Postmodern Approaches & Family Systems

Postmodern Approaches

Key Figures:

Insoo Kim Berg

Steve De Shazer

Michael White

David Epston

Postmodern Approach Therapy Goal:

Postmodern therapy focuses on deconstructing common beliefs and examining their value in an individual’s life.

Postmodern Approach Key Concepts:

Solution-Focused Brief Therapy

Emphasizes strengths and resiliencies of people by focusing on exceptions

to their problems and their conceptualized solutions.

Narrative Therapy

Seeks to help people identify their values and the skills and

knowledge they have to live these values.

Postmodern Approach Techniques:

Solution-Focused Brief Therapy

• Pre-therapy Change: Therapists elicit, evoke, and amplify what clients have already done to start making positive changes. This helps encourage clients to rely less on therapy and more on their resources to reach their goals.
• Exception Question: Questions about a client's past experience's when it would have been reasonable to expect problems to occur but they did not. This helps clients identify and examine the past exceptions, which helps clients work toward solutions.
• Miracle Question: Question that asks clients to consider that a miracle happens opens up the range of future possibilities. This helps shift the emphasis on past and current problems toward a more satisfying future.
• Scaling Questions: Questions used when change in experiences is not easily observed and assists clients in noticing that they are not defeated by their problems. This helps clients to pay closer attention to what they are doing and what steps they can take that lead to the changes they want.
• Formula First Session Task: A form of homework given to clients between the first and second session where the client is asked to observe things that happen in everyday life. In the second session, clients are asked what they saw and what they would like to see in the future. This helps give clients hope that change is inevitable and that its not if but when change will happen.
• Therapist Feedback to Client: Therapists give feed back to the client in three basic parts: compliments, a bridge, and suggesting a task. This addresses what clients need to do more of and differently to increase their chances of reaching their goals.

 Narrative Therapy

• Question and More Questions: Questions that help generate experience rather than gathering information. This helps clients to progressively discover or construct their experiences so they have a preferred sense of direction.
• Externalization and Deconstruction: Externalization allows clients to experience the problem outside of themselves and deconstruction allows clients to generate a more positive experience. This helps facilitate hope and allows clients take a stand against self-blame.
• Search for Unique Outcomes: Questions that are aimed at highlighting moments when the clients problem had not occurred or the problem had been dealt with successfully. This enables clients to see that change is possible.
• Alternative Stories and Reauthoring: The therapist listens for clues to competence in the midst of problematic stories and builds a story of competence around it. This helps clients remember, reclaim, and reinvent a richer, thicker, and more meaningful alternative story.
• Documenting the Evidence: The therapist writes letters that record the session, a description of the problem, and its influence on the client. These letters will include the client's strengths and abilities that were identified during the session. This helps highlight the struggle the client has had with the problem, draws distinction between the problem story and the new, preferred story. These letters can be read at different times, re-inspiring the client.

Family Systems Therapy

 Key Figures:

Alfred Adler, Murray Bowen, Virginia Satir

Carl Whitaker

Salvador Minuchin, Jay Haley, Cloe Madanes

Family Systems Therapy Viewpoints:

Adlerian Family Therapy

• Key Figure: Alfred Adler
• Time Focus: Present with some reference to the past.
• Therapy Goals: Enable parents as leaders; unlock mistaken goals and interactional patterns in the family; promotion of effective parenting.
• Role & Function of Therapist: Educator; motivational investigator; collaborator.
• Process of Change: Formation of relationship based on mutual respect; investigation o birth order and mistaken goals; re-education.
• Techniques & Innovations: Family constellation; typical day; goal disclosure; natural/logical consequences.

Multi-Generational Family Therapy

• Key Figure: Murray Bowen
• Time Focus: Present and past; family of origin; three generations.
• Therapy Goals: Differentiate the self; change the individual within the context of the system; decrease anxiety.
• Role & Function of Therapist: Guide, objective researcher, teacher; monitor of own reactivity.
• Process of Change: Questions and cognitive processes lead to differentiation and understanding of family origin.
• Techniques & Innovations: Genograms; dealing with family-of-origin issues; detriangulating relationships.

 Human Validation Process Model

• Key Figure: Virginia Satir
• Time Focus: Here and now.
• Therapy Goals: Promote growth, self-esteem, and connection; help family reach congruent communication and interaction.
• Role & Function of Therapist: Active facilitator; resource detective; model for congruence.
• Process of Change: Family is helped to move from status quo through chaos to new possibilities and new integrations.
• Techniques & Innovations: Empathy; touch, communication; sculpting; role playing; family-life chronology.

Experimental/Symbolic Family Therapy

• Key Figure: Carl Whitaker
• Time Focus: Present
• Therapy Goals: Promote spontaneity, creativity, autonomy, and ability to play.
• Role & Function of Therapist: Family coach; challenger; model for change through play.
• Process of Change: Awareness and seeds of change are planted in therapy confrontations.
• Techniques & Innovations: Co-therapy; self-disclosure; confrontation; use of self as change agent.

Structural Family Therapy

Key Figure: Salvador Minuchin

Time Focus: Present and past.

Therapy Goals: Restructure family organization; change dysfunctional transactional patterns.

Role & Function of Therapist: "Friendly Uncle"; stage manager; promoter of change in family structure.

Process of Change: Therapist joins the family in a leadership role; changes structure; sets boundaries.

Techniques & Innovations: Joining and accommodating; unbalancing; tracking; boundary making; enactments.

Strategic Family Therapy

• Key Figures: Jay Haley and Cloe Madanes
• Time Focus: Present and future.
• Therapy Goals: Eliminate presenting problem; change dysfunctional patterns; interrupt sequence.
• Role & Function of Therapist: Active director of change; problem solver.
• Process of Change: Change occurs through action-oriented directives and paradoxical interventions.
• Techniques & Innovations: Reframing; directives and paradox; amplifying; pretending; enactments.

In Family Systems Therapy, the members and systems are assessed based on power, alignment, organization, structure, development, culture, and gender.

Cognitive Behavior, Reality, and Feminist Therapies

Cognitive Behavior Therapy

(CBT)

Key Figures:

Albert Ellis

Aaron T. Beck

Judith S. Beck

CBT Goal:

The main goal of cognitive behavior therapy is to help clients form clear ideas of their thoughts, attitudes and expectations. People tend to attach false and distressing beliefs to the things and situations that cause problems and CBT helps people reveal and change these beliefs.

CBT Key Concepts:

• Rational emotive behavior therapy (REBT) is the main concept used in CBT which focuses on resolving emotional and behavioral disturbances with the goal of leading to a more fulfilling life. 
• Cognitive therapy is a type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order treat mood disorders.
• Behavior Therapy is the treatment of neurotic symptoms by training a patient’s reactions to stimuli.
• Multimodal Therapy is an approach which focuses on each modality, such as behavior, sensation, and interpersonal relationships.

CBT Techniques Used:

Cognitive Methods:

• Disputing irrational disbeliefs: therapists actively dispute clients irrational beliefs and teach them how to do this on their own.
• Doing cognitive homework: clients make lists of their problems, look for their absolutist beliefs, and dispute these beliefs. Homework is a way for clients to track down their "shoulds" and "musts" that are part of their internalized self-messages,
• Bibliotherapy: involves the reading of specific texts with the purpose of healing.
• Changing one's language: clients are taught that "musts", "oughts", and absolute "shoulds" can be replaced with preferences that employ new self-statements that help them think and behave differently.
• Psychoeducational methods: introduces clients to educational materials that educate them about their problems and how treatment will likely proceed.

Emotive Techniques:

• Rational emotive imagery: clients are asked to imagine themselves in a situation where they experience disturbing feelings and then shown how to train themselves to develop healthy emotions in place of disruptive ones.
• Using humor: which shows the absurdity of certain unhealthy ideas that clients maintain and teaches them laugh at their self-defeating ways of thinking.
• Role playing: to help clients work through unhealthy beliefs that are related to unpleasant feelings.
• Shame-attacking exercises: helps clients reduce shame and anxiety over behaving a certain way by increasing self-acceptance and mature responsibility.
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Reality Therapy

Key Figures:

William Glasser

Robert E. Wubbolding

Reality Therapy Goal:

To help clients assess current behaviors and determine if these behaviors are effective methods of obtaining needs, including achievement, power or inner control, freedom or independence, and fun.

Reality Therapy's Key Concepts:

The main emphasis is on the clients actions. If clients can change what they are doing,

they can change how they are thinking and feeling which will lead to

more successful methods of obtaining needs.

Reality Therapy Techniques:

Cycle of Counseling

• Creating the counseling environment: creating an environment that is caring, accepting, and non-coercive.
• Implementing behaviors that lead to change: helping clients see that their current behavior is not meeting their needs and that choosing other behaviors can get them closer to what they want.

WDEP System

• Wants: Exploring wants, needs, and perceptions
• Direction and Doing: help clients make more need satisfying choices
• Self-Evaluation: assists clients in evaluating their present behavior ant the direction it is taking them.
• Planning and Action: enables clients to gain effective control over their lives

  
  

  

Feminist Therapy

Key Figures:

Jean Baker Miller

Carol Zerbe Enns

Olivia M. Espin

Laura S. Brown

(from top left to bottom right)

Feminist Therapy Goal:

The overarching long-term goal is to empower clients. On an individual level, the goal is to help clients, females and males, recognize, claim, and embrace their personal power.

Feminist Therapy Key Concepts:

The key concepts of this therapy are to help clients:

• Become aware of their own gender-role socialization process.
• Identify their internalized messages and replace them with more self-enhancing beliefs.
• Understand how sexist and oppressive societal beliefs and practices influence them in negative ways.
• Acquire skills to bring about change in the environment.
• Restructure institutions to rid them of discriminatory practices.
• Develop a wide range of behaviors that are freely chosen.
• Evaluate the impact of social factors on their lives.
• Develop a sense of personal and social power.
• Recognize the power of relationships and connections.
• Trust their own experience and their intuition.

Person-Centered, Gestalt, and Behavior Therapies

Person-Centered Therapy

Key Figure:

Carl Rogers

Key Concepts:

• How client's react in their world with others
• How client's can move forward in constructive directions
• How client's successfully deal with internal and external obstacles

Person-Centered Therapy Goal:

• To help client's with their growth process so they can better cope with problems as the client identifies them.

Techniques used in Person-Centered Therapy:

Therapist creates an environment that is conducive to self-exploration by:

1. Being congruent (genuine, integrated, and authentic)
2. Having unconditional positive regard and acceptance
3. Having accurate empathetic understanding

Gestalt Therapy

Key Figures:

Frederick ("Fritz") Perls and Laura Posner Perls

Key Concepts:

• Holism - the treating of the whole person, including mental and social factors
• Field Theory - examining patterns of interaction between the individual and the environment.
• Figure-Formation Process - examining how a client organizes experiences from moment to moment
• Organismic Self-Regulation - examining how mental stability is distributed by the rise of a need, a sensation, or an interest.

Gestalt Therapy Goal:

To raise clients' awareness regarding how they function in their environment

(with family, at work, school, friends).

Techniques used in Gestalt Therapy:

Experiments that involve exercises that elicit emotion, produce action, or achieve a specific goal.

Exercises include:

• The Internal Dialogue Exercise - Empty-chair Technique - used to promote a higher level of integration between the polarities and conflicts that exist in everyone.
• Making the Rounds - purpose is to confront, to risk, to disclose the self, to experiment with new behavior, and to grow and change
• The Reversal Exercise - used to help clients begin to accept certain personal attributes they have tried to deny.
• The Rehearsal Exercise - used to show clients the many preparatory means they use in bolstering their social roles.
• The Exaggeration Exercise - used to make clients more aware of the subtle signals and cues they are sending through body language.
• Staying With the Feeling - used to help clients face and overcome feelings that they would normally avoid.
• The Gestalt Approach to Dream Work - used to help clients become more aware of his or her range of feelings.  

Behavior Therapy

Key Figures:

B. F. Skinner

Albert Bandura

Arnold Lazarus

Key Concepts:

• Focus is on overt behavior, specifying goals of treatment, development of specific treatment plans, and evaluation of therapy outcomes.
• Therapy is based on principles of learning theory.
• Normal behavior is learned through reinforcement and imitation.

Behavior Therapy Goals:

• Help clients eliminate maladaptive behaviors. 
• Help clients learn more effective behaviors.
• To identify factors that influence behaviors.
• Help clients learn how to cope and deal with problematic behaviors.
• To encourage clients to take an active role in setting treatment goals and evaluating how well goals are being achieved.

Techniques used in Behavior Therapy:

• Applied Behavioral Analysis - Operant Conditioning Techniques: Positive and Negative Reinforcement - Positive and Negative Punishment
• Progressive Muscle Relaxation
• Systematic Desensitization
• Exposure Therapies
• Eye Movement Desensitization and Reprocessing
• Social Skills Training
• Self Management Programs and Self-Directed Behavior
• Multimodal Therapy: Clinical Behavior Therapy
• Mindfulness and Acceptance-Based Cognitive Behavior Therapy

Psychoanalytic, Adlerian, & Existential Theories

Psychoanalytic Theory

Psychoanalysis is defined in the Oxford English Dictionary as:

• A therapeutic method, originated by Sigmund Freud, for treating mental disorders by investigating the interaction of conscious and unconscious elements in the patient's mind and bringing repressed fears and conflicts into the conscious mind, using techniques such as dream interpretation and free association.

Freud believed that personality is made up of three systems:

• ID: Ruled by the pleasure principle which is aimed at reducing tension, avoiding pain, and gaining pleasure.
• EGO: Ruled by the reality principle that does realistic and logical thinking and formulates plans of action for satisfying needs.
• Superego: Is the judicial branch of personality that inhibits the id impulses, persuades the ego to substitute moralistic goals with realistic ones, and to strive for perfection.

The ultimate goal of psychoanalytic theory is to make the unconscious conscious

and the ego stronger so behavior is based more on reality instead of

instinctual cravings or irrational guilt.

Techniques used to achieve this goal are:

• Free Association: Client's are encouraged to say whatever comes to mind regardless of how irrelevant, illogical, silly, or embracing they may seem. Free association opens the door to the patient's unconscious wishes, fantasies, conflicts, and motivations.
• Interpretation: The therapist explains and teaches the patient the meanings of behaviors in dreams, free association, and the therapeutic relationship in terms that the patient understands.
• Dream Analysis: Interpretation of dreams to uncover underlying motivations, symbolic meanings and representations.

Adlerian Theory

Adlerian theory is defined by EncartaDictionaries as:

• A body of psychological thought deriving from the work of Alfred Adler, theorizing that individual behavior largely results from subconscious efforts to deal with a sense of inferiority.

The key concepts of Adlerian theory are:

• Humans are social beings.
• Humans are motivated to find one's place in society and belong.
• Personality is complete and indivisible.
• Humans are naturally creative, active, and decisional.
• Human nature is driven by an unknown creative force to better oneself.

The goal of Adlerian theory is to develop the client's sense of belonging and to assist in the adoption of behaviors and processes characterized by community feeling an social interest.

The four phases of Adlerian therapy are:

1. Establish the proper therapeutic relationship.
2. Explore the psychological dynamics operating in the client (an assessment).
3. Encourage the development of self-understanding (insight into purpose).
4. Help the client make new choices (reorientation and reeducation).

Existential Theory

Existential psychotherapy confronts the ultimate concerns and sometimes tragic existential

facts of life: death, finitude, fate, freedom, responsibility, loneliness, loss, suffering,

meaninglessness, and evil.

The key figures in Existential Theory are:

The goals of Existential Therapy are:

• The capacity of self-awareness
• Freedom and responsibility
• Striving for identity and relationship to others
• The search for meaning
• Anxiety as a condition of living
• Awareness of death and nonbeing

There are three phases to Existential Therapy:

1. Initial phase: Therapists assist clients in identifying and clarifying their assumptions about the world.
2. Middle phase: Clients are assisted in more fully examining the source and authority of their present value system.
3. Final Phase: Focuses on helping people take what they are learning about themselves and put it into action.