Hi, this is Dr. Diane Gehart, and this is my lecture on Virginia Satir's Human Growth Model. Virginia Satir was, perhaps, one of the most beloved family therapists ever. And in this lecture I'm going to give you an introduction to her work. And this lecture does go with my textbooks, Mastering Competencies in Family Therapy, as well as Theory and Treatment Planning in Family Therapy. Virginia Satir is one of the leading experiential family therapists or humanistic family therapists. And so I would like to just spend a quick moment introducing you a bit to the assumptions of humanistic experiential family therapy approaches. There are four approaches that fall broadly within the humanistic family therapies. These include Satir's model, symbolic-experiential therapy developed by Carl Whitaker, also, emotionally focused couples therapy, primarily developed by Sue Johnson, as well as internal family systems developed by Dick Schwartz. Some of the common practices and assumptions across these humanistic approaches includes that all of these approaches target emotional transactions, primarily. And so when you're thinking about working with the family system, they're looking at the emotional system and focusing on how the emotional elements of the system. There's also, in all of these approaches, very much an emphasis on the warmth and empathy on the part of the therapist, as well as with-- they talk about the therapist's use of self, the therapist's presence, their way of being in the room. And, obviously, these elements may be included in other forms of therapy, but they are particularly emphasized and important, and particularly part of the change process, in experiential family therapies. And then also, one thing you will notice is that these approaches tend to have more of an individual and family focus, when compared to other family approaches. And so they will emphasize the individual level of functioning-- in setting goals at the individual level as well as at the family level. So now let's take a look at Virginia Satir's family therapy approach. And we're going to begin with the juice, one of her most important contributions to the field of psychotherapy as a whole. One of Satir's most impactful ideas was this idea of the communication stances. And this is a very-- it's kind of a shorthand way of looking at how people, when they feel emotionally threatened in one way or another, what kind of survival stance or communication stance they take. And Satir believed that when we are children, in our families growing up, whenever we felt unsafe-- we revert to one of these stances. We learn these in our families of origin. And to a certain degree, a person's communication stance might actually relate to another person in the family. So it could be learned from them, or it could be complimentary to them. And so-- and these are stances that a person uses when they feel threatened. And so the idea here is that there are basically five different communication stances, with one of them being the kind of healthy, ideal approach-- stance, which is congruent. And then the other four are variations of this, kind of more of the survival stances. So, theoretically, everyone is trying to get to congruent most the time. But, essentially, all of us revert to one or more these stances when under pressure. So congruent means that you're able to acknowledge what you're thinking and feeling, what the other person is thinking and feeling, as well as have your communication be appropriate for the context-- whatever that might be, whether it's a professional relationship or an intimate relationship. Now when we feel threatened-- and, typically, as children we develop survival stances, ways to survive when we don't feel safe when we're young. And so one potential stance is the placating stance. And in this stance, the person, in order to survive in the relationship, they ignore their own thoughts and feelings, and focus on the thoughts and feelings of others. And there's some variation in Satir's work, at to what degree a placater acknowledges context. And with her earlier work, not having that acknowledged in later work, adding that. And I think there really can be a variation to what degree a placater acknowledges the context, also. And so placaters are very quick to put aside their thoughts, needs, and wishes in order to keep the peace. And so you will find that there are a lot of placaters who come to counseling and therapy for services, because often they're so quick to deny their own thoughts and feelings. And so when you're working with someone who uses this stance, your job as a therapist is to help that person learn how to acknowledge their own thoughts and feelings, as well as those of others, and not just give up their own thoughts and feelings just because they're worried about having conflict. Because a placater would rather not have their way and have peace, than have to assert their needs and risk having tension in the relationship. So, and in fact, I would say most people called to this profession, tend to take the placating stance. So you will see a fair amount of this. The kind of opposite of this is the blamer stance. And the person who takes the blamer stance-- when they feel threatened, what they will do is assert their needs and desires, and minimize those of others. And so oftentimes you'll find a placater and a blamer married together because their two stances are complementary. So blamers, when they're in therapy, they-- what your task as a therapist is to help this person learn how to acknowledge and develop empathy for the thoughts and needs of others. And so that's the task there. And in terms of the superreasonable, this is a person who, when they're feeling threatened in one way or another, they revert to the context, some kind of logical external system in order-- and what they do is actually deny both the thoughts and the feelings of others. So often these people will revert to some sort of external system of logic. It could even be a type of religious system of black and white thinking, interpreting it in a very black and white way. Or it can be a very legalistic or pure logical-- sometimes you can think of Doctor Spock on Star Trek kind of had a superreasonable approach to things. And so this is someone who often just focuses on what is logical or what is allowed, given whatever system of rules they have applied to, or ascribed to when under stress. And so that often they're not particularly emotional in their presentation. And then finally, we have the irrelevant type. And this is the person who, under stress, distracts. And so at a very benign level, or a common level, is the class clown. So this is a person, when tension and stress seems to rise in a relationship or in a room, they're going to distract with humor or something off the topic, but they're going to do something to just distract everyone from the tension in the room. The most extreme form, this is seen schizophrenics because schizophrenia is a way of just being totally irrelevant to the extent that you're not connecting with everyone else is reality. So the irrelevant type doesn't acknowledge self, other, or context. And so for the irrelevant type, a lot of the task is to just get that person reengaged with the difficult topic that they would prefer to just avoid in one way or another. And so what's interesting about these communication stances is that when you're working with clients, you can use them to help better understand how to intervene, or how to communicate with your client. For example, when you're working with the placator, these are probably the most delightful clients to work with because they will never typically let their therapists know that they're unhappy with what's going on. And so they will often agree with whatever the therapist has to say because they like to agree with everybody. And so when working with a placator, for example, I'm very cautious in terms about if I am going to make some suggestion or comment, I like to have multiple options, multiple perspectives, and ask them which one do you think is the best fit or might work for you. And it's always asking them to give voice to their thoughts and opinions because they will be very quick even try to please the therapist. And so for placators, their task is to learn how to assert themselves in a healthy way-- you don't want to turn them into a blamer. Sometimes that can happen-- but how to learn how to assert their needs so that they don't become resentful. Or often they can become depressed because they don't get their needs taken care of because they don't advocate for them. And so it's important when you look at a family, too, to look at how all these different roles are interacting within the family system. So in terms of working with the different survival stances, as I mentioned before, that placators, they minimize the self. They're people-pleasers, and so typically they do need less directive therapy methods to allow their voice to come to the forefront. In terms of working with the blamer, since they minimize the other, the focus of the therapist is to really increase their awareness of others' thoughts and feelings, whether or not those others are in the room. And often time, a blamer actually responds really well to more direct confrontation and communications. And that actually can strengthen the therapeutic relationship because often blamers, people who tend towards this, they find people who are-- tend more towards the placating side, who are not direct, they will often see that as a weakness of sorts. And so sometimes with blamers, therapists can actually strengthen the relationship by being more direct and upfront. And oftentimes, they'll say, don't sugarcoat things for me. Just tell me the way I-- just tell me the truth. And so often those are people who like that type of direct confrontation. So when working with people who tend towards the superreasonable stance, it's important that therapists understand the logic and/or rules that they use to organize their world. And so oftentimes, therapists may need to refer to this context in order to gain validity. It's very important to understand the logic of whatever system that they are applying to. And at the same time, though, bringing in recognition of both their own personal-- identifying and valuing their own personal desires and needs, even if they're not logical. And also, acknowledging that the needs and desires of others are valid, even if they're not perfectly logical, or fitting with a particular moral code, or whatever. So learning how to teach them how to acknowledge all three areas of functioning. And with the irrelevant type, there really is an emphasis because as soon as things get tense, their tendency is to distract in some way and to have irrelevant-- whether it's humor, or just a different topic, switch topics. So with the irrelevant type, the therapist really needs to focus on creating safety because if someone who tends towards this type feels safe, they're much less likely to distract. So the emphasis is really on safety, and then helping them learn how to recognize, and not be afraid of, their own thoughts and feelings and those of others, and to help them learn how to stay present and engage with these various realities and areas of functioning. So now I want to give you an overview of treatment in the Satir approach. So when Satir conceptualised family therapy, she conceptualized it in terms of a six stage model. And the beginning, you're engaging, and as a therapist, you're assessing what is the status quo? How is a system and family functioning at this time? And then the therapist is going to be, basically, introducing a foreign element. And so that foreign element can be a new way of looking at the interactions, and this foreign element of how to communicate in a more congruent way. And then the next phase of what happens is what she calls chaos because the family is having to deal with this new element, this new way of interacting, this new idea, or new belief, this-- learning to tolerate direct emotional expression, whatever it might be. And so that's very-- that disrupts the family homeostasis, for lack of a better word. And so there's this chaos-- that people are beginning to integrate. There's a positive feedback loop, and there's new information in the system, and so there's chaos. And then eventually, there's this integration of the new possibilities. So eventually, then they integrate-- with the therapist's help-- this new element to the family system. And they practice this new skill, and they learn how to become comfortable with-- it could be direct communication, expressing emotions, whatever it might be. And then there is a new status quo, new family homeostasis. As you may recall that Satir was a member of the MRI Institute, and so she very much was at the foundation, using systems to understand families. And so you can see very clearly, here, this emphasis on homeostasis in her work as the foundation, and kind of conceptualizing. And the family can go through several cycles of this. It's not like it's just you integrate one foreign element and you're done. It could be the case, but typically the family would engage in this kind of cycle of change more than once. So now we're going to move on to talk about the therapeutic relationship in the Satir approach, and this really is a hallmark in her approach. If you get a chance to see Virginia Satir in action, her presence is just unmistakable. It is unique, it is signature, it is so much-- it is why she's so unforgettable, really, as a figure in the field. And a lot of her way of interacting with people comes from this these very fundamental assumptions about human nature, which are humanistic in origin. And her humanistic beliefs just permeate the room, and this is very much part of the approach. And so when working from this approach, this belief, these assumptions about human nature, really, are at the heart of the relationship. And she really believed that all people naturally tend towards positive growth. And so very much like other humanists, such as Carl Rogers, Virginia Satir really believed that people naturally tend towards positive growth. And that there can be obstacles in the way, but as we remove those, this natural tendency will occur, and so extremely optimistic. So all people possess the resources for positive growth is another assumption that people can grow, people can do this, people can change. And this is just palpable in the room. She also believes everything impacts and is impacted by everything else. And so this is a basic systemic view, and that everything is interrelated, everyone's affecting each other. And then finally, her fourth assumption is within the therapy process itself, is that therapy is actually an interaction between therapist and client. It's a human relationship in that each person is responsible for him or herself within this relationship. And so each person needs to take responsibility for how they're communicating, and how they're relating, and that includes the therapist. So these are the basic assumptions that are just foundational to how the therapist engages the client at a very, very fundamental, philosophical level. So Satir shares, with many other humanistic therapists, assumptions about how they engage the family therapy-- family relationship, the therapeutic relationship. So first of all, there is a warmth and humanity that is unmistakable. The therapist is a fully engaged, warm, human being who is very-- the empathy is very first and foremost in that relationship, very much in line with Carl Rogers. There's an incredible sense of conveying hope, and that comes from her assumptions. And she also talks about making contact, and she's talking about making emotional contact here. And this is also language that you see in Gestalt therapy, but this is about making real contact with the person at an intimate level, contacting them in very intimate, authentic, engaged way. And this is something that's really unmistakable to the parties in the room. And then finally, there is an emphasis on establishing credibility, that Satir really believed that the therapist-- it's not just that you're warm and fuzzy, but there is a credibility. The clients-- you need to instill that hope in the clients that you can be helpful to them. So now let's talk about a bit about case conceptualization using Satir's ideas. So like other family therapists, Satir believed that the symptom played a role in balancing the family's homeostasis. Particularly, there's an emotional role there. And so what the therapist tries to do is understand how the symptoms within the family, even if they're at the individual level, function to keep the family balance. And so an example could be a child's acting out could serve to reduce tension in the marriage by getting the parents to work together to parent the child who's acting out. And so there's always this emphasis, just like any other systemic family therapist, on what is the role of the symptom within the broader family system. Satir also considered other family dynamics, such as looking at power struggles within the family-- which could be between parents, or between parents and children, or even between siblings sometimes-- looking at parental conflicts and those patterns. And she also looked for lack of validation between members, as well as a lack of intimacy between family members. So looking at it, kind of in more contemporary terms, looking at attachment patterns within the family. Another way Satir looked at families was to consider the roles, kind of like the archetypal roles, although she wouldn't use-- not using Jungian archetypes-- so the roles of the members of the family. So some of the more common roles are being a role of a martyr, the victim, the one who rescues, the good child or good parent versus the bad child or bad parent. So she would look at these patterns within the family to help understand the system and how it worked, and each person's role within it. Another assessment element, or technique, that Satir frequently used was what she called taking a family life chronology. And this is a timeline, actually, that looked at the major events within a family's life. And so looking at the births and deaths, looking at events like marriages, moves, various tragedies, major illnesses, job loss, those sorts of things, any type of-- even historical events, such as a war or a natural disaster. even an economic downturn, how all those pieces fit together. And this is used to give both the therapist and the client insight into the broader context of a given problem, as well any strengths and resources that might exist within the family. And so this is just basically a timeline that you can construct with your families and clients to help understand the dynamics in a broader sense. Also when working with families, Satir looked at what she called the survival triad, and that is the child and it's two parents. And so Satir really believe that this primary triad is how a child learns to be human. She calls it sometimes either the primary triad, or the survival triad. And so this triad needs to be a nurturing system for the child. And so when a child's experiencing difficulty, the therapist looks at how this triad is functioning. And so this is real central to how Satir would understand what's going on in a client's life, and of course, looking for a nurturing relationship between the child and both of its parents. Satir used the iceberg to describe the six levels of experiencing, and this is more at an individual level here, in terms of how each individual is experiencing an interaction, for example. And so the layers of the iceberg are this. And so imagine an iceberg with-- what you can really see are the top elements, and what's below it is the things that are lower down, or below the surface, so you may not see them on the outside. So the top layers here are behavior-- so that's something you can definitely see-- and then coping, how a person is coping with a stressful situation. And these lower ones, increasingly, are things that often are below the surface, and you can't see. What are the feelings that are related to that coping? What are the perceptions-- how is the person perceiving what's going on in their life? What kind of meanings are they making? Then their expectations-- what are the expectations that are fueling all of this? And then finally, underneath, what are the very primal yearnings? And so this iceberg is used to help clients explore both if something's problematic. Here's this problematic behavior. You're yelling and screaming at your child. You don't want to even be doing that, so let's look at how are you coping, what are the feelings underneath that? Maybe feeling helpless, angry, betrayed. What are the perceptions that may underlie that? Well kids should be listening to their parent. They should always be respectful of their parents. And then looking at the yearnings underneath that. I do want to have a loving relationship with my child. I want to feel my child respects me, or whatever it might be, feel like I'm a good parent. So you would go through these various layers to help clients understand. And then from that, you can look at how they can move forward to better meet those deep yearnings that may be fueling something that may even be problematic behavior on the outside, at the top level, at the tip of the iceberg. So another concept that's very central to Satir's work, and probably one of the elements that is most well known, is the concept of self-worth and self-esteem. She really made this part of her therapy approach. And so she focuses on building the self-worth and sense of self-esteem within her client. In more recent years, there's also the inclusion of what they call self-compassion, which actually happens to be better indicator of happiness than self- esteem. And so part of the therapy process, and the assessment conceptualization process, is looking at to what extent does the client value themselves because that's often going to be very much a place-- if someone doesn't value themselves, if they don't have a strong sense of self-worth or self-esteem, they're likely to be struggling in their relationships, and other areas of life. And so looking at this and trying to strengthen this is part of the therapeutic process. And so Satir also looked at the mind-body connection, and this is something we do see with a fair number of experiential therapists, more than many other schools. And so Satir would also look at how emotional issues may be manifesting, either symbolically or functionally, within the person. And then also, when doing the communication stances-- we're going to talk about sculpting in just a couple minutes here-- these stances are actually associated with certain ways of holding one's body. And so congruent communication tends to be an open, relaxed body posture. Placating tends to be much more timid and reserved. Blaming stances tends to be much more angry, pointed, stiff. The superreasonable tends to be kind of an aloof, cold, and distant posture. And the irrelevant tends to be much more hyper, distracted. And so she also tracked the mind-body connection when working with clients. So now let's look at goal setting, using the Satir approach. So at its broadest level, Satir, like all the other humanists, have the basic overarching goal of personal transformation and realizing one's full potential, self- actualization. So she has this goal that's very much out of the humanist tradition, which is distinct from many other family therapy approaches. Within that, though, there are two practical goals that you're going to see in the treatment planning. One is relationally focused, and as always, the focus is on having congruent communication in all relationships. And then the more individual goal is this self-actualization of each member of the family, if you're working with the system. So now we're going to move on to talk about interventions into the Satir approach. Capturing interventions in the Satir approach is not necessarily an easy thing. She has both some very broad, general ways of intervening, as well as some very specific, almost structured exercises, some that would be used more specifically and rarely, such as sculpting-- typically you wouldn't be doing that every week-- and others that are much more general. So let's jump into some of these. And first and foremost, as we talked about earlier, too, is this therapist use of self. The way the therapist is in the room, their presence, is so much part of the intervention and transformation process for the clients. So along with that, in a more structured way, is this concept of the ingredients of interaction. And so whenever the therapist is talking with clients about difficult situations and interactions with others, they ask a series of questions. And again, this goes along with some of the elements of the iceberg. So what do I hear and see, OK? What's happening at the behavioral level, without any interpretation, very behavioral description? I ask my child to take out the trash, and they did not do so. And then you move on to, what are the meanings I make of this? And so here, again, you're moving down the iceberg, in a way. And so looking at what are the parents saying? My child doesn't respect me, my child's lazy, whatever might be going on. Then what feelings do I have about these meanings that I'm making? And so, I'm angry, I feel betrayed, I feel sad, I feel helpless-- there are a range of feelings a person can have, even about the similar situation. And then what feelings do I have about those feelings? And so what are my secondary feelings? How do I feel about feeling helpless that my child won't take out the trash, or how do I feel about being angry that my child won't take out the trash? So to have the parent even reflect-- because even if you're having a feeling, you can often have a secondary feeling about that. I'm embarrassed, or I'm embarrassed that I'm angry at my child about this, or I'm angry that feel helpless. So you can have secondary feelings. And then what defenses do I use? So what am I doing? How do I respond? How does this trigger me, and what kind of defensive behaviors might I bring? That makes me yell, or that makes me be cold and distant, or I may attack my partner because of this. So to have the personal look at what they're doing. And what are the rules for commenting? Do I use-- and this comes really directly out of the communication research that she worked on the MRI Institution. So what are the rules within the system about how to comment about what's going on? What is allowed, what is appropriate? And so this can vary wildly from one family to another. It's often-- very much defines a system. And then what is my response in this situation, so what am I doing? And so at all these different levels, going through these and identifying these, can often-- helps people see what they're doing, and make better decisions and/or they can work with a therapist to find alternative ways to respond better and communicate in a more congruent way. And so this kind of let links into a lot of when you see Satir in action, a lot of what she's doing is facilitating congruent expression, emotional expression, so helping family members communicate with each other in a congruent way, without the placating, the blaming, the superreasonableness, or the irrelevant stance. And so a lot of what she's doing is having people turn chairs to each other, talk directly, look in their eyes, hold hands, whatever it might be. Softening family rules is another type of intervention used in the approach. And what this refers to is when families have very rigid rules about, perhaps, who can say what, when, where, and how, she will soften some of these to create more space for everyone's particular way of communicating in a comfortable way, to hopefully reduce the use of survival stances. Communication enhancement, again, goes into helping each member of the family learn to communicate congruently, even under stressful circumstances. Even when they do feel threatened by their partner or their child, rather than reverting to a survival stance, to help them learn how to be fully congruent, and present, and to have more effective communications. There is a very signature technique within the Satir approach, which is called sculpting-- sometimes called spatial metaphor, but most often called sculpting-- where she would take each person and sculpt them. And so she would position each person in the family to metaphorically represent their role. So a placator may be sculpted as being on their knees and begging. The blamer may be there pointing their finger angrily at someone. The irrelevant type might be in a strange position, far off from everybody else. The superreasonable might be sitting there with the book, in a very cold, distant, I'm citing the book, the rule book. So it may sound a little bit odd, but when you're part of the sculpting, it can be a very emotional experience. And it's a very interesting because it's visual, more than verbal-- you can add a verbal element to it by having each person say a motto of theirs. Oh, please be nice to me, or do what I say, or whatever it is, follow the rules, whenever their basic motto is that represents their position in the family-- but primarily, it's very visual. And it's a very emotionally intense experience, and so it can often bypass a lot of other defenses. When you have your child sculpt the family, and realize where the child feels totally on the outs, or totally disconnected, or whatever, often that can bypass a lot of other intellectual defenses because it is such an emotional experience. This can be done with actual family members sculpting themselves. Typically, you would have each member sculpt how they see the family, how he or she sees a family. Or it can be done in a group therapy context, where members of the group sculpt out roles within individuals' family, we'd have to do each person's family separately. So those are different ways that sculpting can be used. And so it can be a very, very powerful intervention that can be used in different types of therapy settings. And then finally, Satir's well known for her use of touch. And she would touch clients, and she would help clients learn how to hold and touch each other in nurturing ways. And this was back in a day where touching clients was probably less legally micromanaged, but it is a hallmark of her approach. And it is something, I would say in today's practice, you need to be very careful about how you approach that because we do have certain ethical and legal mandates around touching clients, but this clearly goes within her theoretical framework of creating nurturing family relationships. And the emphasis really should be on helping clients learning how to nurture each other, both emotionally and physically. And I just want to spend a few moments here talking about working with diverse populations. Satir's approach is used widely around the world. And so it certainly can be used with a variety of cultural, ethnic groups, but it's very important, when you're working with diverse clients, to be very mindful of cultural norms and attitudes about emotional expression. And so humanistic approaches very much favor very direct, warm, engaged communication, and that's not true about all cultures. So it's very important to consider the cultural norms. For example, in East Asia, that type of warm, direct communication is outside of the norm of typical communication. That said, Satir's work and other humanistic approaches are very popular in East Asia, but it does need to be adopted, especially in terms of how the therapist is assessing and evaluating the emotional expression within the family, definitely has to be considered within both gender and cultural norms. Similarly, this approach has been used quite widely in the LGBTQ community. And there is this-- because of the emphasis on self-worth, and recognition, and becoming one's authentic self-- it very much focuses on this in the sculpting and communication stances, I think, add a very rich element that can be used when working with highly marginal populations. And so this has been an approach that has been used, but with a wide range of diverse clients. It's just important that when you're thinking about emotional expression that it's very much dictated by culture, gender, even social economic norms, and so to keep this in mind when you are working with clients, and coaching them, and helping them to learn how to communicate more directly with those in intimate relationships, and to make sure that it's clearly appropriate for a given culture or gender group. And so in wrapping this lecture up, I just want to highlight that what's really unique about Virginia Satir's approach, besides her amazing human presence that she brings, personally, but her approach is also very signature in that addresses both systemic, as well as individual, ideas, and works both at the individual and systemic levels. And so this is unique, I think, among all therapies, to have this nice balance. And so it is an approach that has a lot of applications and utiliting to be used with a wide range of issues because of its multiple levels at which it conceptualizes and intervenes. And for those who are interested in learning more about practicing from the Satir approach, I highly recommend you connect up with the Satir's Global Network, which has links across the globe, because this is the primary place where you can learn to do this approach. And so I encourage you to research further if you're interested.