Multigenerational Family Therapy

David S Freeman

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781317765431
• Edition: 1
• Topic: Psicología
• Subtopic: Salud mental en psicología

Multigenerational Family Therapy is a book about honoring and helping families. Rich with personal reflections and anecdotes from the author's many years as a family therapist, this volume's major strength lies in its precise definition of the process and content of the therapy itself. As the family is the major resource system available to an individual, this important book provides therapists with the keys for helping family members help each other and provides a framework for understanding how the family, as a multigenerational system, moves through various stages of the therapeutic process. By emphasizing the importance of family members utilizing the past as a positive force for change and featuring complete transcripts of family therapy sessions, this sensitive book clearly illustrates how therapists can use the positive forces of family for dealing with today's uncertainties and dilemmas. The step-by-step approach details how family therapists can work with families in a positive, healing manner. Several chapters illustrate the transition from the beginning to middle phases of family therapy to the terminating phase and provide a framework for how therapy evolves over time. Other chapters discuss the special skills required to work with various family constellations, such as couples, parents with children, siblings, adult children with aged parents, and individuals as well as extended family members. Helpful advice on how to deal with special issues and dilemmas of family therapy such as secret-keeping, affairs, co-therapy, crises and emergencies is also included in this comprehensive book. Beginning and advanced family therapy practitioners, students of family theory and therapy, faculty of social work practice, clinical psychology, nursing, family life education, and counseling psychology will find many positive ideas for working with families in this detailed book.

Chapter One

Family Therapy

Introduction

A multigenerational approach to family therapy honors the family in a special way. The approach recognizes that the family can be both a resource and a problem for its members. One of the goals of the therapeutic process is to maximize the family’s positive influences as a way of dealing with the problem areas.

It is critical that the family therapist understand the influence and power the family exerts over its members. Without this understanding, a therapist may unwittingly side with a family member against his or her family. The collusion is subtle but profound. It is common for a client to begin therapy by telling the therapist various stories about how rejecting, critical, and unloving his or her family is. Many therapists assume these stories are generally accurate and focus their efforts on helping the family member deal differently with his or her family. These therapists may have a view of family similar to that of their clients and may even advise that family contact should be kept at a minimum. Other therapists may encourage their clients to confront family members about the behavior they see as upsetting and destructive. These approaches, although intended to be supportive and helpful to the client, in fact, reinforce the client’s preconceived assumptions about family thereby maintaining distance, a lack of family connection, and a sense of loss.

Multigenerational family therapy emphasizes the importance of family connections in people’s lives. Therapists employing this framework encourage their clients to work on family relationships. Ordinarily, people enter therapy feeling quite ambivalent about their families. If the therapist shares this ambivalence, he or she will feel discomfort about involving the family and avoid this potentially positive resource. My model of family therapy views the family as a powerful ongoing influence in its members’ lives. My approach may involve seeing aged parents, adult siblings, and other important family members as well as the more traditional parents and children.

This introductory chapter describes the major family therapy principles that underlie a multigenerational approach to family therapy. When a therapist involves several generations in the therapeutic process, he or she embarks upon a radical approach to problem solving. This chapter provides a framework for that approach.

Section One: Major Principles of Family Therapy

Principle One: A family member’s problem is contributed to and reinforced by the other family members’ response to it.

All family therapy models endorse this basic principle. However, there continues to be an active debate about which came first, the problem or the “response.” My position is that it does not matter. By the time the family is seen by a therapist, the problem has existed for so long that it has become part of the way in which the family functions.

The family therapist’s task is to understand the functional nature of the problem and how the family reinforces it as a way of problem solving. When an individual family member experiences difficulty, either physically, socially, or psychologically, the family system has to respond to him or her in some way. This response will set up certain family behavioral patterns that may influence behavior after the original problem is gone. Family members who define a particular individual as having a problem will do so in relation to their view of themselves as “healthy.” Perceived dysfunctional behavior in one family member may contribute to another family member’s feelings of adequacy. And so, certain responses, once set in motion, may become part of a permanent behavior pattern.

In a session that I once had with two parents and their three adolescent children, the father told me that his wife usually jumped in to break up any conflict between him and his older adolescent daughters. When I asked him how that affected the way he dealt with his daughters he answered that he knew he could count on his wife to rescue him if he became too angry. He went on to explain that knowing this allowed him to indulge his anger and, at times, actually get angrier than he felt initially. When I asked his daughters what they had learned about their father from their conflicts, they answered that they had discovered their father was not as safe as their mother because his temper got out of control. In fact, the mother’s rescuing the father contributed to the father’s unsafe appearance to the daughters and added to the distance that developed between father and daughters. The family members had not recognized the reciprocal nature of their behaviors.

Whatever the nature of the problem, it is up to the practitioner to take a holistic view of the family and resist zeroing in on the identified problem. The immediate concern of the family is often not the major underlying problem. The important issue is how the problem has affected the relationship network within the family.

Principle Two: Change will not be sustained in a family unless the most powerful members of the family are willing to sustain it.

It is an important system’s principle that change occurs from top to bottom. If a child tries to change his or her behavior towards a parent without a corresponding change from the parent, within a short period of time, the child will revert to the old familiar behavior. However, if the parental unit is able to sustain a change in their behavior towards a child, eventually the child will behave differently.

The general principle is when one member in the family system changes and remains involved with the entire system, the other members will be unable to maintain their old behavior. The question for the therapist to determine is which members of the family have the greatest potential for change. In many families, the child acts out as a way of connecting with his or her family. It is futile to try to get such a child to change without the cooperation of the parents. A more effective approach is to help the parents understand how their reaction to the child encourages this behavior. The family therapist must analyze the family system to discover the functional nature of the problem and the reciprocal roles the family members play with the problem. The next objective is to determine which unit within the family has the greatest potential for change. In my opinion, the parental unit is the most powerful one in the family. When a therapist helps the parents respond to a child’s behavior in new ways, the child will modify the behavior and a new family structure will develop.

A simple experiment will help the reader understand how difficult and risky it is to do something differently in one’s family. Think about some traditional behavior that your family counts on you to continue exhibiting. Then stop behaving in this manner and examine the reactions. The usual response by family members is anger, hurt, and criticism. In turn, the one who has changed becomes anxious about the reaction that his or her new behavior has brought about. He or she quickly discovers that by resuming the old behavior his or her own anxiety and the anxiety of family members can be reduced. This exercise illustrates how difficult it is for a family member to change his or her customary way of taking care of other family members.

Principle Three: Functional families maintain a balance between individual autonomy issues and family solidarity concerns.

When assessing a family, it is important to evaluate how it is able to balance the individual needs and expectations of its members and the solidarity concerns of the group. Often parents enter family therapy with the hope that the therapist will work toward greater solidarity in the family; and in effect, bring the family members together in a closer, more involved way.

Adolescents and young adult children tend to resist coming into family therapy because they are apprehensive about becoming more involved in family issues. Adolescents are in the process of moving away from the family. Even the term family therapy increases their anxieties about their ability to eventually emancipate from the family. The family therapist, therefore, has a unique balancing act to perform. He or she has to address the parents’ concern for greater togetherness while also communicating to the adolescents that their needs for greater autonomy and separateness from the family are understood and supported.

In most functional families, individual autonomy is not a major concern. Family members are able to respect each other’s differences while at the same time feeling connected as a group. When there is a dysfunctional member within the family, whether a parent or a child, this balance becomes threatened. Some of the family becomes overinvolved with the dysfunctional member and others are more on the periphery. Usually when there is a concern about one family member, the ability of the family to maintain a balance between individual needs and group concerns is lost. The anxiety is too high and the preoccupation with the dysfunctional member too great to maintain the balance. The involvement of helping professionals usually reinforces the imbalance with its focus on the dysfunctional member. The responsibility of the family therapist is to realign the family boundaries.

The family with an alcoholic parent provides an example of family imbalance. The common pattern is for the nonalcoholic parent to be preoccupied with helping the alcoholic partner give up his alcoholism. During periods of sobriety, the children will tend to feel great anxiety about when the alcoholic parent will start drinking again and throw the family back into chaos. A great deal of thinking, talking, and feeling is directed towards the alcoholic and his drinking.¹ The drinking behavior controls the family. Families function for years maintaining this anxiety. Everyone is cheated because of the preoccupation with the alcoholic. Individual needs of the children are considered secondary concerns and the individual needs of the nonalcoholic parent are seen as less important than taking care of the alcoholic member. When the alcoholic partner ceases to drink, it also creates anxieties within the family because the members have not learned how to function as a family without the familiar preoccupation.

Whenever there is a family problem, it in some way undermines the ability of the family to be able to give attention to the individual needs of its members. One of the therapist’s task is to help the family support the individual growth and development of its members and in the case of children to help them leave the family while at the same time feel connected and supported by it.

Principle Four: The family therapy session must be safe for all members and respect individual differences.

Principles three and four are interconnected. One of the ways in which the family therapist operationalizes principle three is by the way he or she relates to the family members in the sessions. It is up to the family therapist to make all the sessions safe for each family member. Family members are worried that they will be scapegoated, held responsible for the problem, focused on excessively, invalidated, etc. It is a great relief to family members to leave the first session feeling respected and understood and to have had the opportunity to explain their view of the world to the rest of the family. One can understand the anger, ambivalence, and silences of family members as stemming from the anxieties that have been described. The job of the family therapist is to join with each family member around his or her concerns and to help to make it safe for them. I routinely ask family members questions that, focus on how they have learned to make it safe for themselves, both in the family and in the world at large.

In addition to providing a safe environment, the therapist must be respectful of the individual differences within the family. The therapist must guard against trying to get family members to perform and/or behave in ways that make the therapist feel comfortable. Some family members may choose to be silent, some may choose to tell their concerns through stories and humor while others may choose to be angry for a while, etc. All the behaviors that family members exhibit during the early phase of family therapy are representative of the way they cope and make it safe for themselves. When they realize that the family therapist is not going to judge them, control them, and/or evaluate them, they will begin to relax and involve themselves in a positive way in the process.

The therapist plays an active role in keeping the sessions safe. He or she must foresee the reactions by family members that would tend to invalidate what another family member is saying. For example, when a child tells his or her story and describes reality as he or she perceives it, it is essential that the family therapist does not permit the parents to criticize or invalidate the child’s story. Allowing parental criticism is a common error of therapists. When a therapist asks a family member to comment on what another member has just said, the member frequently responds with criticism and verbally attacks the other family member. When this happens, the therapist has allowed the session to get out of control. He or she has set up a situation in which one family member has undermined and invalidated what another family member has said. It is essential that the family therapist prevent that from happening. The therapist must give the family members an opportunity to say things through him or her to other family members without the statements stirring up anger, criticism, or hostility. Being heard without being criticized is a powerful experience for a family member. The degree to which the therapist is able to prevent family members from reacting to each other with hurt or anger determines the degree of safety experienced by family members in the session.

Principle Five: The family therapy session must offer the family members an opportunity to experience each other differently.

In the early stages of the family therapy process, the family tries to duplicate their “at home” behaviors in the therapist’s office. Family members are both hopeful and anxious about the therapist being wise enough to prevent this duplication of experience. Family members desire change yet are frightened by it. They will resist it. Behavior that is unpleasant and makes one sad and/or unhappy is nonetheless familiar. Coping mechanisms for dealing with the behavior have be...