family therapy models, diagnosis and principles are compared based upon Bowen’s Transgenerationaland/Family Systems model with Minuchin’s Family therapy. Later on, we will see the link between the two and the relationship of each model to divorce. In the case study, we will attempt to apply the lessons of the Bowen/Ackerman and Minuchin style approaches to get to the underlying causes of a patient’s depressive disorder.
The goal of the counseling session from the family therapist would be to aid the psychiatric team. Depression is simply a condition that reflects underlying issues. In this case, the patient’s past home life and separation of her parents have caused abuse and bereavement issues to be dealt with more effectively and to break the triggers that bring about the onset of depression. This is especially necessary, since the abuse issues and bereavement caused by the loss (or lack) of a caring father figure in her life have made drug therapy only marginally successful.
A.) Models, Diagnosis and Principles (Overview)
Family therapy is based upon understanding how families work and interact. To understand this basic principle is the key objective of every therapist.
During the past seventy years, the family therapy movement has tried to understand the family. Adler and Sullivan were the pioneers who laid the foundations of the discipline and began the task of applying Freud’s theories in the psycho-dynamic arena (Goldenberg & Goldenberg, 2008, 150-151). Ackerman went further by attempting to more systematically apply Freud to family therapy (ibid, 155).
Psychoanalysis was taken further to try to plumb the depths of the mystery of family relations. In the light of Freud’s research, Dr. Murray Bowen attempted to further uncover how unresolved conflicts from the past of a family continue to affect it in the present. The Bowen school introduced the hypothesis that many mental illnesses are simply the result of dysfunctional family system patterns. Bowen was one of the first to advocate and treat the whole family and their emotional system rather than treating a single member with his or her personal behaviors or emotions.
Beyond this, Bowen pioneered transgenerational patterns that have laid the foundation to help clients to identify the root of their family problems and search for a way to break those cycles (ibid, 175-178).
Family therapists discovered the emotional process in which a person is involved and how this matters to the patient. They focused on individual growth and the development of a person’s self-esteem. This is one of the most basic and primary concepts of a human being in a family relationship.
On the other hand, cognitive-behavioral family therapists predict that illogical beliefs work as the principal triggers for a family’s emotional distress
. Both schools have provided a unique advances to our understandings of interactions within the family unit (ibid).
B.) Comprehensive coverage of Transgenerational and Structural Models & Principles
In this paper transgenerational models and the structural family therapy models will be presented in more detail. First, we will consider the transgenerational model as pursued by Bowen and others. Then, we will consider the Minuchin model of structural models and principles.
Transgenerational theory contains 8 key elements. These include triangles, differentiation of self, nuclear family emotional system, family projection process, multigenerational transmission process, emotional cutoff, sibling position and societal emotional process (ibid, 178-190). Bowen stressed how important family relational patterns over time are. The relational patterns constitute a strong influence over the lives of an individual and the family that noticing them is crucial to become a differentiated person. This is by definition is a person that possesses a capacity for reflective thinking. Such a person does not respond automatically to emotional pressure, be it external or internal. Genograms are crucial to mapping these relationships so that patterns can be drawn and the patient can be effectively treated (ibid, 192). Briefly will follow some of what the author feels are the more important of Bowen’s work.
Much of the therapy is based around the concept of differentiation of self. Through this concept, a therapist can assess a patient’s capability to preserve their strong sense of self-
identity. This can be done while maintaining a natural attachment to his or her family system.
The term differentiation is used by Bowen as a synonym for maturity. This has been wrongly understood as meaning a person who is autonomous, disconnected or separated from others. In the post-modern critique, feminists who did not agree with Bowen’s concept of differentiation and his distinction between thinking and feeling. This was as a way of trying to elevate male attributes of rationality over female expressiveness. Bowens’ approach was attempting to emphasize the primary goal of the transgenerational school. This is to teach a person’s mind to maintain control of their emotional reactivity so that one can control their behavior and not to think about how they want to control others (ibid, 179)
Differentiation of self is related to the notion of emotional triangles. A triangle is a 3 person relationship structure. This can be considered as the fundamental base of a larger system.
An emotional triangle is the smallest stable relationship unit that is created when a situation or an unresolved problem between 2 people cannot find a solution. In such a situation, one of the affected persons turns to a third in search for understanding, or a way to fix the crisis. In this way an individual is able to see how the interlocking triangles in his family are working and how they may have the power to resolve their feelings about the past. The ability of a person to break out of a triangle depends upon the level of differentiation of self that the person has reached (ibid, 183).
Bowen’s approach can be applied by using 2 techniques. These include the genogram
(mentioned above). By using the genogram, the therapist can help the family to assess their own family of origin, discovering patterns of behavior and triangles and measuring their own self-differentiation. By doing so, the family will be able to reach the principal goals of the therapy which are the differentiation of themselves and detriangulation. A genogram is a kind of family map that goes to the third or fourth generation. A genogram is a way to map the family history which should not be treated as a form to fill out, but rather as a framework for understanding family patterns (ibid, 192).
The structure shown in the genogram can be used to understand how a specific family unit acts. This is the point where the structural family model comes into play. Even though the structural school does not focus its attention in the root and history of the problem, the conceptualization of patterns of behavior and how the family system has tried to resolve the problem, is a fundamental predicament in the theoretical framework of the structural school
Self-disclosure is a key element in Bowen’s model. Self-disclosure is presented as a crucial component in the training process of future therapists and in the supervision of them. Additionally, therapists who follow
Bowen’s family therapy model needed to experience emotional explorations of concepts in order to adequately understand them.
In Bowen’s model, the role of the therapist is like the role of a coach, who helps the family in creating and building fair relationships. Acting in this way, the therapist avoids becoming part of any type of triangles, and helps the family to find their own way of solving the problems, instead of telling them how to do it. In the transgenerational model, the therapist is like a tutor, whose principal work is to alleviate the dyadic stress created in a triangle. The therapist intervention as a middle person-moderator-coach-tutor is an essential element in a successful therapeutic work. The process of coaching a family or a member of a family begins by helping them to become observers of their roles and behaviors in their family. Being an observer will help them to realize the patterns existing in their own family. This will then motivate them to break those patterns that weaken the family system and work together toward a pattern of behaviors that are more productive and healthiest according to their moral, family and social values (ibid. 178-190).
Salvador Minuchin’s approach to family therapy stated that the focus of therapy is not the individual but the person within the family. The focus is not only in the past, how they try to solve the problem, but mainly in the present, in how the family is trying now to solve it.
According to Nichols, the structural model has three essential theoretical components: the family structure, the family subsystems and the family boundaries. Minuchin focuses his intervention not in the person who he thinks has the problem, but in the individual in his social context (ibid, 236-247).
According to Minuchin, a family is a natural association of individuals that during their lives, develops a specific structure that can be recognized by patterns of interaction. The family structure is in itself an invisible set of functional demands that organizes the ways in which family members interact.
These patterns of interaction are necessary for the regular functioning of the family, even though the members do not realize they are part of this structure. Another key component in the Minuchin’s model is the notion of subsystems. Families can be differentiated into subsystems based on generation, gender, and function, which are demarcated by interpersonal boundaries. When a therapist observes a family, they may realize that the structure that flows from those patterns of interactions is contained within a sub-substructure and these sub-structures interact within the whole system according to certain rules or boundaries (ibid, 240-247).
Systems or subsystems are created when two partners join with the intention of forming a family, this is the formal beginning of a new family unit. Nevertheless, the new family must walk through many steps until they can create a viable unit. Minuchin explored the subsystems that exist in this family. Each person within the family belongs to a subsystem, that we may call it, dyad (husband and wife), generational (siblings),
gender (men, women) or task (parental subsystem) (ibid, 248-253).
The structural model has three essential theoretical components: family structure, family subsystems and family boundaries. family boundaries are non-visible limits or perimeters that regulate contact with other members in the family. An important task of the parental subsystem is to develop healthy limits or boundaries that keep the whole family system safe from inappropriate intrusion of outsiders or any possible danger. Structural family therapists use an array of techniques to help the family discover the inner strength that they have to overcome their problems (ibid, 240-247).
Joining is a technique used with the purpose of bringing ease and a sense of confidence into the family therapy session. It is generally known among structural therapists that if a therapist wants to help a family in restructuring or finding a way to solve their problems, it is necessary for the therapist to join that family in a way that they see the therapist as somebody in whom
they can trust (ibid, 249).
The first strategy a therapist must implement is to find a way to disarm defenses and ease anxiety so, the course of therapy will be a useful and helpful way to change the family’s unhealthy patterns. Joining is not only courtesy or social respect, it is a deeper way of becoming part of the family, of enlisting oneself with them, so the family can be better helped. There are many different ways of joining with a family. For instance, making every family member feel comfortable, being attentive to the concerns of each member, repeating key expressions they might use during the sessions, and showing empathy and understanding. This attitude, when it is showed in a way that each family member is welcome to talk and be listened to opens the way for family members to begin listening to each other and establish a bond with the therapist that enable them to accept the challenges to come. Joining is the process through which a therapist helps a family and its members to open their hearts and minds to each other in a family therapy session.
This process of joining will help the therapist to have a deeper understanding of the structure and dynamic of this particular family. If the family has not created clear boundaries, it is necessary to help them to create them.
Minuchin indicated a starting point in determining the boundaries in a family is how they sit in a session. Sometimes this non-spoken arrangement shows internal alliances, for instance, mother and son against father, or mother and daughter, against father and son. The therapist needs to see the way members talk and if they let other members speak without interruptions.
Establishing or creating a boundary is a technique that helps to create a new structure which makes it possible for a family to find a solution to their problem. An example of boundary making is the therapist’s intervention allowing the daughter to complete her statement when the mother tries to interrupt her. Another way is to help the rebellious son to see in his parents the ones from whom he received life and actual economic sustenance. By doing so, he will see a boundary that must be respected, even though he is not happy with his parents’ performance (ibid, 243).
The therapist’s role is to help the family to find a way to change their dysfunctional patterns. By direct and active interventions, by positive reinforcement, by using a respectful sense of humor and by sporadic and strategic advices. The structural therapist helps the family members to restructure their own family. The goal of a therapist while working in family therapy is to change the organization of the family in a way that the members of the family can experience and see the positive changes. Structural therapists are window openers, who help family members to expand their perspectives and context, to the point of exploring the unfamiliar as a possible solution of the family’s problem. The therapist confirms family members and encourages them to experiment with behavior that has previously been constrained by the family system. As new possibilities emerge, the family organism becomes more complex and develops more acceptable alternatives for problem solving.
Psychiatric Diagnosis of Divorce-Case Study-Related to Depression-
The DSM IV defines depression as a complication (especially in the case of minor or brief recurrent depression) that is symptomatic of a deeper underlying condition. Even in the case of major depressive episodes, they are usually arise from bereavement and may persist in normal circumstances from 2 months for 1 year in the wake of the loss. Divorce causes similar effects. Therefore, the use of family treatment in coordination is advisable to preclude over diagnosis in the depression arena that might lead to an inadvertent diagnosis of Major Depressive episodes (First, Frances & Pincus, 2004. 190-192). This might lead to the occasion of inadvertent mixed episodes diagnosis such as hyper manic episodes (ibid, 196) or a major depressive disorders (ibid, 199).
Case Study and Conclusion
From the DSM-IV-TR Case Study book is a case study which deals with Ms. A who is a 28-year-old woman with an ongoing history of mood instability that dates back to her adolescence. Her mood varies from depressed to irritable and to being to rapidly cheerful. This happens several times a day. Her suicide attempts have numbered five, although all were nonlethal.
She is from is the product of a broken home where the parents were estranged. Her father was verbally and physically abusive and left when the patient was aged 9 years. Her mother is an alcoholic and a cocaine addict and has never been reliable. The patient has had several intense relationships with a number of men. None of these have lasted more than 6 months. She has experimented with homosexual relationships, and cannot decide if she is bisexual or not. She takes antidepressants from several different classes. There has been moderate initial relief, but are followed up by the return of her depression. She has tried psychotherapy several times but has always terminated prematurely when she perceived her therapist to be unhelpful (First, Frances & Pincus, 2004, 170) .
This would be a classic time for family therapy to step in and attempt to sort out the issue. Obviously, a transgenerational pattern approach is necessary due to the causes being buried in the past and connected with the lack of a firm parental relationship due to substance abuse, parental abuse and divorce issues in the home. It would be important to try to engage the mother in therapy with the daughter so that she can have some closure on the childhood issues and try to deal with the deeper issues that are bringing on the depression and the need for medication. Obviously she needs to stay on the psychiatric treatment regimen, but we have to try to deal with the older childhood issues as well.
While bringing in the mother might be difficult, is necessary to break the emotional cycle that triggers the depressive episodes as she recalls the childhood traumas. As we saw above, family therapists work on the emotional process in that involves the person and analyzes how this matters to the patient. The therapist must focus on the individuals growth and in the development of person’s self-esteem.
In the case of Mrs. A, she has a horrible self-esteem problem. Approval from a mother figure would likely be positive since the father was abusive. While the mother has substance abuse issues, she was uninvolved in the abuse, so it would provide an alternative handle for the issues. In this way, while the cycle may not be broken totally, the therapist has to work with the tools that are at hand.
From a cognitive-behavioral approach, the family therapist predict could work on breaking the illogical beliefs that work as the principal triggers for the emotional distress
. Obviously, with the father out of the picture, this approach could provide the therapist with the ability to point out the present reality where he is not there and there is a mother available to bond with. In this way, the patient’s issues could be attacked from multiple directions to get to the underlying family history bring on the present depressive condition. They then can hopefully begin developing healthy relationships to replace
Family therapists are in business to get to the underlying causes of problems in the home dynamic, break the cycles of negativity and stop the triggers that bring on negative relationships.
For this reason, we examined modern family therapy models, including the basic diagnosis and principles and techniques upon Bowen’s transgenerational and/family Systems model with Minuchin’s Family therapy.
In this paper, we explored the links between the two approaches and the relationship of each model to divorce. Then we applied the lessons of the Bowen/Ackerman and Minuchin style approaches to get to the underlying causes of a patient’s depressive disorder.
As stated above, the goal of the counseling session for the family therapist would be to aid the psychiatric team. Depression is simply a condition that reflects underlying issues. They can help to make a patient’s psychiatric session more effective and hopefully eventually wean them off medication by helping them to reconstruct their lives by dealing with the deeper issues.
The fact of the matter is that family therapy is meant to be short-term. Therapy sessions like Ms A are meant to kick start treatment sessions that are stalled due to the inability of family members to get past old baggage that is holding them back from moving on and improving their lives. Family therapy sessions can teach patients the skills to deepen family connections and to get through stressful times. Given the base belief in family therapy that the family is a unique social system, inherent in this belief is that it can also heal itself. By understanding these systems and then using their self healing devices, the family members themselves can be called upon and engaged to heal the unhealthy tendencies that have held them back from being the fully functioning organisms that they inherently have the capability to be.
First, M.B., Frances, A., & Pincus, H.A. (2004). Dsm-iv-tr guidebook. Arlington, VA:
Psychiatric Publishing, Inc.
Frances, A., & Ross, R. (2004). Dsm-iv-tr case studies: a clinical guide to differential diagnosis.
Arlington, VA: American Psychiatric Publishing, Inc.
Goldenberg, H., & Goldenberg, I. (2008). Family therapy: an overview. (7th ed., pp. 175-205).
Belmont, CA: Thompson Higher Education.
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