Approaching Bowenian Family System Therapy

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Experiential Family Therapy (EFT) is the central place of humanistic therapies and psychology. This therapy includes the works of Fritz Perls, Carl Rogers, and Abraham Maslow, along with the communication theories and family systems of Paul Watzlavick, Don Jackson, and Gregory Bateson. It is called a meeting place for all the theorists because clearly the experiential family therapy includes multiple systems used for therapy. The authors Becvar & Bevcar (2006) like to call these 'experimental approaches to family therapy' instead of 'experimental models'. Virginia Satir, one of the main predecessors of the experiential approach, is also considered to be part of communication approaches as well as experiential (Lester, 2009).

The family tree of the family system has three main parts: (1) the Communications approach of Virginia Satir; (2) the Gestalt experiential approach of Walter Kempler; and (3) the Symbolic experiential approach of Carl Whitaker (Becvar & Becvar, 2006). However, the focus of the therapists concerning the unique self provides the idea that different models exist; the focus on unique responses and experiences gives an impression that many differences exist. Experiential psychotherapy or psychology arose as a reaction to behaviorism -- which sometimes overlooks the inner experience of a person and focuses on the behaviors that are easily quantifiable. As well, humanist therapists were reacting against the emphasis of Freud on the intellectual understanding, analysis, and past of the client. All of the humanist therapies were considered to be experiential because it was believed that accurate and honest changes not only occur in the client but also in the therapist during the session, creating an empathic and genuine relationship (Greenburg, Watson & Lietaer, 1998). Humanistic therapies focused on sharing beliefs and valuing self-realization by reaching the natural tendencies and abilities of the client (Nichols & Scwarts, 2008).

a. The first interview/joining process

Weber, KcKeever & McDaniel (1985) present a framework that guides therapists in the starting sessions of therapy; this also serves as a teaching and assessment instrument for therapists who are just beginning. The initial treatment for the therapists is critical and important. The first interview of the therapists starts with joining the family and noting their organizational structure by using the therapeutic style. This makes the members of the family feel safe and supported. The structure of the session should give the impression to the family members that the therapist has planned everything and will lead them through the entire session. This defines the surface of the family and the contract emphasizes the changes that are desired and the goals of the family (Strategic and Systematic, n.d.).

If the initial contact of the therapist and the family members is through telephone, then basic information, including name, contact numbers, address, brief summary of the issue, identification of the family members who are involved in the problem, contract for the initial session, date, location, time, directions to facility or office, fees, and who would be present, are all discussed. The phone call also reflects the behavior of the client. For example, if the client makes the initial contact, the therapist might consider him/her to be 'motivated', and wonder about the other members' opinion of the therapy. Furthermore, if the family is referred by someone else, the therapist also learns about the relationship with the referrer, and the perspective of that person concerning the family (Strategic and Systematic, n.d.).

Making a Hypotheses/Building a Strategy

Initial hypotheses may be generated from the call by the help of a framework that the therapist has created by making sense of the structure of the family. This also helps him to formulate a strategy, along with questions that will be asked during the first interview. The therapist, however, should treat the first hypotheses tentatively, as obviously more data will be added during the interview that will assist in formulation of a new strategy (Strategic and Systematic, n.d.).

b. The therapeutic alliance/relationship

Engaging a client is critical and an important part of the therapy. Those clients who engage are likely to create a bond with the therapist and participate to higher degrees with high satisfaction levels. A therapeutic alliance is constructed when the therapist makes the family members feel safe and supported; this also shows the quality of communication and interaction. A personal and close bond is created between the therapist and the family members; this may make it easier to achieve the goals and the desired needs of the therapy. If a therapist does not make the members feel supported and safe, and there is no positive alliance between them, then the treatment is likely to either terminate or become interrupted.

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Therapeutic alliance mainly has three objectives: goals' agreement, establishment of tasks, and forming a bond.

A number of family therapy trials have been carried out that showed treatment was effective when both the client and the therapist engaged with each other, and there was a positive outcome for the families as well as the particular client. The therapy also requires the formation of a therapeutic relationship with every family member; therefore the family system and their patterns of interaction are considered important for therapy engagement and attendance. In a meta-analysis by Karver, Handelsman, Fields & Beckham (2006), the treatment had positive results when the therapist had strong interpersonal and influential skills. Therapeutic alliance is necessary to form a bond between the family members and create a positive outcome of the session (Thompson, Bender, Lantry, & Flynn, 2007).

c. How change is brought about

In order to bring changes as a result of the theory, the information collected from the sessions is assessed by observing the repeating patterns of the members of the family and their interaction with each other. The therapy generally includes ten sessions which also provide high expectations to bring change. The changes taking place through treatment are called first order or second order changes (Strategic and Systematic, n.d.).

First Order Changes: The pattern of sequences or interactions of the family are changed at the behavioral level only.

Second Order Change: The beliefs and rules of the family are changed. For example, a child learns to behave properly with his father, and his attitudes of misbehavior are changed after the session. Similarly, the rules of the family might also change in order to solve the problems that exist in the family (Strategic and Systematic, n.d.).

2. Create a Short Case Example -- Vignette

A 15-Year-old Boy and His Family

John was a fifteen-year-old adolescent who was admitted for mental health care after admitting that he had thought about suicide. He was caught smoking by his stepfather who told his mother about it. John told his stepfather that he 'did not care anymore and wanted to die,' after which his stepfather became angry and told him to get out of the house because he was untrustworthy and disrespectful. John's mother got angry with her husband and told him that she would go too, if he made John go. John wanted to be an actor and despite doing well in academics, he did not see the point of studying. His grades dropped down which also stopped him from participating in the drama club. He started associating with children who were into drugs and skipped classes. His symptoms of depression included decreased concentration, motivation, energy, and sad mood. He also cut himself when he broke up with his girlfriend in addition to having suicidal thoughts (Broderick & Weston, 2009).

3. Systemic Case Conceptualization/Hypotheses

Beginning

Developing hypotheses for John and his family, the therapist would first observe and learn about the family's failed attempts to overcome the problem; these were actually a part of the problem and provided a strategic approach. A solution would be formulated that would replace the failed attempts with successful attempts. One of the approaches of this method would be to explain the reaction of John's stepfather; his action in throwing John out of the house came about because he was concerned and cared about John and his future.

Middle

John's stepfather's action -- throwing him out of the house - was an extreme reaction that actually showed that John's stepfather cared about him. It would be stated that the reaction might have gone too far, yet on the other hand, it also showed the stepfather's love for John (Broderick & Weston, 2009).

Furthermore, a positioning tactic could work from the disagreement about how to handle John between the stepfather and the mother. The therapist here can point out that John's mother is seeking to support her son, yet the situation is overwhelming for John's mother in the physical and fragile condition that she is in.

It was important that John's depression be understood by his family so that they could empathize with him and help him overcome it. This strategy would successful in uniting the family as they would realize how John needs their love and support (Broderick & Weston, 2009).

4. Three Stage Treatment Plan

Stage One: Psychodynamic Family Therapy

Beginning

With the psychodynamic family therapy, the past relationships between John….....

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