Orientation by Therapeutic Model/Approach
As my work with clients continued, my awareness of the complexity of family interactions grew. An integrative model of therapy helps to unravel the growing “complexities.” My working model builds on the foundation of Murray Bowen’s perception of the family as “an emotional unit” (Nichols & Schwartz, 2008), the process of family projection and of multigenerational transmission joined by the developmental structure for “healthy family functioning” (Doherty, Colangelo & Hovander, 1991) as organized by the Fundamental Interpersonal Relations Orientation (FIRO) model (Schutz, 1958). The model then integrates the empowering perspective of the client as upheld by Motivational Interviewing (Miller & Rollnick, 2002), and the defining tasks as arranged through the “experiential” threads of Emotion-Focused and Internal Family Systems theories. My chosen process of therapy attempts to reach beyond the previous “one-size-fits-all” mentality (Nichols & Schwartz, 2008) respond to the complexities of family interactions and improve the belief and practice that formerly isolated and focused on the individual and individual behavior.
The Family as a System
Murray Bowen’s (1978) theory that the family was an “emotional system” (Walsh, 2003) viewed the functioning of the individual within the context of family (Nichols & Schwartz, 2008). Carter and McGoldrick (2001) clarified the individual’s functioning as the “differentiation of self in relation to others” (Walsh, 2003). “Differentiation” allowed an individual member of the system choice in both giving and allowing “influence” to familial, cultural and social “others” (Walsh, 2003). The therapist coached the client to “gather information, gain new perspectives on key family members and patterns to then redevelop relationships” (Walsh, 2003).
The Developmental Structure of FIRO
With the family system in place, a structure for this system must be defined. The Fundamental Interpersonal relations Orientation (FIRO) model first introduced by William Schutz (1958) and later expanded by Doherty, Colangelo & Hovander (1991) provides that developmental structureof my model. The three core domains of Fundamental Interpersonal Relations Orientation (FIRO) theory: inclusion, control and intimacy, provide a developmental structure for healthy family functioning (Doherty, Colangelo & Hovander, 1991). The first domain of inclusion refers to the “interactions that relate to bonding and organization within the family system” (Doherty, Colangelo & Hovander, 1991). The “three subcategories” (Doherty, Colangelo & Hovander, 1991) of this domain include; “structure, connectedness, and shared meaning” (Doherty, Colangelo & Hovander, 1991).
The second domain of control refers to “interactions that relate to influence and power exertion during family conflict” (Doherty, Colangelo & Hovander, 1991). The subcategories of this domain include; dominating, reactive, and collaborative interactions. The third and final domain of intimacy refers to interactions related to “open self-disclosure and close personal exchanges” (Doherty, Colangelo & Hovander, 1991) or the “depth” of interactions. This “depth” involves a “mutual sharing of feelings; relating to one another as unique personalities; sharing vulnerabilities” (Doherty, Colangelo & Hovander, 1991) and in couple relationship “sharing emotionally close sexual interactions” (Doherty, Colangelo & Hovander, 1991).
FIRO recognizes that when a family experiences “life-cycle transitions or major, ongoing stressful events, they must create new patterns” (Doherty, Colangelo & Hovander, 1991). FIRO suggests that first addressing categories of inclusion, then issues of control and finally issues of intimacy is the “optimal sequence for managing major family change” (Doherty, Colangelo & Hovander, 1991). This sequence informs my assessment process as I sit with clients during conflict providing guidelines on which domain(s) the task of “creating new patterns” begins and how to then proceed with the family. I utilized FIRO’s developmental structure to understand where in the family structure my clients are “stuck” (Miller & Rollnick, 2002) and work to move forward from that point.
Motivational Interviewing
In order to move forward, the perceptions of Motivational Interviewing provides the vigor by recognizing the client as the source of energy behind change. This energy is captured by my acknowledgment and treatment of the client as such. This “facilitates the natural process of change” (Miller & Rollnick, 2002) as envisioned by the client.
Motivational Interviewing (MI) is an “evidence based approached (Miller & Rollnick, 2002)” developed by William Miller and Stephen Rollnick (2002) that provides the therapist with a helpful, healthy perspective of the client. Motivational interviewing is both client-focused and draws on the client’s own perceptions and strength and recognizes that clients present in therapy at different stages of change (Miller & Rollnick, 2002).
Motivational interviewing is based upon four general principles (Miller & Rollnick, 2002). The first is the therapist’s “expression of empathy” (Miller & Rollnick, 2002) for the client through “empathetic listening”. The second principle is the development of discrepancy between how the client wants to “live their lives” (Miller & Rollnick, 2002) versus how the client currently lives. The final two principles ask that the therapist “roll” with the client’s resistance and support their “self-efficacy” (Miller & Rollnick, 2002). The primary goals of motivational interviewing are to encourage client collaboration with the therapist, elicit the clients own “perception, goals and values” (Miller & Rollnick, 2002) for their lives, and support client autonomy (Miller & Rollnick, 2002). In the process of therapy, once the family system has been acknowledged, the structure for development established and the perspective of approach is clarified, the tasks of therapy must be determined. The experiential threads of Emotion-Focused and Internal Family Systems theories have determined those tasks for my work with clients.
The Experiential Threads
I chose the experiential theories of Emotion-Focused and Internal Family Systems to influence my current work because of their connection and ability to translate Bowen’s Family System Theory Schutz’s (1958) Fundamental Interpersonal Relations Orientation (FIRO) model and Miller and Rollnick’s (2002) Motivational Interviewing in a way that is relevant to the clients’ experience.
Emotion-Focused
Emotion-focused therapy, (EFT), championed by both Les Greenberg and Susan Johnson, supports Bowen’s view of the family as an “emotional unit” (Nichols & Schwartz, 2008). EFT integrated Bowlby’s ‘basic tenets of attachment theory, (Johnson, 2004) and viewed marital distress as the result of an attachment wound that created “negative affect.” This “negative affect” impacts the organization and processing of their “emotional experiences” (Johnson, 2004) and resulted in “rigid structured patterns of interaction” (Johnson, 2004). EFT recognizes that the problem behaviors are a response to a perceived past and/or present threat that creates distress. The distress is maintained through these rigid “patterns” intended to protect the relationship.
Distressed families perceive there is a threat to their structure and attempt to control the other by controlling the response or behavior that “triggers” the fear of abandonment or connection. This theory connects to the first FIRO domain of inclusion that refers to the “interactions that relate to bonding and organization within the family system” (Doherty, Colangelo & Hovander, 1991). EFT addresses the domain of inclusion by addressing the attachment concerns and fostering the formation of a secure bond.
The key concept of EFT is the awareness of a continuous “emotional state” (Nelson, 2008) that informs our response to our experiences. The tendency is to “turn away” and/or “turn against” those “uncomfy” (Nelson, J., 2008) emotional experiences and results in a general lack of awareness on how these historical, “hidden emotions” (Johnson & Whiffen, 2003) and patterns, inform our current behavior and decision-making processes. This detachment increases the isolation and the individual sense of “abandonment and rejection” and intensifies the distress. The statement that “We cannot detach from our feelings or we cannot attach to people (Nelson, 2008),” illustrates the double-bind in which many families find themselves. They want intimacy, but this requires that they turn towards their “uncomfy” (Nelson, 2008) experiences and emotions and that of others. Emotion-focused therapy facilitates the reprocessing and expansion of the emotional experiences, fosters positive affect and sentiment and creates new interactional patterns (Johnson, 2004) from a “secure base” (Johnson, 2004).
Internal Family Systems
Internal family systems (IFS) developed by Richard Schwartz another experiential model also focuses on the productive nature of relationships through the development of a “secure” base. This model defines the secure base as the “healthy self” (Schwartz, 2010). This “healthy self” (Schwartz, 2010) is part of the internal system that then impacts the “external system” (Schwartz, 2010). The internal system creates “subdivisions” (Schwartz, 2010) of its self or “parts” (Schwartz, 2010) in response to “attachment injuries” (Johnson, 2004). IFS highlights that if there are changes in the “internal system those changes will affect changes in the external system” (Schwartz, 2010). This approach informs my work by acknowledging and empowering the contribution each individual has on the creation and maintenance of the family system.
Conclusion
All three approaches integrate the “internal (emotional, physiological and mental) processes” of the clients and encourage mutual curiosity into the “origins” of their “patterns of interactions.” This shared curiosity forms a collaboration between the client and the therapist that facilitates the initiation of new “patterns” that are “useful and lead to preferred outcomes” (Nichols & Schwartz, 2008). The models emphasize “the role of language” (Nichols & Schwartz, 2008) and reinforce the idea that the clients’ historical perceptions of internal (emotional, physiological and mental) processes greatly influence the current external behavior (reactions and responses), and can be “recreated” or “reframed” to benefit the family system’s overall functioning.
Personal Integration of Therapeutic Models/Approaches
The Genogram
Murray Bowen’s (1978) theory that the family was an “emotional system” (Walsh, 2003) informs my work when clients present in therapy. As the client tells their story I work to view each individual’s functioning within the context of family. I listen to how the individual is influenced by familial, cultural and social “others.”
I am able to accomplish this goal through the use of the genogram paired with a simple timeline. Through the use of this combination I am able to gather information about the family history. This history reveals “patterns” that emerge in the collection of general information related to the parents and grandparents including, age, marital status, siblings and sibling position, health issues, deaths and status of relationships. I am then able to connect this key information through a simple timeline, assessing the impact of these events through the context of family. The genogram can also expose the kinds of stressors (drug use/abuse, childhood trauma, violence, financial) a family has encountered. With the family system drawn out, the genogram also helps to elicit information on which domain in the family system the work should begin. The genogram can elicit information on “who’s in and who’s out” of the family structure, who holds the power and where there are “emotional’ cut-offs and lack of “intamcy.”
Drawing out this information on paper helps the family view the system in a way they have probably never attended to before therapy. I am able to then coach the client to “gather information, gain new perspectives on key family members and patterns to then redevelop relationships” (Walsh, 2003).
Tracking
Tracking, a technique defined by structural family therapists Minuchin and Fishman (1981) as an essential part of the therapist's joining process with the family allows the therapist to be become a part of the family system (inclusion). During the tracking process I listen to the language in the family’s story and connect the pieces to the events and their sequence uncovered during the process of mapping the genogram. Through tracking, I am able to identify the dominating pattern of relating that has the clients “stuck,” access the client’s language around the “problem,” and gather information on how the client wishes to change. To externalize the dominating pattern and provide the clients with a tangible perspective on these patterns I use another technique that was developed during the Mental Research Institute’s research on communication feedback loops.
Mental Research Institute Recursive Cycle
The Mental Research Institute’s communication assessment model although a technique of strategic therapy (Nichols & Schwartz, 2008) is useful in externalizing the “problem pattern.” This can be accomplished by mapping out the MRI recursive cycle. Externalization will help to define the problem and identify the attempts of the members to solve that problem. This will also reveal how the “problem pattern” is maintained and the client’s unique language in defining the problem. The objective is to use the clients language as a way of seeing their crisis and reframing it in a way that is meaningful to them. (Nichols & Schwartz, 2008). This can also provide insight into who in the family has influence and power and how it is exerted during family conflict (Doherty, Colangelo & Hovander, 1991) addressing FIRO’s second domain of control and influence. Externalization also reveals the reactive interactions as the drawing out of the “internal family’ system as developed by Richard Schwartz.
Mapping the Internal Family System
There are several methods to illustrating the structure of the internal family system.
Reframing
Most family therapists use reframing as a method to both join with the family and offer a different perspective on presenting problems. Specifically, reframing involves taking something out of its logical class and placing it in another category (Sherman & Fredman, 1986). For example, a mother's repeated questioning of her daughter's behavior after a date can be seen as genuine caring and concern rather than that of a non-trusting parent. Through reframing, a negative often can be reframed into a positive. The methods described above allows for the “externalization” of the problem.
Summary
As my work with clients continues, my intent is to develop my process of therapy to reach beyond the previous “one-size-fits-all” mentality (Nichols & Schwartz, 2008) and to respond to the complexities of family interactions and improve the belief and practice that formerly isolated and focused on the individual and individual behavior. My continued application of an integrative and flexible model of therapy built on the foundation of Murray Bowen’s perception of the family as “an emotional unit” (Nichols & Schwartz, 2008), joined by the developmental structure for “healthy family functioning” (Doherty, Colangelo & Hovander, 1991) as organized by the Fundamental Interpersonal Relations Orientation (FIRO) model (Schutz, 1958), the empowering perspective of the client as upheld by Motivational Interviewing (Miller & Rollnick, 2002), and the defining tasks as arranged through the “experiential” threads of Emotion-Focused and Internal Family Systems theories which considers the growing “complexities” of the family will facilitate help and healing to my clients in a meaningful and powerful way.
References
Brock, G., & Barnard, C. (1999). Procedures in Marital and Family Therapy, 3rd Edition. New York: Guilford Press.
Doherty, W.J., Colangelo, N., Hovander, D., 1991. Priority setting in family change and clinical practice: The family FIRO model, Family Process, 30:227-240, 1991.
Duncan, B, & Miller, S. (2000). The heroic client. San Francisco: Jossey-Bass
Habben, C., Nelson, J., & Nelson, T. (Fall 2008). Foundations of marriage and family therapy. Class Lecture. Lenexa, KS.
Johnson, S. & Whiffen, V. (Eds.) (2003). Attachment processes in couple and family therapy. New York: The Guilford Press.
Johnson, S. (2004). The practice of emotionally focused couple therapy. Brunner-Routledge: New York.
Kerr, M. (1988, Sep). Chronic anxiety and defining self. The Atlantic Monthly, pp. 35-58.
McGoldrick, M. & Gerson, R., Petry, S. (2008). Genograms: Assessment and Intervention (3rd ed.). New York: W.W. Norton & Co.
Miller, W.R. & Rollnick, S. (2002). Motivational interviewing. New York: Guilford Press.
Nelson, J. (Fall 2008). Emotion, Attachment, Trauma. Class Lecture. Retrieved from Lecture Notes dated 9/11/2008. Lenexa, KS.
Nelson, J. (Fall 2009). Clinical Foundations II. Group Lecture. Lenexa KS.
Nelson, J., Nelson, T. (Spring 2009). Eliciting Client Stories. Class Lecture. Retrieved from Lecture Notes dated 02/03/2009 Lenexa, KS.
Nelson, T. (Fall 2008). Clinical Foundations I. Class Lecture. Lenexa KS.
Nelson, T. (Fall 2009) Postmodern Therapeutic Approaches. Class Lecture. Retrieved from Lecture Notes dated 12/03/2009. Lenexa KS.
Nichols, M.P., Schwartz, R.C. (2008). Family Therapy: Concepts and Methods (8th Ed.). Boston: Allyn & Bacon.
Perry, B. & Szalavitz, M. (2006). The boy who was raised as a dog. New York: Basic Books.
Schwartz, R., (2010, May 7). The internal family system model outline. The Center for Self Leadership Website. Retrieved from http://www.selfleadership.org/node/7284
