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Please see attached. Only complete the highlighted parts. Chapter 7 Experiential Family Therapy Family Therapy as an Emotional Encounter Learning Outcomes · Describe the evolution of experiential family therapy. · Describe the main tenets of experiential family therapy. · Describe healthy and unhealthy family development from an experiential perspective. · Describe the clinical goals and the conditions necessary for meeting those goals from an experiential perspective. · Discuss and demonstrate the assessment and intervention techniques of experiential family therapy. · Discuss research support for experiential family therapy. An experiential branch of family therapy emerged from the humanistic wing of psychology that, like the expressive therapies that inspired it, emphasized immediate, here-and-now experience. Experiential therapy was popular when family therapy was young, when therapists talked about systems but borrowed their techniques from individual and group therapies. From Gestalt therapy and encounter groups came techniques like role-playing and emotional confrontation, while other expressive methods such as family sculpting and family drawing bore the influence of the arts and of psychodrama. In focusing more on emotional experience than on the dynamics of interaction, experiential therapists seemed out of step with the rest of family therapy. Indeed, by emphasizing individuals and their feelings, experiential treatment may never have been as well suited to family therapy as were approaches that dealt with systems and interaction. With the passing of the inspirational leaders of this tradition, Virginia Satir and Carl Whitaker, the methods they popularized began to seem a little dated, more a product of the 1960s than of today’s world. Recently, however, experiential approaches have been enjoying a revival and, as we will see, two of the newer models—Johnson’s (2004) emotionally focused couples therapy and the internal family systems model (Schwartz, 1995)—have combined the emotional impact of an experiential focus on the individual with a more sophisticated understanding of family systems. As the first great cathartic therapist, Sigmund Freud, discovered, getting in touch with painful feelings is not by itself a complete form of psychotherapy. On the other hand, ignoring or rationalizing unhappy emotions may cheat clients out of the opportunity to get to the heart of their problems. Thus the experiential emphasis on emotional expression may be a useful counterweight to the reductionistic emphasis on behavior and cognition in today’s problem-solving approaches. Sketches of Leading Figures Two giants stand out in the development of experiential family therapy: Carl Whitaker and Virginia Satir. Whitaker was the leading exponent of a freewheeling, intuitive approach aimed at puncturing pretense and liberating family members to be themselves. He was among the first to do psychotherapy with families, and although he was considered a maverick, he eventually became one of the most admired therapists in the field. Iconoclastic, even outrageous at times, Whitaker nevertheless retained the respect of the family therapy establishment. He may have been their Puck, but he was one of them. Whitaker grew up on a dairy farm in upstate New York. Rural isolation bred a certain shyness but also conditioned him to be less bound by social convention. After medical school and a residency in obstetrics and gynecology, Whitaker went into psychiatry, where he became fascinated by the psychotic mind. Unfortunately—or fortunately—back in the 1940s Whitaker couldn’t rely on antipsychotic drugs to blunt the hallucinatory imaginings of his patients; instead, he listened and learned to understand thoughts crazy but human, thoughts most of us usually keep buried. After working at the University of Louisville College of Medicine and the Oakridge Hospital, Whitaker accepted the chair of Emory University’s Department of Psychiatry, where he remained from 1946 to 1955. Then, in the face of mounting pressure to make the department more psychoanalytic, Whitaker and his entire faculty, including Thomas Malone, John Warkentin, and Richard Felder, resigned to establish the Atlanta Psychiatric Clinic. Experiential psychotherapy was born of this union, and the group produced a number of provocative and challenging papers (Whitaker & Malone, 1953). In 1965 Whitaker moved to the University of Wisconsin Medical School. After his retirement in the late 1980s, he traveled widely to share his wisdom and experience at conventions and workshops. He died in 1995. Among Whitaker’s best-known students are Augustus Napier, now in private practice in Atlanta; and David Keith, at the State University of New York in Syracuse. The other towering figure among experiential family therapists was Virginia Satir. As an early member of the Mental Research Institute (MRI), Satir emphasized communication (see Chapters 1 and 5) as well as emotional experiencing. Satir began seeing families in private practice in Chicago in 1951. In 1955 she was invited to set up a training program for residents at the Illinois State Psychiatric Institute (where one of her students was Ivan Boszormenyi-Nagy). In 1959 Don Jackson invited her to join him at MRI, where Satir became the first director of training. She remained until 1966, when she left to become the director of the Esalen Institute in Big Sur, California. Satir was the archetypal nurturing therapist in a field enamored with abstract concepts and strategic maneuvers. Her warmth and genuineness gave her tremendous appeal as she traveled the country giving demonstrations and workshops. Her ability to move audiences made her family therapy’s most celebrated humanist. Satir died of pancreatic cancer in 1988.Among the most recent experiential approaches is emotionally focused couples therapy, which draws on Perls, Satir, Bowlby’s attachment theory, and the MRI group (Greenberg & Johnson, 1985, 1986, 2010; Johnson, 2004). Susan Johnson has emerged as this main proponent of the model. Another specialized approach to the emotional life of families is Schwartz’s (1995) internal family systems therapy, in which clients’ conflicting inner voices are personified as “parts” and then reintegrated using a variety of psychodramatic techniques. Theoretical Formulations Experiential family therapy is founded on the premise that the root cause of family problems is emotional suppression. Although children must learn that they can’t always do whatever they feel like doing, many parents have an unfortunate tendency to confuse the instrumental and expressive functions of emotion. They try to regulate their children’s actions by controlling their feelings. As a result, children learn to blunt their emotional experience to avoid criticism. Although this process is more or less universal, dysfunctional families tend to be less tolerant of unruly emotions than most. Children in such families often grow up estranged from themselves and feeling only the residues of repressed affect: boredom, apathy, and anxiety. While systemic therapists see the roots of symptomatic behavior in the dance of family interactions, experientialists view those interactions as the result of family members’ shadow dancing with the projections of each other’s defenses. From this perspective, attempts to bring about positive change in families are more likely to be successful if family members first get in touch with their real feelings—their hopes and desires as well as their fears and anxieties. Thus, experiential family therapy works from the inside out, helping individuals uncover their honest emotions, and then forging more genuine family ties out of this enhanced authenticity. The exception to the experiential de-emphasis on theory is emotionally focused couples therapy, which draws on attachment theory (Bowlby, 1969). According to Greenberg and Johnson (2010), emotion organizes attachment responses and serves a communicative function in relationships. When people express their vulnerability directly, they’re likely to elicit a compassionate response from their partners. But when an insecurely attached person fears vulnerability and shows anger instead, the response is more likely to be withdrawal. Thus the person most in need of attachment may, by being afraid to expose that need, push away the loved ones he or she longs to get close to. The antidote for this dilemma is what experiential therapy is all about: helping people relax defensive fears so that deeper and more genuine emotions can emerge. Family Dynamics In focusing on the importance of honest emotional experience and expression, the experientialists offered a useful corrective to the original family therapists’ narrow focus on behavioral interaction. This same corrective influence is relevant today, in the field’s narrow emphasis on biology and cognition. Normal Family Functioning Experiential therapists share the humanistic faith in the natural wisdom of honest emotion. According to this point of view, if people are allowed to follow their own instincts they tend to flourish. Problems arise because this innate tendency toward self-actualization (Rogers, 1951) runs afoul of social pressures. Society enforces repression to tame people’s instincts and make them fit for group living. Unhappily, self-control is achieved at the cost of “surplus repression” (Marcuse, 1955). Families add their own controls to achieve peace and quiet, perpetuating family myths (Gehrke & Kirschenbaum, 1967) and relying on mystification (Laing, 1967) to alienate children from their experience. In the ideal situation, parental control isn’t excessive, and children grow up in an atmosphere of support for their feelings and creative impulses. Parents appreciate their children, accept their feelings, and validate their experience. Children are encouraged to experience life fully and to express the full range of human emotions. Experiential therapists describe the family as a place of sharing experience (Satir, 1972). Functional families are secure enough to support and encourage a wide range of experiencing; dysfunctional families are frightened and bloodless. Neither problem-solving skills nor particular family structures are considered as important as nurturing spontaneous experiencing. In short, the healthy family offers its members the freedom to be themselves. Development of Behavior Disorders From an experiential perspective, denial of impulses and suppression of feeling are the root of family problems. Dysfunctional families are locked into self-protection and avoidance (Kaplan & Kaplan, 1978). In Harry Stack Sullivan’s (1953) terms, they seek security rather than satisfaction. Their presenting complaints are many, but the basic problem is that they smother emotion and desire. According to Whitaker (Whitaker & Keith, 1981), there’s no such thing as a marriage—only two scapegoats sent out by their families to perpetuate themselves. Together they must work out the inherent conflict in this situation. Couples who remain together eventually reach some kind of accommodation. Whether based on compromise or resignation, reconciling themselves to each other lessens the friction. Dysfunctional families, fearful of conflict, adhere rigidly to the rituals that they establish. Having experienced the anxiety of uncertainty, they now cling to their routines. In her portrayal of troubled families, Satir (1972) emphasized the atmosphere of emotional deadness. Such families are cold; they seem to stay together only out of habit or duty. The adults find their children annoying, and the children learn not to respect themselves or care about their parents. In consequence of the lack of warmth in the family, people avoid each other and preoccupy themselves with work and other distractions. It’s important to notice that the dysfunction Satir described isn’t the kind found in diagnostic manuals. Like others in the experiential camp, Satir was as concerned with normal people who lead lives of quiet desperation as with the officially recognized patients families usually focus on. As she (Satir, 1972) put it, It is a sad experience for me to be with these families. I see the hopelessness, the helplessness, the loneliness. I see the bravery of people trying to cover up—a bravery that can still bellow or nag or whine at each other. Others no longer care. These people go on year after year, enduring misery themselves or in their desperation, inflicting it on others. (p. 12) Satir stressed the role of destructive communication in smothering feeling and said that there were four dishonest ways people communicate: blaming, placating, being irrelevant, and being super reasonable. What’s behind these patterns of inauthentic communication? Low self-esteem. If people feel bad about themselves, it’s hard to tell the truth about their own feelings—and threatening to hear what others feel. A healthy relationship, according to Susan Johnson, is a secure attachment bond—that is, one characterized by emotional accessibility and responsiveness (Johnson & Denton, 2002). Secure attachment refers both to having grown up with a sense of being loved and to the confidence that comes from having a dependable intimate relationship. But when attachment security is threatened, people typically respond with anger—a protest that, unfortunately, may drive the other person away rather than evoke the desired responsiveness. Recently, Johnson (2004) has introduced the notion of attachment injuries: traumatic occurrences that damage the bond between partners and, if not resolved, maintain negative cycles and attachment insecurities (Johnson, 2004). Mechanisms of Change There are two unique aspects of the experiential perspective on change. The first is an emphasis on challenging emotional defenses. In this model, it might be said that the customer is always wrong—in the sense that family members often don’t know what they really feel. This leads directly to the second distinguishing characteristic of this approach, which is that experientialists tend to be fairly aggressive in attacking defenses to promote emotional expression. Goals of Therapy Experientialists emphasize the feeling side of human nature: creativity, spontaneity, and emotional honesty—and, in therapy, the value of emotional experience for its own sake. Emotional expression from family members is thought to break down rigid expectancies and unblock awareness—all of which promotes individuation (Kaplan & Kaplan, 1978). Bunny and Fred Duhl (1981) speak of their goals as a heightened sense of competence, well-being, and self-esteem. In emphasizing self-esteem, the Duhls echo Satir (1964), who believed that low self-esteem and the destructive communication responsible for it were the main problems in unhappy families. Whitaker (1976a) thought that families come to treatment because they’re unable to be close and therefore unable to individuate. By helping family members recover their own potential for experiencing, he believed that he was also helping them recover their ability to care for one another. Conditions for Behavior Change Among the misconceptions of those new to family therapy is that families are fragile and therapists must be careful to avoid breaking them. A little experience teaches the opposite: Effective treatment requires powerful interventions—and for experiential family therapists that power comes from emotional experiencing. Gus Napier (Napier & Whitaker, 1978) wrote, in The Family Crucible, a nice description of what experiential therapists think causes change. Breakthroughs occur when family members risk being “more separate, divergent, even angrier” as well as “when they risk being closer and more intimate.” To help clients take those risks, experiential therapists are alternately provocative and warmly supportive. This permits family members to drop their protective defenses and open up to each other. Existential encounter is believed to be the essential force in the psychotherapeutic process (Kempler, 1973; Whitaker, 1976a). These encounters must be reciprocal; instead of hiding behind a professional role, the therapist must be a genuine person who catalyzes change using his or her personal impact on families. As Kempler (1968) said: In this approach the therapist becomes a family member during the interviews, participating as fully as he is able, hopefully available for appreciation and criticism as well as he is able to dispense it. He laughs, cries and rages. He feels and shares his embarrassments, confusions and helplessness. (p. 97)For Satir, caring and acceptance were the keys to helping people open up to experience, and to each other: Some therapists think people come into therapy not wanting to be changed; I don’t think that’s true. They don’t think they can change. Going into some new, unfamiliar place is a scary thing. When I first begin to work with someone, I am not interested in changing them. I am interested in finding their rhythms, being able to join with them, and helping them go inside to those scary places. Resistance is mainly the fear of going somewhere you have not been. (quoted in Simon, 1989, pp. 38–39) Therapy Experiential family therapists share the humanistic belief that people are naturally resourceful and, if left to their own devices, will be creative, loving, and productive (Rogers, 1951). The task of therapy is therefore seen as unblocking defenses and releasing people’s innate vitality. Assessment Because experientialists are less interested in solving problems than in enhancing family functioning, they pay limited attention to the specifics of the presenting problem. Moreover, because they focus on individuals and their experience, they have little interest in the structure of family organization. For most experientialists, assessment takes place informally as the therapist gets to know a family. In the process of developing a relationship, the therapist learns what kind of people he or she is dealing with. Whitaker began by asking each family member to describe the family and how it works. In this way, he got a composite picture of individual family members and their perceptions of the family group. This kind of inquiry is about as formal as most experiential therapists get in sizing up families. The majority of what serves as assessment in this approach is an attempt to decode the defenses that emerge in the ongoing course of trying to help family members open up to each other. Watch this video of an experiential therapist provoking a couple into a healthier interaction. What is your reaction to experiential therapy? Therapeutic Techniques In experiential therapy, according to Kempler (1968), there are no techniques, only people. This epigram neatly summarizes the faith in the curative power of the therapist’s personality. It isn’t so much what therapists do that matters, but who they are. However, this point is at least partly rhetorical. Whoever they are, therapists must also do something. Even if what they do isn’t planned, it can nevertheless be described. Moreover, experiential therapists tend to do a lot; they’re highly active and some (including Kempler) use a number of evocative techniques. Some use structured devices such as family sculpting and choreography; others like Satir and Whitaker rely on the spontaneity of just being themselves. Satir had a remarkable ability to communicate. Like many great therapists, she was a dynamic personality. But she didn’t rely merely on personal warmth. Rather, she worked actively to clarify communication, turned people away from complaining toward finding solutions, supported the self-esteem of every member of the family, pointed out positive intentions (long before positive connotation became a strategic device), and showed by example how to be affectionate (Satir & Baldwin, 1983). She was a loving but forceful healer. One of Satir’s hallmarks was the use of touch. Hers was the language of tenderness. She often began by making physical contact with children, as evidenced in her case “Of Rocks and Flowers.” Bob, a recovering alcoholic, was the father of two boys, Aaron (four) and Robbie (two), whose mother had abused them repeatedly—pushing them down stairs, burning them with cigarettes, and tying them up under the sink. At the time of the interview, the mother was under psychiatric care and didn’t see the children. Bob’s new wife, Betty, had been abused by her previous husband, also an alcoholic. She was pregnant and afraid that the boys would abuse the baby. The boys had already been expressing the violence they’d been exposed to—slapping and choking other children. Bob and Betty, acting out of frustration and fear, responded roughly to the boys, which only increased their aggressiveness. Throughout the session, Satir showed the parents how to touch the children tenderly and how to hold them firmly to stop them from misbehaving. When Bob started to tell Aaron something from a distance, Satir insisted on proximity and touch. She sat Aaron down in front of his father and asked Bob to take the little boy’s hands and speak directly to him. The following fragments from the session are taken from Andreas (1991).Virginia Satir focused more on helping family members connect than on the psychological and systemic forces that kept them apart. Courtesy of the Virginia Satir Global Network Case Study Those little hands know a lot of things; they need to be reeducated. OK. Now, there is a lot of energy in both these youngsters, like there is in both of you. And I am going to talk to your therapist about making some room for you to have some respite (from the children). But use every opportunity you can to get this kind of physical contact. And what I would also recommend that you do is that the two of you are clear about what you expect. And if you (Bob) could learn from Betty how to pay attention (to the kids) more quickly, I would like you to be able to get your message without a “don’t” in it—and that your strength when you pick them up—I don’t know if I can illustrate it to you, but let me have your arm for a minute (reaching for Bob’s forearm). Let me show you the difference. Pick up my arm like you were going to grab me. (Bob grabs her arm.) All right. Now when you do that, my muscles all start to tighten, and I want to hit back. (Bob nods.) Now pick up my arm like you wanted to protect me. (Bob holds her arm.) All right. I feel your strength now, but I don’t feel like I want to pull back like this. (Bob says, “Yeah.”)And what I’d like you to do is lots and lots of touching of both of these children. And when things start to get out of hand, then you go over—don’t say anything—go over to them and just take them (demonstrating the protective holding on both of Robbie’s forearms) but you’re not pulling them (Aaron briefly puts his hands on top of Virginia’s and Robbie’s arms) like this (demonstrating), but you are taking them in a strong way (stroking Bob’s arm with both hands), like you saw the difference.(Virginia turns to Betty and offers her forearm.) OK. Now I’d like to do the same with you. So, take my arm really tight. . . . (Betty grabs Virginia’s arm, and Aaron does, too.) Yeah, that’s right, like you really wanted to give me “what for.” OK. All right. Now give it to me like you want to give me support, but you also want to give me a boundary. So the next time you see anything coming, what you do is you go and make that contact (Virginia demonstrates by holding Aaron’s upper arm.) and then let it go soft. Now, Aaron, I’d like you to come up here so I could demonstrate something to your mother for a minute. (Aaron says, “OK.”) Now, let’s suppose some moment I’m not thinking and I take you like that (grabbing Betty’s arms suddenly with both hands). You see what you want to do? (Betty nods.) All right. Now I am going to do it another way. I am giving you the same message (Virginia holds Betty’s arm firmly with both hands, looking directly into her eyes, and starts to stand up.), but I am doing it like this. And I am looking at you, and I’m giving you a straight message. OK. Now your body at that point is not going to respond negatively to me. It is going to feel stopped, but not negative. And then I will take you like this. (Virginia puts one arm around Betty’s back and the other under her upper arm.) Just like this (Virginia puts both arms around Betty and draws her close.) and now I will hold you. I will hold you like that for a little bit. Following this session, Satir commented on her technique: There had been so many things happening, and the fear was so strong in relation to these children that if you thought of one image it was like they were monsters. So one of the things that I wanted to do was also to see that they had the capacity to respond with a touch, using myself in that regard by having them put their hands on my face—that was a kind of mirror for the family itself, the people in the family. And then allowing them, and encouraging them to do that with their own parents. See, touch, that comes out of the kind of ambience which was there at the time, says things no words can say. To encourage empathy and bring family members closer together, Satir often used the following exercise (adapted from Satir & Baldwin, 1983):Think of a difficult situation with your child. Perhaps your child has been doing something that you haven’t known how to handle or that drives you up the wall. Run your movie of this situation from your own point of view. Imagine you are going through this situation with your child again. Notice how you feel, what you see, what you hear. Re-experience this situation, but this time as your child. Visualize the entire situation slowly and in detail, as you would imagine seeing it through the eyes of your child. Let yourself feel what your child must be feeling. Do you notice any feelings that you weren’t aware your child might be having? Do you notice something that your child might need or want that you hadn’t been aware of? Re-experience the same situation, this time as an observer. Watch and listen to what’s happening, and allow yourself to observe both your child and yourself. Do you notice anything about the way you and your child respond to each other? What do you see more clearly about yourself and your child? Because Whitaker favored a personal encounter over a calculated approach, it’s not surprising that his style was the same with individuals, couples, and groups (Whitaker, 1958). He assiduously avoided directing real-life decisions, preferring instead to open family members up to their feelings and join them in their uncertainty. This may sound trite, but it’s an important point. As long as a therapist (or anyone else for that matter) is anxious to change people, it’s hard, very hard, to help them feel understood—and even harder to really empathize with them. A comparison between Whitaker’s early (Whitaker, 1967; Whitaker, Warkentin, & Malone, 1959) and later work (Napier & Whitaker, 1978) shows how he changed over the years. He started out as deliberately outlandish. He might fall asleep in sessions and then report his dreams; he wrestled with patients; he talked about his own sexual fantasies. In later years he was less provocative. This seems to be what happens to therapists as they mature; they have less need to impose themselves and more willingness to listen. Because Whitaker’s treatment was so intense and personal, he believed that two therapists should work together. Having a co-therapist to share the burden keeps therapists from being absorbed in the emotional field of a family. Family therapy tends to activate therapists’ own feelings toward certain types of family members. A detached, analytic stance minimizes such feelings; emotional involvement maximizes them. The trouble with countertransference is that it tends to be unconscious. Therapists are more likely to become aware of such feelings after sessions are over. Easier still is to observe countertransference in others. Consider the example of Dr. Fox, a married man who specializes in individual therapy but occasionally sees married couples. In 75 percent of such cases, Dr. Fox encourages the couple to seek a divorce, and his patients have a high rate of following his advice. Perhaps if Dr. Fox were happier in his own marriage or had the courage to change it, he’d be less impelled to guide his patients where he fears to go. To minimize countertransference, Whitaker recommended sharing feelings openly with families. If feelings are openly expressed they’re less likely to be acted out. Whitaker’s first sessions (Napier & Whitaker, 1978) were fairly structured, and they included taking a family history. For him, the first contacts with families were opening salvos in “the battle for structure” (Whitaker & Keith, 1981). He wanted the family to know that the therapist was in charge.1 This began with the first telephone call. Whitaker (1976b) insisted that the largest possible number … Wk 3 Team - Theoretical Interventions Presentation Assignment Content Obtain an instructor-assigned theoretical approach discussed this week. Chapter 7: Experiential Family Therapy Create a 5- to 8-slide Microsoft® PowerPoint® presentation on interventions associated with your assigned theoretical approach to family therapy. Include the following: · Introduction – Speaker notes · Describe a brief background of the theory. · Explain how the theory drives the assessment process in family therapy. · Describe the interventions used with this theoretical approach. · Evaluate each intervention for its strengths and limitations when used with families. · Conclusion - Speaker notes · References Include a minimum of 2 sources. Format any citations within your presentation according to APA guidelines.