FAMILY PSYCHOTHERAPY

FAMILY PSYCHOTHERAPY, psychotherapeutic work with problems of marital, child-parent, intergenerational relationships, symptoms (including addictions) and behavioral dysfunctions of family members. Center. The place is taken by systemic S. p., in which work with the entire family is based on the methodology of the systems approach (see System). Its distinctive features: 1) consideration of the problem (symptom) in the context of relationships in the system (family), subject to circular (circular) rather than “direct” (linear) dependencies; 2) finding out not the cause, but the purpose of the existence of a symptom in this system of relationships, that is pragmatic. the functions he performs in it; 3) influencing this entire system of interaction in such a way that the symptom is no longer “needed” in it.

The emergence of systemic S. p. is associated with a new understanding of the symptoms of schizophrenia, different from that accepted in psychoanalysis, with reference to the analysis of the actual family of a schizophrenic (T. Lits, 1949; L. Winn, 1952) and his family in several generations (I. Bosormeni- Nagy, USA, 1957). This concept was fully developed in the theory of family systems by M. Bowen (USA), who linked the level of differentiation (a person’s ability to maintain an indirect intellectual response under stress, as opposed to an automatic emotional one) with the features of the “basic triangle” - the relationship between a person and his parents. A decrease in this level of differentiation in several generations as a result of the “projection of anxiety” to a child with whom one or both of his parents have established “fused” (very close, dependent) or “fused-conflict” relationships leads, according to Bowen, to the emergence of schizophrenia. Bowen formulated an idea of the neutral position of a psychotherapist and introduced a genogram - schematic. depiction of family and emotional ties between family members. The genogram method was then developed by M. McGoldrick (USA, 1985).

Handcrafted. G. Bateson project in Palo Alto (California) schizophrenic. the symptom was considered as a result of existence in conditions of a kind of trap - a “double message”, a communicative paradox - a contradiction between the verbal level of communication and the behavior accompanying it. manifestations, with a ban on his “clarification” (for example, a mother visiting a patient in the clinic first pulled away when he approached, and then immediately asked: “Aren’t you glad to see me?”); the response is the patient’s “non-discrimination” of these communicative levels.

V. Satir (USA), who revised the ideas of K. Rogers, M. Bowen and the Palo Alto project (1983), aimed at transforming dysfunctional intrafamily communication, realized through “double messages,” into open communication between family members with each other, recognizing the boundaries and individuality of another (primarily a child) - through communication with the family of the psychotherapist himself and emotional acceptance of her experience.

The results of the Palo Alto studies and V. Satir’s concept were adopted by the antipsychiatry movement of the 1960s and 1970s. (family as a system of suppression of individuality in R. Laing and others). In the so-called The existential approach of K. Whitaker (Whitaker; 1958) challenged the existing family structure and ideas about life.

General theory of systems L. von Bertalanffy (1931), cybernetic. N. Wiener’s theory (1948), as well as the related theory of communication (P. Vaclavik, J. Beavin, D. Jackson, USA, 1966) became the basis of the systemic social system proper. The family began to be understood as a living open system, hierarchically organized and included in other social systems, which at each stage of the life cycle has the task of establishing balance “within itself” and with the environment, as well as passing through a “crisis” with the transition to a new stage of the cycle.

Founded by S. Minukhin (USA), the so-called. In the structural version of systemic S. the goal is to gradually overcome the dysfunctional organization of the family (disturbed hierarchy, existing “coalitions,” etc.), leading to the disappearance of the symptom. Minukhin’s method of work (various methods of joining the family system, including using hidden observation through the “Gesell’s mirror”, regulating the therapist’s distance from family members and between them, challenging the existing family organization, imbalance, staging, etc.) d.) made it possible to achieve visible changes in the family system in a short time.

Created in 1958 by D. Jackson in Palo Alto, the Institute of Mental (Psychical) Research, based on the theory of communication, laid the foundation for strategic research. short-term S. p., searching for “economical” means of influencing family interaction through highlighting behavior in it. “chains” with a general focus on specific and minimal behavioral changes.

The idea of a symptom as an analog communicative message (i.e., representing, at the level of behavior of one person, the features of interaction in the entire family) has become key for the school of strategic thinking. systemic S. p., founded by J. Haley (USA), who collaborated with S. Minukhin and was influenced by M. Erickson. Therapeutic the influence is carried out here through a system of directive, often paradoxical instructions (game imitation, simulation of a symptom, emphasizing its “arbitrary” nature and thereby potential removability - K. Madanes, 1981).

Transformation of strategic approach was the Milan school (M. Selvini Palazzoli, S. Prata, G. Chekin, L. Boscolo, 1972), which proposed in working with schizophrenic. communication that covers the whole family (if direct therapeutic interaction is impossible in this case), the so-called method. positive connotation, which makes it possible to present to the family the meaning of the symptom and the circular exchange of double messages that exists in it, to suggest possible behavior. alternative without insisting on it, and by directly prescribing the symptom, thereby achieving its abandonment.

Transformation of the classic systems approach took place in the 1980s–90s. in the works of L. Boscolo, J. Chekin (1987), G. Gulishian and G. Anderson (USA, 1987), K. Thomm (Canada, 1989), T. Andersen (Norway, 1991), L. Hoffman (USA, 1991), representatives of the “women’s project” [O. Silverstein, P. Pepp (Pepp), USA], etc. Under the influence of the ideas of post-structuralism, constructivism, and “second-order” cybernetics, the idea of therapeutics developed. process as the interaction between the client and the therapist, the exchange of information between them, and not the influence of the therapist on the client (G. Bateson).

In the Milwaukee Center for Short-Term S.P. (S. de Shazer, 1985, I. Kim Berg, 1994, USA), the rapid introduction of the “solution” picture needed by the client, emphasizing the turning point of the “minimal change” in client behavior were accompanied by the creation of the “wonderful question” techniques ", scaling, etc.

In narrative psychotherapy (M. White and D. Epston, Australia, 1991), the transformation of problem behavior, its “deconstruction” is realized through the therapist listening to the client from a position of non-knowledge, externalizing the problem (separation of it from the person and studying its influence on his life), finding a “unique” (preferred by the client) life episode, expanding it, etc.

In the 2000s. such integrative neoclassical approaches in systemic psychotherapy, such as emotionally focused marital therapy (S. Johnson, L. Greenberg, USA), subpersonality therapy (R. Schwartz, USA), etc.

Family psychotherapy

Marital and sexual psychotherapy Adolescence and adolescent psychotherapy Cost of services

In recent years, the vector of development of domestic medicine has increasingly shifted towards the training of family specialists, taking into account the greater therapeutic effectiveness of systemic interventions, better contact and proximity with family members and its immediate social environment, and economic feasibility.

Parents seeking medical and psychological help for their children often face the following problem: a symptom or problem either remains in the child during individual therapy or, after weakening, quickly returns again. In addition to everything, in such a situation the parents themselves suffer, often experiencing pressure from social authorities and their own feelings of guilt. It also happens that within a large family, consisting of several generations, there are many contradictions and psychological stress, in which any member of this family system can suffer. When you contact a specialist, regardless of age or the nature of the problem, they will help you and not the family as a whole. In this way, the consequences of problems are eliminated, not their causes.

Sokolov Roman Evgenievich, Candidate of Medical Sciences, doctor of the highest category

In psychology and psychotherapy, the family approach has existed for decades and is constantly evolving, adapting to new realities. Family therapy is diverse and works with family history, family structure, family life cycle, boundaries, intergenerational transmission and family scripts, family myths and secrets, and much more. Its main differences from individual psychotherapy are that the targets of therapy are not a specific symptom, but the unique influences of the family system that support it. There are cybernetic ideas of the influence of each element (family member) on the family system as a whole. And feedbacks, thanks to which the constancy or variability of the system is maintained in specific circumstances. In addition, the family system is a living open system; it is in constant exchange with the environment and is able to self-organize.

When conducting family psychotherapy, the presence of an extended family is immediately desirable. In practice, it happens that those family members who have a higher level of anxiety and who suffer first come to the first appointment. In the process of contacting them, the family therapist often manages to overcome the problem applicant’s doubts regarding the appearance of the rest of its members at the appointment. If a family finds the resources to work and comes, already at the first meeting, even without words during the arrangement, family rules and coalitions are noticeable, and the level of tension between family members is felt. In further work with the family, taking into account the principles of circularity and neutrality, it is possible to form a therapeutic hypothesis. Any family system, when a symptom decreases (or simply changes appear in it), will unconsciously strive towards maintaining stability and thus demonstrate resistance to the therapy process. In some cases, anxiety about change can be so high that it is easier for family members to maintain the symptom than to change the system. Only by combining efforts can we achieve a more or less satisfying result for family members.

Other approaches

The starting point for systemic therapy is to clarify the contract between therapist and client as precisely as possible (the word “patient” is rejected in most cases). Once treatment goals are specific and acceptable to both therapist and client, therapy itself can begin. If therapy lasts several sessions, a new clarification of the contract is permitted, since the goals of therapy may change over time. The preferred form is considered to be a small number of sessions, if possible, with maximum intervals between them, during which the client tries to try out the new knowledge acquired during the sessions in life and (or) performs so-called homework. In this regard, the systemic therapeutic approach is characterized by economy, which emphasizes the personal initiative of clients. Techniques used, types of therapeutic interventions, methods:

Circular questions, the purpose of which is to find out the possible position of a third party (including those present);
Scale questions to clarify differences and progress in therapy;
Positive assessment and development of a positive aspect of the problematic order of things;
Reframing the order of things is necessary to stimulate changes in meaning or interpretation;
Paradoxical intervention is usually the description of problem behavior in order to change automatisms;
Homework of various, individually oriented nature is completed between sessions;
Metaphors, parabolas and stories as a technique for working with possible “resistance”;
Questioning exceptions to the problematic order of things in order to clarify the variability of the statistically considered order of things;
Using the subjunctive mood to focus on options and possibilities;
The sculpture is a depiction of family relationships from the client’s point of view;
Sociogram is a graphic representation of social relations;
Group reflection - see the article about Tom Andersen;
Inviting family members or friends to participate in a particular session or phases of therapy;

and many others.