Structural and ClientCentered Theories Meeting 5 Cheung M
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Structural and Client-Centered Theories Meeting 5 © Cheung, M. , & Leung, P. (2008). Multicultural practice and evaluation: A case approach to evidence-based practice. Denver, CO: Love. Instructors who adopt this book may use this Power. Point to teach your course without prior permission. Please address questions and comments to mcheung@uh. edu. © Love Publishing: Monit Cheung & Patrick Leung 1
Family of Origin Scale ¡ ¡ ¡ Step 1: Fill out the FOS in reference to you when you were age 12. Fischer, J. , & Corcoran, K. (2007). Measures for clinical practice and research. Oxford: Oxford University Press. (pp. 306– 308) Step 2: Reverse score the following items so that l 5=1 l 4=2 l 3 unchanged l 2=4 l 1=5 (e. g. , if you score 1 in item #2, cross out 1 and write 5 next to it) 2, 4, 5, 7, 9, 13, 16, 17, 18, 20, 22, 23, 25, 26, 28, 30, 32, 33, 37, 39 ¡ The reverse score is only a psychometric method to calculate your FOS score. It is not to change your answer. © Love Publishing: Monit Cheung & Patrick Leung 2
Scoring Method Add up the scores according to the item numbers provided ¡ Divide each total score by 4 and round it to the nearest hundredth ¡ l l ¡ Quick math: Use to remainder to calculate the nearest hundredth: R 1=. 25; R 2=. 50; R 3=. 75 For example: 13 / 4=3 R 1=3. 25 Move all average scores to Step 3 l l Compare your scores to the norms Higher scores mean higher in FOO functioning © Love Publishing: Monit Cheung & Patrick Leung 3
Your Score Find your Total Score of all 40 items (i. e. , add up all the scores under the “Total Score” column) ¡ Range of scores should be 40 to 200 ¡ © Love Publishing: Monit Cheung & Patrick Leung 4
Family of Origin Scale ¡ Originally conducted among 278 college students in Texas l l ¡ ¡ No difference between black and white students Range of Total Scores: 40– 200 l l ¡ 239 White students (86%) 39 Black students (14%) White students: 144. 1 Black students: 147. 0 Source: Hovestadt, A. J. , Anderson, W. T. , Piercy, F. A. , Cochran, S. W. , & Fine, M. (1985). A family-of-origin scale. Journal of Marital and Family Therapy, 11(3), 287– 297. © Love Publishing: Monit Cheung & Patrick Leung 5
Practice Research Exercise Review current research on FOS: For Example: ¡ Manley, C. M. , Searight, H. R. , Skitka, L. J. , & Russo, J. R. (1993). The family-of-origin scale with adolescents: Preliminary norms. Social Behavior & Personality: An International Journal, 21(1), 17– 23. ¡ Niedermeier, C. L. , & Searight, H. R. (1995). Perceived family functioning among adolescent psychiatric inpatients: Validity of the family-of-origin scale. Child Psychiatry & Human Development, 25(4), 253– 265. © Love Publishing: Monit Cheung & Patrick Leung 6
Freud’s Family Life Cycle Anna Sigmund Anna (c) Love Publishing: Monit Cheung & Patrick Leung http: //academic. evergreen. edu/curricular/hhd 2005/Downloads/Genop. pdf 7
The Life Cycle & Ecological Perspectives with Genogram ¡ 1855 (Before Sigmund’s Birth) l Marital relationships implying from missing information about spouses © Love Publishing: Monit Cheung & Patrick Leung 8
Life Cycle & Ecological Interactions ¡ 1855 (Before Sigmund’s Birth) l l l Marital relationships implying from missing information about spouses Parents’ expectations through their own experiences with FOO Economic consideration ¡ l Business failed one year prior to daughter’s marriage Problematic life cycle transition Age when remarrying (Wife 20 yrs. younger) ¡ As grandfather ¡ © Love Publishing: Monit Cheung & Patrick Leung 9
1859: Sigmund (3 years old) ¡ Death in the family © Love Publishing: Monit Cheung & Patrick Leung 10
1859: Sigmund (3 years old) ¡ ¡ Multiple losses l Priority as the earliest son l Sibling’s birth after the death of another sibling l Death of a maternal uncle l Dismissal of the nursemaid l Emigration of stepbrothers, nephew and nieces l Uprooting of his own family Significant events l Jacob’s father died less than 3 mos. before Sigmund was born. l Anna was born when the family had to migrate twice. l Death of a sibling and its replacement effect l Maternal uncle dies just 1 mo. before brother’s death Close relationship patterns Tension between mother and stepsons © Love Publishing: Monit Cheung & Patrick Leung 11
1866: Sigmund (10 years old) ¡ Center of attention © Love Publishing: Monit Cheung & Patrick Leung 12
1866: Sigmund (10 years old) ¡ ¡ ¡ Center of attention Decision making and authority generating l Making decisions for the family (e. g. , naming Alexander) l Disposing of unwanted items in the family (e. g. , made his mom get rid of Anna’s piano) Theory generating l Oedipus complex l Sibling rivalry © Love Publishing: Monit Cheung & Patrick Leung 13
1873: Sigmund (17 years old) ¡ Sigmund entered medical school © Love Publishing: Monit Cheung & Patrick Leung 14
1873: Sigmund (17 years old) Sigmund entered medical school ¡ Excelled in school but not in socializing ¡ Jacobs felt the age and disappointed in Emanuel & Philip Sigmund made up for their absence ¡ Mother had more energy for kids than for the spouse ¡ © Love Publishing: Monit Cheung & Patrick Leung 15
1886: Sigmund (30 years old) ¡ Double connection © Love Publishing: Monit Cheung & Patrick Leung 16
1886: Sigmund (30 years old) ¡ Double connection l l Are they rivals? Relationship btw. Eli and Sigmund? Secret engagement reasons? ¡ Martha’s family’s moving in 1881 ¡ © Love Publishing: Monit Cheung & Patrick Leung 17
1896: Sigmund (40 years old) ¡ Turned 40 and had his last child © Love Publishing: Monit Cheung & Patrick Leung 18
1896: Sigmund (40 years old) ¡ ¡ ¡ ¡ Economic situation in supporting a large family? Wife’s sister moved in Father’s death Mid-life crises? ? Last child (Anna) was born as a turning point? l Oedipus Complex (1897) l Self analysis (1897– 1900) l The Interpretation of Dreams (1899) l Professor Extraordinary (1902) Anna was named after Freud’s teacher’s (Samuel Hammerschlag) daughter (Anna Hammerschlag Lichtheim) Wife’s emotional state after the 6 th pregnancy? Intimate relationship? © Love Publishing: Monit Cheung & Patrick Leung 19
1923: Sigmund (67 years old) ¡ Tuberculosis and other lung diseases © Love Publishing: Monit Cheung & Patrick Leung 20
1923: Sigmund (67 years old) ¡ ¡ ¡ Tuberculosis and other lung diseases Wife diagnosed pneumonia in 1919 Daughter died of pneumonia in 1920 Reaction to grandson’s death (TB) and his own diagnosis of cancer and operations in the same year (1923) Anna was not married caregiver? Other thoughts? © Love Publishing: Monit Cheung & Patrick Leung 21
Insight gained from the life cycle of a family? Structure of the family ¡ Sibling Position ¡ Societal regression ¡ Emotional cutoff ¡ © Love Publishing: Monit Cheung & Patrick Leung 22
Practice with Family Systems Theory From last week ¡ Connection to Structural Approach? ¡ l l l Alignment (Triangulation) System Maintenance Breaking down rigidity in the family structure (c) Love Publishing: Monit Cheung & Patrick Leung 23
STRUCTURAL APPROACH Goal: To restructure the family system of transactional rules so that members learn alternate ways of communicating with each other to allow for better coping methods for future conflict or stress. © Love Publishing: Monit Cheung & Patrick Leung 24
Theoretical Constructs of Structural Family Practice • Assume: How a family organizes itself is important to the well-being and effective psychological functioning of the members. • Three major concepts used in therapy: subsystems, homeostasis, alignments © Love Publishing: Monit Cheung & Patrick Leung 25
1. Subsystems • Defined by boundaries & rules • Key communications through – Individual subsystems – Spousal subsystems – Parental subsystems – Sibling subsystems © Love Publishing: Monit Cheung & Patrick Leung 26
2. Homeostasis • Change in behavior Structural Change • Boundaries Flexibility requirements • If rigid barriers between subsystems – Enmeshment • Overconcerned or overinvolved in each other’s live – Disengagement • Not willing or able to enter into the other’s world © Love Publishing: Monit Cheung & Patrick Leung 27
3. Alignments • Way that family members join together or oppose one another in carrying out a family activity • How supportive or unsupportive of each member when others are working on an activity • Coalitions (stable vs. detouring) © Love Publishing: Monit Cheung & Patrick Leung 28
Steps in Family Therapy (Minuchin, 1974) • Join the family in a position of leadership • Map the underlying structure • Intervene to transform this structure © Love Publishing: Monit Cheung & Patrick Leung 29
Family Mapping Symbols Clear Boundary Conflict Diffuse Boundary Coalition Rigid Boundary Detouring Affiliation Over-involvement © Love Publishing: Monit Cheung & Patrick Leung 30
Family Mapping of Joe’s Family (F): Father, Joe (M) Mother, Mary, Identified Patient F M (IP) Children • There is a rigid boundary between Joe and Mary. • Mary is overinvolved with her children. © Love Publishing: Monit Cheung & Patrick Leung 31
Mary’s Case M (IP) Ami More specifically, Mary has conflict with Ami, who is more vocal with her objection to her mother’s overinvolvement. © Love Publishing: Monit Cheung & Patrick Leung 32
Who’s Siding with Mary? C F M (IP) The children and father all hold Mary responsible for their difficulties in transitioning to a new family life stage. © Love Publishing: Monit Cheung & Patrick Leung 33
Structural Strategies • • (1) Joining (2) Working with interaction (3) Diagnosing (4) Highlighting and modifying interactions • (5) Boundary making • (6) Adding cognitive constructions © Love Publishing: Monit Cheung & Patrick Leung 34
Joining with the Family 1. Tracking: Adopt the family's way of thinking about their situation. 2. Accommodating: Relate to the family's current rules and roles. 3. Mimesis: Become like a family member by adopting the family's style of communication. © Love Publishing: Monit Cheung & Patrick Leung 35
Enactment • Technique: Ask the family to function in therapist session as it does in the home situation. • Purpose: Allow therapist to understand the family's current structure. • Procedure: Direct the family to think about and act on the way each subsystem (e. g. the couple, the children, mother and children, father and children) usually interacts when each has to make a decision or deal with an issue or problem. © Love Publishing: Monit Cheung & Patrick Leung 36
Symptom Focusing • • • 1. Re-label the symptom 2. Alter the effect of the symptom 3. Expand the symptom 4. Exaggerate the symptom 5. Deemphasize the symptom 6. Move the focus to a new symptom © Love Publishing: Monit Cheung & Patrick Leung 37
Structural Modification 1. Challenge the current family reality 2. Create new subsystems and boundaries 3. Block dysfunctional transactional pattern 4. Reinforce new and adaptive family structure 5. Educate about family change © Love Publishing: Monit Cheung & Patrick Leung 38
Paradoxical Constructions Provide the family with a different frame of experiencing in order to stimulate reactions toward change. • Example: Worker: Child: Worker: How old are you? Seven. Oh, I thought you were younger, because when you really get to be seven, you won't need Mommy to take you to school anymore. © Love Publishing: Monit Cheung & Patrick Leung 39
Practice • Issue #1: Issues with Children (pp. 160– 163) • Pair up and role-play in your seat • Then discuss how paradoxical constructions can be useful in social work intervention. © Love Publishing: Monit Cheung & Patrick Leung 40
Making Arrows • Two volunteers: Mary & Ami • Make an arrow on a note card to represent your relationship with each other © Love Publishing: Monit Cheung & Patrick Leung 41
Therapeutic Questions • Mary, when you’re pointing the arrow to Ami, what was in your mind? • How do you feel when the psychological burden is lifted (after the arrow is pointing at a chair)? © Love Publishing: Monit Cheung & Patrick Leung 42
Practice Again • 4 volunteers (Mary, Joe , MC, and Ami) • Issue #3: Family Changes (pp. 165– 166) © Love Publishing: Monit Cheung & Patrick Leung 43
Structural Practice Skills • Joining • Structural Perspective • Paradoxical Restructuring • Reframing (Restructuring) • Use of Metaphor • Focusing on Structure – Alignment – Detouring – Enactment © Love Publishing: Monit Cheung & Patrick Leung 44
Drawing your Qualities l l l Use the small sheet provided to write down one of your best qualities Place that sheet in the basket Take one and read it aloud as if this is your quality Tell a story about it. Implication: Support and affirmation is important in one’s life © Love Publishing: Monit Cheung & Patrick Leung 45
Humanistic Approaches to Practice l Carl Rogers’ Person-Centered Approach l Virginia Satir’s Validation Process Approach/Theory Watch a clip from Freaky Friday (2 mins. ) © Love Publishing: Monit Cheung & Patrick Leung 46
Person-Centered Based on Virginia Satir © Love Publishing: Monit Cheung & Patrick Leung 47
Four Common Factors Underlying Effective therapy Therapist’s Model or Technique 15% Client Expectations “Placebo Effect” Client Factors: • participation • strengths/ resources • perceptions of therapist • support network • desire/luck 40% Therapeutic Relationship (as perceived by the client) 30% 48 From: Miller, S. , Hubble, M. , & Duncan, B. No more bells and whistles. The Family Therapy Networker, 19(2), p. 52– 63.
Therapeutic Techniques l No matter which school or model of therapy, the client-centered therapist: • “prepares clients to take some action to help themselves” and • “expects them to do something different; develop new understandings, feel emotions, face fears, take risks, or alter old patterns of behavior. ” (p. 56) From: Miller, S. , Hubble, M. , & Duncan, B. No more bells and whistles. The Family Therapy Networker, 19(2) p. 52– 63. © Love Publishing: Monit Cheung & Patrick Leung 49
Client Expectations l l l “The therapist’s attitude toward the client during the opening moments of therapy. ” It creates in the client a sense of “increased hope and positive expectation of change simply from making their way into treatment. ” It improves positive outcome. (p. 56) From: Miller, S. , Hubble, M. , & Duncan, B. No more bells and whistles. The Family Therapy Networker, 19(2) p. 52– 63. © Love Publishing: Monit Cheung & Patrick Leung 50
Therapeutic Relationships l l l “Clients who are motivated, engaged and connected with therapist … benefit the most from therapy. Their participation is … largely a result of the bond [they] form with the helping professional; studies show that the consumer’s participation in therapy is the single most important determinant of outcome. …When clients perceive therapist as warm, trustworthy, nonjudgmental, and empathic, a strong alliance is formed. (p. 56) From: Miller, S. , Hubble, M. , & Duncan, B. No more bells and whistles. The Family Therapy Networker, 19(2), p. 52– 63. © Love Publishing: Monit Cheung & Patrick Leung 51
Client Factors l l “The most influential contributor to change is the client. ” The total matrix of who they are—their strengths and resources, the duration of their complaints, their social supports, the environments in which they live, even fortuitous events …matter more …than anything therapists might do. ”(p. 57) From: Miller, S. , Hubble, M. , & Duncan, B. No more bells and whistles. The Family Therapy Networker, 19(2), p. 52– 63. © Love Publishing: Monit Cheung & Patrick Leung 52
Satir Communication Theory Uniqueness: Emphasis on helping clients to expand their experiences through an understanding that: • Dysfunctional families do not appropriately practice communication skills • Family communication patterns are passed from one generation to the next • Families are guided to understand that sometimes failure is a normal part of life • Therapy usually ends when the family is able to communicate well with each other and self-esteem has been restored (c) Love Publishing: Monit Cheung & Patrick Leung 53
Goals: Self-Awareness Satir viewed dysfunctional behavior as a deficit in growth because we need: l Family to express true feelings without fear of rejection l Individual positive self-esteem l Supportive family environment l Balanced family system where each member understands roles and communication styles © Love Publishing: Monit Cheung & Patrick Leung 54
8 Interactive Elements in Family Assessment l l Physical • • • l Health issues Repeated illnesses Genetic illnesses l Sensual • Emotional vulnerability Spiritual • • • Religion Energy Death & Dying Intellectual • • Education Expectations l l Interactional • • Communication styles Relationship lines Contextual • • Environment Immigration, migration Nutritional • • Eating habits Exercise routines Emotional • • Negative self talk Self esteem © Love Publishing: Monit Cheung & Patrick Leung 55
Four Communication Styles that cover up low self-esteem l l Placator Blamer Super-reasonable (Intellectual) Irrelevant (Distracter) 1. Practice these 4 styles (in family sculpture or psychodrama) to raise self awareness (through an increase in anxiety in a guided environment) toward relationship building problems 2. Since it is important to plant the SEED of nurturing within the family (not Threat-or-Reward), everyone is encouraged to practice the fifth style: Leveler/Congruent communication style (in order to access the fullest potential). © Love Publishing: Monit Cheung & Patrick Leung (c) Love Publishing: Monit Cheung & Patrick Leung 56
Placator l Puts own needs aside l Tries to relieve the problems of others l Often takes the blame © Love Publishing: Monit Cheung & Patrick Leung 57
Blamer § Does not take responsibility for own actions § Focuses attention on actions of others © Love Publishing: Monit Cheung & Patrick Leung 58
Super-reasonable (Intellectual) § Denies feelings of self and others § Thinks he or she is always right but is ‘rigid’ © Love Publishing: Monit Cheung & Patrick Leung 59
Irrelevance (Distracter) § Tries to distract others § Takes focus off of the problem © Love Publishing: Monit Cheung & Patrick Leung 60
Practicing Healthy Posture: Congruent/Leveler • Congruent • Consistent • Concerned • Caring & Nurturing • Unconditional © Love Publishing: Monit Cheung & Patrick Leung 61
Practice Client-Centered l l 5 volunteers (Mary, Joe, Ami, Kevin, MC) Multicultural practice applications (p. 195) © Love Publishing: Monit Cheung & Patrick Leung 62
Daily Affirmation ¡ Today my happiness radiates from within me. l By Gary Seidler © Love Publishing: Monit Cheung & Patrick Leung 63
References • • • Carter, B. , & Mc. Goldrick, M. (1989). The changing family life cycle. Boston: Allen & Bacon. Cheung, M. , & Leung, P. (2008). Multicultural practice and evaluation: A case approach to evidence-based practice. Denver, CO: Love. Fischer, J. , & Corcoran, K. (2007). Measures for clinical practice and research. Oxford: Oxford University Press. Goldenberg, H. , & Goldenberg, I. (2008). Family therapy: An overview. Belmont, CA: Thomson Brooks/Cole. Hovestadt, A. J. , Anderson, W. T. , Piercy, F. A. , Cochran, S. W. , & Fine, M. (1985). A family-of-origin scale. Journal of Marital and Family Therapy, 11(3), 287– 297. Manley, C. M. , Searight, H. R. , Skitka, L. J. , & Russo, J. R. (1993). The family-oforigin scale with adolescents: Preliminary norms. Social Behavior & Personality: An International Journal, 21(1), 17– 23. Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press. Miller, S. , Hubble, M. , & Duncan, B. No more bells and whistles. The Family Therapy Networker, 19(2), p. 52– 63. Niedermeier, C. L. , & Searight, H. R. (1995). Perceived family functioning among adolescent psychiatric inpatients: Validity of the family-of-origin scale. Child Psychiatry & Human Development, 25(4), 253– 265. © Love Publishing: Monit Cheung & Patrick Leung 64
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