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The Essentials of Family Therapy

Sixth Edition

Michael P. Nichols

College of William and Mary

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10 9 8 7 6 5 4 3 2 1ISBN-10: 013419487X

ISBN-13:9780134194875

Table of Contents

Chapter 1The Foundations of Family Therapy1

Chapter 2The Evolution of Family Therapy2

Chapter 3Basic Techniques of Family Therapy6

Chapter 4The Fundamental Concepts of Family Therapy8

Chapter 5Bowen Family Systems Therapy11

Chapter 6Strategic Family Therapy15

Chapter 7Structural Family Therapy19

Chapter 8Experiential Family Therapy22

Chapter 9Psychoanalytic Family Therapy26

Chapter 10Cognitive-Behavioral Family Therapy30

Chapter 11Family Therapy in the Twenty-First Century33

Chapter 12Solution-Focused Therapy37

Chapter 13Narrative Therapy39

Chapter 14Comparative Analysis42

Chapter 15Research on Family Intervention49

Answer Key50

1

Chapter 1

The Foundations of Family Therapy

Short Answer

  1. Compare and contrast individual and family therapy modalities. What types of clients and client problems may be best suited for each and why? Provide examples to illustrate your answer. Is it possible to integrate individual and family treatment? Take a position and argue for or against.
  2. How might an individual therapist counsel Bob or Shirley (in the case example)? How might individual therapy progressed with either one of them that might reinforce the conflict between them? How might an individual therapist, seeing either Bob or Shirley, help them reduce their conflicts?
  3. What do you believe to be the necessary and sufficient conditions for real therapeutic change to occur? A brief but decisive intervention in the family system or the long-term exploration of one’s personality? Some argue that changes initiated via family therapy are lasting because change is exerted throughout the entire system – that each family member changes and continues to exert synchronous change on each other. Others believe that long-term insight-oriented therapy is necessary to prevent the patient’s personality pathology from reasserting itself. Take a position for or against and cite evidence to support your view.
  4. Make up a brief case in which one person who has trouble in a relationship sees only the contributions of the other person to their mutual problems and acts in such a way as to perpetuate the conflict – even though he or she is trying to improve the relationship.
  5. What advantage does family therapy offer over individual therapy in maintaining positive therapeutic change? What disadvantage does family therapy create in initiating positive therapeutic change?
  6. What is gained by seeing family problems, such as those seen in Holly’s family, as transitional? As triangular?
  7. Identify: Self-actualization
  8. Identify: Transference

Chapter 2

The Evolution of Family Therapy

Multiple Choice

  1. Lyman Wynne’s term for the façade of family harmony that characterized many schizophrenic families is:
  2. pseudocomplementarity
  3. pseudomutuality
  4. pseudoharmony
  5. pseudohostility
  6. Hospital clinicians began to acknowledge and include the family in an individual’s treatment when:
  7. they noticed when the patient got better, someone in the family got worse
  8. they realized the family was footing the bill for treatment
  9. they realized the family continued to influence the course of treatment anyway
  10. a and c
  11. none of the above
  12. Kurt Lewin’s idea of ______can be seen in action in Minuchin’s promotion of crises in family lunch sessions, Norman Paul’s use of cross-confrontations, and Peggy Papp’s family choreography.
  13. unfreezing
  14. social equilibrium
  15. group process
  16. field theory
  17. Paying attention to how members of a group interact rather than merely to what they say is called:
  18. Basic assumption theory
  19. Group dynamics
  20. Field theory
  21. Process/content distinction
  22. The first to apply group concepts to family treatment was:
  23. Murray Bowen
  24. John Elderkin Bell
  25. Virginia Satir
  26. Carl Whitaker
  27. A second, covert, level of communication which conveys something about how the communicants should relate is called:
  28. denotation
  29. connotation
  30. metacommunication
  31. didacticism
  32. Frieda Fromm-Reichmann’s concept, “______mother,” described a domineering, aggressive, rejecting, and insecure mother who was thought to provide the pathological parenting that produced schizophrenia.
  33. undifferentiated
  34. schizophrenogenic
  35. reactive
  36. symbiotic
  37. According to Wilfred Bion, most groups become distracted from their primary tasks by engaging in patterns of:
  38. fight-flight
  39. pairing
  40. dependency
  41. any of the above
  42. all of the above
  43. Ivan Boszormenyi-Nagy emphasized the importance of ______in families.
  44. communication
  45. ethical accountability
  46. triangles
  47. systems dynamics
  48. Gregory Bateson and his colleagues at Palo Alto introduced this concept to describe the patterns of disturbed family communication which cause schizophrenia.
  49. schizophrenogenesis
  50. double bind
  51. pseudohostility
  52. none of the above
  53. The only means to effectively escape a double bind is to:
  54. withdrawal from the relationship
  55. metacommunicated
  56. quid pro quo
  57. a and b
  58. According to Theodore Lidz, marital schism occurs when:
  59. one spouse with serious psychopathology dominates the other
  60. there is a chronic failure of spouses to achieve role reciprocity
  61. one spouse consistently engaged in double-binding communication
  62. there is a loss of autonomy due to a blurring of psychological boundaries between spouses
  63. Jackson’s concept, ______, that families are units that resist change, became the defining metaphor of family therapy’s first three decades.
  64. emotional reactivity
  65. quid pro quo
  66. family homeostasis
  67. a and c
  68. A ______relationship is one based on differences that fit together.
  69. complimentary
  70. symmetrical
  71. homeostatic
  72. imbalanced
  73. This family therapist’s personal resolution of emotional reactivity in his family was as significant for his approach to family therapy as Freud’s self-analysis was for psychoanalysis.
  74. Salvador Minuchin
  75. Jay Haley
  76. Murray Bowen
  77. Carl Whitaker
  78. This family therapist believed in the existence of an interpersonal unconscious in every family.
  79. Murray Bowen
  80. Nathan Ackerman
  81. Ivan Boszormenyi-Nagy
  82. Virginia Satir
  83. The restructuring techniques of structural family therapy are designed to bring about:
  84. first-order change
  85. second-order change
  86. ethical accountability
  87. transmuting interpretations
  88. The group therapy model was not entirely appropriate for families for what reason?
  89. family members are peers
  90. families have a shared history
  91. both a and b
  92. none of the above

Short Answer

  1. Describe the “double-bind theory” of schizophrenia. Historically, why was the theory important?
  2. How are family systems therapies different from traditional individual therapies?
  3. Some would argue that there is a radical divergence between family systems therapies and the more traditional psychotherapeutic approaches. Others would challenge this view, arguing that there are many points of similarity and that the differences are exaggerated. Take one position or the other and defend your stand.
  4. Choose two of the individuals below and describe how they helped to launch the family therapy movement. Be specific in discussing their contributions to the field.
  5. Gregory Bateson
  6. Theodore Lidz
  7. Milton Erickson
  8. Nathan Ackerman
  9. Murray Bowen
  10. Don Jackson
  11. Jay Haley
  12. Salvador Minuchin
  13. Virginia Satir
  14. Carl Whitaker
  15. How is group therapy similar to and different from family therapy?
  16. What is the positive impact of research on family dynamics and schizophrenia? What was its negative impact?
  17. What are some of the factors that have resulted in diminished academic enthusiasm for family therapy?

Chapter 3

Basic Techniques of Family Therapy

Multiple Choice

  1. For initial interviews, the author recommends seeing:
  2. the “problem-determined system”
  3. the adults in the family
  4. the parents
  5. everyone in the household
  6. A treatment contract typically includes:
  7. the therapist’s strategies for solving the presenting problem
  8. the fee and how it should be paid
  9. the therapist’s therapeutic model
  10. all of the above
  11. What is the major presenting pitfall in listening to a family’s perspective on the presenting problem?
  12. accepting a linear perspective on the problem
  13. hearing too many conflicting points of view
  14. allowing children too much leverage in family decision making
  15. challenging the family’s perspective too soon
  16. The “child-protective approach” to cases of sexual abuse:
  17. may undermine the integrity of the family
  18. tries to ensure that the abuse doesn’t continue
  19. tries to reduce the long-term impact of the trauma
  20. all of the above
  21. Treating the couple together in cases involving domestic violence:
  22. has been shown to produce better outcomes than seeing the partners separately
  23. may allow the batterer to rationalize his behavior
  24. is the most widely accepted approach
  25. all of the above
  26. According to the author, therapists should inquire about drug and alcohol consumption:
  27. when there is suspicion that this may be a problem
  28. in every case
  29. in every case where the identified patient is a teenaged child
  30. when there is a history of this being a problem
  31. Family structure involves:
  32. how people interact in a family
  33. the overall organization of the family
  34. patterns of communication
  35. all of the above

Short Answer

  1. What are the pros and cons of insisting that the entire family attend the initial consultation?
  2. What is the “problem-determined system?” Give a couple of examples.
  3. What is essential to accomplish in the first session in order to establish a productive therapeutic alliance with a family?
  4. How can a therapist effectively challenge linear attributions of blame? Give a couple of examples.
  5. Why is it important for a clinician to develop a therapeutic hypothesis, and what are some of the elements that such a formulation should include?
  6. What is the danger of a therapist taking too active and directive a role in the middle stages of a family’s treatment?
  7. Why are traditional couples considered potentially dangerous in the treatment of cases involving marital violence?
  8. What are some of the arguments in favor of treating violent partners together in couples therapy?
  9. What are the first priorities in treating cases involving child sexual abuse?

Chapter 4

The Fundamental Concepts of Family Therapy

Multiple Choice

  1. Which is not a concept of von Bertalanffy’s general systems theory?
  2. “black box” metaphor
  3. a system is more than the sum of its parts
  4. equifinality
  5. homeostatic reactivity
  6. A biological model of living systems as whole entities which maintain themselves through continuous input and output from the environment, developed by Ludwig von Bertalanffy is known as:
  7. systems theory
  8. cybernetics
  9. constructivism
  10. general systems theory
  11. The stages of a family’s life from separation from one’s parents to marriage, having children, growing older, retirement, and finally death, are known as the:
  12. family structure
  13. homeostasis
  14. function of the system
  15. family life cycle
  16. Which phenomena are not a focus of cybernetics, as applied to families?
  17. sequence of interaction
  18. family hierarchy
  19. family rules
  20. negative feedback
  21. Constructivism first found its way into psychotherapy in the work of:
  22. Paul Watzlawick
  23. Kenneth Gergen
  24. George Kelly
  25. Michael White
  26. Panic attacks are fueled by:
  27. lack of communication
  28. lack of metacommunication
  29. positive feedback
  30. negative feedback
  31. According to attachment theory, attachment is:
  32. a biologically based drive
  33. a product of reinforcement
  34. a product of interaction
  35. a byproduct of nurture
  36. A balanced steady state of equilibrium is known as:
  37. metacommunication
  38. homeostasis
  39. morphogenesis
  40. equifinality
  41. A pursuer-distancer relationship is:
  42. complementary
  43. driven by positive feedback
  44. homeostatic
  45. an open system
  46. a closed system
  47. The study of control processes in systems, particularly the analysis of the flow of information in closed systems, is known as:
  48. functional analysis of behavior
  49. cybernetics
  50. existentialism
  51. general systems theory
  52. Narrative therapy differs from solution-focused therapy in being more focused on ______than ______.
  53. exceptions; problems
  54. cognitions; interactions
  55. attitudes; behavior
  56. individuals; families
  57. With the exception of the feminist critique, what has been largely missing in family therapy has been an examination of:
  58. cultural biases
  59. the society we are helping people fit into
  60. value systems
  61. all of the above
  62. General systems theory, cybernetics, and social constructionism are ______concepts.
  63. epistemological
  64. metapsychological
  65. clinical
  66. metaphysical
  67. The greatest conceptual influence on the early development of family therapy was:
  68. the family life cycle
  69. constructivism
  70. feminism
  71. systems theory
  72. ______said that relationship problems usually involve triangles.
  73. Murray Bowen
  74. Don Jackson
  75. Gregory Bateson
  76. All of the above
  77. Systems theory ______sensitivity to gender roles.
  78. supports
  79. does not support
  80. is irrelevant to
  81. none of the above
  82. The concept of the family life cycle was introduced to the field by:
  83. Salvador Minuchin
  84. Betty Carter and Monica McGoldrick
  85. Jay Haley
  86. Don Jackson
  87. The notions of functionalism, structuralism, and general systems theory are all embraced by which family theory?
  88. Behavioral family theory
  89. Experiential family theory
  90. Communications family therapy
  91. Structural family therapy
  92. Boundaries around the executive subsystem in the family are of particular importance because the family ______is seen by structural therapists as crucial to the family’s well-being.
  93. network
  94. hierarchy
  95. life cycle
  96. quid pro quo

Short Answer

  1. Why should a family’s ethnicity and culture be considered in assessment?
  2. List the stages of the family life cycle (Carter & McGoldrick, 1999) and describe the primary task(s) of each stage. Consider how the therapist would intervene with the family at each of these stages.
  3. List and describe at least three contextual influences on the evolution of family therapy.
  4. What is a relationship triangle? How are triangles relevant in couples therapy?
  5. What are positive and negative feedback and how do they operate in families?
  6. Listed below are a number of concepts and methods that have endured and continue to shape the field of family therapy. Choose any three and describe them. How can each concept be used to enrich our understanding of families and guide our treatment interventions?
  7. Importance of family context
  8. Triadic models
  9. Family structure
  10. Psychopathology serving a function in families
  11. Circular sequences of interaction
  12. Family life cycle
  13. Multigenerational patterns
  14. How can general systems theory revitalize family therapy and bridge the chasm between the narrative approaches of the twenty-first century and the traditional schools (i.e., structural, Bowenien, communications, and/or strategic) of family therapy?

Chapter 5

Bowen Family Systems Therapy

Multiple Choice

  1. A Bowen therapist working with an individual family member in treatment is most likely to do which of the following?
  2. Create a therapeutic triangle
  3. Use displacement stories
  4. Model how to take an “I” position
  5. Work with a genogram
  6. C and D
  7. The primary goal of Bowen family therapy is to:
  8. heighten emotional experiencing in family members
  9. increase the family’s repertoire of problem-solving skills
  10. improve communication between family members
  11. increase the level of differentiation of self in family members
  12. The “differentiated” individual:
  13. can extricate him or herself from all emotional triangles
  14. can balance his or her needs for closeness and autonomy
  15. avoids contact with his or her parents
  16. approaches life in a purely rational fashion
  17. According to Bowen theory, more highly differentiated individuals will likely:
  18. avoid the expression of intense emotions
  19. avoid contact with dysfunctional family members
  20. have parents who are highly differentiated
  21. be first born children
  22. a and c
  23. An increase in chronic anxiety in the nuclear family system will tend to ______less differentiated families, while it will ______more highly differentiated families.
  24. be absorbed by/promote growth in
  25. promote growth in/be absorbed by
  26. cause an increase in symptoms in/be absorbed by
  27. cause a decrease in symptoms in/promote growth in
  28. Murray Bowen developed his ideas about family therapy while at the NIMH, studying ______families. Based on his observation of these families’ intense clinging interdependence, he concluded that a lack of differentiation was responsible for all family pathology.
  29. alcoholic
  30. depressed
  31. neurotic
  32. psychotic
  33. By training family members in 3 areas – teaching differentiation, avoiding triangulation, and ______, Bowen therapists can enable a single individual to transform from the whole network of his or her family system.
  34. avoiding expression of intense emotions
  35. reopening cut-off family relationships
  36. increasing contact with dysfunctional family members
  37. all of the above
  38. According to the Bowen theory, the flight from an unresolved emotional attachment to one’s parents is known as:
  39. emotional cutoff
  40. enmeshment
  41. disengagement
  42. fusion
  43. In Bowen theory, this is a process wherein the projection of varying degrees of immaturity to different children in the same family occurs. The child who is most involved in the family emerges with the lowest level of differentiation, and passes on problems to succeeding generations.
  44. societal emotional process
  45. family projection process
  46. nuclear family emotional process
  47. multigenerational emotional process
  48. This Bowenian term describes the level of emotional “stuck-togetherness” or fusion in the family.
  49. unconscious need complementarity
  50. undifferentiation
  51. triangling
  52. a and c
  53. According to Bowen, ______are the smallest stable unit of human relations.
  54. dyads
  55. triangles
  56. one well-differentiated individual
  57. none of the above
  58. The central premise of Bowen theory is that unresolved ______must be resolved before one can differentiate a mature, healthy personality.
  59. oedipal conflicts
  60. emotional experiencing
  61. emotional reactivity to one’s family of origin
  62. career concerns
  63. From a Bowenian perspective, optimal development in the family occurs when all members are relatively differentiated, anxiety is low, and parents ______.
  64. form an executive subsystem
  65. cut-off from dysfunctional family members
  66. avoid heightened emotionality
  67. remain in emotional contact with family of origin
  68. People tend to marry spouses at ______levels of differentiation.
  69. varying
  70. similar
  71. complementary
  72. opposite
  73. Unlike experiential therapists, Bowenians seek to ______levels of anxiety in order to increase levels of differentiation of self in the family.
  74. increase
  75. identify
  76. monitor
  77. decrease
  78. ______is a prominent technique in Bowenian therapy designed to clarify emotional processes involved in altering key triangles. The technique is used in order to help family members become aware of systems processes and recognize their own roles in them – it was first developed for use with emotional pursuers and distancers.
  79. relationship experiments
  80. coaching
  81. use of genograms
  82. use of displacement stories
  83. A flight from an unresolved emotional attachment to one’s parents is known as:
  84. disengagement
  85. triangling
  86. fusion
  87. emotional cutoff
  88. Philip Guerin and Betty Carter differ from Bowen in terms of therapeutic technique in that they do more:
  89. active coaching
  90. analysis of triangles
  91. extended family work
  92. b and c
  93. According to the principles of which Bowenian construct, simply teaching a mother better techniques for disciplining her son will fail, because the intervention ignores the problem that she is overinvolved with the boy as a result of her husband’s emotional distance.
  94. enmeshment
  95. multigenerational transmission process
  96. emotional cutoff
  97. triangles

Short Answer