Family therapies, that's what I'll be going over today at PMHNP 101 here with you. So in this video, I'll go over family therapies such as family systems therapy, also known as systemic family therapy, structural family therapy, experiential therapy, strategic therapy, and last but not least, solution-focused therapy. What does this all mean?
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I think some of us sometimes get the word confused because we see the term systemic and then systems and family therapy. Yes, of course we are talking about family therapies but it's also good to know What does it mean by system? So system is basically any unit that's based on feedback, and it is the family. That's just another fancy term.
And family system is basically how members operate together. So when we have family system theory, now this is basically saying the idea that one can't understand a member or part without understanding how all family members operate. together, which is the system. So there are some rules in family, right?
So family rules could be overt or they could be covert. And there are boundaries in families. Boundaries are barriers that protect and enhance functional integrities of family, individuals, and subsystems, right?
And there are boundary types. Now, boundary types you can have clearly defined, right? that's maintaining individual separateness, emphasizing belongingness. You can have rigid or inflexible boundary, which is going to be leading to distant relationship or disengagement. And you can also see relationships be diffused, where it's blurred, indistinct.
They lead to enmeshment. So let's start off with family systems therapy, also known as systemic family therapy. So we know, according to Bowen, a family is a system in which each member has a role to play and rules to follow.
And members of the system are expected to respond to one another in a specific way based on their role and as defined by relationship agreements. Right. And so we can see patterns emerge within the system as one family member's behavior is caused by and causes.
the behavior of another family member in predictable ways. And so maintaining the same pattern of behaviors within a system can lead to a balance, but it can also lead to dysfunction of a family. So in family systems therapy, associate family systems therapy, also known as systemic family therapy, they're the same thing, okay?
So the focus is to deal with chronic anxiety within the families. The treatment goal we're going to do... is to increase the family's awareness in each member's function.
What is their role? What are the issues going on within that family? And to increase the levels of self-differentiation.
What is that? Self-differentiation is the level at which one's self-worth is not dependent on external relationships or circumstances or occurrences. So in other words, self-differentiation is the ability to separate thoughts and feelings.
This can be both interpersonal as well as interpsychic process. So differentiation is the ability to take more neutral position. When you have higher differentiation, with higher differentiation, if a person says something to you and you're able to hold that thought as a cognition and not allow it to turn to a feeling, that is higher differentiation.
Now, every other concept in Bowen's family therapy basically gets back to self-differentiation. Let me give you an example of poor self-differentiation and high self-differentiation. Now, let's say the situation is a conflict.
An example of poor self-differentiation would be somebody who says, I chose to either fight or avoid. I fight when I cannot control my emotions and flee. because I fear my emotions will take control.
Now that is an example of poor self-differentiation. Someone with high self-differentiation when there is a conflict would be saying, I'm willing to disagree with another person and experience the discomfort in order to achieve a win-win situation. I try to understand contrary positions. That is an example of high self-differentiation. Now let me give you another example of poor self-differentiation in a situation like stress.
When stressed, I tend to react impulsively and respond before I think through. That is an example of poor self-differentiation. Somebody with high self-differentiation, when stress comes on, would say, stress signals that I should focus on a solution and it creates urgency in me but it does not overwhelm my thinking.
So that is somebody with high self-differentiation. Now when we think about family systems therapy, self-differentiation is a key term to focus on. Now what's another key term that we can look out for in family systems therapy? If you said triangles, that's correct.
Triangles. triangulation, genograms, genomes, dyads, triads. All these words are basically in family systems therapy or systemic family therapy. So triangles are dyads that form triads to decrease stress.
So the lower the level of family adaptation, the more likely a triangle will develop. So we can see triangulation. defined as a tactic in which one person does not communicate directly with another person but instead they use a third person to relay information or communicate to the second forming a triangle. So manipulation, control, and destruction can be seen at this point.
So here we can see the patient's problematic behavior serves a purpose for the family or is a symptom of the dysfunctional patterns in a family. So let's take a look at structural family therapy. Now structural family therapy, the focus is how family members interact with one another to better understand and then change the structure of the family.
And we can see that change take place through transactional patterns and family structure. So when we get individual symptoms that are rooted in family transactions, they create patterns and they have an effect. on the family's overall health. So we do this by changing that transactional pattern and changing that family structure in order to manage the family's problems.
Okay, so what do I mean by family structure? Family structure is an invisible set of functional demands that organize how members interact with one another consisting with subsystems such as marital, parental, siblings. coalitions where two members banding together against a third member or boundaries.
You can also see structured mapping in structural family therapy, right? Because that's going to help you see the family structure. This is where you see genograms take place.
You're going to see relationships that are mapped using symbols to represent an over-involvement, a conflict, or a coalition. and so on and so forth. So we use a system called structured mapping to help you see a picture of where the family structure and the role of each person falls in that family. We can also see hierarchies.
Hierarchies are power distribution. So we can see who in the family has power or who in the family has authority and takes control over certain situations. So the keywords to focus here in structural family therapy are going to be transactional patterns, family structure, hierarchies, structural mapping, or genogram.
So these are the keywords to kind of help you associate that it is structural family therapy that is being discussed. Now remember, the goal in structural family therapy, or you know that this is structural family therapy, is when The example or the test question tells you that you're not trying to explore the past, but modify the present. This is going to be the goal of structural family therapy. You're not looking at what happened in the past, but you're modifying what is taking place currently.
The goal is also not to symptom relief, but for a family to reorganize itself around a symptom. Here we have experiential therapy, and this therapy is behavior that is decided by personal experience and it's not by external reality. And so the focus is on being authentic, freedom of choice.
human validation, experiencing the moment. The goal of experiential therapy is to develop authentic nurturing communication that increases self-worth of each of the family member. The goal is overall growth versus symptom reduction. There's no particular technique, there are multiple techniques that we can use to help with this experiential therapy. So experiential therapy, as the name suggests, it works to assist the patient in experiencing his or her emotions and challenges rather than just simply talking to them.
Experiential therapy, it provides the provider with the opportunity to observe the patient in his or her natural environment. So, for example, a client who struggles in social situation may act out. typical conversation, but observing the client as he or she does so allows the provider to better identify and treat potential challenges that the patient or the client might otherwise emerge within the confines of therapy. Does that make sense?
I hope so. Experiential therapy is diving deep into One's past experiences, it's not by external reality, it's their personal experience. So here we have strategic therapy.
What is strategic therapy? Strategic therapy, it not only addresses people on an individual level, but also focuses on family, builds on people's relationships, dealing with interactions of groups, and even their interactions, patterns, and dynamics. So that's why we can see strategic therapy. And in strategic therapy, who is this therapy good for? These are therapies that are good for families with children or adolescents.
It helps to address factors that are leading to family instability or dysfunction, where maybe the adolescent is showing some behavioral issues or having some difficulty with emotional regulation. So what are some techniques we can use for these clients? The techniques that we can use for these clients would be straightforward directives, paradoxical directives, and reframing belief system. These are major techniques that are used in joining, engaging, or entering the family system and tracking and diagnosing, and then restructuring the family to have a better relationship. So in strategic therapy, there are techniques.
such as straightforward directives, paradoxical directives. And so directives can either be direct or indirect. The goal is simple.
Directive is to alter the way the family interacts by introducing new behaviors. And these directives typically are necessary for minor changes so that it's easier to implement. An indirect directive would be also known as symptom prescriptions. So that is going to be instructing the patient to engage in a problem behavior in some way. So when dealing with families who are resistant to change, paradoxical interventions can be used.
And in a family where one member may be perceived as a problem and the other member may be resistant to that change, their perspectives of fear and experiencing greater discomfort may be their provider or the therapist at that point. would want to use something that's paradoxically encouraging the family to continue arguing so that this way things will be better in the end. Techniques used in strategic therapy can be directives, they could be reframing, it can also be family sculpting.
So family sculpting would be recreating a family system that is going to help the family member to see how they are contributing to the problem. Reframing is going to be a technique that shifts the frame in which the family situation is viewed. So there's new meaning, new meaning that could bring change in the person's behavior.
And directives are basically when you as a provider give the client a task and they're aimed at changing the family structure. So there are straightforward directives and indirect directives. In straightforward directives, the tasks are designed in expectation of the family member's compliance. Meanwhile, paradoxical directive is a negative task that is assigned when family members are resistant to change, and the member is expected to be non-compliant. Let's take a look at reframing belief system.
Reframing belief system is problematic behaviors that are relabeled to be more positive, meaning jealousy is refrained into caring. So now let's take a look at solution-focused therapy. In solution-focused therapy, the treatment goal is to resolve problems through cognitive problem solving and by using personal resources and strength.
So the techniques that we can see that are used in solution-focused therapy are going to be like miracle questions, exception finding questions, and scaling questions. So let me give you an example. Example of miracle question.
Miracle questioning would be asking the patient, what would be different if a miracle happened tonight while you were sleeping? and you woke up tomorrow morning to find out that the problem no longer exists, how would you know that the miracle occurred, and how would you find out? That is an example of a miracle question. Now, exception-finding questions are going to be questions that are directing the patient to a time in their life when the problem did not exist.
So this is going to help that patient to move. from having the problem and trying to figure out a solution by helping them search, searching for times or patterns in their life where they did not have that problem. So you're going to ask the person, was there ever a time when the problem did not occur?
That is exception finding questions. So let's take a look at scaling solutions. Now scaling solutions is basically you'd ask the patient How would you rate how you are feeling on a scale of 1 to 10? With 10 being very anxious and depressed, this would be an example of using scaling question. Thanks for watching this video to the very end.
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