Next up in our adventure tour of the ASWB exam outline: Family therapy models, interventions, and approaches. Let's take a look at the topic and then at how this material may appear on the social work licensing exam. Ready...? Let's go.

Models of Family Therapy

  • Structural Family Therapy (SFT)

    • Founder: Salvador Minuchin
    • Focus: Restructuring family dynamics and hierarchies.
    • Interventions:
      • Enactments: Role-playing family interactions to identify and change dysfunctional patterns.
      • Boundary Making: Establishing clear boundaries between family members and subsystems.
      • Joining: The therapist connects with the family to build trust and understand their dynamics.
  • Strategic Family Therapy

    • Founders: Jay Haley, Cloe Madanes
    • Focus: Solving specific problems through strategic interventions.
    • Interventions:
      • Paradoxical Interventions: Assigning tasks that seem counterintuitive to highlight problematic behaviors.
      • Directives: Specific instructions given to family members to change their interactions.
      • Reframing: Changing the perception of a problem to alter its impact.
  • Systemic Family Therapy

    • Focus: Understanding family issues in the context of larger systems (e.g., social, cultural).
    • Interventions:
      • Circular Questioning: Asking each family member about the same event or behavior to reveal different perspectives.
      • Systemic Reframing: Changing the way family members view their problems within the context of the whole system.
      • Genograms: Visual maps of family relationships and history to identify patterns.
  • Bowenian Family Therapy

    • Founder: Murray Bowen
    • Focus: Intergenerational patterns and differentiation of self.
    • Interventions:
      • Genograms: Mapping family history and patterns across generations.
      • Differentiation Techniques: Helping individuals separate their own emotional and intellectual functioning from that of their family.
      • Triangulation Analysis: Identifying and addressing triangles (three-person relationships) that create tension.
  • Narrative Family Therapy

    • Founders: Michael White, David Epston
    • Focus: Separating individuals from their problems and rewriting narratives.
    • Interventions:
      • Externalizing Conversations: Treating problems as separate from the person.
      • Re-authoring Stories: Helping family members create new, positive narratives about their lives.
      • Deconstructive Listening: Breaking down problematic stories to understand their origins.
  • Solution-Focused Brief Therapy (SFBT)

    • Founders: Steve de Shazer, Insoo Kim Berg
    • Focus: Building solutions rather than focusing on problems.
    • Interventions:
      • Miracle Question: Asking clients to envision how their lives would change if their problems were solved overnight.
      • Scaling Questions: Using scales to assess the severity of issues and progress.
      • Exception-Finding: Identifying times when the problem did not occur to build on successes.
  • Emotionally Focused Therapy (EFT)

    • Founders: Sue Johnson, Les Greenberg
    • Focus: Emotion regulation and attachment needs.
    • Interventions:
      • Attachment-Focused Interventions: Strengthening emotional bonds and improving attachment security.
      • Emotional Processing: Helping family members express and understand their emotions.
      • Restructuring Interactions: Changing negative interaction patterns to more positive ones.

Common Interventions in Family Therapy

  • Genograms: Visual maps of family relationships, patterns, and history to identify intergenerational issues.
  • Enactments: Role-playing scenarios to explore and change family interactions.
  • Circular Questioning: Asking each family member about the same event or behavior to understand different perspectives.
  • Reframing: Changing the way a situation or behavior is perceived to alter its meaning.
  • Boundary Setting: Defining and maintaining appropriate boundaries within the family structure.
  • Miracle Question: Asking clients to envision how their lives would be different if a miracle occurred and their problem was solved.
  • Scaling Questions: Assessing the severity of issues on a scale to identify progress and areas of focus.
  • Externalization: Treating problems as separate from the individual to reduce blame and shame.
  • Home Assignments: Tasks given to family members to practice new skills or behaviors outside of therapy sessions.

Approaches in Family Therapy

  • Cognitive-Behavioral Family Therapy (CBFT)

    • Focus: Changing dysfunctional thought patterns and behaviors.
    • Techniques:
      • Cognitive Restructuring: Changing negative thought patterns.
      • Behavioral Experiments: Testing new behaviors to see their impact.
      • Skill-Building Exercises: Teaching specific skills to improve family interactions.
  • Psychodynamic Family Therapy

    • Focus: Uncovering unconscious conflicts and historical family issues.
    • Techniques:
      • Free Association: Allowing family members to speak freely to uncover unconscious thoughts.
      • Dream Analysis: Interpreting dreams to understand unconscious conflicts.
      • Exploring Family of Origin Issues: Understanding how past family dynamics affect current relationships.
  • Integrative Family Therapy

    • Focus: Combining elements from various models to suit the needs of the family.
    • Techniques:
      • Tailored Interventions: Customizing techniques to fit the family’s unique needs.
      • Eclectic Methods: Using a variety of approaches depending on the situation.
      • Adaptive Strategies: Being flexible and responsive to the family's changing needs.
  • Experiential Family Therapy

    • Founders: Virginia Satir, Carl Whitaker
    • Focus: Promoting growth and change through emotional experiences.
    • Techniques:
      • Sculpting: Creating physical representations of family relationships and dynamics.
      • Family Drawing: Using art to express and explore family issues.
      • Role-Playing: Acting out scenarios to explore and resolve conflicts.

Choosing the Right Approach

The choice of model, intervention, or approach in family therapy depends on several factors:

  • Presenting Issues: Specific problems or conflicts within the family.
  • Family Dynamics: The unique structure and interactions of the family members.
  • Therapist's Training and Orientation: The theoretical background and expertise of the therapist.
  • Family Preferences and Goals: The desired outcomes and comfort levels of the family.

Example: A family consists of two parents and three children. The parents have difficulty enforcing rules, and the children often argue and defy their authority. ..Based on the need for clear boundaries and defined roles, Structural Family Therapy may be chosen to help establish hierarchies and reduce conflicts.

Example: A family has a teenage son who refuses to attend school despite various attempts by his parents to resolve the issue...Given the specific, ongoing problem, Strategic Family Therapy may be chosen to use targeted interventions, such as paradoxical directives, to address the teen's school refusal.

Example: A family is concerned about their son who exhibits anxious behaviors and negative thinking patterns...Cognitive-Behavioral Family Therapy (CBFT) may be chosen to address the child's cognitive distortions and teach the family behavioral strategies to support his coping skills.

Combining various techniques and adapting them to the family's needs often yields the best results in family therapy.

On the Exam

How might this all look on the ASWB exam? Expect vignettes like the ones above and/or questions like these:

  • Which technique is commonly used in Bowenian Family Therapy to understand intergenerational patterns?
  • Which of the following is a primary focus of Structural Family Therapy (SFT)?
  • What is the primary goal of Emotionally Focused Therapy (EFT)?

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July 1, 2024
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