Family therapy gained its initial legitimacy during the 1950's by

Family Therapy ConCepts and Methods

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iii

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