Comparing theoretical models of family systems therapy development

Social Work Practice: Family Treatment

The objective of this work is to compare at least three different theoretical models of family/systems therapy.

The work of Barker (2007) entitled: "Basic Family Therapy" states in Chapter 1: The Development of Family Therapy that family therapy "emerged during the second half of the twentieth century, as an often potent means of helping individuals and families with a variety of problems." Barker relates that before World War II "the response of psychiatrists to the difficulties their patients appeared to have in adapting to their family and social environments was often to remove patients from their families in order to ensure recovery in a setting away from the possible adverse effects of their family environments." (2007)

During the decade of the 1950s, "several groups embarked on the investigation and/or treatment of subjects with schizophrenia and their families." (Barker, 2007) During the 1960s the study of family treatment systems continued and Jackson (1961, 1965) "distinguished between family norms - rules that are not overtly acknowledged, but can be observed when the functioning of families is studied; 'values' - rules that are consciously acknowledged; and 'homeostatic mechanisms' - rules about how the family's norms and values are to be applied." These 'rules about rules' were dubbed by Jackson to be 'metarules'.

The work of Murray Bowen expanded the range of the previous clinical work in treating families of children with problems, except the cases of schizophrenia." (Barker, 2007) the work of Singer (1994) states that the concept of triangles in family therapy was developed by Murray Bowen in 1955. Triadic-based family therapy was addressed in the work of Zuk (1981) who suggested that family therapy is "mainly dyadic-based because of the influence of psychoanalytic theory." (Singer, 1994) Bowen held that "in order to understand the emotional dynamics, the therapist must examine the triangle" and states specifically that "the triangle, a three-person emotional configuration, is the...basic building block of any emotional system, whether it is in the family or any other group." (Singer, 1994)

The theories of Bowen "provide the basis for the study of triangles in family therapy."(Singer, 1994) According to Bowen (1978), all emotional systems can be understood through triangles. Two variables were identified by Bowen (1978) which are important in the determination of why triangles are existent in a relationship: (1) differentiation; and (2) anxiety. Differentiation "...refers to the degree to which individuality is maintained in a system" and anxiety "refers to the amount of emotional tension in a system." (Singer, 1994)

Family therapy is stated of Singer (1994) to have come of age in the 1970s and that it was increasingly accepted in major psychiatric centers. Family therapists began to address themselves to a wider range of disorders" than only schizophrenics and their family members. During this time there were many new study centers and developmental therapies for family and the work of Peggy Papp (1977) Family Therapy: Full Length Case Studies" made a presentation of "the work of 12 prominent family therapists including herself." (Singer, 1994) This work illustrates the diversity of the treatments used during the 1970s for family therapy. During the 1980s, family therapy is described to have been a form of "reapproachment" and meanwhile "new concepts and techniques continued to emerge." (Singer, 1994) Included is the narrative approach as well as "the technique of 'externalizing' problems." (Singer, 1994) During this time, there was also an interest in "brief solution-focused therapy. During the 1990s and in the first part of the new millennium family therapy is stated to have now "...a well established place among the psychotherapies." (Singer, 1994) Furthermore, interest has increased in "the application of cognitive behavioral methods of family therapy." (Singer, 1994) Family therapy is stated to also be presently applied."..to an ever-widening range of family types and ethnic groups." (Singer, 1994)

I. FUNCTIONAL FAMILY THERAPY

The work of Sexton and Alexander (2000) entitled: "Functional Family Therapy" states that Functional Family Therapy (FFT) is a "family-based prevention and intervention program that has been applied successfully in a variety of contexts to treat a range of...high risk youth and their families." Family Functional Therapy is stated to draw on "multisystemic perspective in its family-based prevention and intervention efforts." (Sexton and Alexander, 2000) Functional Family Therapy is a combination of the following elements and combines and integrates these "into a clear and comprehensive clinical model":

1) Established clinical theory;

2) Empirically supported principles; and 3) Extensive clinical experience. (Sexton and Alexander, 2000)

This model enables intervention that is successful in various complex and multidimensional problems "through clinical practice that is flexibly structured and culturally sensitive - and also accountable to youth, their families, and the community." (Sexton and Alexander, 2000) Sexton and Alexander state that Functional Family Therapy enables the identification of the primary focus of intervention and reflects "an understanding that positive and negative behaviors both influence and are influenced by multiple relational systems." (2000) Functional Family Therapy is a "multisystemic prevention program" with a focus on "the multiple domains and systems within which adolescents and their families live." (Sexton and Alexander, 2000) Functional Family Therapy first works in developing the inner strengths of the family members as well as improving their belief "of being able to improve their situations - even if moderately at first." (Sexton and Alexander, 2000) Functional Family Therapy "at the level of clinical practice...includes a systematic and multiphase intervention map - Phase Task Analysis that forms the basis for responsive clinical decisions. This map gives FFT a flexible structure by identifying treatment strategies with a high probability of success and facilitating therapists' clinical options." (Sexton and Alexander, 2000)

Functional Family Therapy has three stages of intervention:

1) Engagement and motivation;

II. BRIEF STRATEGIC FAMILY THERAPY

The work of Szapocznik (nd) entitled "Brief Strategic Family Therapy" states that BSFT is a "short-term problem-focused therapeutic intervention targeting children and adolescents 6 to 17 years old that improves youth behavior by eliminating or reducing drug use and its associated behavior problems and that changes the family members' behaviors that are linked to both risk and protective factors related to substance abuse." (Szapocznik, nd) the therapeutic process is stated by Szapocznik to use techniques of:

1) Joining - forming a therapeutic alliance with all family members;

2) Diagnosis - identifying interactional patterns that allow or encourage problematic youth behavior; and 3) Restructuring - the process of changing the family interactions that are directly related to problem behaviors. (Szapocznik, nd)

The Spanish Family Guidance Center in the Center for Family Studies at the University of Miami developed Brief Strategic Family Therapy and it has been used since 1975. Brief Strategic Family Therapy involves "creating a counselor-family work team that develops a therapeutic alliance with each family member and with the family as a whole; diagnosing family strengths and problematic interactions; developing change strategies to capitalize on strengths and correct problematic family interactions; and implementing change strategies and reinforcing family behaviors that sustain new levels of family competence." (Szapocznik, nd) Strategies are inclusive of:

1) Reframing;

2) Changing alliances;

3) Building conflict resolution skills; and 4) Parental empowerment. (Szapocznik, nd)

Brief Strategic Family Therapy can be used in various settings including "community social services agencies, mental health clinics, health agencies and family clinics." (Szapocznik, nd) BFSF is generally in 8 to 12 weekly sessions lasting between one and one-half hours in which the family and the counselor meet either in the office of the program location of in the home of the family. The four primary steps in Brief Strategic Family Therapy are those as follows:

Step One - Organize a counselor-family work team. Development of a therapeutic alliance with each family member and with the family as a whole is essential for BSFT. This requires counselors to accept and demonstrate respect for each individual family member and the family as a whole.

Step 2: Diagnose family strengths and problem relations. Emphasis is on family relations that are supportive and problem relations that affect youths' behaviors or interfere with parental figures' ability to correct those behaviors.

Step 3: Develop a change strategy to capitalize on strengths and correct problematic family relations, thereby increasing family competence. In BSFT, the counselor is plan- and problem focused, direction-oriented (i.e., moving from problematic to competent interactions), and practical.

Step 4: Implement change strategies and reinforce family behaviors that sustain new levels of family competence. Important change strategies include reframing to change the meaning of interactions; changing alliances and shifting interpersonal boundaries; building conflict resolution skills; and providing parenting guidance and coaching. (Szapocznik, nd)

III. MULTIDIMENSIONAL FAMILY THERAPY

Multidimensional Family Therapy (MFDT) is a "Comprehensive and flexible family-based program for substance-abusing adolescents or those at high risk for substance use and other problems behaviors." (Liddle, nd) the interventions of MDFT target "the research-derived risk factors and processes that have created and perpetuate substance use and related problems such as conduct disorder and delinquency." (Liddle, nd) the interventions of MDFT are systematic in assisting individual and families in their development of "empirically derived protective and healing factors and processes that offset substance use and behavioral problems." (Liddle, nd) MDFT is stated to be."..a multicomponent and multilevel intervention system." (Liddle, nd) MFDT makes assessments and provides intervention multisystemically with the following:

1) the adolescent and parent(s) individually;

2) the family as an interacting system; and 3) the individuals in the family relative to their interactions with influence social systems that impact the development of the adolescent. (Liddle, nd)

Key program approaches and components are stated by Liddle (nd) to include those as follows:

1) Community service;

2) Community collaboration;

3) Parent Training;

4) School collaboration;

5) Skill development; and 6) Substance Abuse/Prevention Education. (Liddle, nd)

MDFT is a multidimensional approach, which works in four specific areas including:

1) the adolescent (self, family, peer);

2) Parent (self, parenting);

3) Family (healthy family functioning); and 4) Extrafamilial (school, neighborhood, legal, social services, and medical)

SUMMARY & CONCLUSION

This work has reviewed three social work and family practice approaches to family therapy: (1) Functional Family Therapy (FFT); (2) Brief Strategic Family Therapy (BSFT); and (3) Multidimensional Family Therapy (MFDT), all of which are used in family treatment and intervention by the social work and family practice professions.