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Author(s): Patricia Pitta

Series: Family Therapy and Counseling

Publisher: Routledge, Year: 2014

ISBN: 1138775134,9781138775138

C O N T E N T S List of Illustrations xx Series Editor’s Foreword by Jon Carlson xxii Preface xxiv Acknowledgments xxvii Introduction: Modern Families: A Changing Family Structure and Context 1 Changing Family Structures 1 Context 2 The Assimilative Family Therapy Model 3 P A R T I The Assimilative Family Therapy Model: An Overview 9 1 The Assimilative Family Therapy Model (AFT): A Model of Choice to Treat Modern Day Families 11 A Defi nition of Psychotherapy Integration 11 History of Psychotherapy Integration 12 The Four Contemporary Approaches to Psychotherapy Integration 13 Technical Integration 13 Theoretical Integration 14 Common Factors 15 Assimilative Integration 16 Family Therapy Integration 17 History of Family Therapy 17 The Assimilative Family Therapy Model 19 The AFT Model: A Generic Framework 20 Questions to Ponder 21 C O N T E N T S xiv 2 Know Your Family’s Context: Essential Elements to Consider 22 Context: The Tapestry That Families Weave 22 Meet the Families: The Role of Context 24 Creation of the Contextual Chart 26 A Therapist’s Context 26 Contextual Variables Examined 27 Contextual Variables 28 Contextual Variables for Each Modern Family System 43 An Example of Context Informing Therapy 43 Questions to Ponder 44 3 Theories and Concepts Included in the Assimilative Family Therapy Model 45 The Evidence-Based Therapy Movement 45 Common Factors as an Effective Means to Client and Family Change 47 Therapeutic Alliance 47 Expectancy, Hope and Placebo 47 Model and Technique 48 Extratherapeutic Factors 48 Common Factors and the AFT Model 49 The Assimilative Family Therapy Model: An Integrative Model for the Modern Family 50 The AFT Model: Underlying Systemic Understanding 51 Bowenian Family Systems Therapy 51 Concepts Included in the “Home Theory”: Bowenian Family Systems Therapy 52 Anxiety Reduction: An Underlying Struggle 52 Fusion and Differentiation 53 Triangles and Intergenerational Transmission Processes 54 Cutoffs 55 Family of Origin Work 56 Coaching 57 Pursuit and Distance 58 How to Use these Concepts to Enable Interventions 59 Additional Theories, Concepts and Interventions to Assist the Home Theory 59 Psychodynamic Theory and Concepts Utilized by the Author 59 Psychodynamic Concepts Included in the AFT Model 61 Repetition Compulsion 61 Denial 61 C O N T E N T S xv Doing and Undoing 62 Repression 62 Distortion 63 Splitting, Projection, Introjection and Projective Identifi cation 63 Psychodynamic Play Therapy 64 How to Use these Concepts to Enable Interventions 64 Cognitive-Behavioral Theories and Techniques 65 Cognitive Re-labeling 66 Assertiveness Training 66 Relaxation Therapy 67 Role-Play and Modeling 67 Behavioral Parent Training, Contingency Contracts, Reinforcement and Punishment 67 Mindfulness 70 How to Use these Concepts to Enable Interventions 71 Communication Theories and Concepts 71 Listener/Speaker Techniques 71 How to Use these Concepts to Enable Interventions 72 Other Systemic Theories, Concepts and Interventions 73 Comprehensive Family Therapy 73 Re-parenting the Parents 73 How to Use Re-parenting the Parents to Enable Interventions 73 Structural Family Therapy 74 How to Use Concepts from Structural Family Therapy to Enable Interventions 74 Exposing Family Secrets and Loyalties 74 How to Use Exposing Family Secrets to Enable Interventions 75 Family Play Therapy 75 How to Use Family Play Therapy to Enable Interventions 76 Questions to Ponder 76 4 How the Assimilative Family Therapy Model Helps Heal 78 Conceptualizing the Assimilative Family Therapy Model 78 Terms and Their Meanings in the AFT Model Explored 79 Health and Healing 79 Therapy Tools 80 Psycho-education 80 Genograms 81 Temperature Checks 82 Resistance and How to Evaluate 83 C O N T E N T S xvi Other Considerations for Successful Treatment 85 Individual Strengths and Weaknesses 85 Getting Stuck 85 Core Competencies for Family Therapists 87 Case Conceptualization 89 Case Conceptualization and the AFT Model 90 The Evaluation Period 90 The Work of Treatment 92 Treatment Guides 93 Termination of Treatment 93 Outcomes of Successful Therapy 94 Uses for the AFT Model 94 Questions to Ponder 95 P A R T I I Treating Child/Adolescent-Centered Families: Through the Assimilative Family Therapy Model 97 5 Child/Adolescent Dilemmas: An Overview 99 Child/Adolescent-Centered Dilemmas: Who Has the Problem? 99 Evaluating Individual Child/Adolescent Dysfunction 100 Acting Out and Acting In 101 Helping Heal the Individual Child/Adolescent 101 Roles of Parents in Treatment 102 Role of Marital Confl ict in Child/Adolescent Problems 102 Types of Parent Relationships Identifi ed 103 AFT Parenting Approach 105 Questions to Ponder 106 6 Issues and Behaviors of Childhood 107 An Overview: Issues and Mastery 107 Specifi c Contextual Variables to Consider During Childhood Years: Children and the Infl uence of Trust, Peers and Power 108 Trust Facilitated by Emotional Coaching 108 Peers 110 Power 110 Parenting Grandchildren 111 Case: Grandparents Parenting a Grandchild 112 Background 112 Pre-Treatment Genogram Summary 113 C O N T E N T S xvii Contextual Summary: Pre-Treatment 114 Resistance Evaluation 114 Initial Case Conceptualization Questions 114 Case Conceptualization Summary 116 Treatment 118 Post-Treatment 134 Contextual Summary: Post-Treatment 134 Post-Treatment Genogram Summary 134 Questions to Ponder 141 7 Adolescent-Centered Dilemmas: Context and Perspectives of Adolescence 142 The Adolescent’s Dilemma 142 Specifi c Contextual Variables to Consider During the Adolescent Years: Adolescents and the Infl uence of Trust, Peers and Power 143 Trust 143 Peers 144 Power 145 Military Families: Their Stresses and Context 146 Case: Military Family with an Acting-Out Adolescent 148 Background 148 Pre-Treatment Genogram Summary 149 Contextual Summary: Pre-Treatment 149 Resistance Evaluation 150 Initial Case Conceptualization Questions 150 Case Conceptualization Summary 152 Treatment 153 Post-Treatment 164 Contextual Summary: Post-Treatment 168 Post-Treatment Genogram Summary 168 Questions to Ponder 170 P A R T I I I Treating Adults Through the Life Cycle: Through the Assimilative Family Therapy Model 171 8 The Individual: LGBTQ Individuation 173 In Society 173 LGBTQ Issues and Mental Health Research 175 Contextual Variables Specifi c to LGBTQ Clients and Their Families 176 Heterosexism 176 C O N T E N T S xviii Micro-Aggression 177 In Therapy: Micro-Aggression and Heterosexism Explored 178 Coming Out and the Family 179 Parents and Coming Out 179 Contextual Issues Specifi c to the Lesbian Population 180 Forming a Lesbian Identity as a Member of a Couple 180 Polycultural Identities for Minority Lesbians 182 Case: Lesbian Individuation from Family of Origin 183 Background 183 Pre-Treatment Genogram Summary 184 Contextual Summary: Pre-Treatment 184 Resistance Evaluation 185 Initial Case Conceptualization Questions 186 Case Conceptualization Summary 187 Treatment 187 Contextual Summary: Post-Treatment 207 Post-Treatment Genogram Summary 207 Questions to Ponder 209 9 The AFT Model and Couple Therapy 210 Using the AFT Model for Couples 210 Theories Infl uencing the AFT Couple Model 210 Contextual Factors: Important Ingredients of Couple Therapy 213 Intimacy: Search for the Self and Each Other 213 The Meaning of Trust in Couple Relationships 214 Power and the Relationship 215 The Assimilative Family Therapy Couple Model: Theories and Factors Included 216 Timing 216 Frequency and Type of Sessions as Informed by Staging Marital Confl ict 218 Individual versus Joint Sessions 219 Steps in Resolving Couple Confl ict 220 The Two-Paycheck Marriage: Dual Earner Couples 220 Case: The Two-Paycheck Family 222 Background 222 Pre-Treatment Genogram Summary 223 Contextual Summary: Pre-Treatment 223 Resistance Evaluation 224 Initial Case Conceptualization Questions 224 Case Conceptualization Summary 225 Treatment 227 C O N T E N T S xix Contextual Summary: Post-Treatment 249 Post-Treatment Genogram Summary 249 Questions to Ponder 253 10 Parenting Parents/Caretaking Spouses: A Struggle for Power, Life and Assistance 254 Contextual Variables in Caregiver and Elderly Populations 255 State of the Caregiver: Family Caregivers 255 Health of the Caregiver 256 Dealing with Elderly Mental and Physical Decline 256 Manipulation, Frustration and Abuse 257 State of the Family Function or Dysfunction 258 Types of Adult Children 259 Types of Elderly-Centered Relationships 260 How Can Therapy Help? 262 Goals of the Therapist with Caregiving Clients 262 The Assimilative Family Therapy Model for Caregivers 263 The Baby Boomer/Sandwich Generation 264 Case: Sandwich Generation Caretaking Elderly Parents 264 Background 264 Pre-Treatment Genogram Summary 266 Contextual Summary: Pre-Treatment 266 Resistance Evaluation 266 Initial Case Conceptualization Questions 267 Case Conceptualization Summary 268 Treatment 269 Contextual Summary: Post-Treatment 285 Post-Treatment Genogram Summary 285 Questions to Ponder 287 Epilogue 288 Appendix A: Contextual Framework Questionnaire 290 Appendix B: Generic Contextual Map 292 Appendix C: Resistance Questionnaire 293 Appendix D: Generic Treatment Guide 294 Appendix E: Initial Case Conceptualization Questions 295 References 296 Index 336 I L L U S T R A T I O N S Tables 2.1 Attachment Styles and Views of the Self and the Other 36 2.2 Life Stages and Life Cycles of Development 40 3.1 Concepts Included in the Assimilative Family Therapy Model 51 4.1 Evaluation Phase 92 5.1 Types of Parent Relationships 105 6.1 Treatment Guide, Grandparents Parenting Grandchild 135 7.1 Treatment Guide, Military Family with Acting Out Adolescent 165 8.1 Treatment Guide, Gay Individuation 204 9.1 Treatment Guide, Two-Paycheck Couple 245 10.1 Types of Elderly Parent–Adult Child Relationships 261 10.2 Treatment Guide, Sandwich Generation 282 Figures 2.1 Contextual Variables Considered in the Assimilative Family Therapy Model 21 6.1a “Before” Contextual Framework, Grandparents Parenting a Grandchild 138 6.1b “After” Contexual Framework, Grandparents Parenting a Grandchild 138 6.2 Genogram: Grandparents Parenting Grandchild, Before 139 6.3 Genogram: Grandparents Parenting Grandchild, After 140 7.1a “Before” Contexual Framework, Military Family with Acting Out Adolescent 168 7.1b “After” Contexual Framework, Military Family with Acting Out Adolescent 169 7.2 Genogram: Military Family, Before 169 7.3 Genogram: Military Family, After 170 I L L U S T R A T I O N S xxi 8.1a “Before” Contexual Framework, Lesbian Individuation 207 8.1b “After” Contextual Framework, Lesbian Individuation 208 8.2 Genogram: Gay Individuation, Before 208 8.3 Genogram: Gay Individuation, After 209 9.1a “Before” Contextual Framework, Two-Paycheck Couple 249 9.1b “After” Contextual Framework, Two-Paycheck Couple 250 9.2 Genogram: Two-Paycheck Couple, Before 251 9.3 Genogram: Two-Paycheck Couple, After 252 10.1a “Before” Contextual Framework, Sandwich Generation 285 10.1b “After” Contextual Framework, Sandwich Generation 286 10.2 Genogram: Baby Boomer Couple, Before 286 10.3 Genogram: Baby Boomer Couple, After 287

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