Family Therapy Concepts and Methods Paper
Family Therapy ConCepts and Methods
eLeVenth edItIon
Michael P. Nichols College of William and Mary
with Sean D. Davis Alliant International University
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Library of Congress Cataloging-in-Publication Data Nichols, Michael P., author. Family therapy : concepts and methods / Michael P. Nichols, College of William and Mary with Sean D. Davis, Alliant International University. — Eleventh edition. pages cm Includes bibliographical references and index. ISBN 978-0-13-382660-9 — ISBN 0-13-382660-0 1. Family psychotherapy. I. Davis, Sean D., author. II. Title. RC488.5.N53 2016 616.89’156—dc23 2015032118
10 9 8 7 6 5 4 3 2 1
Student Edition ISBN 10: 0-13-382660-0
ISBN 13: 978-0-13-382660-9
eText ISBN 10: 0-13-382681-3 ISBN 13: 978-0-13-382681-4
Package ISBN 10: 0-13-430074-2 ISBN 13: 978-0-13-430074-0
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v
The Stages of the Family Life Cycle xiii Major Events in the History of Family Therapy xv Foreword xxi Preface xxiii
PART One THE CONTEXT OF FAMILY THERAPY
Introduction The Foundations of Family Therapy 1 The Myth of the Hero 3 Psychotherapeutic Sanctuary 4 Family versus Individual Therapy 5 Thinking in Lines, Thinking in Circles 6 The Power of Family Therapy 6
1 The Evolution of Family Therapy 8 The Undeclared War 8
Small Group Dynamics 9 The Child Guidance Movement 11 Marriage Counseling 12
Research on Family Dynamics and the Etiology of Schizophrenia 13 Gregory Bateson—Palo Alto 13 Theodore Lidz—Yale 15 Lyman Wynne—National Institute of Mental Health 15 Role Theorists 16
From Research to Treatment: The Pioneers of Family Therapy 16 John Bell 16 Palo Alto 17 Murray Bowen 19 Nathan Ackerman 21 Carl Whitaker 21 Ivan Boszormenyi-Nagy 22 Salvador Minuchin 22 Other Early Centers of Family Therapy 23
The Golden Age of Family Therapy 24 SUMMARY 25
ConTEnTS
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vi Contents
2 Basic Techniques of Family Therapy 27 Getting Started 27
The Initial Telephone Call 27 The First Interview 28 The Early Phase of Treatment 30 The Middle Phase of Treatment 32 Termination 33 Termination Checklist 34
Family Assessment 34 The Presenting Problem 34 Understanding the Referral Route 35 Identifying the Systemic Context 35 Stage of the Life Cycle 36 Family Structure 36 Communication 36 Drug and Alcohol Abuse 37 Domestic Violence and Sexual Abuse 37 Extramarital Affairs 37 Gender 38 Culture 38
The Ethical Dimension 39 The Marriage and Family Therapy License 42
Family Therapy with Specific Presenting Problems 42 Marital Violence 42 Sexual Abuse of Children 45
Working with Managed Care 46 Fee-for-Service Private Practice 48
SUMMARY 49
3 The Fundamental Concepts of Family Therapy 50 Cybernetics 51 Systems Theory 54
General Systems Theory 55 Social Constructionism 55
Constructivism 56 The Social Construction of Reality 56
Attachment Theory 57 The Working Concepts of Family Therapy 60
Interpersonal Context 60 Complementarity 60 Circular Causality 60 Triangles 61 Process/Content 62 Family Structure 62 Family Life Cycle 63
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Contents vii
Family Narratives 64 Gender 65 Culture 66
SUMMARY 67
PART TWO THE CLASSIC SCHOOLS OF FAMILY THERAPY
4 Bowen Family Systems Therapy 69 Sketches of Leading Figures 70 Theoretical Formulations 70
Differentiation of Self 71 Emotional Triangles 71 Multigenerational Emotional Processes 72 Emotional Cutoff 72 Societal Emotional Process 73
Family Dynamics 73 Normal Family Functioning 73 Development of Behavior Disorders 74
Mechanisms of Change 76 Goals of Therapy 76 Conditions for Behavior Change 77
Therapy 77 Assessment 77 Therapeutic Techniques 80
Evaluating Therapy Theory and Results 85 SUMMARY 87
5 Strategic Family Therapy 89 Sketches of Leading Figures 89 Theoretical Formulations 91 Family Dynamics 93
Normal Family Functioning 93 Development of Behavior Disorders 93
Mechanisms of Change 94 Goals of Therapy 95 Conditions for Behavior Change 95
Therapy 95 Assessment 95 Therapeutic Techniques 97
Evaluating Therapy Theory and Results 107 SUMMARY 109
6 Structural Family Therapy 111 Sketches of Leading Figures 112 Theoretical Formulations 112
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viii Contents
Family Dynamics 115 Normal Family Functioning 115 Development of Behavior Disorders 116
Mechanisms of Change 118 Goals of Therapy 118 Conditions for Behavior Change 118
Therapy 119 Assessment 119 Therapeutic Techniques 121
Evaluating Therapy Theory and Results 127 SUMMARY 129
7 Experiential Family Therapy 131 Sketches of Leading Figures 132 Theoretical Formulations 132 Family Dynamics 133
Normal Family Functioning 133 Development of Behavior Disorders 133
Mechanisms of Change 134 Goals of Therapy 134 Conditions for Behavior Change 135
Therapy 135 Assessment 135 Therapeutic Techniques 136
Evaluating Therapy Theory and Results 146 SUMMARY 147
8 Psychoanalytic Family Therapy 149 Sketches of Leading Figures 150 Theoretical Formulations 150
Freudian Drive Psychology 151 Self Psychology 152 Object Relations Theory 152
Family Dynamics 154 Normal Family Functioning 155 Development of Behavior Disorders 156
Mechanisms of Change 158 Goals of Therapy 158 Conditions for Behavior Change 159
Therapy 159 Assessment 159 Therapeutic Techniques 160
Evaluating Therapy Theory and Results 165 SUMMARY 166
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Contents ix
9 Cognitive-Behavioral Family Therapy 167 Sketches of Leading Figures 167 Theoretical Formulations 169 Family Dynamics 169
Normal Family Functioning 169 Development of Behavior Disorders 170
Mechanisms of Change 172 Goals of Therapy 172 Conditions for Behavior Change 172
Therapy 173 Behavioral Parent Training 173 Behavioral Couples Therapy 177 The Cognitive-Behavioral Approach to Family Therapy 180 Treatment of Sexual Dysfunction 184
Evaluating Therapy Theory and Results 185 SUMMARY 187
PART THRee RECENT DEVELOPMENTS IN FAMILY THERAPY
10 Family Therapy in the Twenty-First Century 189 Challenges to Traditional Family Systems Models 189
Erosion of Boundaries 189 Postmodernism 190 The Feminist Critique 190 Feminist Family Therapy 191 Social Constructionism and the Narrative Revolution 194 Multiculturalism 195 Race 195 Poverty and Social Class 196 Gay and Lesbian Rights 197
New Frontiers 198 Advances in Neuroscience 198 Sex and the Internet 199 Spirituality and Religion 203
Tailoring Treatment to Populations and Problems 204 Single-Parent Families 205 African American Families 207 Gay and Lesbian Families 209 Home-Based Services 212 Psychoeducation and Schizophrenia 213 Medical Family Therapy 215 Relationship Enrichment Programs 215
SUMMARY 216
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x Contents
11 Solution-Focused Therapy 219 Sketches of Leading Figures 219 Theoretical Formulations 220 Family Dynamics 221
Normal Family Development 221 Development of Behavior Disorders 221
Mechanisms of Change 221 Goals of Therapy 222 Conditions for Behavior Change 222
Therapy 222 Assessment 222 Therapeutic Techniques 224 Taking a Break and Giving Feedback 232 Later Sessions 233 Interviewing Children 235
Evaluating Therapy Theory and Results 236 SUMMARY 237
12 narrative Therapy 239 Sketches of Leading Figures 240 Theoretical Formulations 240 Family Dynamics 242
Normal Family Development 242 Development of Behavior Disorders 242
Mechanisms of Change 243 Goals of Therapy 243 Conditions for Behavior Change 244
Therapy 245 Assessment 245 Therapeutic Techniques 246
Evaluating Therapy Theory and Results 254 SUMMARY 255
PART FOUR THE EVALUATION OF FAMILY THERAPY
13 Comparative Analysis 257 Theoretical Formulations 257
Families as Systems 257 Stability and Change 258 Process/Content 259 Monadic, Dyadic, and Triadic Models 259 Boundaries 260
Family Dynamics 261 Normal Family Development 261
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Contents xi
Development of Behavior Disorders 262 Inflexible Systems 262 Pathologic Triangles 263
Therapy 264 Assessment 264 Decisive Interventions 264
Integrative Models 268 Eclecticism 268 Selective Borrowing 268 Specially Designed Integrative Models 269
Integrative Problem-Centered Metaframeworks (IPCM) Therapy 269 The Narrative Solutions Approach 270 Integrative Couples Therapy 271 Dialectical Behaviorism 272 Other Integrative Models 273 Community Family Therapy 274
SUMMARY 275
14 Research on Family Intervention 276 Research and Practice: Worlds Apart 276 Methodological Issues in Studying the Effectiveness of Family Therapy 277 Research Findings on the Effectiveness of Family-Focused Interventions 279
Family Interventions for Childhood Problems 279 Family Interventions for Adult Disorders 281 Family Interventions for Relationship Difficulties 283
Family Therapy Process Research 284 Common Factors 285 The Therapeutic Alliance 285 Critical Change Events in Family Therapy 286
Future Directions 288
Appendix A Chapter-by-Chapter Recommended Readings 290
Appendix B Selected Readings in Family Therapy 296
Appendix C Glossary 298
References 305
Index 342
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xiii
Family Life-Cycle Stage emotional Process of Transition: Key Principles
Second-Order Changes in Family Status Required to Proceed Developmentally
Leaving home: single young adults
Accepting emotional and financial responsibility for self
a. Differentiation of self in relation to family of origin b. Development of intimate peer relationships c. Establishment of self in respect to work and financial
independence
The joining of families through marriage: the new couple
Commitment to new system
a. Formation of marital system b. Realignment of relationships with extended families
and friends to include spouse
Families with young children
Accepting new members into the system
a. Adjusting marital system to make space for children b. Joining in childrearing, financial and household tasks c. Realignment of relationships with extended family to
include parenting and grandparenting roles
Families with adolescents Increasing flexibility of family boundaries to permit children’s independence and grandparents’ frailties
a. Shifting of parent–child relationships to permit ado- lescent to move into and out of system
b. Refocus on midlife marital and career issues c. Beginning shift toward caring for older generation
Launching children and moving on
Accepting a multitude of exits from and entries into the family system
a. Renegotiation of marital system as a dyad b. Development of adult-to-adult relationships c. Realignment of relationships to include in-laws and
grandchildren d. Dealing with disabilities and death of parents (grand-
parents)
Families in later life Accepting the shifting generational roles
a. Maintaining own and/or couple functioning and interests in face of physiological decline: exploration of new familial and social role options
b. Support for more central role of middle generation c. Making room in the system for the wisdom and expe-
rience of the elderly, supporting the older generation without overfunctioning for them
d. Dealing with loss of spouse, siblings, and other peers and preparation for death
ThE STAgES oF ThE FAMIlY lIFE CYClE
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xv
Social and Political Context Development of Family Therapy
1945 F.D.R. dies, Truman becomes president World War II ends in Europe (May 8) and the
Pacific (August 14)
Bertalanffy presents general systems theory
1946 Juan Perón elected president of Argentina Bowen at Menninger Clinic Whitaker at Emory Macy Conference Bateson at Harvard
1947 India partitioned into India and Pakistan
1948 Truman reelected U.S. president State of Israel established
Whitaker begins conferences on schizophrenia
1949 Communist People’s Republic of China established
Bowlby: “The Study and Reduction of Group Tensions in the Family”
1950 North Korea invades South Korea Bateson begins work at Palo Alto V.A.
1951 Julius and Ethel Rosenberg sentenced to death for espionage
Sen. Estes Kefauver leads Senate probe into organized crime
Ruesch & Bateson: Communication: The Social Matrix of Society
Bowen initiates residential treatment of mothers and children
Lidz at Yale
1952 Eisenhower elected U.S. president Bateson receives Rockefeller grant to study communication in Palo Alto Wynne at NIMH
1953 Joseph Stalin dies Korean armistice signed
Whitaker & Malone: The Roots of Psychotherapy
1954 Supreme Court rules school segregation unconstitutional
Bateson project research on schizophrenic communication
Bowen at NIMH
1955 Rosa Parks refuses to move to the back of the bus; Martin Luther King, Jr., leads boycott in Montgomery, Alabama
Whitaker in private practice, Atlanta, Georgia. Satir begins teaching family dynamics in Chicago
1956 Nasser elected president of Egypt Soviet troops crush anti-Communist rebellion
in Hungary
Bateson, Jackson, Haley, & Weakland: “Toward a Theory of Schizophrenia”
Bowen at Georgetown
MAjoR EvEnTS In ThE hISToRY oF FAMIlY ThERAPY
(continued)
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xvi Major events in the History of Family Therapy
Social and Political Context Development of Family Therapy
1957 Russians launch Sputnik I Eisenhower sends troops to Little Rock,
Arkansas, to protect school integration
Jackson: “The Question of Family Homeostasis” Ackerman opens the Family Mental Health Clinic of
Jewish Family Services in New York Boszormenyi-Nagy opens Family Therapy
Department at EPPI in Philadelphia
1958 European Common Market established Ackerman: The Psychodynamics of Family Life
1959 Castro becomes premier of Cuba Charles de Gaulle becomes French president
MRI founded by Don Jackson
1960 Kennedy elected U.S. president Family Institute founded by Nathan Ackerman (renamed the Ackerman Institute in 1971)
Minuchin and colleagues begin doing family therapy at Wiltwyck
1961 Berlin Wall erected Bay of Pigs invasion
Bell: Family Group Therapy Family Process founded by Ackerman and Jackson
1962 Cuban Missile Crisis Bateson’s Palo Alto project ends Haley at MRI
1963 Kennedy assassinated Haley: Strategies of Psychotherapy
1964 Johnson elected U.S. president Nobel Peace Prize awarded to Martin Luther
King, Jr.
Satir: Conjoint Family Therapy Norbert Wiener dies (b. 1894)
1965 Passage of Medicare Malcolm X assassinated
Minuchin becomes director of Philadelphia Child Guidance Clinic
Whitaker at University of Wisconsin
1966 Red Guards demonstrate in China Indira Gandhi becomes prime minister of
India
Brief Therapy Center at MRI begun under director- ship of Richard Fisch
Ackerman: Treating the Troubled Family
1967 Six-Day War between Israel and Arab states Urban riots in Cleveland, Newark, and Detroit
Watzlawick, Beavin, & Jackson: Pragmatics of Human Communication
Dicks: Marital Tensions
1968 Nixon elected U.S. president Robert Kennedy and Martin Luther King, Jr.,
assassinated
Don Jackson dies (b. 1920) Satir at Esalen
1969 Widespread demonstrations against war in Vietnam
Bandura: Principles of Behavior Modification Wolpe: The Practice of Behavior Therapy
1970 Student protests against Vietnam War result in killing of four students at Kent State
Masters & Johnson: Human Sexual Inadequacy Laing & Esterson: Sanity, Madness and the Family
1971 Twenty-Sixth Amendment grants right to vote to 18-year-olds
Nathan Ackerman dies (b. 1908)
1972 Nixon reelected U.S. president Bateson: Steps to an Ecology of Mind Wynne at University of Rochester
1973 Supreme Court rules that states may not prohibit abortion
Energy crisis created by oil shortages
Center for Family Learning founded by Phil Guerin Boszormenyi-Nagy & Spark: Invisible Loyalties
1974 Nixon resigns Gerald Ford becomes 39th president
Minuchin: Families and Family Therapy Watzlawick, Weakland, & Fisch: Change
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Major events in the History of Family Therapy xvii
Social and Political Context Development of Family Therapy
1975 Vietnam War ends Mahler, Pine, & Bergman: The Psychological Birth of the Human Infant
Stuart: “Behavioral Remedies for Marital Ills”
1976 Carter elected U.S. president Haley: Problem-Solving Therapy Haley to Washington, D.C.
1977 President Carter pardons most Vietnam War draft evaders
Family Institute of Westchester founded by Betty Carter
American Family Therapy Academy (AFTA) estab- lished
1978 Camp David Accords between Egypt and Israel
U.S. and People’s Republic of China establish diplomatic relations
Hare-Mustin: “A Feminist Approach to Family Therapy”
Selvini Palazzoli et al.: Paradox and Counterparadox
1979 England’s Margaret Thatcher becomes West’s first woman prime minister
Iranian militants seize U.S. Embassy in Tehran and hold hostages
Founding of Brief Therapy Center in Milwaukee Bateson: Mind and Nature
1980 Reagan elected U.S. president U.S. boycotts summer Olympic Games in
Moscow
Haley: Leaving Home Milton Erickson dies (b. 1901) Gregory Bateson dies (b. 1904)
1981 Sandra Day O’Connor becomes first woman justice of Supreme Court
Egyptian president Sadat assassinated
Hoffman: The Foundations of Family Therapy Madanes: Strategic Family Therapy Minuchin & Fishman: Family Therapy Techniques
1982 Equal Rights Amendment fails ratification Falklands war
Gilligan: In a Different Voice Fisch, Weakland, & Segal: Tactics of Change The Family Therapy Networker founded by Richard Simon
1983 U.S. invades Grenada Terrorist bombing of Marine headquarters in
Beirut
Doherty & Baird: Family Therapy and Family Medicine
Keeney: Aesthetics of Change
1984 Reagan reelected U.S. president U.S.S.R. boycotts summer Olympic Games in
Los Angeles
Watzlawick: The Invented Reality Madanes: Behind the One-Way Mirror
1985 Gorbachev becomes leader of U.S.S.R. de Shazer: Keys to Solution in Brief Therapy Gergen: “The Social Constructionist Movement in
Modern Psychology”
1986 Space shuttle Challenger explodes Anderson et al.: Schizophrenia and the Family Selvini Palazzoli: “Towards a General Model of
Psychotic Family Games”
1987 Congress investigates the Iran–Contra affair Tom Andersen: “The Reflecting Team” Guerin et al.: The Evaluation and Treatment of
Marital Conflict Scharff & Scharff: Object Relations Family Therapy
1988 George H. W. Bush elected U.S. president Kerr & Bowen: Family Evaluation Virginia Satir dies (b. 1916)
(continued)
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xviii Major events in the History of Family Therapy
Social and Political Context Development of Family Therapy
1989 The Berlin Wall comes down Boyd-Franklin: Black Families in Therapy
1990 Iraq invades Kuwait Murray Bowen dies (b. 1913) White & Epston: Narrative Means to Therapeutic
Ends
1991 Persian Gulf War against Iraq Harold Goolishian dies (b. 1924)
1992 Clinton elected U.S. president Family Institute of New Jersey founded by Monica McGoldrick
1993 Ethnic cleansing in Bosnia Los Angeles police officers convicted in
Rodney King beating
Israel Zwerling dies (b. 1917) Minuchin & Nichols: Family Healing
1994 Republicans win majority in Congress Nelson Mandela elected president of South
Africa
David and Jill Scharf leave Washington School of Psychiatry to begin the International Institute of Object Relations Therapy
1995 Oklahoma City federal building bombed Carl Whitaker dies (b. 1912) John Weakland dies (b. 1919) Salvador Minuchin retires Family Studies Inc. renamed The Minuchin Center
1996 Clinton reelected U.S. president Edwin Friedman dies (b. 1932) Eron & Lund: Narrative Solutions in Brief Therapy Freedman & Combs: Narrative Therapy
1997 Princess Diana dies in auto accident Hong Kong reverts to China
Michael Goldstein dies (b. 1930)
1998 President Clinton impeached by House of Representatives
Minuchin, Colapinto, & Minuchin: Working with Families of the Poor
1999 President Clinton acquitted in impeachment trial
Neil Jacobson dies (b. 1949) John Elderkin Bell dies (b. 1913) Mara Selvini Palazzoli dies (b. 1916)
2000 George W. Bush elected U.S. president Millennium Conference, Toronto, Canada
2001 September 11 terrorist attacks James Framo dies (b. 1922)
2002 Sex abuse scandal in Catholic Church Corporate corruption at Enron
Lipchik: Beyond Techniques in Solution-Focused Therapy
2003 U.S. invades Iraq Greenan & Tunnell: Couple Therapy with Gay Men
2004 George W. Bush reelected U.S. president Gianfranco Cecchin dies (b. 1932)
2005 Hurricane Katrina devastates New Orleans Steve de Shazer dies (b. 1940)
2006 Democrats regain control of U.S. House and Senate
Minuchin, Nichols, & Lee: Assessing Families and Couples
2007 Shootings at Virginia Tech Jay Haley dies (b. 1923) Lyman Wynne dies (b. 1923) Insoo Kim Berg dies (b. 1934) Albert Ellis dies (b. 1913) Thomas Fogarty dies (b. 1927)
2008 Barack Obama elected U.S. president Michael White dies (b. 1949)
Family Therapy Concepts and Methods Paper