INFLUENCES 1) Reaction to psychoanalytic theories - Freud's theory - psychosexual development    - Individual ---> Family "Little Han" story (horse phobia) - Theories are more individual 2) Research into the causes of schizophrenia - 1950s - observations by therapists    1) Patient got better ---> then someone in the family gets worse    2) Patient go better in hospital ---> got worse when they returned home 3) General Systems Theory - Researchers discovering whole group (group therapy) equally applies to whole families 4) Child Guidance and Marriage Counseling - Alfred Adler (associate of Freud)    - child guidance movement in 1900s    - intrapsychic view to include social context in which problems occurred    - first to believe treating children may prevent development of mental problems
   Beliefs:    - People motivated to overcome feelings of inferiority    - Behavior consistent with persons style of life       - functional or dysfunctional - Adler helped people develop style of life to have concern for fellow humans (social interest); success is the genuine care and concern for others rather than the         need to feel superior - Rudolf Dreikers (associate of Adler)    - founded family counseling centers 1920s       - extended Adler's child guidance approach       - found problems were in family tensions       - tendency to blame families       - Child guidance programs tended to treat parents (usually mothers) separate from their children - Abraham and Hannah Stone - two physicians who opened the first marriage counseling center in New York City in 1929 - Paul Popenoe - founded the American Institute of Family Relations on the West Coast - Emily Mudd - begun The Marriage Council of Philadelphia in 1932; she helped found the American Association of Marriage Counselors in 1941, renamed the American Association for Marriage & Family Therapy in 1979.    - marriage counseling was thought of as a short-term attempt to repair a damaged relationship; typically with current issues than the past    - marriage counseling began to focus on the system as a context for behavior (due to the introduction of general systems theory and family research)    - marriage counseling was practiced either collaboratively (each partner was seen by his/her own therapist) or concurrently (one therapist worked with both spouses at different times) - Don Jackson - introduced conjoint therapy in 1959 where spouses were seen together - Group Therapy and Group Dynamics - Ideas of family therapy movement came from early work in group dynamics    - Kurt Lewin - 1940s and 1950s - influential researcher and developer of field therapy (advanced the idea that the whole of a group was greater than the sum of its individual members)     - groups produced greater changes in ideas and behaviors than took place with individual discussions    - Encounter groups and T-groups (Training groups) were developed by Lewin; these therapists used participant observation to study small group dynamics, a procedure that was elaborated on by the family therapists using one-way mirrors and other therapist/family observation techniques    - Wilfred Bion - at Tavistock Institute in England; found predictable properties emerge out of group dynamics       - Bennis - stages of group development and predictable changes that occurred as families progressed through their life cycle - Group therapists made an important distinction between what groups discussed (its content) and how they discussed it (its process).    - In applying to families, therapists learned to attend as much to the ways families discussed their problems as to what problems were being reported    - Jacob Moreno - 1940s Austrian psychiatrist, psychodrama (a combination of group therapy and theatrical techniques); participants engaged in lively enactments of troubling events, exploring family relations in the process; clients experienced themselves and their histories in new ways, and many of Moreno's role playing techniques were widely adapted by family therapists.    - Family dynamics differ significantly from those in a group of strangers; primary residual influence of group therapy on family therapy is the process/content distinction    - Peter Laqueur - 1950; multiple family group therapy (Creedmore State Hospital in New York); saw several families together in a group using techniques from traditional therapy, psychodrama, and encounter groups. Families were used as co-therapists to each other - Family therapy movement began to group in 1960s; 1962 Ackerman and Jackson founded the journal, Family Process, with Jay Haley as first editor.
THE PIONEERS
Ludwig von Bertalanffy - general systems theory (GST) - developed in 1940s; states that the parts of a system are interrelated and that the whole is greater than the sum of its parts - individuals behavior is connected to other member's behavior and reflective of family system's rules - GST allows for multiple valid analyses of problems (ex. individuals eating disorder may be considered biological problem (genetic or hormonal) or be considered a need-driven individual choice
Nathan Ackerman - father of family therapy - initially suggested utility of viewing the family as a single entity (1938) - predicted that working with and studying the whole family would provide psychiatry with a deeper understanding of the influence of both biological and interpersonal influences on personality development - strong proponent of the need to consider intrapsychic phenomena when working with families and was engaged in an ideological debate with others who favored a more systemic orientation - helped shift therapeutic focus from individual to his/her interpersonal interactions
John Bell - 1951; psychologist at Clark University in Worchester, MA - may have been the first to treat families - family group therapy - multiple family groups; used model drawn from group therapy work; if families could stimulate open discussions, family could solve its own problems - found that families in therapy proceed through stages, and he structured his work to concentrate on those stages - later in his career, he allowed the stages to unfold naturally
Gregory Bateson, John Weakland, William Fry, Don Jackson, Jay Haley and Virginia Satir - Mental Research Institute (MRI) - Gregory Bateson and wife Margaret Meade began studying patterns, processes, and organization in communication - Bateson - greatly influenced by Macy Conferences in NYC from 1941 to 1942 - Introduced to Milton Erickson; Bateson became aware of cybernetics (study of how systems are controlled and how information feedback loops work.    - Initially in Europe, cybernetics theory was the overarching theory, but US general systems theory dominated. - In 1952, Bateson studied paradoxes of abstraction in communication; joined by Jay Haley and John Weakland. - In 1954, received a Macy Foundation grant to head a research project on schizophrenic communication and was joined by Don Jackson.    - Resulted in landmark paper, Towards a theory of Schizophrenia, in 1956; concepts of schizophrenic families and schizophrenic communication - Jackson focused on dynamics of communication and founded the Mental Research Institute (MRI) in 1959. - joined by Weakland, Haley, and then Satir. - concentrated on studying the communication patterns of families with a member diagnosed with schizophrenia. - cybernetics - suggested that symptoms including schizophrenia, function to keep the family in equlibrim - homeostasis- tendency of families to resist change; posited homeostasis - behavioral redundancy - Jackson and others found that people in continuing relationships develop rule-determined repetitive patterns of interaction - double bind - (schizophrenic symptoms stemmed from communication patter); one person received contradictory commands from which there was no escape - Jackson also wrote Family Rules: Marital Quid Pro Quo (1965) - Roles that spouses develop do not stem primarily from gender differences, but emerge in the relationship as a result of a series of quid pro quos or mutual exchanges - Jay Haley - influenced by Milton Erickson - he developed a model of problem-focused family therapy (brief therapy) where he used directives (tasks) to get the families to change their behaviors. - maneuvers were therapeutic paradoxes, designed to get patients to "take a stand in relationship to the therapist, instead of obfuscating their actions in psychiatric denial" - later worked with Salvador Minuchin (founder of structural model) and became interested in family coalitions bridging strategic and structural models
Virginia Satir - Palo Alto; interested in communication but added feelings or affect to her work. - fostered humanizing atmosphere of warmth and acceptance in her work with families - leader of human potential movement
Milton Erickson - Hypnotist in Pheonix - believed people could make rapid and dramatic changes if they could be induced to try something new (contrasted with cybernetics) - influences stemmed from his belief in the possibility of rapid change and his ability to turn people's natural reluctance to change (resistance) to therapeutic advantage - When at MRI, Haley and Weakland consulted with him regularly - Used paradoxical techniques (directly from ability to maneuver the situation to use people's resistance to his advantage - therapy was like Haley's - done TO not WITH families (hallmark of both MRI and strategic)
Frieda Fromm-Reichmann - 1940s searched for clues to onset of schizophrenia in parent-child dynamics - Article: Notes On The Development Of Treatment Of Schizophrenia By Psychiatric Psychotherapy (1948) - termed no discredited term schizophrenogenic mother (domineering, cold, rejecting, possessive, guilt-producing person who, in combination with a passive, detached, and ineffectual father, could cause children to become schizophrenic); blamed parents
Theodore Lidz - Yale University; disputed idea that it was primarily maternal rejection that contributed to the development of schizophrenia asserting "the more destructive influence was that of the fathers" - interviews with families; found five patterns of pathological fathering - deficiencies in marital relationship - marital schism and marital skew ---> contribute the development of dysfunction in children - marital schism- parents are overly focused on their own problems; undercut each other, do not accommodate each other, compete for children's attention while failing to attend to children's needs; high levels of threats to continuation of family unit - marital skew - one parent dominates the family; other is dependent; children torn between parents; deficits in developmental needs ---> dysfunction or schizophrenia result
Lyman Wynne - focused on "how pathological thinking is transmitted in families" - continued research at National Institute of Mental Health (NIMH) (1960s) - pseudomutuality - describes pretense of harmony and closeness that masks conflict and blocks intimacy; these families have an unnatural fear of separation - pseudohostility - noisy and intense way of masking and distorting both affection and splits - rubber fence boundary- disturbed families he studied had a specific kind of boundary around them; seem yielding but nearly impenetrable to information from outside; boundaries bind them together in their resistance to separation - alliances and splits help maintain family equilibrium - developed when he and Bowen were both at NIMH - family should be unit of treatment
Murray Bowen - Studied schizophrenic patients and their families at Menninger Clinic (1940s and 1950s) - NIMH then Georgetown - 1955 concluded "that the family was the unit of disorder and began treating the families together"; arranged families to live together at hospital - emotional divorce- cool distance between the parents and suggested these relationships vacillated between overcloseness and overdistance. - interested in interrelated processes by which a sense of identity is transferred across generations and by which individuals separate from their families - concluded schizophrenia took three generations to develop - differentiation of self- autonomy from one's family, more specifically to the ability to differentiate between one's thoughts and feelings - worked with families on modulating intensity of their emotional reactivity - undifferentiated ego mass- remain neutral and nondirective in therapy and not succumb to pressure of families to draw the therapist - triangulation- tendency of two people in conflict to try to divert the conflict onto a third person - believed most important quality of successful therapy was the differentiation of the therapist
Carl Whitaker - know to turn up the heat - symbolic-experiential family therapy- model supported and goaded patients and families, working in ways that were deeper and more personal than his contemporaries. - late 1940s, he held conferences where therapists observed and discussed one another's work - mutual observation and one-way mirrors - encouraged the use of co-therapists, which enabled him to access and use his own craziness as a therapist
Ivan Boszormenyi-Nagy - psychoanalytically trained and son of a judge - found psychiatric center in Philadelphia - sponsored many students - James Framo - developed tx model for couples - Ross Speck - (with Carolyn Attneave) developed model of network therapy - frequently used co-therapy - father's legacy regarding concepts of justice and fairness influenced model - contextual therapy - multigenerational ethical accountability - relational ethics - family members are bound across generations by loyalty and trust - System of internal moral accounting - ledger of accountability -  ledger of indebtedness - therapist should have ethical accountability - multidirectional partiality - accountable to everyone whose well-being is potentially affected by his/her interventions
Salvador Minuchin - Physician, raised in Argentina - trained with Nathan Ackerman - influenced the worked of Harry Stack Sullivan - began his family therapy work in the early 1960s while working with multiproblem poor families at the Wiltwyck School for Delinquent Boys in New York - structural family therapy- hypothetical structures which both influence how families operate and make them resistant to change - 1965 - director of the Philadelphia Child Guidance Clinic. - colleagues were Dick Auerswald, Charlie King, Braulio Montalvo, and Clara Rabinoqitz. - Minuchin met Jay Haley on a trip to Palo Alto; took an understanding of importance of sequences, value of paradox in family therapy - Haley learned structures such as heirarchies and coalitions from Minuchin which influenced his strategic work - 1967 - Haley left Palo Alto and joined Minuchin in Philadephia; most influential family therapy treatment and training centers in the worlkd - boundaries- suppositional lines both between family subsystems and also between the family and wider community - Enmeshed- families that are chaotic and tightly connected; their boundaries are overly diffuse; parents in these families are too involved with their children to take executive control of the family - Disengaged- parents are too uninvolved and distant to provide adequate encouragement, direction, and leadership; boundaries are rigid - Minuchin used variety of techniques to join with families in order to be accepted by family members to become part of the system in order to change dysfunctional structures (strengthen diffuse boundaries and loosen rigid ones) - 1974; wrote Families and Family Therapy (most popular book in family therapy) - later in career worked with families with psychosomatic illness of anorexia nervosa - 1959 - Fred and Bunny Duhl & David Kantor - founded Boston Family Institute; developed integrative model of family therapy - combined techniques from several models and created expressive, experiential, and nonverbal techniques - spacialization and family sculpting
PIONEERS IN EUROPE
- Tavistock Institute in London - Henry Dicks - worked with couples - Robin Skynner - brief approach to family therapy - Helm Stierlin - Germany; wrote about adolescents being launched from their families - Italy; 1970s family therapy movement - Mara Selvini Palazzoli - adopted the MRI group model; formed Institute for Family Studies in Milan - Milan systemic therapy - founded in 1967
The GAP Report
- 1970; Group for the Advancement of Psychiatry (GAP) published report that majority of therapists who worked with families identified improved communication (primary goal in tx) - Beels - study distinguished family therapists based upon their style: conductors (initiate interactions) vs. reactors (more likely to respond to others)
THE GOLDEN YEARS: The 1970s and 1980s
- By 1980s; two dozen family therapy journals and hundreds of centers dedicated to providing and teaching family therapy - The Family Institute was renamed The Ackerman Institute after Nathan Ackerman's death in 1971 - Lynn Hoffman and Peggy Papp - distinguished staff members; started using team approach - Minuchin and Haley - more influential at Philadelphia Child Guidance Clinic - Haley - moved to Washington where he with Cloe Madanes founded Family Institute of Washington - Bowen was at Georgetown Family Center - Philip Guerin (Bowen's student) - founded Center for Family Learning in New York in 1973 - The Family Institute of Westchester - Betty Carter and Monica McGoldrick - Richard Bandler and John Grinder - 1970s; founded neuro-linguistic programming (NLP); studied hypnotic communication patterns of Milton Erickson and Virginia Satir - NLP practitioners - strive to understand hidden effects of language, meaning of nonverbal behavior, and the utilization of communication and trance to create change. - work present in Structure of Magic series - Developments at MRI - designed strategic techniques to "interrupt the problem-maintaining interactions" - in this view    - problems maintained by feedback loops that attempt to correct for deviations from normal family behavior    - primary interventions were paradoxical injunctions - prescribing the symptom and reframing (renaming the problem to make it more amenable to change - Mara Selvini Palazzoli, Luigi Boscolo, Gianfranco Cecchin, and Guiliana Prata - The Milan Group - group of therapists in Italy who had become disaffected with psychoanalysis, began working strategically with families - interested in Bateson's cybernetic model (in book Steps to an Ecology of Mind - primary techniques of Milan model:    - rituals - engaged the family in behaviors that violated the family rules    - positive connotations - used to foster change through paradox by complimenting family members for devising the symptom to maintain homeostasis as well as enjoining the family from changing - split in early 1980s     - Palazzoli and Prata formed one technique invariant prescription to counteract the dirty game (power struggle between parents and patient/child       - Boscolo and Cecchin moved away from strategic approach, developing collaborative style of therapy          - therapist/client interactions within the session were the treatment          - circular questions - to open family to new ways of thinking while maintaining an irreverence about the beliefs and remaining indifferent about the specific outcome of treatment
Transformation: The 1990s
- Most important factor in tranformation was that "family therapy was one of many social sciences turned upside down by the postmodern revolution"; idea which challenged philosphic foundation on which MFT ideas and practices had been built -  modernism - suggested that "truth" consists of tangible, knowable set of observable or deducible facts; assumed that there were universal principles that would guide researchers and therapists toward theoretic tenets, diagnoses, and treatment - postmodernism - suggests there are no universal truths, only points of view, which radically altered family therapy - postmodern therapists do attend to social context, and they are interested in the ways that individuals and families construct their views of reality - emphasis on language and meaning; suggested view of life is as valid or "real" as another - therapists work as partners with families (collaborate) to find a new meaning or a more useful epistemology (way of knowing) through language    - not know as experts but part of the therapy process; does not establish goals nor determines direction for client families' lives but asks questions as a method of learning and reinterpreting experiences - feminism; late 1980s - writings of Virginia Golder, Peggy Penn, Marion Walters, and Olga Silverstein date back to 1970s but not integrated into tx until postmodern movement of 1980s and 1990s - postmodernists advocate neutrality while feminists stress the need for therapists to abandon neutrality in order to acknowledge and counteract entrenched gender-based power structures. - feminists agree with the importance of language and meaning, they content the patriarchal social system is a real structure with negative consequences - feminist postmodernists support a modernist view - feminists assert that since men still hold most of the power in relationships, feminist therapist to offset the imbalance by giving more weight to the woman's perspective than to the man's -social constructionist- primary postmodern school; includes the models: narrative, solution-focused, and collaborative language systems - Michael White and David Epston developed narrative therapy in Australia and New Zealand. - interested in narrative stories people have constructed by which they understand themselves and other and conduct their lives - therapists work with clients and families to create a new narrative that emphasize their preferred ways of relating to themselves, to one another, and to the larger culture Steve de Shazer and Insoo Berg - Milwaukee; initially influenced by MRI but solution-focused therapy shifted dramatically from other models by emphasizing family's problem or its cause - they help clients identify and repeat behaviors in which they were engaged during times when the problems did not exist - solutions develop out of amplifying a pattern or behavior that already works well; assert reality is created through language and use client's or family's meaning system rather than imposing a theory-driven definition of "normal" onto a client system Harlene Anderson and Harry Goolishian - maintain that humans create meaning through language - collaborative language systems - based on premise that since knowledge is constructed through social discourse, so too problems and potential solutions - do not diagnose, give directives, make hypotheses, instead they convey an attitude of not knowing and work with clients to co-create stories in which the problem-solver discovers new possibilities until the problem dissolves Kenneth Gergen - 1991; described postmodern family and general social experiences as saturated - myriad responsibilities, relationships, technology, choices, opinions, etc. make it difficult for an individual to have a clear sense of his/her desires and beliefs
Critics of postmodern therapy - Doherty - risk of "leaving families who need therapy at the mercy of every passing therapeutic fad" - brief problem-solving contextual methods are increasingly favored by  managed care  organizations

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