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FAMILY AND COUPLES THERAPY:POSSIBLE RISKS

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Clinical Psychology­ (PSY401)
VU
Lecture 36
FAMILY AND COUPLES THERAPY
FAMILY THERAPY:
Family therapy is a form of psychotherapy that involves all the members of a nuclear or extended family.
It may be conducted by a pair of therapists--often a man and a woman--to treat gender-related issues or
serve as role models for family members. Although some types of family therapy are based on behavioral or
psychodynamic principles, the most widespread form is based on family systems theory, an approach that
regards the entire family as the unit of treatment, and emphasizes such factors as relationships and
communication patterns rather than traits or symptoms in individual members.
PURPOSE:
The purpose of family therapy is to identify and treat family problems that cause dysfunction. Therapy
focuses on improvement in specific areas of functioning for each member, including communication and
problem-solving skills.
Family therapy is often recommended when:
·  A family member has schizophrenia or suffers from another severe psychosis; the goal in these
cases is to help other family members understand the disorder and adjust to the psychological
changes that may be occurring in the patient.
·  Problems cross generational boundaries, such as when parents share a home with grandparents, or
children are being raised by grandparents.
·  Families deviate from social norms (unmarried parents, gay couples rearing children, etc.). These
families may or may not have internal problems, but could be troubled by societal attitudes.
·  Members come from mixed racial, cultural, or religious backgrounds.
·  One member is being scapegoated, or their treatment in individual therapy is being undermined.
·  The identified patient's problems seem inextricably tied to problems with other family members.
·  A blended (i.e. step-) family is having adjustment difficulties.
PRECAUTIONS:
Before family therapy begins, family members are required to undergo a comprehensive clinical evaluation
(interview) that includes questions of a personal and sensitive nature. Honest communication between the
family members and the therapist is essential; people who are not willing to discuss and change behaviors
may not benefit from therapy.
Families that may not be considered suitable candidates for family therapy include those in which:
·  One or both parents is psychotic or have been diagnosed with antisocial or paranoid personality
disorder.
·  Cultural or religious values are opposed to, or suspicious of, psychotherapy.
·  Some family members cannot participate in treatment sessions because of illness or other physical
limitations.
·  Individuals have very rigid personality structures and might be at risk for an emotional or psychological
crisis.
·  Members cannot or will not be able to meet regularly for treatment.
·  The family is unstable or on the verge of break-up.
Intensive family therapy may be difficult for psychotic family members.
HISTORY OF FAMILY THERAPY:-
Family therapy is a relatively recent development in psychotherapy. It began shortly after World War II,
when doctors who were treating schizophrenic patients noticed that the patients' families communicated in
disturbed ways. The doctors also found that patients' symptoms rose or fell according to the level of tension
between their parents. These observations led to considering a family as an organism (or system) with its
own internal rules, patterns of functioning, and tendency to resist change. When the therapists began to treat
the families as whole units instead of focusing solely on the hospitalized member, they found that in many
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cases the schizophrenic family member improved. (This does not mean that schizophrenia is caused by
family problems, although they may aggravate its symptoms).
This approach was then applied to families with problems other than schizophrenia. Family therapy is
becoming an increasingly common form of treatment as changes in American society are reflected in family
structures; it is also helpful when a child or other family member develops a serious physical illness.
Family therapy tends to be short term, usually several months in length, aimed at resolving specific
problems such as eating disorders, difficulties with school, or adjustments to bereavement or geographical
relocation. It is not normally used for long-term or intensive restructuring of severely dysfunctional
families.
In therapy sessions, all members of the family and both therapists (if there is more than one) are present.
The therapists try to analyze communication and interaction between all members of the family; they do not
side with specific members, although they may make occasional comments to help members become more
conscious of patterns previously taken for granted. Therapists who work as a team also model new
behaviors through their interactions with each other.
Family therapy is based on systems theory, which sees the family as a living organism that is more than the
sum of its individual members and evaluates family members in terms of their position or role within the
system. Problems are treated by changing the way the system works rather than trying to "fix" a specific
member.
Family systems theory is based on several major concepts:
The identified patient:-The identified patient (IP) is the family member with the symptom that has brought
the family into treatment. The concept of the IP is used to keep the family from scapegoating the IP or using
him or her as a way of avoiding problems in the rest of the system.
Homeostasis:-This concept presumes that the family system seeks to maintain its customary organization
and functioning over time. It tends to resist change. The family therapist can use homeostasis to explain
why a certain family symptom has surfaced at a given time, why a specific member has become the IP, and
what is likely to happen when the family begins to change.
The extended family field:-The extended family field is the nuclear family plus the network of grandparents
and other members of the extended family. This concept is used to explain the intergenerational
transmission of attitudes, problems, behaviors, and other issues.
Differentiation:-Differentiation refers to each family member's ability to maintain his or her own sense of
self while remaining emotionally connected to the family; this is the mark of a healthy family.
Triangular relationships:-Family systems theory maintains that emotional difficulties in families are
usually triangular--whenever any two persons have problems with each other, they will "triangle in" a third
member to stabilize their own relationship. These triangles usually interlock in a way that maintains
homeostasis. Common family triangles include a child and its parents; two children and one parent; a
parent, a child, and a grandparent; three siblings; or, husband, wife, and an in-law.
POSSIBLE RISKS:
There are no major risks involved in receiving family therapy, especially if family members seek the
therapy with honesty, openness, and a willingness to change. Changes that result from the therapy may be
seen by some as "risks"--the possible unsettling of rigid personality defenses in individuals, or the
unsettling of couple relationships that had been fragile before the beginning of therapy, for example.
NORMAL RESULTS:
The goal of therapy is the identification and resolution of the problem that is causing the family's unhealthy
interactions. Results vary, but in good circumstances they include greater insight, increased differentiation
of individual family members, improved communication within the family, and loosening of previously
automatic behavior patterns.
VARIETIES OF FAMILY THERAPY:
Conjoint Family Therapy:
In conjoint family therapy, the entire-family is seen at the same time by one therapist. In some varieties of
this approach, the therapist plays a, rather passive, nondirective role. In other varieties, the therapist is an
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active force, directing the. Conversation, assigning tasks to various family members, imparting, direct
instruction regarding human relations, and, so on.
Satir (1967a, 1967b) regarded the family therapist as a resource person who observes the family process in
action and then becomes a model of communication to the family through clear, crisp communication.
Thus, Satir viewed the therapist as a--teacher, a resource person, and a communicator. Such a therapist
illustrates to family members how they can communicate better and thereby bring about more satisfying
relationships.
Concurrent Family Therapy:
In concurrent family therapy, one therapist sees all family members, but in individual sessions. The overall
goals are the same as those in conjoint therapy. In some instances, the therapist may conduct traditional
psychotherapy with the principal patient but also occasionally see other members of the family. As a matter
of fact, it is perhaps unfortunate that the last variation is not used more often as a part of traditional
psychotherapy. Because it is often the case that an individual patient's problems can be understood better
and dealt with better in collaboration with significant others in the patient's life. The use of such
arrangements should facilitate the therapeutic process.
Collaborative Family Therapy:
In collaborative family therapy, each family member sees a different therapist. The therapists then get
together to discuss their patients and the family as a whole. As we saw earlier, the use of this approach with
child patients was one of the factors that stimulated the early growth of family therapy. In a variation of this
general approach, co therapists are sometimes assigned to work with the same family. That is, two or more
therapists meet with the family unit.
Behavioral family therapy:
Behavioral family therapy becomes a process of inducing family members to dispense the appropriate rein-
forcements to one another for the desired behaviors. Indeed, some therapists (Stuart, 1969) even have
family members use tokens for this purpose. For example, a husband might earn four tokens if he does not
watch Sunday football on TV and instead takes his wife for a drive in the country. Of course, it must be
made clear in advance exactly what these tokens may be exchanged for later!
Given the recent developments in cognitive behavioral therapy, it is not surprising that this approach has
found its way into the family therapy enterprise. Similar to cognitive-behavioral therapy for the individual,
the family "version" involves teaching individual family members to self-monitor problematic behaviors
and patterns of thinking, to develop new skills (communication, problem resolution, negotiation, managing
conflict), and to challenge interpretations of family events and reframe these interpretation if necessary.
The Couples Therapy:
The focus of couples therapy is to identify the presence of dissatisfaction and distress in the relationship,
and to devise and implement a treatment plan. The objectives of treatment are to improve or alleviate the
symptoms and restore the relationship to a healthier level of functioning.
Couples therapy, also called marital therapy or marriage counseling, is designed to help intimate partners
improve their relationship Couples therapy is a form of psychological therapy used to treat relationship
distress for both individuals and couples.
Purpose:
The purpose of couples therapy is to restore a better level of functioning in couples who experience
relationship distress. The reasons for distress can include poor communication skills, incompatibility, or a
broad spectrum of psychological disorders that include domestic violence, alcoholism, depression, anxiety,
and schizophrenia. The focus of couples therapy is to identify the presence of dissatisfaction and distress in
the relationship, and to devise and implement a treatment plan with objectives designed to improve or
alleviate the presenting symptoms and restore the relationship to a better and healthier level of functioning.
Couples therapy can assist persons who are having complaints of intimacy, sexual, and communication
difficulties.
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Precautions:
Couples who seek treatment should consult for services from a mental health practitioner who specializes in
this area.
Patients should be advised that honesty, providing all necessary information, cooperation, keeping
appointments on time, and a sincere desire for change and improvement are all imperative to increase the
chance of successful outcome. Additionally, a willingness to work "towards" and "with" the process of
treatment is essential.
Description:
Couples therapy sessions differ according to the chosen model, or philosophy behind the therapy. There are
several models for treating couples with relationship difficulties. These commonly utilized strategies
include psychoanalytic couples therapy, object relations couple therapy, ego analytical couples therapy,
behavioral couples therapy, integrative behavioral couples therapy, and cognitive behavioral couples
therapy.
Psychoanalytical Couples Therapy:
Psychoanalytic therapy attempts to uncover unresolved childhood conflicts with parental figures and how
these behaviors are part of the current relationship problems. The psychoanalytic approach tends to develop
an understanding of interpersonal interactions (at present) in connection with early development. The
success in development of early stages dictates the future behavior of interpersonal relationships. The
essential core of this model deals with the process of separation and individuation (becoming a separate,
distinct self) from mother-child interactions during childhood. A critical part of this model is introjection.
The process of introjection includes introjects (infant processing versions) of the love object (mother). The
developmental process of introjection forms the basis an unconscious representation of others (objects) and
is vital for development of a separate and defined sense of self. The psychoanalytic approach analyzes
marital relations and mate selection as originating from parent-child relationship during developmental
stages of the child.
Object Relations Couple Therapy:
The object relations model creates an environment of neutrality and impartiality to understand the
distortions and intra-psychic (internalized) conflicts that each partner contributes to the relationship in the
form of dysfunctional behaviors. This model proposes that there is a complementary personality fit between
couples that is unconscious and fulfills certain needs. This model supports the thought that a "mothering
figure" is the central motivation for selection and attachment of a mate. Choosing a "mothering" figure
induces further repression (non-development) of portions of personality that were not well-developed
(referred to as "lost parts"). This repression causes relationship difficulties.
Ego Analytical Couples Therapy:
Ego analytical approaches utilize methods to foster the ability to communicate important feelings in the
couple's relationship. This model proposes that dysfunction originates from the patient's incapabilities to
recognize intolerance and invalidation of sensitivities and problems in a relationship. According to this
model, there are two major categories of problems. The first category of problems relates to dysfunction
brought into the relationship from early childhood trauma and experiences. The second involves the
patient's reaction to difficulties and a sense of un-entitlement (a personal feeling that one does not deserve
something). A patient's shame and guilt are major factors precipitating the thoughts of un-entitlement.
Behavioral Marital Therapy
Behavioral marital therapists tend to improve relationships between a couple by increasing positive
exchanges and decreasing the frequency of negative and punishing interactions. This model focuses on the
influence that environment has in creating and maintaining relationship behavior. Behavior exchange
between partners is flowing continuously and prior histories can affect relationship interactions. Behavior
therapy in general is based on the idea that when certain behaviors are rewarded, they are reinforced. The
amount of rewards (positive rein forcers) received in relation to the amount of aversive behavior is linked to
an individual's sense of relationship dissatisfaction.
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Cognitive Behavioral Couples Therapy:
The cognitive approach therapist educates and increases awareness concerning perceptions, assumptions,
attributions or standards of interaction between the couple. The central theme for understanding marital
discourse using cognitive behavioral therapy is based on the behavioral marital therapy model. A couple's
emotional and behavioral dysfunctions are related to inappropriate information processing (possibly
"jumping to conclusions," for example) and negative cognitive appraisals. This models attempts to discover
the negative types of thinking that drive negative behaviors that cause relationship distress.
Follow Up In Couples Therapy:
Treatment usually takes several months or longer. Once the couple has developed adequate skills and has
displayed an improved level of functioning that is satisfactory to both, then treatment can be terminated. An
awareness of relapse prevention behaviors and relapsing behaviors is important. (Relapsing behaviors refer
to the return to the behaviors that the couple is trying to change or eliminate.) Patients are encouraged to
return to treatment if relapse symptoms appear. Follow-up visits and long-term psychological therapy can
be arranged between parties if this is mutually decided as necessary and beneficial.
Positive Results:
A normal progression of couple's therapy is relief from symptomatic behaviors that cause marital discourse,
distress, and difficulties. The couple is restored to healthier interactions and behaviors are adjusted to
produce a happier balance of mutually appropriate interactions. Patients who are sincere and reasonable
with a willingness to change tend to produce better outcomes. Patients usually develop skills and increased
awareness that promotes healthier relationship interactions.
Risk Factors:
The major risk of couples therapy is lack of improvement or return to dysfunctional behaviors. These tend
not to occur unless there is a breakdown in skills learned and developed during treatment, or a person is
resistant to long-term change.
Limitations:
There are no known abnormal results from couples therapy. At worst, patients do not get better because
they cannot break away from self-induced, self-defeating behaviors that precipitate marital dysfunction and
distress. The problems are not worsened if treatment is provided by a trained mental health practitioner in
this specialty.
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Table of Contents:
  1. MENTAL HEALTH TODAY: A QUICK LOOK OF THE PICTURE:PARA-PROFESSIONALS
  2. THE SKILLS & ACTIVITIES OF A CLINICAL PSYCHOLOGIST:THE INTERNSHIP
  3. HOW A CLINICAL PSYCHOLOGIST THINKS:Brian’s Case; an example, PREDICTION
  4. HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY:THE GREEK PERIOD
  5. HISTORY OF CLINICAL PSYCHOLOGY:Research, Assessment, CONCLUSION
  6. HOW CLINICAL PSYCHOLOGISTS BECAME INVOLVED IN TREATMENT
  7. MODELS OF TRAINING IN CLINICAL PSYCHOLOGY:PROFESSIONAL SCHOOLS
  8. CURRENT ISSUES IN CLINICAL PSYCHOLOGY:CERTIFICATION, LICENSING
  9. ETHICAL STANDARDS FOR CLINICAL PSYCHOLOGISTS:PREAMBLE
  10. THE ROLE OF RESEARCH IN CLINICAL PSYCHOLOGY:LIMITATION
  11. THE RESEARCH PROCESS:GENERATING HYPOTHESES, RESEARCH METHODS
  12. THE CONCEPT OF ABNORMAL BEHAVIOR & MENTAL ILLNESS
  13. CAUSES OF MENTAL ILLNESOVERVIEW OF ETIOLOGY:PANDAS
  14. THE PROCESS OF DIAGNOSIS:ADVANTAGES OF DIAGNOSIS, DESCRIPTION
  15. THE CONCEPT OF PSYCHOLOGICAL ASSESSMENT IN CLINICAL PSYCHOLOGY
  16. THE CLINICAL INTERVIEW:The intake / admission interview, Structured interview
  17. THE ASSESSMENT OF INTELLIGENCE:RELIABILTY AND VALIDITY, CATTELL’S THEORY
  18. INTELLIGENCE TESTS:PURPOSE, COMMON PROCEDURES, PURPOSE
  19. THE USE AND ABUSE OF PSYCHOLOGICAL TESTING:PERSONALITY
  20. THE PROJECTIVE PERSONALITY TESTS:THE RORSCHACH
  21. THE OBSERVATIONAL ASSESSMENT AND ITS TYPES:Home Observation
  22. THE BEHAVIORAL ASSESSMENT THROUGH INTERVIEWS, INVENTORIES AND CHECK LISTS
  23. THE PROCESS AND ACCURACY OF CLINICAL JUDGEMENT:Comparison Studies
  24. METHODS OF IMPROVING INTERPRETATION AND JUDGMENT
  25. PSYCHOLOGICAL INTERVENTIONS AND THEIR GOALS:THE EXPERT ROLE
  26. IMPORTANCE OF PSYCHOTHERAPY:ETHICAL CONSIDERATIONS
  27. COURSE OF NEW CLINICAL INTERVENTIONS:IMPLEMENTING TREATMENT
  28. NATURE OF SPECIFIC THERAPEUTIC VARIABLES:CLIENT’S MOTIVATION
  29. THE BEGINNING OF PSYCHOANALYSIS:THE CASE OF ANNA, THE INSTINCTS
  30. PSYCHOANALYTIC ALTERNATIVES:EGO ANALYSIS, CURATIVE FACTORS
  31. CLIENT CENTERED THERAPY:PURPOSE, BACKGROUND, PROCESS
  32. GESTALT THERAPY METHODS AND PROCEDURES:SELF-DIALOGUE
  33. ORIGINS AND TRADITIONAL TECHNIQUES OF BEHAVIOR THERAPY
  34. COGNITIVE BEHAVIORAL THERAPY:MODELING, RATIONAL RESTRUCTURING
  35. GROUP THERAPY: METHODS AND PROCEDURES:CURATIVE FACTORS
  36. FAMILY AND COUPLES THERAPY:POSSIBLE RISKS
  37. INTRODUCTION AND HISTORY OF COMMUNITY PSYCHOLOGY:THE ENVIRONMENT
  38. METHODS OF INTERVENTION AND CHANGE IN COMMUNITY PSYCHOLOGY
  39. INTRODUCTION AND HISTORY OF HEALTH PSYCHOLOGY
  40. APPLICATIONS OF HEALTH PSYCHOLOGY:OBESITY, HEALTH CARE TRENDS
  41. NEUROPSYCHOLOGY PERSPECTIVES AND HISTORY:STRUCTURE AND FUNCTION
  42. METHODS OF NEUROLOGICAL ASSESSMENT:Level Of Performance, Pattern Analysis
  43. FORENSIC PSYCHOLOGY:Qualification, Testifying, Cross Examination, Criminal Cases
  44. PEDIATRIC AND CHILD PSYCHOLOGY: HISTORY AND PERSPECTIVE
  45. INTERVENTIONS & TRAINING IN PEDIATRIC AND CLINICAL CHILD PSYCHOLOGY