This book is co-written by Dr. Salvador Minuchin, founder of structured family therapy, Dr. Michael Cowles, professor of psychology at William and Mary College in the United States, and Professor Wai-Yung Lee, director of the Family Research Institute of HKU. The purpose is to collect the clinical experience of family therapy into a book, point out the development direction for young scholars, and let the public understand the influence of family relationship on individual psychology more comprehensively.
Next, I will show you the charm of family therapy from two aspects: cognitive family therapy, four steps of family therapy, and how to treat the behavior and psychological problems of family members with these four steps.
First, let's look at what family therapy is.
Generally speaking, the family-oriented group psychotherapy model is called family therapy. Its purpose is to help families eliminate bad conditions and restore healthy family relations. Its main feature is that in the process of treatment, it will pay more attention to the interaction and relationship between family members, rather than the individual's state and problems, and will explain the individual's behavior and problems from the perspective of family system.
Simply put, when family member A shows abnormal behavior, such as anxiety, irritability or depression, family therapy tends to look for the reasons from the interaction between member A and other family members, rather than identifying that this anxiety, irritability or depression is caused by member A's own factors.
Then we will combine a case to see the four steps of family therapy and how to use these four steps to treat the psychological problems of family members.
Step 1: expand the current complaint.
This step will be used in the initial stage of family therapy and run through the whole treatment process.
Generally speaking, when a person has abnormal behavior, especially when it has an impact on his family, it is easy for his family to define him or even reach an understanding that this is his problem.
For example. In a Spanish family, Sarah, a 22-year-old second daughter, was diagnosed as depressed and suicidal by a psychiatrist. In the eyes of her married sister, Sarah works too hard, not only to finish college courses, but also to teach table tennis after school and take the initiative to take care of her two younger brothers at home. In their father's view, Sarah's sense of responsibility is so strong that she often cries because of pressure; In their mother's view, the second daughter took the initiative to do everything for her two adolescent brothers because she thought her mother was too hard.
From these narratives, we can easily see that their whole family has reached a certain consistency-Sarah is a person who is too willing to help family members, and her excessive sense of responsibility and depression for her family are caused by her personal reasons. Under this consistency, the real cause of Sarah's psychological problems is covered up.
Therefore, in order to really help Sarah, the therapist will first break this "consistency", and he began to label Sarah with some humor, which is actually used to break everyone's inherent cognition of Sarah. For example, when everyone thinks that Sarah likes to help her family so much that she takes on jobs that don't belong to her, the therapist will ask Sarah, who is she trying to protect by doing so much?
In Sarah's narrative, we find that her behavior is not because she is a person who especially likes to help others, but because in her opinion, her mother is very hard. If she doesn't help take care of her brother, her mother will do these things, but her mother is actually overloaded every day.
Through the first step, the therapist breaks the family members' inherent cognition of the patient and helps the family members of the patient to look at his problems in a new way.
Step 2: Focus on the interaction of maintenance issues.
When a family member has a problem that affects the family, it is easy for everyone to "centralize" this member, and all the treatments will revolve around this member, such as accusing him of not being so emotional or persuading him to relax.
But in fact, there is no single behavior, and individual behaviors and emotions come more from interaction with others than from their own internal production.
Or take Sarah's case for example.
How does she usually get along with her family?
When the father asked his two sons to do something, but the sons didn't want to do it, Sarah would take the initiative to discipline her younger brother or take on this part of the work, but the two younger brothers would not obey her sister's discipline and even laugh at her.
When her mother is worried, Sarah can always be very sensitive to detect her mother's fragility at the first time and come out to take on her work.
This shows that the structure of this family is not that the father and mother are taking care of four children, but that the father is alienated from the family and the mother is overworked. Because the elder sister got married and left home, Sarah, as the second daughter, subconsciously became the "mother" of her younger brothers and took on the work and responsibility of helping them discipline, but the younger brothers in adolescence did not obey her discipline, which made Sarah very helpless and sad.
Through the second step, the therapist further broke the family members' inherent cognition of patients, and made them start to think about whether their own practices had a bad influence on patients.
Step 3: Explore the past from the structure.
In the first two steps of treatment, in order to break the inherent cognition of family members to patients, the therapist will guide the core of the problem to the interaction between family members, but this guidance will easily make the relative authoritative role of father or mother in the family become the core of being accused and think that they are not doing well, which will lead to problems for other members.
Therefore, in this step, the therapist will explore the past of the nuclear family members, find out the reasons for their behavior, and avoid making them feel unnecessary guilt.
Or take Sarah's case as an example.
The therapist asked Sarah's parents to recall their childhood stories. From these memories, Sarah's parents grew up in a single-parent family with only her mother who worked in a very hard textile factory. So Sara's mother has to take care of three younger brothers and sisters and even all her family since she was a child, which makes her very tired, because she actually wants to be like her younger brothers and sisters. She just needs to play in childhood.
Sarah's father has a very responsible brother. After his father died, his brother became his mother's good helper and took care of the family. He just needs to take care of himself.
It can be seen that the mother unconsciously turned Sarah into the second self, and the father unconsciously marginalized himself in the family because he was not good at taking responsibility.
Through the third step, the therapist helps the family members to find deeper problems and further let the family members face up to the influence of their relationship on the patients.
Step 4: Explore relevant ways of change.
In family therapy, the best treatment method is to encourage family members to improve the current situation through cooperation and help patients get rid of their previous psychological or behavioral problems through changes in their relationships.
Take Sarah's case as an example.
Because Sarah's family is that her father works hard outside and her mother takes care of the family full-time, so many times, in order to make her father less hard, other people in the family rarely ask her for help because of family problems, such as a fight between two younger brothers. Sarah and mom will be more inclined to tell dad after dealing with the problem than to let dad deal with it.
Therefore, the first thing the therapist should do is to encourage the father to take on more responsibilities and tell Sarah and her mother that they can't deprive him of the responsibilities he needs as a father and the respect his children enjoy after taking on responsibilities.
Then, the therapist let Sarah's parents learn to appreciate their two sons and let them know that these two adolescent boys actually have their own ability to deal with problems. They shouldn't be a burden to the family, and they don't need their mother or sister to deal with their problems all the time.
Finally, the therapist asked her mother to learn to ask for help from her husband instead of her daughter, thus really helping Sarah get out of the family circle, spend more time with herself and find her own life.
And by improving the interaction between patients and their families, help patients get rid of the original vicious circle and get a new life.
Well, after reading this, we know the content of this book. Let me summarize it for you.
Personal behavior and psychological problems are not isolated, but more come from unhealthy family relationships. Therefore, in family therapy, therapists should first break the family's inherent cognition of patients and let them think from their own behavior instead of thinking that patients are their own problems; Secondly, it is necessary to guide family members to think about whether their bad interaction with patients leads to abnormal behavior or psychological problems; Thirdly, the therapist can not simply attribute this bad interaction to the fault of a family member, but should trace back to the source and find the real reason for this bad behavior from the growth process of this family member; Finally, therapists need to encourage family members to improve their interaction together, so as to help patients get a cure.