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The Essentials of Family Therapy
Sixth Edition
Michael P. Nichols
College of William and Mary
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10 9 8 7 6 5 4 3 2 1 ISBN-10: 013419487X
ISBN-13: 9780134194875
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Table of Contents
Chapter 1 The Foundations of Family Therapy 1
Chapter 2 The Evolution of Family Therapy 2
Chapter 3 Basic Techniques of Family Therapy 6
Chapter 4 The Fundamental Concepts of Family Therapy 8
Chapter 5 Bowen Family Systems Therapy 11
Chapter 6 Strategic Family Therapy 15
Chapter 7 Structural Family Therapy 19
Chapter 8 Experiential Family Therapy 22
Chapter 9 Psychoanalytic Family Therapy 26
Chapter 10 Cognitive-Behavioral Family Therapy 30
Chapter 11 Family Therapy in the Twenty-First Century 33
Chapter 12 Solution-Focused Therapy 37
Chapter 13 Narrative Therapy 39
Chapter 14 Comparative Analysis 42
Chapter 15 Research on Family Intervention 49
Answer Key 50
Chapter 1
The Foundations of Family Therapy
Short Answer
1. Compare and contrast individual and family therapy modalities. What types of clients and client problems may be best suited for each and why? Provide examples to illustrate your answer. Is it possible to integrate individual and family treatment? Take a position and argue for or against.
2. How might an individual therapist counsel Bob or Shirley (in the case example)? How might individual therapy progressed with either one of them that might reinforce the conflict between them? How might an individual therapist, seeing either Bob or Shirley, help them reduce their conflicts?
3. What do you believe to be the necessary and sufficient conditions for real therapeutic change to occur? A brief but decisive intervention in the family system or the long-term exploration of one’s personality? Some argue that changes initiated via family therapy are lasting because change is exerted throughout the entire system – that each family member changes and continues to exert synchronous change on each other. Others believe that long-term insight-oriented therapy is necessary to prevent the patient’s personality pathology from reasserting itself. Take a position for or against and cite evidence to support your view.
4. Make up a brief case in which one person who has trouble in a relationship sees only the contributions of the other person to their mutual problems and acts in such a way as to perpetuate the conflict – even though he or she is trying to improve the relationship.
5. What advantage does family therapy offer over individual therapy in maintaining positive therapeutic change? What disadvantage does family therapy create in initiating positive therapeutic change?
6. What is gained by seeing family problems, such as those seen in Holly’s family, as transitional? As triangular?
7. Identify: Self-actualization
8. Identify: Transference
Chapter 2
The Evolution of Family Therapy
Multiple Choice
1. Lyman Wynne’s term for the façade of family harmony that characterized many schizophrenic families is:
a. pseudocomplementarity
b. pseudomutuality
c. pseudoharmony
d. pseudohostility
2. Hospital clinicians began to acknowledge and include the family in an individual’s treatment when:
a. they noticed when the patient got better, someone in the family got worse
b. they realized the family was footing the bill for treatment
c. they realized the family continued to influence the course of treatment anyway
d. a and c
e. none of the above
3. Kurt Lewin’s idea of ______ can be seen in action in Minuchin’s promotion of crises in family lunch sessions, Norman Paul’s use of cross-confrontations, and Peggy Papp’s family choreography.
a. unfreezing
b. social equilibrium
c. group process
d. field theory
4. Paying attention to how members of a group interact rather than merely to what they say is called:
a. Basic assumption theory
b. Group dynamics
c. Field theory
d. Process/content distinction
5. The first to apply group concepts to family treatment was:
a. Murray Bowen
b. John Elderkin Bell
c. Virginia Satir
d. Carl Whitaker
6. A second, covert, level of communication which conveys something about how the communicants should relate is called:
a. denotation
b. connotation
c. metacommunication
d. didacticism
7. Frieda Fromm-Reichmann’s concept, “______ mother,” described a domineering, aggressive, rejecting, and insecure mother who was thought to provide the pathological parenting that produced schizophrenia.
a. undifferentiated
b. schizophrenogenic
c. reactive
d. symbiotic
8. According to Wilfred Bion, most groups become distracted from their primary tasks by engaging in patterns of:
a. fight-flight
b. pairing
c. dependency
d. any of the above
e. all of the above
9. Ivan Boszormenyi-Nagy emphasized the importance of ______ in families.
a. communication
b. ethical accountability
c. triangles
d. systems dynamics
10. Gregory Bateson and his colleagues at Palo Alto introduced this concept to describe the patterns of disturbed family communication which cause schizophrenia.
a. schizophrenogenesis
b. double bind
c. pseudohostility
d. none of the above
11. The only means to effectively escape a double bind is to:
a. withdrawal from the relationship
b. metacommunicated
c. quid pro quo
d. a and b
12. According to Theodore Lidz, marital schism occurs when:
a. one spouse with serious psychopathology dominates the other
b. there is a chronic failure of spouses to achieve role reciprocity
c. one spouse consistently engaged in double-binding communication
d. there is a loss of autonomy due to a blurring of psychological boundaries between spouses
13. Jackson’s concept, ______, that families are units that resist change, became the defining metaphor of family therapy’s first three decades.
a. emotional reactivity
b. quid pro quo
c. family homeostasis
d. a and c
14. A ______ relationship is one based on differences that fit together.
a. complimentary
b. symmetrical
c. homeostatic
d. imbalanced
15. This family therapist’s personal resolution of emotional reactivity in his family was as significant for his approach to family therapy as Freud’s self-analysis was for psychoanalysis.
a. Salvador Minuchin
b. Jay Haley
c. Murray Bowen
d. Carl Whitaker
16. This family therapist believed in the existence of an interpersonal unconscious in every family.
a. Murray Bowen
b. Nathan Ackerman
c. Ivan Boszormenyi-Nagy
d. Virginia Satir
17. The restructuring techniques of structural family therapy are designed to bring about:
a. first-order change
b. second-order change
c. ethical accountability
d. transmuting interpretations
18. The group therapy model was not entirely appropriate for families for what reason?
a. family members are peers
b. families have a shared history
c. both a and b
d. none of the above
Short Answer
1. Describe the “double-bind theory” of schizophrenia. Historically, why was the theory important?
2. How are family systems therapies different from traditional individual therapies?
3. Some would argue that there is a radical divergence between family systems therapies and the more traditional psychotherapeutic approaches. Others would challenge this view, arguing that there are many points of similarity and that the differences are exaggerated. Take one position or the other and defend your stand.
4. Choose two of the individuals below and describe how they helped to launch the family therapy movement. Be specific in discussing their contributions to the field.
a. Gregory Bateson
b. Theodore Lidz
c. Milton Erickson
d. Nathan Ackerman
e. Murray Bowen
f. Don Jackson
g. Jay Haley
h. Salvador Minuchin
i. Virginia Satir
j. Carl Whitaker
5. How is group therapy similar to and different from family therapy?
6. What is the positive impact of research on family dynamics and schizophrenia? What was its negative impact?
7. What are some of the factors that have resulted in diminished academic enthusiasm for family therapy?
Chapter 3
Basic Techniques of Family Therapy
Multiple Choice
1. For initial interviews, the author recommends seeing:
a. the “problem-determined system”
b. the adults in the family
c. the parents
d. everyone in the household
2. A treatment contract typically includes:
a. the therapist’s strategies for solving the presenting problem
b. the fee and how it should be paid
c. the therapist’s therapeutic model
d. all of the above
3. What is the major presenting pitfall in listening to a family’s perspective on the presenting problem?
a. accepting a linear perspective on the problem
b. hearing too many conflicting points of view
c. allowing children too much leverage in family decision making
d. challenging the family’s perspective too soon
4. The “child-protective approach” to cases of sexual abuse:
a. may undermine the integrity of the family
b. tries to ensure that the abuse doesn’t continue
c. tries to reduce the long-term impact of the trauma
d. all of the above
5. Treating the couple together in cases involving domestic violence:
a. has been shown to produce better outcomes than seeing the partners separately
b. may allow the batterer to rationalize his behavior
c. is the most widely accepted approach
d. all of the above
6. According to the author, therapists should inquire about drug and alcohol consumption:
a. when there is suspicion that this may be a problem
b. in every case
c. in every case where the identified patient is a teenaged child
d. when there is a history of this being a problem
7. Family structure involves:
a. how people interact in a family
b. the overall organization of the family
c. patterns of communication
d. all of the above
Short Answer
1. What are the pros and cons of insisting that the entire family attend the initial consultation?
2. What is the “problem-determined system?” Give a couple of examples.
3. What is essential to accomplish in the first session in order to establish a productive therapeutic alliance with a family?
4. How can a therapist effectively challenge linear attributions of blame? Give a couple of examples.
5. Why is it important for a clinician to develop a therapeutic hypothesis, and what are some of the elements that such a formulation should include?
6. What is the danger of a therapist taking too active and directive a role in the middle stages of a family’s treatment?
7. Why are traditional couples considered potentially dangerous in the treatment of cases involving marital violence?
8. What are some of the arguments in favor of treating violent partners together in couples therapy?
9. What are the first priorities in treating cases involving child sexual abuse?
Chapter 4
The Fundamental Concepts of Family Therapy
Multiple Choice
1. Which is not a concept of von Bertalanffy’s general systems theory?
a. “black box” metaphor
b. a system is more than the sum of its parts
c. equifinality
d. homeostatic reactivity
2. A biological model of living systems as whole entities which maintain themselves through continuous input and output from the environment, developed by Ludwig von Bertalanffy is known as:
a. systems theory
b. cybernetics
c. constructivism
d. general systems theory
3. The stages of a family’s life from separation from one’s parents to marriage, having children, growing older, retirement, and finally death, are known as the:
a. family structure
b. homeostasis
c. function of the system
d. family life cycle
4. Which phenomena are not a focus of cybernetics, as applied to families?
a. sequence of interaction
b. family hierarchy
c. family rules
d. negative feedback
5. Constructivism first found its way into psychotherapy in the work of:
a. Paul Watzlawick
b. Kenneth Gergen
c. George Kelly
d. Michael White
6. Panic attacks are fueled by:
a. lack of communication
b. lack of metacommunication
c. positive feedback
d. negative feedback
7. According to attachment theory, attachment is:
a. a biologically based drive
b. a product of reinforcement
c. a product of interaction
d. a byproduct of nurture
8. A balanced steady state of equilibrium is known as:
a. metacommunication
b. homeostasis
c. morphogenesis
d. equifinality
9. A pursuer-distancer relationship is:
a. complementary
b. driven by positive feedback
c. homeostatic
d. an open system
e. a closed system
10. The study of control processes in systems, particularly the analysis of the flow of information in closed systems, is known as:
a. functional analysis of behavior
b. cybernetics
c. existentialism
d. general systems theory
11. Narrative therapy differs from solution-focused therapy in being more focused on ______ than ______.
a. exceptions; problems
b. cognitions; interactions
c. attitudes; behavior
d. individuals; families
12. With the exception of the feminist critique, what has been largely missing in family therapy has been an examination of:
a. cultural biases
b. the society we are helping people fit into
c. value systems
d. all of the above
13. General systems theory, cybernetics, and social constructionism are ______ concepts.
a. epistemological
b. metapsychological
c. clinical
d. metaphysical
14. The greatest conceptual influence on the early development of family therapy was:
a. the family life cycle
b. constructivism
c. feminism
d. systems theory
15. ______ said that relationship problems usually involve triangles.
a. Murray Bowen
b. Don Jackson
c. Gregory Bateson
d. All of the above
16. Systems theory ______ sensitivity to gender roles.
a. supports
b. does not support
c. is irrelevant to
d. none of the above
17. The concept of the family life cycle was introduced to the field by:
a. Salvador Minuchin
b. Betty Carter and Monica McGoldrick
c. Jay Haley
d. Don Jackson
18. The notions of functionalism, structuralism, and general systems theory are all embraced by which family theory?
a. Behavioral family theory
b. Experiential family theory
c. Communications family therapy
d. Structural family therapy
19. Boundaries around the executive subsystem in the family are of particular importance because the family ______ is seen by structural therapists as crucial to the family’s well-being.
a. network
b. hierarchy
c. life cycle
d. quid pro quo
Short Answer
1. Why should a family’s ethnicity and culture be considered in assessment?
2. List the stages of the family life cycle (Carter & McGoldrick, 1999) and describe the primary task(s) of each stage. Consider how the therapist would intervene with the family at each of these stages.
3. List and describe at least three contextual influences on the evolution of family therapy.
4. What is a relationship triangle? How are triangles relevant in couples therapy?
5. What are positive and negative feedback and how do they operate in families?
6. Listed below are a number of concepts and methods that have endured and continue to shape the field of family therapy. Choose any three and describe them. How can each concept be used to enrich our understanding of families and guide our treatment interventions?
a. Importance of family context
b. Triadic models
c. Family structure
d. Psychopathology serving a function in families
e. Circular sequences of interaction
f. Family life cycle
g. Multigenerational patterns
7. How can general systems theory revitalize family therapy and bridge the chasm between the narrative approaches of the twenty-first century and the traditional schools (i.e., structural, Bowenien, communications, and/or strategic) of family therapy?
Chapter 5
Bowen Family Systems Therapy
Multiple Choice
1. A Bowen therapist working with an individual family member in treatment is most likely to do which of the following?
a. Create a therapeutic triangle
b. Use displacement stories
c. Model how to take an “I” position
d. Work with a genogram
e. C and D
2. The primary goal of Bowen family therapy is to:
a. heighten emotional experiencing in family members
b. increase the family’s repertoire of problem-solving skills
c. improve communication between family members
d. increase the level of differentiation of self in family members
3. The “differentiated” individual:
a. can extricate him or herself from all emotional triangles
b. can balance his or her needs for closeness and autonomy
c. avoids contact with his or her parents
d. approaches life in a purely rational fashion
4. According to Bowen theory, more highly differentiated individuals will likely:
a. avoid the expression of intense emotions
b. avoid contact with dysfunctional family members
c. have parents who are highly differentiated
d. be first born children
e. a and c
5. An increase in chronic anxiety in the nuclear family system will tend to ______ less differentiated families, while it will ______ more highly differentiated families.
a. be absorbed by/promote growth in
b. promote growth in/be absorbed by
c. cause an increase in symptoms in/be absorbed by
d. cause a decrease in symptoms in/promote growth in
6. Murray Bowen developed his ideas about family therapy while at the NIMH, studying ______ families. Based on his observation of these families’ intense clinging interdependence, he concluded that a lack of differentiation was responsible for all family pathology.
a. alcoholic
b. depressed
c. neurotic
d. psychotic
7. By training family members in 3 areas – teaching differentiation, avoiding triangulation, and ______, Bowen therapists can enable a single individual to transform from the whole network of his or her family system.
a. avoiding expression of intense emotions
b. reopening cut-off family relationships
c. increasing contact with dysfunctional family members
d. all of the above
8. According to the Bowen theory, the flight from an unresolved emotional attachment to one’s parents is known as:
a. emotional cutoff
b. enmeshment
c. disengagement
d. fusion
9. In Bowen theory, this is a process wherein the projection of varying degrees of immaturity to different children in the same family occurs. The child who is most involved in the family emerges with the lowest level of differentiation, and passes on problems to succeeding generations.
a. societal emotional process
b. family projection process
c. nuclear family emotional process
d. multigenerational emotional process
10. This Bowenian term describes the level of emotional “stuck-togetherness” or fusion in the family.
a. unconscious need complementarity
b. undifferentiation
c. triangling
d. a and c
11. According to Bowen, ______ are the smallest stable unit of human relations.
a. dyads
b. triangles
c. one well-differentiated individual
d. none of the above
12. The central premise of Bowen theory is that unresolved ______ must be resolved before one can differentiate a mature, healthy personality.
a. oedipal conflicts
b. emotional experiencing
c. emotional reactivity to one’s family of origin
d. career concerns
13. From a Bowenian perspective, optimal development in the family occurs when all members are relatively differentiated, anxiety is low, and parents ______.
a. form an executive subsystem
b. cut-off from dysfunctional family members
c. avoid heightened emotionality
d. remain in emotional contact with family of origin
14. People tend to marry spouses at ______ levels of differentiation.
a. varying
b. similar
c. complementary
d. opposite
15. Unlike experiential therapists, Bowenians seek to ______ levels of anxiety in order to increase levels of differentiation of self in the family.
a. increase
b. identify
c. monitor
d. decrease
16. ______ is a prominent technique in Bowenian therapy designed to clarify emotional processes involved in altering key triangles. The technique is used in order to help family members become aware of systems processes and recognize their own roles in them – it was first developed for use with emotional pursuers and distancers.
a. relationship experiments
b. coaching
c. use of genograms
d. use of displacement stories
17. A flight from an unresolved emotional attachment to one’s parents is known as:
a. disengagement
b. triangling
c. fusion
d. emotional cutoff
18. Philip Guerin and Betty Carter differ from Bowen in terms of therapeutic technique in that they do more:
a. active coaching
b. analysis of triangles
c. extended family work
d. b and c
19. According to the principles of which Bowenian construct, simply teaching a mother better techniques for disciplining her son will fail, because the intervention ignores the problem that she is overinvolved with the boy as a result of her husband’s emotional distance.
a. enmeshment
b. multigenerational transmission process
c. emotional cutoff
d. triangles
Short Answer
1. What are emotional triangles? How and why are they formed?
2. Explain differentiation of self
3. What are the multigenerational emotional processes? Give an example that illustrates these processes
4. Compare and contrast emotional fusion and enmeshment. How are they alike; how are they different?
5. According to Bowen theory, a lack of differentiation in the nuclear family will tend to be expressed in one of three ways. List and give an example of each.
6. A 25-year-old, single man seeks consultation. He is depressed and anxious, and his self-esteem is low. He states that his father expects him to be an attorney like himself, but the client has not been successful in his repeated applications to law school. He lives with his parents, and there is much tension in the home whenever his career plans are discussed. At present he is working as a therapy aide in a state psychiatric center. He enjoys his work but is embarrassed that he is employed beneath the level one would expect for a college graduate.
First, discuss the case from a Bowenian perspective. Be specific when applying Bowen’s theoretical constructs (i.e., define them first). Second, indicate how, for this client, the Bowenian approach would differ from a more traditional theoretical approach (individual therapy or vocational counseling). Specify that other in your answer.
7. List the stages of the family life cycle (Carter and McGoldrick, 1988) and describe the primary task(s) of each stage. Consider how the therapist would intervene from a Bowenian perspective with the family at each of these stages.
8. What is the basic procedure Bowenian therapists use with couples and how does this differ from, say, structural family therapy (or narrative, etc.) with couples?
9. What are the primary (concrete) things to accomplish in working to improve relationships in one’s original family?
10. To what extent is “differentiation of self” more than just a synonym for “maturity”?
Chapter 6
Strategic Family Therapy
Multiple Choice
1. Both strategic and Milan systemic therapies aim to achieve personality change through:
a. use of reframing
b. use of circular questioning
c. hierarchical restructuring
d. use of various paradoxical techniques
e. none of the above
2. The strategic and systemic therapies were most directly influenced by the ideas of:
a. Gregory Bateson
b. Carl Rogers
c. Virginia Satir
d. Milton Erickson
e. a and d
3. A paradoxical technique that forces a patient to either give up a symptom or admit that it is under voluntary control is known as:
a. a positive connotation
b. scapegoating
c. an ordeal
d. prescribing the symptom
4. A primary goal of communications family therapy is to:
a. foster insight
b. negatively reinforce symptoms
c. promote individuation of family members
d. interrupt dysfunctional feedback loops
5. Relabeling a family’s description of behavior to make it more amenable to therapeutic change is called:
a. reframing
b. prescribing the symptom
c. reinforcement reciprocity
d. a double-bind
6. Basic change in the structure and functioning of a system is known in general systems theory as:
a. first-order change
b. second-order change
c. quid pro quo change
d. paradoxical change
7. The development and use of “pretend techniques,” paradoxical interventions in which family members are asked to pretend to engage in symptomatic behavior, is associated with which strategic/systemic therapist?
a. Mara Selvini Palazzoli
b. Virginia Satir
c. Cloe Madanes
d. none of the above
8. The Bateson group may be best remembered for the concepts of the double bind and ______.
a. metacommunication
b. family structure
c. group processes
d. triangles
9. MRI therapists identify 3 categories of client solutions which tend to perpetuate or exacerbate their problems. They include attempting to solve something which isn’t really a problem, taking action to solve a problem but doing so at the wrong level, and ______.
a. complying with a paradoxical directive
b. failing to take action, though action is necessary
c. b and c
d. none of the above
10. Though many schools of family therapy believe that the real problem in families is some form of underlying family pathology, ______ family therapists deny that underlying dynamics are the cause of symptomatic behavior.
a. strategic
b. structural
c. Bowenian
d. all of the above
11. The idea that because the mind is so complex, it’s better to study people’s input and output (e.g. behavior and communication) than to speculate about what goes on in their minds is known as:
a. black box concept
b. general systems theory
c. paradox
d. metacommunication
12. All of these schools have for their goals of therapy both symptom resolution and transformation in the whole family system, except which?
a. MRI
b. experiential
c. Bowenian
d. Structural
13. A method of interviewing developed by the Milan associates in which questions are asked to highlight differences among family members, is known as:
a. a therapeutic double-bind
b. circular questioning
c. positive connotation
d. a family ritual
14. A technique used by the Milan group that prescribes a specific act for family members to perform – it is designed to change the family system’s rules.
a. circular questioning
b. pretend technique
c. positive connotation
d. ritual
15. Action and insight are the primary vehicles of change in family therapy. The ______ school emphasized behavioral change and eschews insight as a medium for change.
a. structural
b. strategic
c. psychodynamic
d. experiential
16. The strategic technique of providing a new label for a family’s description of behavior, in order to make it more amenable to therapeutic change; for example, describing someone as “lonely” rather than “depressed.”
a. interpretation
b. restraining
c. reframing
d. a and c
17. Selvini Palazzoli’s technique of ascribing positive motives to family behavior in order to promote family cohesion and avoid resistance to therapy is known as:
a. ordeal therapy
b. mystification
c. pretend technique
d. positive connotation
18. Jay Haley’s approach incorporates a functionalist viewpoint with his Ericksonian and cybernetic influences, thus combining aspects of the ______ and ______ approaches into his style of treating families.
a. structural/behavioral
b. Bowenian/behavioral
c. Strategic/experiential
d. Structural/strategic
19. Madanes categorizes family problems according to 4 basic intentions of family members involved in them. They are: the desire to dominate and control, the desire to love and protect others, the desire to repent and forgive, and the desire to ______.
a. manipulate
b. be loved
c. be secure
d. none of the above
20. A conflict created when a person receives contradictory messages on different levels of abstraction is known as a:
a. reframe
b. double bind
c. complementary message
d. quid pro quo
21. The use of ______ is designed to block or change dysfunctional behavior using indirect, seemingly illogical means.
a. therapeutic double-binds
b. paradox
c. directives
d. all of the above
22. ______ therapists believe there is no one model of health or normality for families, therefore, they refrain from imposing any such model on their clients.
a. strategic
b. Milan
c. MRI
d. b and c
23. The current form of Haley/Madanes therapy is called ______, and still involves giving directives based on therapist hypotheses, though shifting the focus away from the power elements of family hierarchy.
a. post-modern strategism
b. positive strategism
c. strategic humanism
d. none of the above
24. The central intervention within the original Milan model consisted of either a ritual or a:
a. family sculpting
b. positive connotation
c. therapeutic double bind
d. a and c
Short Answer
1. What is the purpose of “circular questioning?”
2. Explain compliance-based and defiance-based directives, and give an example of each. How would a strategic therapist decide which type of directive to use with a family in treatment?
3. In communications family therapy, resistance and symptoms were treated with a variety of paradoxical techniques known as therapeutic double binds. Define and give an illustration of a double-bind. Why were they considered to be so powerful?
4. Describe the invariant prescription.
5. What is the “black box” concept? How does it inform the goals for therapy according to the communications perspective?
6. Compare and contrast the strategic and Milan systemic theories. Consider theoretical adequacy; specificity of constructs, strategy, and technique; role of the therapist; and types of client problems best suited for each approach.
7. How does the therapist’s role differ in Milan systemic versus solution-focused therapy?
8. What is a negative feedback loop and how or why is it initiated? Give an example? What is a positive feedback loop and how or why is it initiated? Give an example.
Chapter 7
Structural Family Therapy
Multiple Choice
1. A family therapist who begins a session by greeting individual family members by name and asking for each person’s view of the problem is demonstrating which strategy?
a. boundary making
b. highlighting the interactions
c. accommodating
d. joining
2. Structural therapists attempt to alter the family’s view of reality by:
a. heightening emotional experiencing
b. challenging unproductive assumptions
c. realigning boundaries between individuals and subsystems
d. accommodating to the viewpoint of the most powerful family member
3. The primary treatment goal of structural family therapy is to:
a. teach the family problem-solving strategies
b. alter the family structure
c. strengthen boundaries around rigid family subsystems
d. heighten emotional experiencing
4. Disengaged subsystems are surrounded by ______ boundaries while ______ subsystems have ______ boundaries.
a. rigid; enmeshed; diffuse
b. executive; rigid; diffuse
c. diffuse; rigid; enmeshed
d. enmeshed; rigid; executive
5. Structural family therapists use ______ to observe and then change transactions that make up family structure.
a. genograms
b. paradoxical directives
c. double-binds
d. enactments
6. “Unbalancing” involves
a. realigning relationships between subsystems
b. therapeutic neutrality
c. restoring the family’s narrative
d. taking sides
7. In order to discern a family’s structure two things are necessary: a theoretical system that explains structure and:
a. family members’ self-reports
b. live observation
c. a structural assessment interview
d. none of the above
8. Minuchin’s term for psychological isolation that results from overly rigid boundaries around individuals and subsystems in a family is ______.
a. enmeshment
b. differentiation
c. emotional cutoff
d. disengagement
9. When two people marry, they must learn to negotiate the nature of the boundary between them, as well as the boundary separating them from the outside. This structural requirement is known as ______.
a. accommodation
b. complementarity
c. disengagement
d. differentiation
10. Structural family therapy was developed with a ______ population.
a. low socioeconomic
b. schizophrenic
c. Latino
d. Psychosomatic
11. The goal in structural family therapy when working with enmeshed families is to:
a. establish reinforcement reciprocity by teaching methods of positive control
b. differentiate individuals and subsystems by strengthening the boundaries around them
c. increase interaction by making boundaries more permeable
d. all of the above
12. Structuralists believe the family must first accept the therapist, in a process called ______, which allows the therapist to increase stress and unbalance the family homeostasis, thus opening the way for structural transformation in the family.
a. detouring
b. taking an “I” position
c. restructuring
d. joining
13. When parents are unable to resolve conflicts between them, a common pattern is to continue to argue through the children. When father says mother is too permissive, she says he’s too strict. He may in turn withdraw, and she responds to the child with excessive concern and devotion. The structural term which best describes the resulting family structure is:
a. diffuse boundaries between husband and wife
b. a cross-generational coalition between mother and child
c. overinvolvement between father and child
d. a pathological triangle
14. An interaction stimulated in structural family therapy in order to observe and then change transactions which make up family structure is called:
a. positive connotation
b. spontaneous behavior exchange
c. reframing
d. enactment
15. During which phase of structural family therapy does assessment occur?
a. opening
b. mapping underlying structure
c. transformation of family structure
d. structural therapists do not use assessments
16. In order to highlight and modify interactions in the family, structural therapists must use intensity to:
a. interrupt rigid patterns of conflict-avoidance
b. break families loose from their patterns of equilibrium
c. extend interactional sequences beyond the point where dysfunctional homeostasis is reinstated
d. all of the above
17. ______ is another method of modifying interactions, which structural therapists use to help family members employ more functional alternatives already in their repertoire of skills.
a. positive connotations
b. shaping competence
c. detriangling
d. operant conditioning
18. Minuchin, Rosman, and Baker (1978) reported a 90% improvement rate in the results of their treatment study of structural family therapy in treating ______.
a. drug addiction
b. anxiety disorders
c. depression
d. anorexia
Short Answer
1. Why are enactments used in structural therapy?
2. Discuss the pros and cons of the argument that structural family therapy (as practiced by Minuchin) is not a collaborative model.
3. A child from enmeshed family is brought into treatment for school phobia. Demonstrate your knowledge of family structure by describing how this presenting problem may be understood as the sign of an enmeshed family. How might members of an enmeshed family system contribute to the maintenance of such a problem?
4. List and describe the three overlapping phases in the process of structural family therapy. Describe the specific strategies that structural therapists employ in each phase. Use a case example for illustration.
5. Compare and contrast structural family therapy to the early communications therapy practiced by Don Jackson and colleagues. Consider theoretical adequacy, specificity of constructs, strategies and techniques, roles of the therapist, and types of client problems best suited for each approach.
6. What are boundaries and why are they important in understanding the problems of a newly married couple?
7. What is family structure and how do families become structured?
Chapter 8
Experiential Family Therapy
Multiple Choice
1. Experiential family therapists believe ______ is/are the primary cause of dysfunction in families.
a. interlocking triangles
b. unexpressed emotion
c. cross-generational coalitions
d. poor problem-solving
2. Experiential therapy differs from most systems approaches with respect to its emphasis on ______ versus techniques that specifically facilitate interaction.
a. expanding experience
b. improving problem solving
c. restructuring the family hierarchy
d. metacommunication
3. R.D. Laing’s concept that many families distort their children’s experience by denying or relabeling it is known as:
a. introjection
b. metacommunication
c. reframing
d. mystification
4. The goals of experiential family therapy would not include:
a. increased personal integrity
b. greater freedom of choice
c. restructuring of the family system
d. increased sensitivity to one’s needs and feelings
5. Carl Whitaker, like Murray Bowen, believes that personal growth (i.e., individuation) also requires:
a. rational thinking
b. family connectedness
c. problem-solving abilities
d. none of the above
6. A collection of beliefs based on a distortion of historical reality and shared by all family members, which help shape the rules governing family functioning are known as:
a. family rules
b. invisible loyalties
c. family myths
d. none of the above
7. Within experiential therapy, the ______ is believed to be the essential healing force in the psychotherapeutic process, whereby the therapist establishes caring, person-to-person relationships with each family member while modeling openness, honesty, and spontaneity.
a. interpretation of unconscious conflict
b. existential encounter
c. therapeutic double-bind
d. paradoxical intervention
8. A non-verbal experiential technique, in which family members position themselves in a tableau that reveals significant aspects of their perceptions and feelings, is known as:
a. existential encounter
b. family sculpting
c. family ritual
d. conjoint family drawing
9. An important concept in experiential family therapy – defined as the process of developing and fulfilling one’s innate, positive potentialities.
a. differentiation of self
b. alienation from experience
c. constructivism
d. self-actualization
10. Experiential family therapy is designed to:
a. interpret and work through unconscious conflicts
b. increase family members’ levels of differentiation of self
c. facilitate emotional experiencing in family members
d. none of the above
11. ______ is considered more important by experiential therapists for healthy family functioning than either problem-solving skills or functional family structure.
a. open, spontaneous experiencing
b. insight
c. symptom relief
d. none of the above
12. The primary goals of experiential family therapy include all except which of the following?
a. enhanced sensitivity
b. greater freedom of choice
c. expanded emotional experiencing
d. symptom relief
13. Unlike Bowenians, experiential therapists will ______ then behave in alternately provocative and supportive ways in order to help families learn to express honest emotion.
a. encourage development of transference
b. discourage development of transference
c. raise the level of anxiety in the family
d. lower the level of anxiety in the family
14. Experiential therapists often use ______ to help minimize countertransference responses to family members in session
a. live observation
b. co-therapists
c. reflecting teams
d. their own therapy
15. Among experientialists, families are typically conceived of and treated as ______.
a. groups of individuals
b. systems
c. parent and child subsystem
d. none of the above
16. Research on emotionally-focused couples therapy has shown that greater ______ on the part of spouses results in more productive sessions and better treatment outcomes.
a. emotional complementarity
b. problem solving statements
c. experiencing
d. catharsis
17. Johnson and Greenberg have found that emotionally-focused couples therapy is more successful when the therapist first ______ and then ______, in that order.
a. softens the attacking spouse’s stance; engages the withdrawn spouse
b. engages the withdrawn spouse; softens the attacking spouse’s stance
c. facilitates an enactment; encourages expression of secondary emotions
d. encourages expression of secondary emotions; facilitates and enactment
18. The goal of internal family systems therapy is to:
a. experience unique outcomes
b. achieve self-leadership
c. de-triangulate
d. b and c
19. The notion that the personality is subdivided has been proposed by Freud, the object relations theorists, and ______ theorists.
a. narrative solutions
b. strategic
c. feminist
d. internal family systems
20. According to Richard Schwartz, underneath people’s defensive postures lies ______.
a. a healthy core self
b. hidden family conflicts
c. deep wounds from early childhood
d. none of the above
21. An essential role of an IFS therapist is to:
a. educate family members about internal positive feedback loops
b. help family members notice when their parts have taken over
c. solve the family’s presenting problem
d. reposition the family hierarchy
Short Answer
1. Experiential therapists have downplayed the role of theory in psychotherapy. Describe the rationale offered by such people as Whitaker and Keith for using an atheoretical approach to treating families.
2. What is an existential encounter?
3. Describe the technique of family sculpting.
4. Experiential therapy derives from existential, humanistic, and phenomenological thought. Explain the general essence of these lines of thinking, and their implications for treatment. Contrast these existential ideas with the determinism inherent in psychoanalytic thinking.
5. What evidence is there for effectiveness of emotionally-focused couples therapy? Discuss the types of couples presenting problems that may be most amenable to change through use of an emotion-focused approach. For which types of presenting problems might it be least effective? How could you test your hypotheses regarding differential effectiveness?
6. Compare and contract Schwartz’s notion of “Self leadership” and Bowen’s construct, “differentiation of self.”
7. Compare and contrast Virginia Satir’s approach to Carl Whitaker’s.
Chapter 9
Psychoanalytic Family Therapy
Multiple Choice
1. The outcome of good object relations in infancy is the emergence of:
a. anaclitic object constancy
b. ambivalent attachment
c. libidinal object constancy
d. ego idealism
2. ______ is an interactive process in which a subject perceives an object as containing elements of the subject’s personality and evokes certain behaviors and feelings from the object that conform to these perceptions.
a. Separation-countertransference
b. Transference-countertransference
c. Reciprocal introjection
d. Projective identification
3. Psychoanalytic family therapy achieves personality change and growth through the technique(s) of:
a. ego development
b. interpretation
c. introjection
d. working through
e. b and d
f. c and d
4. According to object relations theory, both ______ and ______ will likely result in poor adult adjustments.
a. inadequate separation-individuation; introjection of pathological objects
b. repression of aggressive and libidinal impulses; introjection of pathological objects
c. introjection of pathological objects; enmeshment with family of origin
d. enmeshment with family of origin; inadequate separation-individuation
5. Non-psychoanalytic family therapists locate problems between people; psychoanalytic family therapists identify problems ______ people.
a. within
b. between
c. within and between
d. none of the above
6. An emotional reaction, usually unconscious and often distorted, on the part of a patient to a therapist or family member is known as:
a. transference
b. countertransference
c. projective identification
d. introjection
7. A process whereby and infant begins, at about two months, to draw apart from the symbiotic bond with a mother and develop autonomous functioning is known as:
a. introjection
b. separation-individuation
c. projective identification
d. identification
8. According to psychoanalytic perspectives, one’s choice of marital partner is based on:
a. the desire to maximize rewards and minimize costs of the relationship
b. one’s level of differentiation of self, and similar levels of differentiation in the families of origin
c. complementary styles of communication
d. one’s desire to find someone with complementary needs who will fulfill one’s unconscious fantasies.
9. According to psychoanalytic theory, marital choice is affected in part by the ______ phenomenon, in which the insecurely attached child grows up learning to hide their real needs and feelings to win approval.
a. false self
b. invisible loyalty
c. introjective
d. double-bind
10. A process in psychoanalytic family therapy, by which insights are translated into new and more productive ways of behaving and interacting is known as:
a. projective identification
b. working through
c. metacommunication
d. interpretation
11. Psychoanalytic family therapists use the technique of interpretation when confronted with ______ in family therapy, because it often takes the form of acting-out.
a. sublimation
b. introjection
c. resistance
d. libidinal impulses
12. Psychoanalytic clinicians identify pathology in families as the result of ______, while structural family therapists locate dysfunction in the boundaries between subsystems.
a. conflict
b. intrapsychic rigidity
c. developmental arrest
d. all of the above
13. Psychoanalytic family therapists pay particular interest to childhood memories when:
a. they feel family members’ need reassurance and direction
b. family members’ associations and spontaneous interactions cease
c. they are re-enacted in the present, manifested as transference
d. none of the above
14. Unlike ______, psychoanalytic clinicians may not complete their assessment or arrive at a final diagnosis until the end of treatment.
a. experientialists
b. behaviorists
c. structuralists
d. b and c
15. Psychoanalytic family therapy consists of four basic techniques: listening, empathy, interpretation, and ______.
a. maintaining analytic neutrality
b. facilitating emotional expression
c. paradoxical directives
d. re-storying
16. According to self-psychology, children are more likely to develop secure and cohesive sense of self when parents provide sufficient opportunities for:
a. anaclitic introjection
b. ego splits
c. projective identification
d. idealization
17. Along with the achievement of insight, the processes of working through and ______ are considered three specific processes that facilitate change in psychodynamic therapy.
a. reintegrating split-off parts of the ego
b. sublimation
c. reciprocal introjection
d. warding off libidinal and aggressive impulses
18. The general goals of psychoanalytic family therapy include all EXCEPT:
a. resolution of unconscious conflict
b. anaclitic object constancy
c. differentiation
d. separation-individuation
Short Answer
1. Explain projective identification.
2. What is resistance? Give an example of how it is manifested in family therapy. How should the therapist work with resistance in treatment?
3. Explain the difference between the psychoanalytic technique of confrontation and interpretation.
4. Transference occurs in all forms of therapy. What is the general psychoanalytic point of view regarding its significance in treatment? How does the occurrence and use of transference differ in psychoanalytic family therapy and individual psychoanalytic therapy?
5. Four basic techniques used in psychoanalytic family therapy are: listening, empathy, interpretation, and maintaining analytic neutrality. Define and give an example of how each technique may be used in a treatment session with a couple experiencing marital difficulties.
6. According to Freud, what are the primary human motivations? According to Kohut what are the primary human motivations? Give an example of each and explain how they differ.
7. What is the difference between Nagy’s concept of invisible loyalty and the more familiar and simpler term loyalty?
8. What is the difference in impact on the patient between a therapist’s mirroring versus expressing praise and reassurance?
Chapter 10
Cognitive-Behavioral Family Therapy
Multiple Choice
1. The use of high-probability behavior to reinforce low-probability behavior is known as:
a. aversive control
b. Premack principle
c. shaping
d. modeling
2. A behavioral technique used to eliminate behavior by not reinforcing it is known as:
a. punishment
b. assertive training
c. contingency contracting
d. extinction
3. The behavioral parent training model:
a. focuses on triadic constructions of the identified problem
b. aims to restructure the family hierarchy and generational boundaries
c. requires that the entire family attend therapy
d. supports the parents’ view that the child is the problem
4. The most commonly used techniques in behavior therapy fall into which category?
a. operant conditioning
b. respondent conditioning
c. cognitive/affective techniques
d. none of the above
5. This behavioral technique uses a system of points or stars to reward children for successful behavior:
a. contingency contracting
b. token economy
c. aversion therapy
d. shaping
6. Systematic desensitization is an example of ______ techniques.
a. operant conditioning
b. cognitive/affective
c. classical conditioning
d. aversion
7. Behavioral assessment methods fall into each of the following categories except which?
a. clinical interview
b. observation
c. objective testing
d. projective testing
8. Assessments conducted in behavioral marriage therapy are designed to evaluate couples on all except which of the following:
a. their ability to discuss relationship problems
b. the manner in which reward and punishment are exchanged
c. their capacity for whole object relationships
d. skill at pinpointing relevant reinforcers in the relationship
9. According to Jacobson, behavioral marital therapists prefer to use ______ to identify problems and understand their etiology.
a. interviews
b. written questionnaires
c. direct observation
d. b and c
e. none of the above
10. According to behaviorists, disturbed marital interactions result from:
a. low rates of positive reinforcement exchange
b. positive expectancies
c. low rates of aversive control
d. none of the above
11. A major treatment strategy in behavioral couples therapy is to:
a. increase the rate of aversive control
b. improve communication skills
c. decrease positive control
d. all of the above
12. The major intent of behavioral exchange procedures is to help couples:
a. with severe marital problems
b. establish reinforcement reciprocity
c. resolve sexual arousal disorders
d. evaluate treatment outcome
13. After identifying problematic assumptions, cognitive-behavioral therapists:
a. offer alternative explanations
b. point out fallacies in thinking
c. help clients test their assumptions
d. check for family schemas
14. Three types of sexual dysfunction identified by Helen Singer Kaplan, which correspond to three stages of the sexual response, include arousal disorders, orgasm disorders, and:
a. premature ejaculation
b. organic disorders
c. disorders of desire
d. none of the above
15. Assessments for the behavioral treatment of sexual dysfunction involve:
a. conducting a medical examination to rule out organic problems
b. establishing goals for treatment
c. conducting extensive interviews to determine the nature of the dysfunction
d. all of the above
16. Masters and Johnson tend to lump sexual problems into which category of problem?
a. Anxiety
b. Lack of motivation
c. Poor technique
d. Lack of information
Short Answer
1. What is a functional analysis of behavior?
2. Describe the essential components of behavioral family assessment using Kanfer and Phillips’ SORKC model of behavior. Provide a case illustration of how this assessment model is applied.
3. What is a quid pro quo contract?
4. Describe the principle components of behavioral parent training. Use a case example to illustrate your answer. How does the approach differ when applied to families with young children versus families with adolescents?
5. Describe the role of Socratic questioning in cognitive-behavioral therapy.
6. Within the field of family therapy, behaviorists place the greatest emphasis on assessment and use the most formal and standardized procedures. List and discuss at least three advantages and three disadvantages of the behavioral emphasis on and techniques of assessment.
7. How is systematic desensitization used in the treatment of sexual dysfunction?
8. Explain how problems develop in a family from a cognitive-behavioral perspective.
Chapter 11
Family Therapy in the Twenty-First Century
Multiple Choice
1. The primary goal of the psychoeducational approach to treatment of schizophrenia is:
a. to cure the patient of schizophrenia
b. to determine the family’s contribution to the illness
c. to remove the patient from their family environment
d. to maximize functioning and minimize relapse
2. One reason for the erosion of boundaries between the various schools of family therapy is:
a. recognizing the need to tailor approaches to fit specific problems
b. emphasizing a behavioral-oriented versus meaning-oriented approach to family problems
c. research demonstrating that several of the classic approaches aren’t effective
d. increasing therapists’ trust in families to come up with their own solutions
3. Which of the following played a major part in the deconstruction of family therapy’s philosophical roots?
a. structural theory
b. experiential theory
c. systems theory
d. feminist theory
4. A relativistic perspective that emphasizes the subjective construction of reality, and implies that what we see in families is based as much on our preconceptions as on what is actually going on, is known as:
a. pluralism
b. constructivism
c. feminism
d. ethnocentrism
5. The feminist revolution in family therapy differs from the Milan or constructivist revolutions because it:
a. subscribes to non-collaborative model of treatment
b. is a more systemically-based approach
c. has had a relatively minor impact on the field
d. is theoretical and personal
6. Hermeneutics first influenced the field of psychotherapy in the ______ approach.
a. solution-focused
b. narrative constructive
c. psychoanalytic
d. experiential
7. The one-day “survival-skills workshop” conducted with groups of family members is used in which treatment approach?
a. internal family systems therapy
b. medical family therapy
c. solution-focused therapy
d. psychoeducation
8. Expressed emotion refers to:
a. criticism
b. hostility
c. emotional over involvement
d. all of the above
9. While the focus on problem resolution or cure has been family therapy’s trademark, these family therapists are advocating coping with serious psychopathology as a worthy goal.
a. structural
b. psychoeducational
c. psychodynamic
d. behavioral
10. While the ______ influence in family therapy has led to increased humility about our theoretical models and less urgency to change or control people, some fear that its valueless relativism may lead therapists to collude with troubled families to deny their problems.
a. constructivist
b. feminist
c. psychodynamic
d. multicultural
11. The dysfunctional family constellation which has been most commonly cited by family therapists typically blames the ______’s relationship with the children for family symptoms.
a. mother
b. father
c. grandmother
d. grandfather
12. The archetypal family case of the overinvolved mother and peripheral father is best understood as the product of:
a. intrapsychic issues in women
b. societal forces
c. men’s disillusionment with their careers
d. all of the above
13. In addition to its use with families with schizophrenia, the psychoeducational model is purportedly applicable to the treatment of ______ as well.
a. family violence
b. eating disorders
c. alcoholism
d. all of the above
14. Medical family therapists believe that the field of family therapy has ignored the impact of ______ on family functioning.
a. gender inequalities
b. systemic forces
c. transitions in the family life cycle
d. chronic illness
15. Feminist and constructivist styles of therapy differ with respect to which notion?
a. constructivists don’t advocate collaboration with the family
b. feminists don’t advocate neutrality in their work with families
c. feminists believe that all realities are created equal
d. all of the above
16. The tension between the ______ position, which asserts that any family structure is fine if its adaptive or functional for the family, and the ecological position, which asserts that there are some basic universal principles that determine a system’s health or illness, has fueled many of the debates in family therapy during the 1980’s.
a. ethnocentric
b. aesthetic
c. systemic
d. relativistic
17. Another trend of the 1980s, in which many authors discussed how to do family therapy with specific types of problems and family constellations, was the trend toward ______.
a. ethnic diversity
b. increased specialization
c. constructivism
d. medical models of treatment
18. According to the ______ approach to family treatment, family stress is thought to cause problems for schizophrenic members, but families don’t cause schizophrenia.
a. psychoeducation
b. psychodynamic
c. strategic
d. structural
19. ______ provides a sectional view of the brain.
a. fMRI
b. MRI
c. PET scan
d. EEG
20. The most effective way to control children’s inappropriate sexual contact through the internet is:
a. installing blocking software
b. dialogue with parents
c. family therapy
d. monitoring the child’s internet use
21. ______ family approaches have demonstrated considerable success in preventing the rehospitalization of schizophrenics.
a. Psychoeducational
b. Experiential
c. Structural
d. None of the above
22. Internet infidelity is:
a. caused by problems in relationships
b. the cause of problems in relationships
c. unrelated to problems in relationships
d. none of the above
23. Medical family therapists help families reorganize their resources and prepare to deal with a family illness by relying on their assessment of:
a. onset and course of the illness
b. stage in the family life cycle
c. the family’s resources and degree of isolation
d. all of the above
Short Answer
1. What is a reflecting team? What are the benefits to using a reflecting team in family therapy?
2. What is a survival-skills workshop?
3. Give one example of a presenting problem that should be viewed (conceptualized) differently if expressed by a middle income white family versus a low income minority family (African American, Latino, Asian, or Native American). Explain your reasoning.
4. What is constructivism? Some would argue that constructivism’s profound impact on clinical theory and practice has been positive (e.g., therapists have become collaborators with the family in a kinder, gentler therapy). Others would argue that serious problems exist with using constructivism as a clinical foundation, that it leads therapists astray. Take one position or the other and defend your stand.
5. Explain the roles of advocacy and clinical neutrality in feminist family therapy.
6. Discuss ways to limit children’s involvement with sexual content and contacts on the Internet.
7. Why should a family’s ethnicity and culture be considered in assessment?
Chapter 12
Solution-Focused Therapy
Multiple Choice
1. In the solution-focused model, behavior problems are thought to be perpetuated by:
a. solutions that don’t work
b. problem-maintaining solutions
c. problem talk
d. none of the above
2. The most important part of the assessment procedure in solution-focused therapy is:
a. goal setting
b. identifying customers
c. identifying problem-maintaining solutions
d. identifying family conflicts
3. Coping questions are designed to:
a. help clients figure out how to cope better with their problems
b. help clients figure out how to work together better to cope with their problems
c. help clients realize that they are already handling their problems
d. help clients consider new solutions for their problems
4. Early in the development of solution focused therapy, all clients were given the same assignment, ______, in which clients are asked to observe what happens in their life/relationships that they want to continue.
a. re-storying task
b. invariant prescription
c. family ritual
d. formula first-session task
5. Relabeling a family’s description of behavior to make it more amenable to therapeutic change is called:
a. reframing
b. prescribing the symptom
c. reinforcement reciprocity
d. a double-bind
6. This question, used by solution focused therapists, is intended to circumvent clients’ global and unremitting perceptions of the problems and directs their attention to times in the past or present when they didn’t have the problem.
a. exception question
b. miracle question
c. scaling question
d. none of the above
7. Compliments are designed to:
a. reinforce successful solutions
b. foster self-confidence
c. enhance the therapeutic alliance
d. discourage problem talk
8. Scaling questions are used to:
a. clarify vague goals
b. break goals into manageable steps
c. measure progress
d. all of the above
Short Answer
1. List and describe three types of questions used in solution-focused therapy. Give an example of each. According to solution-focused theory, discuss how each facilitates client change/improvement.
2. What types of clients and client problems are best suited for solution-focused therapy and the MRI model of treatment? Are these approaches effective only with high functioning clients, or can they be used effectively to treat more serious problems (e.g., substance abuse, sexual abuse, personality disorders, or severe mental illness)?
3. How does the therapist’s role differ in a variety of different approaches (name or have students pick one or two) versus solution-focused therapy?
4. Does solution-oriented therapy ignore people’s pain (as some critics of the approach suggest) or does it facilitate clients’ positive experiences, which in turn empower them to change what is painful in their lives?
5. What is the miracle question and how is it used in solution-focused therapy?
Chapter 13
Narrative Therapy
Multiple Choice
1. In narrative therapy, families are asked about ______, times when they have had some control over the problem that have been obscured by their problem-saturated story.
a. unique outcomes
b. examples of self-leadership
c. exceptions
d. invisible loyalties
2. Both the narrative and Milan systemic approaches are characterized by an:
a. interest in the origin or cause of problems
b. ethic collaboration
c. emphasis on paradoxical intervention
d. none of the above
3. The narrative technique of ______ enables family members to distance from their problem by externalizing it, and thus experiencing their control over the problem.
a. creating self-leadership
b. family rituals
c. re-storying
d. the invariant prescription
4. Narrative therapy consists of a series of questions designed to:
a. identify the locus of the problem
b. assess the function the problem serves for the family
c. clarify the family’s power over the problem
d. all of the above
5. In mapping the influence of the problem, narrative therapists:
a. explore the impact of the problem on the clients
b. discourage problem talk
c. discourage problem-saturated stories
d. encourage solutions
6. Narrative therapy is practiced in the form of:
a. narrative scripts
b. narrative suggestions
c. cultural stories
d. a series of questions
7. Unlike the cybernetic metaphor, which focuses on self-defeating patterns of ______, the narrative metaphor focuses on self-defeating ______.
a. culture(s); behavior(s)
b. cognition(s); behaviors(s)
c. emotion(s); culture(s)
d. behavior(s); cognition(s)
8. The narrative approach first found its way into psychotherapy in the hermeneutic traditions in ______.
a. psychoanalysis
b. gestalt therapy
c. feminism
d. client-centered therapy
9. According to narrative theory, therapists should NOT:
a. take a collaborative, listening approach with clients
b. help people separate from the dominant cultural narratives
c. consider the larger historical and political context
d. search for flaws in the family system
10. Narrative therapists ______ problems in order to free the family and individual family members from blame.
a. re-story
b. externalize
c. prescribe
d. reframe
11. Externalizing conversations seek to:
a. locate problems in the larger culture
b. locate problems in the family system
c. detoxify problems
d. personify problems
12. According to narrative therapy, by maintaining a dominant story of their problem, family members fail to see ______ their problems.
a. the paradox in
b. their contributions to
c. exceptions to
d. underlying causes of
13. The narrative school applied Michel Foucault’s ______ analysis of societies to an understanding of individuals and families as dominated by oppressive, internalized narratives.
a. political
b. social psychological
c. gender-based
d. cultural
14. Narrative therapists search the family’s history for ______, in their efforts to separate them from their problems.
a. multigenerational patterns
b. miracle outcomes
c. sparking outcomes
d. none of the above
15. In order to fortify gains made in narrative treatment, ______ are organized to discuss how to facilitate the client’s success in countering the effects of their problem story.
a. nurturing teams
b. reflecting teams
c. multiple family groups
d. none of the above
16. In order to externalize a problem, whether it’s an internal experience, a syndrome, or a relationship pattern, the narrative therapist must ______.
a. prescribe it
b. personify it
c. ignore it and focus on unique outcomes
d. ask the miracle question
Short Answer
1. What are relative influence questions, and how are they used in narrative therapy?
2. What types of clients and client problems are best suited for narrative models of treatment? Is this approach effective only with high functioning clients, or can it be used effectively to treat more serious problems (e.g., substance abuse, sexual abuse, or severe mental illness)?
3. Describe the technique of “externalizing” and illustrate using a clinical example.
4. Is it necessary to reject systems thinking in order to practice a narrative approach? What might be some advantages and disadvantages of trying to incorporate systemic thinking into narrative therapy?
5. What is a unique outcome?
6. Define and give an example of each of the following narrative questions: deconstruction questions, open space questions, preference questions, story development questions, and meaning questions.
Chapter 14
Comparative Analysis
Multiple Choice
1. The practice of family therapy has generally preceded ______; thereafter the progress in the field typically proceeds in leapfrog fashion.
a. politics
b. theory
c. technique
d. science
2. While theories may serve a political purpose and bias observations, they also:
a. prevent the artistic component of therapy from being expressed
b. hamper beginning therapists from mastering the proven techniques in the field
c. generally are developed before therapy can be practiced
d. provide conceptual categories to organize observations in therapy
3. Cognitive-behavioral and strategic therapists tend to emphasize the technical role of the therapist, while ______ and ______ therapists stress the artistic side of the person.
a. structural; experiential
b. communications; Bowenian
c. Bowenian; structural
d. experiential; constructivist
4. Which school introduced the idea that families are systems – more than the sum of their parts?
a. communications
b. group
c. behavioral
d. structural
5. Which school tends not to incorporate systems thinking into their practice?
a. Milan
b. Bowenian
c. behavioral
d. structural
6. During the 1970s, most family therapists tended to overestimate the homeostatic forces in families and underestimate their flexibility and resourcefulness- except whom?
a. Salvador Minuchin
b. Virginia Satir
c. Mara Selvini Palazzoli
d. Don Jackson
7. Though many schools of family therapy believe that the real problem in many families is some form of underlying family pathology, ______ family therapists deny that underlying dynamics are the cause of symptomatic behavior.
a. strategic
b. structural
c. Bowenian
d. all of the above
8. While intrapsychic conflict is an inferred psychological concept, ______ is an observed interactional concept.
a. mystification
b. developmental arrest
c. structural pathology
d. none of the above
9. The ______ model of mental disorder, which proposes that an individual develops a disorder when a genetic weakness is sufficiently stressed by an event in the environment, is supported by Bowen theorists and psychoeducational therapists.
a. diathesis-stress
b. general systems
c. object relations
d. none of the above
10. The concept of ______ describes how when two people are in conflict, the one who experiences the most anxiety will triangle in another person.
a. cross-generational coalitions
b. pathological need complementarity
c. pathological triangles
d. all of the above
11. All of these schools have for their goals of therapy both symptom resolution and transformation in the whole family system, except which?
a. MRI
b. experiential
c. Bowenian
d. structural
12. While the focus on problem resolution or cure has been family therapy’s trademark, these family therapists are advocating coping with serious psychopathology as a worthy goal.
a. structural
b. psychoeducational
c. psychodynamic
d. behavioral
13. Action and insight are the primary vehicles of change in family therapy. The ______ school emphasizes behavioral change and eschews insight as a medium for change.
a. behavioral
b. strategic
c. psychodynamic
d. experiential
14. A primary goal of communications family therapy is to:
a. interrupt dysfunctional feedback loops
b. promote individuation of family members
c. reinforce symptoms
d. foster insight
15. These family therapists believe that supervised change during therapy sessions seems more effective for families than unsupervised change at home.
a. Bowenian
b. structural
c. strategic
d. a and b
16. While most schools of family therapy believe that families are notoriously resistant to change, ______ therapists minimize the importance of resistance.
a. strategic
b. experiential
c. narrative
d. structural
17. One variation of the patient-therapist relationship is exemplified by this model which instructs its therapists to empathize with a family’s predicament while also empowering them to use their own strengths to find solutions, from a position of partnership.
a. solution focused
b. Milan
c. communications
d. a and b
18. The use of ______ is designed to block or change dysfunctional behavior using indirect, seemingly illogical means.
a. therapeutic double-binds
b. paradox
c. directives
d. all of the above
19. Though most family therapists invite everyone living under the same roof to the first session, members of this school do not insist on seeing the entire family.
a. MRI
b. structural
c. behavioral
d. a and c
20. Teams of observers positioned behind a one-way mirror are most commonly used by ______ family therapists.
a. experiential
b. behavioral
c. Bowenian
d. strategic
21. Which family therapy model incorporates intrapsychic concepts into their description of behavior disorders?
a. structural
b. integrative problem-centered metaframeworks
c. solution-focused
d. MRI strategic
22. While the broad goals of many family therapy schools are to solve presenting problems and to reorganize families, the primary aim of ______ therapists is to reorganize families.
a. experiential
b. strategic
c. behaviorists
d. structural
23. The only integrative approach to explore intrapsychic processes is the:
a. externalization model
b. solution-focused model
c. integrative problem-centered metaframeworks therapy
d. narrative-constructive model
24. Bowen’s notion of triangles, Haley’s focus on hierarchical control, and Minuchin’s concept of boundaries represent examples of the metaframework, ______.
a. sequences
b. internal processes
c. development
d. organization
25. The clinical application of metaframeworks is centered around the practice of ______ rather than finding deficits.
a. externalizing the problem
b. detriangling
c. releasing constraints
d. shifting cognitive constructions
26. The multicultural framework encourages therapists to speak with families about their ______.
a. ethnicity
b. culture
c. ethnicity, education, and religion
d. race
27. Integrative problem-centered metaframework therapists:
a. have conversations with families about potential constraints
b. collaborate with family members to form hypotheses
c. use a reflecting team to help re-story the family problem
d. b and c
e. a and b
28. ______ therapists take the position that the simplest and least expensive intervention should be tried before using more complex and expensive treatments.
a. Integrative problem-centered metaframeworks therapy
b. Narrative solutions therapy
c. Integrative couple therapy
d. None of the above
29. The narrative solutions approach combines the insights of ______ with narrative techniques.
a. experiential therapy
b. structural therapy
c. Bowenian theory
d. MRI’s model
30. The narrative solutions approach revolves around the concept of ______, which assumes that people have strong preferences for how they would like to see themselves, and be seen by others.
a. externalizing the problem
b. preferred views
c. emotional reactivity
d. self-leadership
31. Jacobson and Christensen’s integrative couples therapy adds what element to traditional behavioral couples therapy?
a. A functional analysis of behavior %
b. Narrative reconstruction
c. Acceptance
d. Communications training
32. In contrast to traditional behavioral therapy, integrative couple therapy emphasizes ______.
a. insight
b. emotional experiencing
c. accountability
d. support and empathy
Short Answer
1. How does the therapist’s role differ in narrative versus structural therapy?
2. Choose a client with whom you have worked individually whose family history and situation you know fairly well. Briefly describe the presenting concern(s), your original case conceptualization, and the general therapeutic approach you took with this person. Then, discuss in some detail how you could conceptualize the client’s problem and situation from a family systems perspective. Include your assessment of life-cycle stage and of important family dynamics. Finally, describe the family systems approach that you could have taken with this client, how your role, strategy, and techniques would have differed, and what differences in outcome could be expected.
3. Imagine that the following information has been provided to you about the “Sanders” family whom you will be seeing for the first time today.
Sue, 36, and Tom, 39, present for an initial consultation along with their two children- Alice, 15, and Ted, 7. Sue does most of the talking, while Alice sits slumped in her chair with a sullen look on her face. Ted looks anxious and stays close to his mother. They have come because Sue is concerned about her children. Alice’s school performance has been deteriorating over the past year; she has gone from a “B” student to a “C” student. She also stays out late many school nights and fights constantly with her parents. Ted has refuses to attend school for the past two weeks because, according to Sue, he is afraid of the other children. Tom is not very involved in the raising of the children. He travels frequently on business, and when he’s home, he goes out at night by himself.
a. How might the Sanders’ problems be conceptualized from a family life cycle perspective (i.e., Carter & McGoldrick, 1999)? Feel free to speculate about the possible causes of the problems presented by the family. (1/3 of total points)
b. Take any one of the theoretical perspectives discussed in the text and describe, from that orientation, how you would work with members of the Sanders family and why. Include expected goals and time frame for treatment, and the strategy and techniques you would employ in treating them. Be specific about how your plan could be suited to the needs of this family. Use only one theoretical approach (even though, of course, many are possible), and support your approach as the treatment of choice. (2/3 points)
4. Some would argue that there is a radical divergence between the family systems therapies and the more traditional individual psychotherapy approaches. Others would challenge this view, arguing that there are many points of similarity and that the differences are exaggerated. Take one position or the other and defend your stand.
5. Compare and contrast the strategic and structural approaches. Consider theoretical elegance; specificity of constructs, strategy, and technique; role of the therapist; and types of client problems best suited for each approach.
6. Compare and contrast the Bowenian and experiential approaches. Consider theoretical adequacy; specificity of constructs, strategy, and technique; role of the therapist; and types of client problems best suited for each approach.
7. A 37-year old woman who is unhappy with her marriage of 5 years is considering divorce and seeks consultation with you. She has lost 3 pregnancies in the past 3 years. Her 45-year-old husband avoids sex, even though he states he is “not unwilling” to have a child. He is not interested in psychotherapy but might be willing to come in once or twice to see what it’s like.
Discuss how you would approach this case from a systems framework. Be specific about your rationale, the theoretical constructs you would employ, and the recommendation you would give her. Recommend only one approach (even though of course many are possible), and support your approach as the treatment of choice.
8. Which schools of family therapy rely most heavily on paradox? Describe two types of paradoxical techniques. What type of families and family problems might best be treated with these techniques? Discuss the problems associated with the use of paradoxical techniques in treating families.
9. Explain the goals for an initial telephone contact with a family member, from a family therapy perspective. How might a family therapist attempt to convert a request for individual therapy into a family case?
10. Why and how should a family’s ethnic culture be considered in assessment and treatment? (Pick at least one ethnic minority culture discussed in class and use the Sanders case- #3 above- on which to base your answers.) Be specific and thorough in your answer.
11. Give three examples of presenting problems that should be viewed (i.e., conceptualized) differently if expressed by a middle-income heterosexual couple and their family versus a middle-income gay or lesbian couple and their family. Explain your reasoning. Be specific and provide examples to support your answer.
12. Choose one family therapy approach described in this text and critique it from a feminist perspective. Discuss theoretical constructs, strategies and techniques, and role of the therapist.
13. List and give an example of at least four of Eron and Lund’s guidelines for managing helpful conversations within their narrative solutions approach.
14. What’s new about Jacobson and Christensen’s integrative couple therapy? How does the approach differ from traditional behavioral couples therapy?
15. Discuss at least three similarities between integrative couple therapy and Bowen family systems therapy.
16. Describe and give examples of how communication training is used in integrative couple therapy.
Chapter 15
Research on Family Intervention
Short Answer/Essay
1. Discuss some of the difficulties encountered in researching the process and outcome of family therapy. Consider samples, instruments, designs, ethics, etc.
2. Choose one of the following theoretical concepts. Define the concept, then describe an original research program (one or more studies) that you believe would confirm or disconfirm the validity of the concept for understanding families or family therapy. (For example: “If x is correct, than one should expect x to predict y in the following situations and x to be independent of y in the following situations.”) Include: rationale for the study, operational definitions/measurement of variables, description of the sample, hypotheses, and limitations.
a. Differentiation of self
b. Therapeutic double bind
c. Enmeshment/disengagement
d. Triangles
e. Homeostatis
f. Functionalism
g. Pseudomutuality
h. Multigenerational transmission of psychopathology
3. Does family therapy work? Take a position for or against and cite empirical support for your position.
4. What do we know about the process of family therapy? Base your answer on the available empirical evidence regarding the process of family therapy. Discuss what is not yet understood about the mechanisms of change in family treatment and suggest 2 or 3 directions for future research.
5. Discuss the empirical evidence supporting the effectiveness of family treatment. For which family problems has it been shown most effective? For which problems is it less effective? Cite relevant research in your responses.
6. Explain the goals for an initial telephone contact with a family member, from a family therapy perspective. How might a family therapist attempt to convert a request for individual therapy into a family case? Cite relevant research and theory to support your answer.
7. Discuss three types of empirically-supported family treatments for child behavioral disorders.
8. Describe an empirically-validated treatment for adolescent drug abuse.
9. Which types of couples generally do best in couples therapy?
Answer Key
Chapter 2
1. B
2. D
3. A
4. D
5. B
6. C
7. B
8. C
9. B
10. B
11. D
12. B
13. C
14. A
15. C
16. B
17. B
18. B
Chapter 3
1. D
2. B
3. A
4. D
5. B
6. A
7. D
Chapter 4
1. A
2. D
3. D
4. B
5. C
6. C
7. A
8. B
9. A
10. B
11. C
12. D
13. B
14. D
15. A
16. B
17. C
18. D
19. B
Chapter 5
1. E
2. D
3. B
4. C
5. C
6. D
7. B
8. A
9. D
10. B
11. B
12. C
13. D
14. B
15. D
16. A
17. D
18. A
19. D
Chapter 6
1. E
2. E
3. D
4. D
5. A
6. B
7. C
8. A
9. D
10. A
11. A
12. A
13. B
14. D
15. B
16. C
17. D
18. D
Chapter 7
1. D
2. B
3. B
4. A
5. D
6. D
7. B
8. D
9. A
10. A
11. B
12. D
13. B
14. D
15. A
16. D
17. B
18. D
Chapter 8
1. B
2. A
3. D
4. C
5. B
6. C
7. B
8. B
9. D
10. C
11. A
12. D
13. C
14. B
15. A
16. C
17. A
18. B
19. D
20. A
21. B
Chapter 9
1. C
2. D
3. E
4. A
5. C
6. A
7. B
8. D
9. A
10. B
11. C
12. D
13. C
14. D
15. A
16. D
17. A
18. B
Chapter 10
1. B
2. D
3. D
4. A
5. B
6. C
7. D
8. C
9. D
10. A
11. B
12. B
13. C
14. C
15. D
16. A
Chapter 11
1. D
2. A
3. D
4. B
5. D
6. C
7. D
8. D
9. B
10. A
11. A
12. B
13. C
14. D
15. B
16. D
17. B
18. A
19. C
20. B
21. A
22. D
23. D
Chapter 12
1. C
2. A
3. C
4. D
5. A
6. A
7. B
8. D
Chapter 13
1. A
2. B
3. C
4. C
5. A
6. D
7. D
8. A
9. D
10. B
11. D
12. C
13. A
14. D
15. A
16. B
Chapter 14
1. B
2. D
3. D
4. A
5. C
6. B
7. A
8. C
9. A
10. D
11. A
12. B
13. B
14. A
15. B
16. C
17. A
18. D
19. D
20. D
21. B
22. D
23. C
24. D
25. C
26. C
27. E
28. A
29. D
30. B
31. C
32. D
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