Structural and Strategic Family Therapy Comparison

Structural and Strategic Family Therapy Comparison

John R. Stafford

Brandman University

Abstract

Family therapy is not a single theory solution for new family therapists. Although it is common for a young therapist to pick a model that he or she may feel most comfortable with, it is a manner of limiting the scope of learning in the early stages of education and even practice. Gaining a full understanding of the four primary constructs of family therapy can assist a young therapist in not only selecting a model that feels right but also in the ability to employ aspects of multiple models when working with various clients and their diverse spectrum of issues.  Although each model has significant differences, they also share some similarities. This paper will examine the differences and similarities of structural and strategic family therapy models. 

Keywords:  Structural Theory, Strategic Theory, Family Therapy Models

Structural and Strategic Family Therapy Comparison

Understanding the differences and similarities of the different family therapy models enhances the ability of a therapist to determine if a particular model or combination of models are best suited for their practice and the individual needs of the client[s] (Silva, et al., 2003). This paper contrasts and compares the Strategic and Structural models of family therapy by discussion the constructs of both models. By careful examination of the different approaches, development, and intervention styles associated with the two models, we can better understand the core concepts, intervention techniques, processes, social contexts, and outcomes represented in each model.

The Creation of Each Model

Salvador Minuchin and his colleagues at the Wiltwick School residential facility in New York developed Structural family therapy base don their experiences working with inner city delinquents (Issitt, 2013; Gladding, 2007). Pulling from their experiences, Minuchin and his colleagues asserted that passive and historical approaches to working with families posed difficulties in working with families in lower socioeconomic and racial minority families (Gladding, 2007; Nichols, 2013). Based on his observations, Minuchin asserted that the households in this demographic tended to display more aggressive behaviors and place blame on other family members or influences when troubles within the family were present (Issitt, 2013; McAdams et al., 2016). Minuchin further surmised that when a dysfunction within the family arose, that it was the result of an inability for the family structure to adjust to changing conditions and that families incorporate subsystems that establish individual roles and responsibilities (Issitt, 2013; Gladding, 2007). Based on these observations and assertions Minuchin developed the concept that therapists should engage families directly to aid in changing the family structure to facilitate change, and that the particular type of clientele they were working with required active and dramatic interventions to be successful (Issitt, 2013; Gladding, 2007).

In the 1960’s and 70’s Minuchin and his associates expanded on the social context that formed the basis of structural family therapy mainly because the clientele of inner city tended to display a heightened level of crude characteristics (Israelstam, 1988; Issitt, 2013). Structural family therapy also assumes that problems arise when family boundaries are not clear and when difficulties are present within the family hierarchal structure. Furthermore, cross-generational influences like coalitions and alliances add additional challenges within the family (Isrealstam, 1988; McAdams et al., 2016). Sequentially families with diffused boundaries are more likely to be enmeshed while families with rigid boundaries are more likely to be disengaged than households with a healthy set of boundaries and hierarchal structures (Isrealstam, 1988; Gladding, 2007; McAdams et al., 2016).

Gregory Bateson (1904-1980) of the Palo Alto research group developed strategic family therapy in the early 1950’s. His primary focus on treating schizophrenic patients and the problems their families experienced as a result of the illness, and he surmised that schizophrenia was a result of discrepancies in various levels of family communications and interactions (Isrealstram, 1988; Nichols, 2013). Strategic family therapy is primarily composed of two subgroups. The first being Haley’s structural-strategic group and the second being the MRI group (Israelstam, 1998). It is fair to note that while both of these subgroups share much in common, they have strong fundamental differences. One aspect of strategic family therapy is that therapists working with families take a lead role in defining the process fo treatment and design the strategies required to aid families in changing their system (Israelstam, 1998). Also, D. Jackson (1920-1968) and John Weakland (1919-1995) expounded on Bateson’s concepts by describing various communicational strategies as processes an individual uses to escape or define intrafamilial relationships (Israelstam, 1988; Sheehan, & Friedlander, 2015). Based on the focus on specific strategies for intervention aimed at changing the current problem within the family, Jackson and Weakland’s theories also became known as strategic family therapy (Israelstam, 1988; Sheehan, & Friedlander, 2015). The process involves a complete assessment of the family interactions and developing a strategy to disrupt the cycle by providing straightforward or paradoxical interventions. The therapeutic process focuses on changes, and the therapist is responsible for the successful outcome of these processes. It is fair to note that strategic therapists do not make interpretation of current interactions of the therapist themselves or exploration of the past when addressing the family’s current interactions.

The strategic family therapy model significantly impacted by social context, combined ideas, accumulated research, and writings of all the theorists at the Mental Research Institute [MRI] established a strong presence in the psychotherapy community. Although there were various therapists and schools of theory involved in the creation of strategic theory, the collaborative research and shared objectives of all concerned defined the theme used to form the model into a modern family therapy technique.

Mechanics of Each Model

The structural theory asserts that changing the structure of a dysfunctional family will enable the family to interact in a positive manner and overcome the pressing issues. Structural family therapy assumes that problems and solutions develop on a series of hierarchal, subsystem, and architectural influences within the household that affect the behaviors of individual family members (Israelstam, 1988). A further assumption is that people interpret issues like social interactions as patterns of interaction that occur on a repetitive basis (McAdams et al., 2016). The dynamics of a family network or structure ranges from dysfunctional to supportive and based on the level of cohesiveness will either promote negative or positive household interactions (McAdams et al., 2016). The structural interpretation of problems versus solutions provides a systemic comprehension of the family unit as an operational network and provides insight into the routine functionality of both the family system and individual components. If the therapist determines a dysfunction in family operations, he or she assists the family in changing the issues to encourage more positive interactions (Israelstam, 1988; McAdams et al., 2016).

The underlying assumptions about problems in strategic family therapy focus on the family system and how it interacts with a problem instead of identifying the problem itself (Gardner, Burr, & Wiedower, 2006; McAdams et al., 2016). Strategic family therapists attempt to change the household interactional processes by focusing on individual communication patterns and developing strategies designed to aid the family to recognize and change actions and interactions associated with the dysfunction (Horigan, Anderson, & Szapocznik, 2016). Strategic family therapists believe that this manner of intervention will aid in the restoration of active family function and the dysfunction will cease (Lindstrom, Filges, & Jorgensen, 2015).

Model Core Concepts

The fundamental concepts of structural family therapy emphasize a systemic and organizational process where the therapist analyzes the family structure to determine how the household interactions maintain the dysfunction without identifying the solution (McAdams et al., 2016). A primary assumption of Minuchin is that a family network core function centers on functional expectations that establish individual interactions and affect household homeostasis (Issitt, 2013; Lindstrom, Filges, & Jorgensen, 2015). Besides the inner workings of the family itself, the therapist also reviews external social influences that potentially affect the dysfunctional behaviors in a negative manner. Another area of focus is subsystems intertwined with the primary system and hierarchal processes identified as potentially harmful influences, hence allowing the therapist to aid in modifying how individuals relate to one another and create a positive rebalance of the primary system (Issitt, 2013; McAdams et al., 2016).

The fundamental concepts of strategic family therapy emphasize systemic process, hierarchal structure, and understanding the intricacies of individual and family communication patterns (Horrigan, Anderson, & Szapocknik, 2016; Sheehan & Friedlander, 2015). The process includes analyzing invisible and visible family guidelines [rules], family function, and repetitive behavioral patterns that appear to reoccur within the family Israelstam, 1988). Emphasizing that problems are inherent to dysfunctional hierarchies in the family structure; therapists seek to aid families to correct the problems by modifying personal interactions to change the family structure. Other concepts of strategic family therapy include the household’s behavioral sequences and the processes that potentially exacerbate or maintain the dysfunction (Szapocznik, Schwartz, Muir, & Brown, 2012).

Model Interventions

Applying unbalancing techniques, aiding individual family members to reframe perceptions, family mapping, joining with the family during sessions, and presenting the dysfunction as a metaphor are core intervention methods employed in structural family therapy (Nichols & Tafuri, 2013). Applying these techniques, a therapist can diagnose the dysfunction and aid the family in restructuring, which allows the process to develop structure and improved esteem within both the individuals and family network (Nichols & Tafuri, 2013). For example, if a therapist is working with a family that has an addiction problem, he or she may choose to use a family structure map to analyze various coalitions to interpret the underlying cause of the addiction (McAdams et al., 2016; Nichols & Tafuri, 2013). The therapist, in this case, objectifies the addiction to detach it from the affected family member and realigns the spousal coalition to strengthen the family’s center of power to combat the influence of the dependency (Nichols & Tafuri, 2013).

Strategic family therapy focuses on a set of planned, practical, and problem-focused strategies to address dysfunctional behaviors and familial structures that are associated with or contribute to the underlying problems (Lindstrom, Filges, & Jorgensen, 2015; Szapocznik, Schwartz, Muir, & Brown, 2012). The unique or core fundamental approaches of strategic family therapy include providing directives, assessing ordeals, and therapeutic paradoxes during interventions. A Therapeutic paradox is a tactic used to engage family members to evaluate unfavorable interactions and to redirect efforts into different interactions or behaviors (Lindstrom, Filges, & Jorgensen, 2015). Directives serve as precise instructions for the family members to enact to facilitate change, whereas ordeals are behavioral prescriptions that direct the family to engage in pernicious behaviors when maladaptive interactions return (Lindstrom, Filges, & Jorgensen, 2015; Szapocznik, Schwartz, Muir, & Brown, 2012).

         Considering that both models were primarily developed to treat addiction problems in young family members and provide assistance to the family unit to restructure the family network either by changing the structure or the strategy of the household dynamic, the benefits of both models apply in other therapeutic settings. For example, the application of both models in long-term care facilities and addiction rehabilitation for adults are both viable use-case scenarios. Hybrid models like brief strategic family therapy have combined elements of structural and strategic family therapy models of effecting changes in family networks troubled with dysfunctional addiction and behavioral problems. Using this hybrid model, a therapist can apply proper treatment to a family with an adult member suffering the same dysfunction. Although the primary applications of these models remain to treat families with children suffering from addiction and dysfunctional behavior, the transition to intervention programs for adults is beneficial and practical. Considering the systems and structures of families with dysfunctional children and dysfunctional adults are similar, if not identical, therapists only need make minor modifications to the intervention process to adapt the treatment to fit the needs of the family.

            A key factor of consideration in adapting these models to adult therapy is the effect addiction has on the mental state of a patient. Chronic addiction modifies and even retards human maturity, and therefore adult addiction patients may, in fact, have reduced mental capacity, or immature behavioral attributes. In cases of adult addiction or dysfunction, there are factors of treatment that remain relevant. Treating the parental structure or system would be considered a primary aspect of treating the dysfunction or an adult family member. The core processes of joining the family system, providing an in-depth evaluation of dysfunctional personal relationships, and aiding in the adjustment of the family structure or system are all viable approaches when providing therapy to families with dysfunctional adults.

Model Goals and Outcomes

In comparison, the goals of structural and strategic family therapy share similarities of altering the family network via methods of behavior modification, communication enhancement, and disruption and restructuring dysfunctional interactions. In both models, the desired outcome is a change in maladaptive patterns that affect both the individuals and family unit. Assuming that changing the structure to recognize and disrupt dysfunction within the person and the family structure, a proper balance will be achieved and family homeostasis returned. Therapists are usually not dedicated to a particular model. Hybrid therapies like Brief Strategic Family Therapy, which incorporates both structural and strategic theories along with intervention are sound methods to engage families coping with adolescent substance abuse and behavioral dysfunction (Robbins et al., 2012; Szapocznik, Schwartz, Muir, & Brown, 2012).

The strategies for structural and strategic therapy model interventions applied to brief strategic family therapy shifts slightly to focus on reconfiguring the overall strategy to emphasize the transformation of family relationships for dysfunctional to an efficient, mutually supportive process. Therapists using this technique concentrate on helping families develop and enhance conflict resolution skills, behavior management skills, parenting and leadership skills, and blocking, directing or redirecting communications within the family network (Robbins et al., 2012).

The evolution of structural family therapy has made advancements in how therapists understand how relational issues affect areas like attachment theory and evolved the original concepts into new practices. For example, ecosystemic structural family therapy focuses on a systemic process (Lindblad-Goldberg, Jones, & Dore, 2004). Ecosystemic structural family therapists concentrate on an evidence-based process that focuses on families with adolescents and children suffering behavioral dysfunction. The primary goal is to aid families in addressing dysfunction and restore household homeostasis (Lindblad-Goldberg, Jones, & Dore, 2004).

Brief strategic family therapy models incorporate the core concepts of strategic family therapy and structural family therapy. The combination of both core models provides an evidence-based model designed to deliver treatment to families with young addicts (Robbins et al., 2012). By combining aspects of both strategic and structural therapy models, brief strategic family therapy increases therapeutic retention, and aids families comprehend and combat the dysfunction (Robbins et al., 2012; Szapocznik, Schwartz, Muir, & Brown, 2012). It is fair to note that although the model itself has undergone extensive research, there is still question as to the effectiveness on actually combating the actual addiction problem (Robbins et al., 2012).

Models Contrasted and Compared

            Structural and strategic family therapy models share numerous similarities in the foundational concepts of practice. A unique identifier of each of these models is the systemic approach employed to understand pathology and by redirecting efforts from a psychoanalytic approach to focus on the individual in conjunction with the family network. In doing so, both models emphasize the importance of understanding how the intrapsychic world affects an individual’s health and integration into the family structure, and how changing interpersonal interactions aids the family in achieving successful outcomes in therapy. Further similarities include the target market [clientele] that both models cater to servicing. Both models emphasize understanding and treatment of dysfunction in family communications and interpersonal relationships that contribute to significant problems in young family members and continue to expand with emerging hybrid therapy models like ecosystemic structural family therapy and brief strategic family therapy (Robbins et al., 2012). A fair comparison of the theoretical approaches of both models is the intervention strategies both employ. In both models, key therapeutic techniques include joining with the family system and assisting the family in restructuring the family dynamic. It is important to state that although these models were developed to combat families with dysfunctional youth, therapists have successfully applied both models to clients outside this demographic.

            In contrast to the similarities both models share, there are also fundamental differences. A primary difference between structural family therapy and strategic family therapy is the method in which each model applies changes to the family system. Structural family therapy models assert that relational interactions become altered by focusing on changing the dysfunctional family structure, whereas strategic family therapy models state that family structure will change organically once the relational strategies become modified.

            Both models share unique strengths and weaknesses, and although these attributes exist in the similarities of the models, it is appropriate to separate them for comparison. Both models emphasize the importance of systems inside and outside the family structure by exploration, interpretation, comprehension, and modification of dysfunctional relation to environmental factors. Secondarily, the therapeutic objective of assisting the younger family member[s] and the entire family to change the dysfunctional systems and structures are the most important aspects of resolving family conflict and dysfunction. Although these issues are considered shared strengths, they also present weaknesses in therapy. Those weaknesses being the fact that both models focus highly on intrapersonal relations within the family system, they often fail to investigate and address the intrapsychic and emotional factors of individual family members involved in the dysfunctional network. A reasonable assertion of both models is the roots fo where they started. Both models were developed to focus on sociocultural and socioeconomic populations most commonly overlooked (Israelstam, 1988). For various reasons, both models have provided a looking-glass view of these communities by emphasizing the importance of diversity of race and class structure (Nichols, 2013).

Conclusion

            In conclusion, one can quickly take note that structural and strategic family therapy models have made revolutionary advancements in the field of family therapy. The emphasis on evaluating and addressing the dysfunction in the family structure or system that allows the structure to operate outside of standard tolerances has not only opened the door to successful treatment of addiction in young family members but also applies to the treatment of adults suffering the same issues. Emphasizing focus on interpersonal relationships, communication, and hierarchal power struggles as a core aspect of family dysfunction and aiding families in implementing proper solutions to address these issues is a critical factor in successful treatment.

         References

Gardner, B. C., Burr, B. K., & Wiedower, S. E. (2006). Reconceptualizing Strategic Family Therapy: Insights from a Dynamic Systems Perspective. Contemporary Family Therapy,28(3), 339-352. doi:10.1007/s10591-006-9007-x

Gladding, S. T. (2007). Family therapy: history, theory, and practice (4th ed.). Boston: Pearson.

Horigian, V. E., Anderson, A. R., & Szapocznik, J. (2016). Taking Brief Strategic Family Therapy from Bench to Trench: Evidence Generation Across Translational Phases. Family Process,55(3), 529-542. doi:10.1111/famp.12233

Israelstam, K. (1988). Contrasting Four Major Family Therapy Paradigms: Implications for Family Therapy Training. Journal of Family Therapy,10(2), 179-196. doi:10.1046/j..1988.00311.x

Issitt, M. (2013). Structural family Therapy (SFT). Salem Press Encyclopedia. Retrieved February 15, 2017, from http://eds.b.ebscohost.com.libproxy.chapman.edu/eds/detail/detail?sid=a9a9e471-bdd0-4ddb-8791-90d91204a4bd%40sessionmgr101&vid=3&hid=103&bdata=JkF1dGhUeXBlPWlwLHVpZCZzaXRlPWVkcy1saXZl#AN=89677644&db=ers

Lindblad-Goldberg, M., Jones, C., & Dore, M. (2004). The Ecosystemic Structural Family Therapy Model. Retrieved February 21, 2017, from https://books.google.com/books?hl=en&lr=&id=Ks2z9zkHrVwC&oi=fnd&pg=PA3&dq=ecosystemic structural family therapy&ots=efqsNTaj7A&sig=tkqqeVafzVa3xHydBWFVHy3I5aw#v=onepage&q=ecosystemic%20structural%20family%20therapy&f=false

Lindstrom, M., Filges, T., & Jorgensen, A. K. (2014). Brief Strategic Family Therapy for Young People in Treatment for Drug Use. Research on Social Work Practice,25(1), 61-80. doi:10.1177/1049731514530003

Mcadams, C. R., Avadhanam, R., Foster, V. A., Harris, P. N., Javaheri, A., Kim, S., . . . Williams, A. E. (2016). The Viability of Structural Family Therapy in the Twenty-first Century: An Analysis of Key Indicators. Contemporary Family Therapy,38(3), 255-261. doi:10.1007/s10591-016-9383-9

Nichols, M. P. (2013). Family therapy: concepts and methods (10th ed.). Boston: Pearson.

Nichols, M., & Tafuri, S. (2013). Techniques of Structural Family Assessment: A Qualitative Analysis of How Experts Promote a Systemic Perspective. Family Process,52(2), 207-215. doi:10.1111/famp.12025

Robbins, M. S., Feaster, D. J., Horigian, V. E., Rohrbaugh, M., Shoham, V., Bachrach, K., . . . Szapocznik, J. (2011). Brief strategic family therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents. Journal of Consulting and Clinical Psychology,79(6), 713-727. doi:10.1037/a0025477

Sheehan, A. H., & Friedlander, M. L. (2015). Therapeutic Alliance and Retention in Brief Strategic Family Therapy: A Mixed-Methods Study. Journal of Marital and Family Therapy,41(4), 415-427. doi:10.1111/jmft.12113

Szapocznik, J., Schwartz, S. J., Muir, J. A., & Brown, C. H. (2012). Brief strategic family therapy: An intervention to reduce adolescent risk behavior. Couple and Family Psychology: Research and Practice,1(2), 134-145. doi:10.1037/a0029002

Bowen Family Theory and Case Study

Bowen Family Theory and Case Study

John R. Stafford II

Brandman University

Abstract

Bowen family systems theory emphasizes the individual human behaviors that contribute to the overall family dynamic. By asserting eight different concepts, Bowen theory aids therapists to determine potential critical areas of practices that influence the complex emotional interactions of individual family members that in turn, affects the overall health of the household.  Bowenian therapists, however, do not seek to provide solutions to the problems, but instead provide the family members with the insight needed to make proper conclusions of the problem, and use their thinking skills to bring forth an appropriate resolution.

Keywords:  Bowen Family Systems, Bowenian Theory, Family Therapy, Family Systems Theory

Bowen Systems Theory

Dr. Murray Bowen (1913-1990) surmised that sociocultural experiences influence and shape perceptions of self and family interactions, and how personal relationships are affected by two primary factors of individuality and togetherness (Bowen Family Therapy, n.d.; Nichols, 2013). Dr. Bowen’s theory of human behavior focuses on all the members of the family as a single emotional unit, meaning that the intense emotional connection between the family members directly influences the mental function of the household as a whole (Kerr, 2000).

Bowen’s theory of change is quite simplistic. Meaning, if individuals within a family structure are emotionally intertwined, it will require changes in the mental and emotional process of the family structure to modify the person, and vice-versa. From a behaviorist perspective, the behaviors and emotions of the family impede or enhance the actions of each member of the household, and in turn, the actions of the individual affect family homeostasis. However, Bowen employs a neutral position of family/therapist interactions where the therapist takes a neutral role in assisting the family in working through the solution on their own by asking open questions and encouraging open dialog to lead to solutions.

Eight Concepts of Bowen Family Systems Theory

A key component of Dr. Bowen’s theory included eight concepts that integrate personal feelings and behaviors associated with family issues like marital problems, communication between parents and children, sibling relationships, and external family members. Although these concepts provide unique insight into a particular family member’s behaviors, it is fair to note that one or more concepts may apply to each family member, and often include more than one person (Kerr, 2000).

Triangles

The triangle concept describes a three-person relationship and is considered a core component of a larger emotional system. Triangles can involve three members of the immediate family, or a combination of immediate family members and individuals outside the household like a friend or relative (Kerr, 2000; Nichols, 2003).

Differentiation of Self

The core foundation of Bowen’s theory asserts that individual family members develop the capacity to think independently, act with flexibility and reason when faced with everyday issues (Nichols, 2003). In contrast, undifferentiated family members tend to become more emotional, become more reactive to problems and are less likely to recognize their autonomy within the family structure (Nichols, 2003).

Nuclear Family Emotional Process

The nuclear family emotional process describes four patterns in a family relationship that influence problems that develop within the family unit. Although individual perceptions of relationships change these trends, the underlying forces causing the problems play a significant role in the family emotional process (Kerr, 2000; Nichols, 2003).

Marital Conflict

Martial conflict arises when tensions within the family increase. This increase in pressure results in one or more of the spouses to externalize anxiety and place emphasis on what the other person is doing and attempt to control his or her partner, resulting in resistance from the receiving partner (Kerr, 2000; Nichols, 2003).

Singular Spousal Dysfunction

In contrast to marital conflict, dysfunction also occurs when one partner applies pressure on the other to react or think in a particular manner, and the receiving partner acquiesces to those pressures. Although this process can result in preserving harmony between spouses, it results in the pressured spouse to feel less comfortable with having his or her integrity and control subverted (Kerr, 2000; Nichols, 2003).

Impairment of children

A family with one or more impaired child suffer additional stressors like excessive worrying, becoming overly protective, and heightened anxiety levels between the parents and other siblings. Additionally, the impaired child may need extra care, which places additional responsibility on the parents, and a feeling of preferential treatment from the child’s siblings. The impaired child is also more likely to have inhibited self-differentiation and may experience problems in various social activities (Kerr, 2000; Nichols, 2003).

Emotional Distance

When issues in a relationship become overwhelming or repetitive in nature, a common reaction is for one partner become distant and sometimes isolated from other members of the family. Emotional distance occurs under different circumstances. Issues that intensify emotions in the family dynamic, or one person absorbing more anxiety than other family members may help the family function normally, but at the expense of one or more family members (Kerr, 2000; Nichols, 2003).

Family Projection Process

It is important to understand that children are susceptible to, and inherit many traits, behaviors, and come mental conditions from their parents. Familial projection occurs when one or more parents project their problems to one or more children in the family. Projection usually results in the child experiencing issues like a heightened need for attention and approval, a tendency to take responsibility for others actions or emotions, and impulsive behavioral patterns (Kerr, 2000; Nichols, 2003). Additionally, the parents may develop reinforcing behaviors like placing additional focus on the child, misinterpreting the child’s actions for a more serious issue and treating the child as if there were more serious behavioral or mental problems (Kerr, 2000; Nichols, 2003).

Multigenerational Transmission Process

A concern for any family unit is how generational differences influence the overall health of the family unit and the ability for family members to adapt to changes that naturally occur in the familial lifespan. Multigenerational transference is a process where older generations, parents, and grandparents, influence children during developmental stages. Although some of these transferences occur consciously through teaching and training, others occur on an unconscious level. Emotional reactions and behavioral patterns are, in many situations, a direct result of parental actions, attitude, and mood patterns (Kerr, 2000; Nichols, 2003). Additionally, family units may experience additional multigenerational stressors when an older family member like a grandparent moves into the home. The effects of multigenerational transmission manifest in the child’s development, and typically reinforce future patterns like mate selection, inhibited or increased differentiation of self, and emotional stability (Bowenian Family Therapy, n.d.; Kerr, 2000).

 Emotional Cutoff

Unresolved emotional issues with various family members may produce consequences of estrangement in an attempt to reduce the amount of emotional conflict. While it is not uncommon for family members to sever relationships with family members they have an unhealthy relationship with, this is not a cure for the underlying problem, and in fact, may result in additional challenges within the family unit.  (Kerr, 2000; Nichols, 2003). Some important causes of emotional cutoff are a child expressing his or her sexuality, religious or political differences, and lifestyle choices that parents disapprove of and are unwilling to accept (Kerr, 2000).

 Sibling Position

The Bowenian concept of sibling position is based largely on the research of psychologist Walter Toman (1920-2003) which surmised that siblings mature based on their position within the family structure. Toman, and consequently Bowen, asserted that the positioning of a sibling directly influences individual behavioral and temperament traits as they mature into adulthood. For instance, the oldest child may naturally adopt a leadership role, whereas a middle child may adopt behaviors of both the older and younger siblings, and younger siblings may become more reliant on either the older or middle sibling (Kerr, 2000). Sibling position roles are also subject to parental influence. If one or both parents place heightened levels of anxiety on the oldest child, he or she may, in fact, become more submissive, or disinterested in a leadership role because of the stress initiated by the parents. In contrast, the middle or youngest child may assert more of a dominant role in this situation, resulting in new conflict amongst the siblings (Kerr, 2000).

 Societal Emotional Process

Although Bowenian Family Systems Theory emphasizes the treatment of families, the eight concepts also apply to non-familial environments. Each concept is applicable in corporate and social environments and provides insight into how individual reactions, attitudes, and emotions affect other people during everyday encounters (Kerr, 2000). Considering the validity that what happens at home affects how we react to situations outside the home, societal emotional process explains how psychological systems control individual and group behaviors on a societal level (Kerr, 2000).

The Family Diagram

Bowen developed the family diagram to represent the family as a living organism and multigenerational emotional process. A therapist will use the family chart as a tool to outline the family lineage and identify important behavioral issues, traumatic family events, or important life events that could influence the family’s current dysfunction, or dysfunction of a particular individual within the family structure (Kerr, 2000; Nichols, 2003).

Family Assessment in Counseling
Family counseling does not only occur when there is trouble in the home. Some people decide to engage a professional before marriage to aid in the assimilation process (Wilmoth & Smyser, 2010), while others may choose to hire a therapist to prepare for an upcoming birth of their first child (Ghanbaripanah & Sharif Mustafa, 2012). Although the myriad of reasons ranges in intensity, the outcome is to seek professional assistance to help resolve the issue at hand. Regardless of the reasons a client seeks help, the therapist must develop a thorough understanding of the people and issue[s] involved (Boughner, Hayes, Bubenzer, & West, 1994; Ghanbaripanah & Sharif Mustafa, 2012).
Because there are different disciplines or methods of family counseling, the initial evaluation is standardized with three primary instruments; self-report, observational, and diagrammatic method (Ghanbaripanah & Sharif Mustafa, 2012). However, these three instruments are vague descriptors of the variety of tools which fall under them, and professionals are left to determine which set of tools is best suited for both the therapist and the client[s] (Ghanbaripanah & Sharif Mustafa, 2012).

Developing a Treatment Plan

After a successful assessment, a treatment plan will be required to assist the client[s] in achieving a satisfactory resolution to the problems (Hutchinson, Casper, Harris, Orcutt, & Trejo, 2008). A successful treatment plan should engage the client[s] in treatment (Hutchinson, et al., 2008). The plan should act as a collaborative, creative, and client-driven activity roadmap developed by the therapist and the client[s] that creates an alliance between the client[s] and the counselor (Hutchinson, et al., 2008). A primary aspect of a successful treatment plan is to include coherent problem statements and the creation of actionable goals that are individualized to the client[s] and the underlying issues (Hutchinson, et al., 2008).

Case Study

Kristen and her family experience multiple dysfunctions in the home that stem from a variety of multigenerational aspects, family triangles, sibling positioning, and family process issues. As a child, Kristen grew up in an abusive household. Her father, an alcoholic was abusive. Although it is not clear if he was abusive to his wife and daughter, it is safe to assume he was. Problems with the father resulted in an alliance triangle between Kristen and her mother, Juana, and her father, George. In this situation, the triangle would be the mother focusing her attention and emotions towards the child because of the neglect and abuse received from the father. The household problems would also create a multigenerational problem where both Kristen and her mother had unresolved attachments to the symptoms of the alcoholic father and the family triangle. These issues further complicate the current relationship between Kristen and Juana and enhance Juana’s attachment to the oldest son, Ronnie.
There is also sufficient information that reflects on Kristen’s unresolved issues influenced her past marital choices. Kristen stated that her first husband and Ronnie’s father was also an abusive alcoholic. However, her current husband Tony is the opposite and breaks the behavioral mold of her past. Furthermore, Juana’s unresolved issues with George, combined with Ronnie sharing similar behavioral traits to George have manifested in Juana emotionally projecting an unhealthy and overly-protective relationship with Ronnie that inhibits differentiation and enhances troubles between other family members; here we discover the second triangle. The second triangle is between Kristen, Juana, and Ronnie, and fueled by the problems between Kristen and Juana, which acts as an enabler for Juana to become intertwined with Ronnie.

Kristen’s concerns about Ronnie’s behaviors stem from his occasional aggressiveness, most likely fueled by Juana’s attention, and Kristen’s projection of unresolved past family experiences. Although there is minor discussion surrounding some other family members, there is enough data to extrapolate the third triangle, which would include Tony, Kristen, and the middle-placed daughter, Brittany. The triangle is a result of problems between Kristen and Tony, which results in Tony and Brittany spending more time together that with other family members. Over time this triangle will most likely impede Brittany’s ability to differentiate herself adequately from her father, and manifest as a disassociative pattern between Brittany and the rest of the family.

While it is fair to note that a fourth triangle involving Kristen and Tanya is apparent, there could be multiple third-party causations, and lack of more accurate information would lead to speculation. However, noting that Tony is more withdrawn, quiet, and reserved and that Kristen and Tony have experienced problems with Juana, there is an indication that Tony would be the third factor in this equation. Exacerbating the problems is the oldest daughter Sophie. Sophie displays a high level of dissociation and emotional cut-off from the family. Sophie’s dissociative behavior is likely a result of sibling positioning as the oldest daughter and second oldest child, combined with Ronnie’s aggressive behavior, problems between Juana and Kristen, and the triangles that exist between her parents and other siblings.

Treatment Plan Considerations

The treatment plan should be designed to emphasize a combination of continued therapy for the family to help improve family structure, communication, and homeostasis. Progress will be measured by milestones to show areas of improvement, or identify areas still in need of improvement. The plan is implemented in phases that allow the family time to explore the issues and come to conclusions with minimal guidance from the therapist. The first step of implementation should be therapy sessions to help the family talk, hear each other, and discover solutions. The second stage is to help the family identify and break old routines that may enhance anxiety in the home and to encourage changing interaction patterns between family members. The final stage would include a reduction and progression towards ending therapy once family homeostasis improves. There are areas where specific family members may seek additional counseling to address unresolved issues.

Family therapy sessions should continue to help the family members identify communication and active listening opportunities to aid in disarming argumentative postures, feelings of not being heard, and improving relations between family members. Continued counseling will also assist family members to identify existing triangles, multigenerational transfers, and sibling placement issues. As the family begins to discover these issues through open communication, they will start to define solutions for them.  Juana and Kristen may desire to seek additional counseling to recognize and resolve past issues that influence current tensions. Also, Juana, Kristen, and Tony should be encouraged to spend equal time with the children, and the family should be invited to change the family routine to foster more interaction and togetherness, and potentially start to change associative behaviors of “favorites” between family elders and children.

Tony and Kristen should be encouraged to spend time together as a couple to restructure and redefine their roles as less adversarial and reactive to active and communicative. Reestablishing the bond and cohesiveness of the marital couple will have a dramatic impact on the overall family structure. The children should be encouraged to spend time together as siblings, which should help identify areas of commonality and interest; a concert or movies perhaps. These activities should reduce triangular interactions that currently exist, promote a healthier home life, and increase healthy differentiation pattern development.

Treatment Plan

Recipient Information

Name: Family X – Vignette
Date: 02/01/2017
Problem/Symptom
See above Assessment


Long Term Goal: Improve family structure, communication, and interactions

Short Term Goals/Objectives

1. Continued family counseling to help family recognize communication and other problem areas
2. Juana and Kristen seek additional counseling for past issues
3. Break old routines
4. Encourage family members to spend more time in groups and as a family
5. Reduce therapy sessions

Milestones

1. Family arguing and contention begins to balance. Communication improves
2. Past issues become resolved. Mother and daughter are talking more openly. Fighting reduces.
3. Breaking old routines introduces exploration as a family.
4. Reduces existing family triangles. Helps family members find commonalities. Notable reestablishment of family structure.
5. As the family structure, communications, and interactions improve, a reduction in therapy sessions will show significant progress.

References

Boughner, S. R., Hayes, S. F., Bubenzer, D. L., & West, J. D. (1994). Use Of Standardized Assessment Instruments By Marital And Family Therapists: A Survey. Journal of Marital and Family Therapy,20(1), 69-75. doi:10.1111/j.1752-0606.1994.tb01013.x

Bowenian Family Therapy. (n.d.). Retrieved January 28, 2017, from http://www.psychpage.com/learning/library/counseling/bowen.html

Ghanbaripanah, A., & Sharif Mustaffa, M. (2012). The Review of Assessment in Family Counseling. International Journal of Fundamental Psychology & Social Sciences,2(2), 32-35. Retrieved February 01, 2017, from http://fundamentaljournals.org/ijfpss/downloads/15-Afsan%20300412.pdf

Hutchinson, M., Casper, P., Harris, J., Orcutt, J., & Trejo, M. (2008, July 31). THE CLINICIAN’S GUIDE TO WRITING TREATMENT PLANS AND PROGRESS NOTES [PDF].

Kerr, M. E. (2000). One Families Story: A Primer on Bowen Theory. Retrieved January 26, 2017, from http://www.thebowencenter.org/theory/

Nichols, M. P. (2013). Family Therapy: Concepts and Methods (10th ed.). Boston: Pearson.

Wilmoth, J., & Smyser, S. (2010). Use of Premarital Assessment Questionnaires by Clergy in Marriage Preparation. Journal of Couple & Relationship Therapy,9(3), 252-267. doi:10.1080/15332691.2010.491783