (BFST) was formulated by Murray Bowen (1913–1990), a family therapy pioneer who was influenced by evolutionary and natural systems theory Bowen’s contributions grew out of his analysis of his own journey to differentiate a self in relation to his family of origin Noted Bowenian scholars and practitioners include Michael Kerr, Thomas Fogarty, Philip Guerin, Katherine Guerin, Betty Carter, Monica McGoldrick, Daniel Papero, and Peter Titelman Basic Philosophy Adopts a neutral view of human beings Contends that “the human family system springs from the evolutionary process and not from the human brain” Practitioners are committed to thinking in terms of circular causality rather than in cause-and-effect mode Holds that the basic motivator of human behavior is the need to balance the twin pulls of individuality and togetherness Central Constructs Differentiation of Self Viewed as both an individual and a family construct A lifelong process of managing one’s inherent tendencies to want to bond with others and to establish one’s self as separate Should be thought of on a continuum Individuals who are relatively well differentiated have a solid sense of self Two dimensions: interpersonal (subdimensions: emotional cutoff and fusion with others) and intrapersonal (subdimensions: emotional reactivity and I-position) Chronic Anxiety Considered to be a natural biological phenomenon An organism’s response to imagined threat as compared to acute anxiety, which is a response to real threat Chronic anxiety is integral to understanding psychological dysfunction Triangles 13 .

Chapter 5: Bowen Family Systems Theory

Most basic unit of human interaction, according to Bowen Triangles involve three living people At any given time, two of the people are “in” the group and the third is on the outside Sibling Position Bowen believed that birth order has a profound influence on an individual’s relationship tendencies Deviation from what is expected based on a particular birth position provides valuable information on levels of differentiation and family functioning Theory of Development The essential feature of human life is differentiation The relative level of differentiation is transmitted by the family—the parents’ levels of differentiation determine the children’s levels very early in life The total amount of chronic anxiety experienced and the ways in which it is bound (triangles, couple conflict, symptoms, etc.) are related to the average level of differentiation of family members As a result of all of the natural family processes, we all emerge with some degree of unresolved emotional attachment to our families, particularly our parental figures Health and Dysfunction Individuals and families are constantly struggling to balance the pulls of togetherness and separateness and never perfectly do so Unresolved attachments are carried into future relationships and can cause problems Four general patterns of relationship problems are seen when families are under stress: conflict in the couple’s relationship, dysfunction in a member of the parental couple, dysfunction in a child, and emotional distance The development of symptoms reflects an overfunctioning–underfunctioning pattern Differentiation of self and anxiety combine to determine the level of an individual’s functioning Nature of Therapy Assessment Two basic techniques: informal assessment accomplished through questioning and the family diagram (also called a genogram) is the formal method of assessment Overview of Therapeutic Atmosphere Therapy is a research project through which all can learn about family process and defining a self with it

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Chapter 5: Bowen Family Systems Theory

Single out the leader of the family (the person with the highest level of differentiation of self), as they are most likely to take steps toward differentiating Roles of Clients and Counselor Therapist is very active and seeks to stay “detriangled from the emotional process” Effective BFST therapists are teachers and coaches Therapists resist attempts to provide direct emotional support, approval, or reassurance Goals Promote differentiation of self Reduce anxiety in the individual and/or system Promote healthy family connections Decrease emotional reactivity, increase self-focus, disrupt dysfunctional patterns Process of Therapy Therapist asks questions and focuses on “facts” rather than feelings Strive to keep affect down in sessions so that all involved can be objective and operate on the basis of intellect instead of emotion Clients are asked for perspectives and opinions rather than feelings Therapeutic Techniques Journeys Home Process Questions Establishing Person-to-Person Relationships Observing Family and Controlling Emotional Reactions Detriangling Taking an I-Position Evaluation of the Theory Research Support Outcome Research Theory-Testing Research Issues of Diversity Bowen maintained that his theory and its constructs are universal; however, some question this assumption The qualities Bowen associates with differentiation have been critiqued for seeming 15 .

Chapter 5: Bowen Family Systems Theory

closer to those associated with men Also criticized for a tendency to blame dysfunction on mothers Some have questioned the theory’s suitability for working with Hispanic clients/families Others contend that the tenets and techniques of BFST are consistent with the expectations of individuals who are of Asian origin Summary Built-in pulls of togetherness and separateness as the driving force behind human behavior Differentiation represents the ability to maintain a steady sense of self while engaging in meaningful intimate relationships The antidote to dysfunction is to increase the level of differentiation in the individual or family

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Chapter 6: Cognitive Behavior Therapy

CHAPTER SIX: COGNITIVE BEHAVIOR THERAPY CHAPTER OUTLINE Overview and Background Cognitive behavior therapy (CBT) is a cluster of models and techniques Involves several different perspectives on human learning that can be applied to working with families and couples (CBT-CF) Influential figures and practitioners: Ivan Pavlov, John B. Watson, B. F. Skinner, Albert Bandura, and Albert Ellis Basic Philosophy Takes a neutral view of human nature Human existence is discussed from an evolutionary perspective—humans are organisms adapting to their environment Behavior serves to obtain things that help people survive How relationship partners think about each other and their behaviors is a strong influence on relationship functioning and health Couples and families are interconnected systems Central Constructs Models of Learning Three major models: classical, operant, and observational Operant Conditioning Behavior is maintained by its consequences (also called reinforcements) Reinforcers are consequences that increase the probability that a behavior will occur Two kinds of reinforcers: positive and negative Extinction refers to the removal of a behavior maintaining reinforcement Punishment, the opposite of reinforcement, is anything that reduces the probability of a behavior occurring Desired behavior can be created by a process called shaping Observational Learning Plays a large part in the acquisition of new behaviors Punished behavior can also be learned through observation Schemas 17 .

Chapter 6: Cognitive Behavior Therapy

The cognitive structures that organize the information with which a person is constantly confronted Can be dominant or active, but we are mostly unaware of them Influence the selection, encoding, and retrieval of information in the cognitive system Automatic Thoughts A normal feature of the cognitive process Swift, evaluative statements or images that exist alongside our more conscious thoughts Can be functional or distressing, but in either case, tend to be reasonable to the thinker Beliefs Rational beliefs are “logical and/or have empirical support, and/or are pragmatic” Irrational beliefs are rigid, demanding musts or shoulds, which are usually, but not always, illogical and unrealistic Five cognitions important for understanding relationship functioning: Assumptions, Standards, Attribution, Expectancies, and Selective Perception Social Exchange Theory Views relationships through the lens of rewards and costs associated with the relationship for each of the participants Theory of Development Interested in what members of couples or families have learned about relationships as they grew up Some believe that patterns of behavior that can be observed in families may have been passed down by previous generations Health and Dysfunction Healthy families engage in adaptive behavior, which promotes survival of the individual and the family unit Healthy relationships and families have more positive interactions than negative Psychological dysfunction is maladaptive cognition and behavior Family/couple distress is attributed to poor communication among members/partners and a lack of, or faulty, problem-solving skills Nature of Therapy Assessment A very important part of CBT-CF 18 .

Chapter 6: Cognitive Behavior Therapy

Three main methods: interviews, self-report questionnaires, and therapist observations Individual assessment may result in a formal diagnosis and consider supplemental individual therapy Overview of Therapeutic Atmosphere Therapeutic relationship is collaborative First few sessions are structured as therapist performs the assessment CBT-CF therapists are likely to teach clients the CBT treatment model, set an agenda and clear ground rules for each session, and assign relevant readings to their clients Roles of Clients and Counselor Primary role for therapists and clients is teacher–student Goals Modify and eliminate problematic cognitions and/or behaviors Replace negative behaviors with positive ones, deactivate negative schemas, and change distorted or irrational thinking Process of Therapy Two distinct phases: assessment and intervention CBT-CF therapist presents a summary of the assessment, which includes a view of presenting problem(s), strengths, and stressors Next, the therapist and couple/family collaborate to set goals The therapist provides a brief explanation of the CBT model and initiates the intervention phase Therapeutic Techniques Behavioral Techniques Shaping Reinforcement Extinction Punishment Communication Training Modeling Altering Behavior Exchanges Cognitive Techniques Identifying Automatic and Distorted Thoughts, Challenging Irrational Beliefs 19 .

Chapter 6: Cognitive Behavior Therapy

Altering Selective Perceptions, Inaccurate Attributions, Inaccurate Expectancies, Unrealistic or Inappropriate Assumptions and Standards Evaluation of the Theory Research Support Outcome Research Theory-Testing Research Issues of Diversity Broad agreement exists that CBT can be adapted to a wide range of client diversity Some Western-based principles of CBT may conflict with the values and norms of other cultures CBT’s individualistic outlook may clash with the values of individuals and families from collectivistic cultures Summary CBT-CF offers a broad and flexible approach to working with individuals in relationships

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Chapter 7: Solution-Focused Therapy

CHAPTER SEVEN: SOLUTION-FOCUSED THERAPY CHAPTER OUTLINE Overview and Background Key figures: Steve de Shazer, Insso Kim Berg, and Bill O’Hanlon Early on, solution-focused therapy (SFT) was referred to as solution-centered, possibility therapy and collaborative, competency-based counseling de Shazer and Berg met at the Mental Research Institute (MRI) in Palo Alto, California, and were married for 28 years SFBT incorporates ideas developed at MRI de Shazer and Berg later founded the Brief Family Therapy Center in Milwaukee, Wisconsin Basic Philosophy Rooted in optimism and believes in the power of language to create and define reality There are no absolute truths Humans create their realities through language and are capable of re-creating more helpful realities during times of trouble Clients are referred to as “customers” and problems are called “complaints” Key assumptions: (1) Clients have strengths and resources to resolve complaints; (2) change is constant; (3) the SF therapist’s job is to identify and amplify change; (4) it is usually unnecessary to know a great deal about the complaint to resolve it; (5) it is not necessary to know the cause or the function of a complaint to resolve it; (6) a small change is all that is necessary—a change in one part of the system can effect change in another part of the system; (7) clients define the goal; (8) rapid change or resolution of problems is possible; (9) there is no one right way to view things; and (10) focus on what is possible and changeable rather than on what is impossible and intractable Central Constructs Exceptions There are always times when the problem does not happen The presenting complaint is not always present—there are times when the client is successful and happy Oftentimes, clients have not paid attention to exceptions Change Talk Problems are discussed in ways that hold the potential to bring about change 21 .

Chapter 7: Solution-Focused Therapy

Complaints are discussed in terms of behaviors that are amenable to change rather than using negative labels Solutions SFT focuses on what clients would perceive as an acceptable solution to the problem Strengths and Resources Therapists in SFT emphasize client strengths and already accessible resources Theory of Development SF advocates do not postulate a theory of development A theory of counseling more than a theory of human nature Not interested in the history of the problem, except in very rare circumstances Health and Dysfunction Therapists in SFT are not concerned with notions of health and dysfunction Clients have complaints and therapists in SFT listen to the client’s construction of the problem, look for exceptions, and construct solutions One way of looking at dysfunction is that clients are stuck Nature of Therapy Assessment Do not believe in traditional assessment Therapists in SFT interview for solutions from the very start of counseling Overview of Therapeutic Atmosphere Clients typically complete four to five sessions, and most find their solutions in fewer than 10 sessions Counselors strive to promote respect and cooperation and avoid passing judgment and making interpretations about client wants, needs, or behaviors Roles of Clients and Counselor Therapists in SFT take full responsibility for what takes place in sessions Therapists take the lead and use a series of questions designed to elicit information about exceptions, solutions, and strengths Three types of clients: visitors, complainants, and customers Goals Three primary goals: (1) change the doing of the situation that is perceived as problematic; (2) change the viewing of the situation that is perceived as problematic; and (3) evoke resources, strengths, and solutions to bring to the situation perceived 22 .

Chapter 7: Solution-Focused Therapy

as problematic Process of Therapy First task is defining and redefining the problem Once a solid relationship is established, the counselor will introduce change talk Therapists in SFT focus on the present, not the past Therapists in SFT interrupt problem-focused talk and redirect discussion to what clients would like to happen instead The initial goal of the first session is to create a solvable complaint The remainder of the first session is devoted to finding exceptions to the complaint and constructing concrete, solvable goals Remaining sessions invite clients to take advantage of the “more of the same” principle—clients are encouraged to do more of what works and abandon what doesn’t Therapeutic Techniques Questions Normalizing the Problem Compliments The Miracle Question Scaling Questions Asking About the Problem Externalizing First Session Formula Task Generic Task Breaking Patterns Surprise Task Write, Read, and Burn Structured Fight Do Something Different Evaluation of the Theory Research Support Outcome Research Theory-Testing Research

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Chapter 7: Solution-Focused Therapy

Issues of Diversity de Shazer argued that because therapists in SFT enter the client’s world, they avoid imposing their own perspective on the client SFT is very focused and directive, which may clash with the values of clients from cultures that are less problem oriented in their approaches to living Some argue that SFT may not be suitable for addressing particular issues, such as domestic violence and past experiences of physical or sexual abuse Summary Therapists in SFT approach couples and families with a model that focuses on client strengths and resources The therapist is the expert on change, but the couple or family is the expert on how and what to change Clients set the goals of therapy and therapists in SFT redefine the problem so that it is solvable

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Chapter 8: Narrative Therapy

CHAPTER EIGHT: NARRATIVE THERAPY CHAPTER OUTLINE Overview and Background Narrative therapists see life as a process of storytelling Narrative therapy (NT) is a relatively new theory rooted in a constructivist approach to psychotherapy Key figures: Michael White, David Epston, Cheryl White, Jill Freedman, and Gene Combs Basic Philosophy Contends that there is no objective reality; instead, the way we view ourselves, others, and the social world in which we live is created (constructed) by social processes and interactions Therapists in NT approach clients from a perspective that emphasizes health and strengths Resists the individualizing of a client’s problems Values accountability of therapists and clients Committed to making therapy as transparent to clients as possible Central Constructs Stories Human life is viewed as a series of stories Some life stories are privileged over others, which become the client’s dominant narrative Other types of stories: alternate, preferred, problem-saturated, and cultural discourse Thinness and Thickness Refers to the qualities of the stories families tell Thin stories contain few events and sparse details Stories become thick because they are told again and again and become embellished with each telling Dominant stories are rich and thick, while alternate stories tend to be sparse and thin Unique Outcomes Events that are not part of the dominant, problem-saturated story They are exceptions to the problem’s rule and are important for helping clients 25 .

Chapter 8: Narrative Therapy

consider new possibilities Five key types: action, reflection, protest, reconceptualization, and new experiences Theory of Development Not interested in traditional theories of development More concerned with the family’s unique trajectory through life, cultural context, and each family member’s understanding of the current situation Therapists in NT see humans as having multiple selves, the expressions of which are situationally determined Health and Dysfunction The term preferred narrative most closely reflects NT’s concept of health A sense of personal agency is evident in members of healthy families Narratives common to all people: fear and love Problem-saturated stories diminish family functioning and well-being Nature of Therapy Assessment Therapists in NT are not very likely to use formal assessments Focus on understanding clients’ perspectives on their lives A series of questions are asked to better understand the life of the problem-saturated story Overview of Therapeutic Atmosphere Marked by a collaborative relationship Process unfolds at the client’s pace Therapist uses clients’ language—typically their actual words and phrasing—as a way of being sure they fully understand the stories shared in session Roles of Clients and Counselor Therapist in NT is a collaborator and consultant Clients are experts on their lives Therapist in NT adopts an attitude of respectful curiosity Goals The creation of new, more satisfying, stories for their clients Deconstruct problem-saturated stories, identify unique outcomes, and reauthor narratives to support preferred outcomes 26 .

Chapter 8: Narrative Therapy

Process of Therapy Clients tell their counselor stories Therapists listen with curiosity and help clients deconstruct problem-saturated stories Five stages: establish relationship, elicit problem stories, deconstruct dominant stories, embrace preferred stories, and live out enriched stories Therapeutic Techniques Questioning Double Listening Outsider Witness Practices Taking It Back Practices Written Artifacts Evaluation of the Theory Research Support Outcome Research Theory-Testing Research Issues of Diversity NT proponents argue that this approach is suitable for working with individuals, couples, and families from diverse cultural backgrounds NT practitioners are well known for commitment to addressing diversity and social justice issues Summary NT is a constructivist approach in which counselors and clients collaborate to create new life stories Therapists in NT help clients externalize problems, identify unique outcomes, and deconstruct problem-saturated stories A new story can be created based on the deconstructed version of the client’s story

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Chapter 9: Emotion-Focused Therapy

CHAPTER NINE: EMOTION-FOCUSED THERAPY CHAPTER OUTLINE Overview and Background Both an individual and couples counseling approach Initially influenced by Gestalt therapy and humanistic/existential approaches Eventually added aspects of systemic thought and attachment theory Key figures: Les Greenberg originated the individual version while Sue Johnson focused on the application of emotion-focused therapy (EFT) to couples Presently attempts to integrate individual EFT and couple EFT in order to help partners address unmet needs from the past and learn to self-soothe Widely considered a valid approach for individuals, couples, and families Basic Philosophy Based in a humanistic philosophy, a “growth-oriented and nonpathologizing view of human functioning” An integration of experiential and systemic perspectives Members of a couple are generally seen as having healthy and adaptive needs and emotions Couple functioning is a product of both internal and interactional processes Four basic principles: (1) the self is organized by emotional experience, (2) organization of the self and interactional positions are a product of interpersonal perception, (3) individuals hold core beliefs that influence interpersonal interactions, and (4) interaction patterns have lives of their own Central Constructs Types of Emotions Four types: primary adaptive, maladaptive primary, secondary reactive, and instrumental Self The self and the nature of one’s relationships with others are intertwined The self is built on emotions and core beliefs about who we are in relation to others Systems Constructs Key notions: whole is bigger than its parts, circular causality, and an emphasis of process over content Interaction Cycles Patterns of communication that develop based on our experiences in relationships 28 .

Chapter 9: Emotion-Focused Therapy

Negative interaction cycles are self-perpetuating and thus become habitual Theory of Development Rooted in attachment theory Attachment bonds are formed with parental figures during infancy Good attachment figures are secure bases from which children can explore the world and are safe havens in times of stress Unavailable or unresponsive parental figures contribute to dysfunction Attachment styles developed early in life stick with an individual and influence how future relationships are managed Health and Dysfunction Four attachment styles: secure, anxious, fearful avoidant, and dismissive avoidant attachment A securely attached person is a healthy one Healthy couples: express their emotions, are able to weather inevitable ruptures, experience and express their distress to their partners, and receive their partner’s support The common issues that bring couples to counseling involve attachment and identity issues Identity threats result in shame, fear, and anger Nature of Therapy Assessment Therapists look to identify primary and secondary emotions experienced by clients Most important EFT assessment is of the negative interaction cycle Overview of Therapeutic Atmosphere Therapists in EFT strive to create a safe environment and a secure base for exploration, validate both partners’ experiences, establish a collaborative relationship and a strong therapeutic alliance Roles of Clients and Counselor Therapists in EFT serve as relationship coach and process consultant Therapists in EFT should be genuine and congruent as they help clients express their thoughts and feelings Clients are considered experts on their emotional experience but must be willing to explore their emotions and to learn how to change negative interactions Goals 29 .

Chapter 9: Emotion-Focused Therapy

Modify or eliminate negative interaction cycles; change each partner’s experience of the relationship; establish a solid, safe, secure alliance with the couple; help partners identify and express emotional responses; restructure the couple’s interaction Process of Therapy Four steps: Validation and Alliance Formation, Negative Cycle De-Escalation, Accessing Underlying Feelings, and Restructuring Negative Interaction and the Self Therapeutic Techniques Empathic Reflections Heightening Emotion Enactment Interpretation or Conjecture Homework Self-Soothing Evaluation of the Theory Research Support Outcome Research Theory-Testing Research Issues of Diversity Proponents of EFT argue that it is suitable for working with clients from diverse cultural backgrounds Some question the universality of attachment theory and the uniformity of emotional expression Summary EFT is an experiential approach based in attachment theory Therapists in EFT focus on negative cycles of interaction and help partners explore their emotions and learn how to change negative interactions

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Chapter 10: The Gottman Approach

CHAPTER TEN: THE GOTTMAN APPROACH CHAPTER OUTLINE Overview and Background Founders: John Gottman and Robert Levenson Studied a wide range and a large number of couples over time Used longitudinal methods to develop basic principles that separate Master Relationships from Disaster Relationships Ideas have also been extended to parenting Basic Philosophy Rooted in attachment theory Focuses on the good and bad elements of couple functioning More of a clinical intervention theory than a theory of human behavior Addresses relationship issues through collaborative teaching and coaching Central Constructs The Sound Relationship House (SRH) Master couples build strong and stable houses based on trust and commitment The foundation of the SRH is the couple’s friendship Trust “Fundamental principle for making relationships work” Involves a sense of feeling protected by one’s partner The Four Horsemen of the Apocalypse These are behaviors that disrupt and even destroy relationships: criticism, contempt, stonewalling, and defensiveness Perpetual Problems Gottman contends that 69% of problems faced by couples are unsolvable Perpetual problems do not go away Strong couples talk about such problems and try to understand one another’s dreams and values Conflict and Repair Discussions about difficult issues should be initiated in a gentle manner Managing conflict involves making attempts to repair (e.g., cognitive and emotional) 31 .

Chapter 10: The Gottman Approach

Emotion, Flooding, and Attunement Specific emotions are not the problem How emotion is experienced and handled is critical Flooding is the state of increased physiological arousal Attunement refers to the awareness of one partner’s and one’s own emotions, accompanied by the ability to tolerate one’s patterner’s emotions without defensiveness and emotion Theory of Development Couples need to be emotionally available to each other There are four types of couples: validators, volatiles, conflict-avoiding, and hostiles Three-phase view of love: (1) falling in love, (2) building trust, (3) building commitment and love Health and Dysfunction Stable relationships endure, while unstable relationships tend to dissolve Healthy relationships are responsive to each other’s bids for attention, are marked by friendship and mutual admiration, share values and dreams, and are capable of managing differences In unhealthy relationships, partners tend to turn away from each other’s bid for attention, repair attempts are often harsh and futile and are marked by a dynamic of distance and isolation Nature of Therapy Assessment A core component of the Gottman Method Conducted over three sessions: (1) joint session where the relationship history is constructed via the Gottman Oral History Interview and a variety of self-report instruments; (2) individual sessions with each partner to explore levels of commitment, expectations for the relationship and for therapy, thoughts about staying versus ending the relationship, and the occurrence of domestic violence and/or infidelity; and (3) feedback on assessments and the therapist helps to set goals Overview of Therapeutic Atmosphere Both parties need to feel understood and that their therapist is being fair Strives for balance and positivity in an effort to help clients honor each other’s dreams Roles of Clients and Counselor Therapist is an expert in relationships who teaches couples about what research 32 .

Chapter 10: The Gottman Approach

says about stable relationships Therapist must develop an atmosphere of caring and respect Couples need to be open to listening and learning about themselves and the Gottman Method Goals Decrease negative affect during conflict Increase positive affect during conflict Build positive affect during nonconflict Bridge meta-emotion mismatches Create and nurture shared meaning systems Process of Therapy Therapist creates rapid, dramatic change: get clients out of gridlock Therapist focuses on structured change: teach clients how to manage conflict productively Therapeutic Techniques Dreams within Conflict Dealing with the Four Horsemen Building Love Maps Stress-Reducing Conversations Conflict-Management Training Repair Training Evaluation of the Theory Research Support Outcome Research Theory-Testing Research Issues of Diversity Effectiveness with a diverse range of couples has been empirically demonstrated Disclosure of emotions and processing conflict may be counternormative for some members of diverse cultural backgrounds

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Chapter 11: Conclusion

CHAPTER ELEVEN: CONCLUSION CHAPTER OUTLINE Where to Go from Here As a beginning couple and family therapist, it might be best (less confusing) to choose one theory to start with Which Theory Is Best?

Some theories have more research supporting their theoretical explanations than others BFST, EFT, CBT, and the Gottman Method have been extensively researched Structural, strategic, and experiential approaches have not been studied as systematically Which Theory Fits?

You do not want to risk choosing a theory based solely on the fact that it matches your personal beliefs Instead, you should be able to point to good quality evidence that supports your perspectives and practices Another factor to consider is how these theoretical ideas lead to what you actually do in therapy sessions Most theories require you to be active in sessions—some require teaching or coaching, other approaches have more structured techniques, whereas others require you to be inventive and more in the moment Preference for spontaneity versus structure may influence the theory you choose Integrative Approaches Sometimes called the “best of all worlds approach” Able to harness the strengths of major approaches and open to adding new techniques as they are developed Four general approaches: technical eclecticism, theoretical integration, assimilative integration, and common factors Common Factors Certain elements and mechanisms are proposed to operate in all effective therapies Common elements: trusting therapeutic relationship, establish expectation that help/change is possible, therapist and client agree on the goals and tasks of therapy

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Chapter 11: Conclusion

In Conclusion It takes time to settle into a theoretical home, and part of the fun is the process

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