© love publishing: monit cheung & patrick leung1 structural and client-centered theories...

© Love Publishing: Monit Cheung & Patrick Leung 1

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 PowerPoint to teach your course without prior permission. Please address questions and comments to [email protected].

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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 5=1 4=2 3 unchanged 2=4 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.


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 Quick math: Use to remainder to calculate the

nearest hundredth: R1=.25; R2=.50; R3=.75 For example: 13 / 4=3R1=3.25

Move all average scores to Step 3 Compare your scores to the norms Higher scores mean higher in FOO functioning


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


Family of Origin Scale

Originally conducted among 278 college students in Texas 239 White students (86%) 39 Black students (14%)

No difference between black and white students

Range of Total Scores: 40–200 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.


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.

(c) Love Publishing: Monit Cheung & Patrick Leung 7

Freud’s Family Life Cycle

http://academic.evergreen.edu/curricular/hhd2005/Downloads/Geno/Genop.pdf

Anna

Anna

Sigmund


The Life Cycle & Ecological Perspectives with Genogram

1855 (Before Sigmund’s Birth) Marital relationships implying from

missing information about spouses


Life Cycle & Ecological Interactions

1855 (Before Sigmund’s Birth) Marital relationships implying from missing

information about spouses Parents’ expectations through their own

experiences with FOO Economic consideration

Business failed one year prior to daughter’s marriage

Problematic life cycle transition Age when remarrying (Wife 20 yrs. younger) As grandfather


1859: Sigmund (3 years old)

Death in the family



Multiple losses Priority as the earliest son Sibling’s birth after the death of another sibling Death of a maternal uncle Dismissal of the nursemaid Emigration of stepbrothers, nephew and nieces Uprooting of his own family

Significant events Jacob’s father died less than 3 mos. before Sigmund

was born. Anna was born when the family had to migrate twice. Death of a sibling and its replacement effect Maternal uncle dies just 1 mo. before brother’s death

Close relationship patterns Tension between mother and stepsons



Center of attention



Center of attention Decision making and authority generating

Making decisions for the family (e.g., naming Alexander)

Disposing of unwanted items in the family (e.g., made his mom get rid of Anna’s piano)

Theory generating Oedipus complex Sibling rivalry



Sigmund entered medical school



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



Double connection



Double connection Are they rivals? Relationship btw. Eli and Sigmund?

Secret engagement reasons? Martha’s family’s moving in 1881



Turned 40 and had his last child



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? Oedipus Complex (1897) Self analysis (1897–1900) The Interpretation of Dreams (1899) Professor Extraordinary (1902)

Anna was named after Freud’s teacher’s (Samuel Hammerschlag) daughter (Anna Hammerschlag Lichtheim)

Wife’s emotional state after the 6th pregnancy? Intimate relationship?



Tuberculosis and other lung diseases



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?


Insight gained from the life cycle of a family?

Structure of the family Sibling Position Societal regression Emotional cutoff

(c) Love Publishing: Monit Cheung & Patrick Leung 23

Practice with Family Systems Theory

From last week Connection to Structural Approach?

Alignment (Triangulation) System Maintenance Breaking down rigidity in the family

structure

© Love Publishing: Monit Cheung & Patrick Leung

24

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.


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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


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1. Subsystems

• Defined by boundaries & rules

• Key communications through– Individual subsystems– Spousal subsystems– Parental subsystems– Sibling subsystems


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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


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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)


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Steps in Family Therapy (Minuchin, 1974)

• Join the family in a position of leadership

• Map the underlying structure

• Intervene to transform this structure


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Family Mapping SymbolsClear

Boundary

Conflict

Diffuse Boundary

Coalition

Rigid Boundary

Detouring

Affiliation

Over-involvement


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Family Mapping of Joe’s Family(F): Father, Joe (M) Mother, Mary, Identified Patient

FM (IP)

Children

•There is a rigid boundary between Joe and Mary. •Mary is over-involved with her children.


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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.


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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.


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Structural Strategies• (1) Joining• (2) Working with interaction• (3) Diagnosing• (4) Highlighting and modifying

interactions• (5) Boundary making• (6) Adding cognitive constructions


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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.


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Enactment• Technique: Ask the family to function in the therapist

session as it does in the home situation.

• Purpose: Allow the 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.


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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


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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


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Paradoxical ConstructionsProvide the family with a different frame of

experiencing in order to stimulate reactions toward change.

• Example:

Worker: How old are you?

Child: Seven.Worker: 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.


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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.


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Making Arrows

• Two volunteers: Mary & Ami

• Make an arrow on a note card to represent your relationship with each other


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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)?


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Practice Again

• 4 volunteers (Mary, Joe ,MC, and Ami)

• Issue #3: Family Changes (pp. 165–166)


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Structural Practice Skills

• Joining• Structural

Perspective• Paradoxical

Restructuring• Reframing

(Restructuring)• Use of Metaphor

• Focusing on Structure– Alignment– Detouring– Enactment


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Drawing your Qualities

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


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Humanistic Approaches to Practice

Carl Rogers’ Person-Centered Approach

Virginia Satir’s Validation Process Approach/Theory

Watch a clip from Freaky Friday (2 mins.)


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Person-Centered

Based on Virginia Satir

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Client Factors

TherapeuticRelationship

ClientExpectations

Therapist'smodel orTechnique

Client Factors:•participation•strengths/ resources•perceptions of therapist•support network•desire/luck

40%Therapeutic Relationship

(as perceived by the client)

30%

Therapist’s Model or

Technique

15%15%Client Expectations

“Placebo Effect”

Four Common Factors Underlying Effective therapy

From: Miller, S., Hubble, M., & Duncan, B. No more bells and whistles. The Family Therapy Networker, 19(2), p. 52–63.


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Therapeutic Techniques

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.


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Client Expectations

“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.


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Therapeutic Relationships

“Clients who are motivated, engaged and connected with the 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 the therapist as warm, trustworthy, nonjudgmental, and empathic, a strong alliance is formed. (p. 56)



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Client Factors

“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)


(c) Love Publishing: Monit Cheung & Patrick Leung

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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

Satir Communication Theory


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Goals: Self-Awareness

Satir viewed dysfunctional behavior as a deficit in growth because we need:

Family to express true feelings without fear of rejection

Individual positive self-esteem Supportive family environment Balanced family system where each

member understands roles and communication styles


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8 Interactive Elements in Family Assessment Physical

• Health issues

• Repeated illnesses

• Genetic illnesses Sensual

• Emotional vulnerability Spiritual

• Religion

• Energy

• Death & Dying Intellectual

• Education

• Expectations

Interactional• Communication styles

• Relationship lines Contextual

• Environment

• Immigration, migration Nutritional

• Eating habits

• Exercise routines Emotional

• Negative self talk

• Self esteem

(c) Love Publishing: Monit Cheung & Patrick Leung

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Four Communication Styles that cover up low self-esteem

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).



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Placator Puts own needs

aside

Tries to relieve the problems of others

Often takes the blame


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Blamer

Does not take responsibility for own actions

Focuses attention on actions of others


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Super-reasonable(Intellectual)

Denies feelings of self and others

Thinks he or she is always right but is ‘rigid’


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Irrelevance(Distracter)

Tries to distract others

Takes focus off of the problem


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Practicing Healthy Posture:Congruent/Leveler

•Congruent

•Consistent

•Concerned

•Caring & Nurturing

•Unconditional


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Practice Client-Centered

5 volunteers (Mary, Joe, Ami, Kevin, MC) Multicultural practice applications (p.

195)


Daily Affirmation

Today my happiness radiates from within me. By Gary Seidler


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References• Carter, B., & McGoldrick, 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-of-

origin 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 leung1 structural and client-centered theories...

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