 John called the therapist for his ongoing sexual problems

with his wife Melissa. The couple has been married for 3
years and have a 1 year old son. John said to the therapist
that their sex life worsened after the birth of their son.
 Melissa: If you made me feel loved, I would then have sex
with you. But, I feel like you don’t love me and that you have
changed.
 John: If you look like how you used to and had sex with me,
maybe then, it would be easier for me to want to be
affectionate towards you. But all you care about is our son.
 Melissa: No, that’s not true, and do not talk to me in that
tone!
 At this point, the room is filled with hostility and anger, and
the therapist starts wondering “is it too late to see them each
individually?”
 Family has been left out of the therapy room
till 1950s. WHY?
 Freud’s psychodynamic therapy
◦ Interested in family as remembered
◦ Mainly focuses on intrapsychic issues
 Carl Rogers’ client-centered therapy
◦ Self-actualization
 Developmental Psychology
◦ Strong focus on the individual across the lifespan
 Emphasis on the individual
◦ Mental illness is believed to be in the individual’s
mind
◦ DSM-IV Diagnostic Manual
 Dominant forces in our lives are externally
located
 50% of all problems brought to counselors
are related to marriage and family issues
 Changing the family structure changes the
life of each of its members
 The whole is bigger than the sum of its parts
 Seeing the family as more than a collection of
its members
 Individual behavior does not occur in
isolation but is embedded in the broader
family context
 Individual’s symptomatic behavior is seen as
an outcome of family interactions and not as
the result of individual dynamics.
 So, then if John is suffering from depression,
how would a individual therapist vs. family
therapist look at his depression?
 Family is the entity of focus
 Family seeks stability (homoeostasis)
 In the face of environmental changes, family
changes its structure
 Q: what are some of the environmental
changes that occur that changes the family?
 1950’s
 Group of psychiatrists studying
schizophrenia: Don Jackson, Gregory Bateson
and Jay Hayley at the Mental Health Research
Institute in Palo Alto, CA
 Murray Bowen at the National Institute of
Mental Health
 2 main observations were made
◦ When a patient got better, someone else in the
family got worse almost as if the family needed
someone to be sick – The opposite is also true
◦ Patients often improved in the hospital only to get
worse when they went back home
 They challenged the idea that schizophrenia
is simply a biological disease
 Can schizophrenia be a byproduct of
communication pathology?
 Double binds and communication pathology
◦ Father to son:
 “Always stand up for your rights, no matter who, no
matter what. AND
 “ Never question my authority, I am your father and
what I say goes”
 Two or more persons are in an important
relationship
 Repeated experience
 Overall experience: "I must do it, but I can't
do it"
 Patient put arm around mom
 She stiffens but then when he withdraws:
“don’t you love me anymore”
 He blushes
 She says: “You shouldn’t be so easily
embarrassed to show your feelings”
 Teacher to students
 “I want you to participate in class”
 When there is participation, teacher gets
impatient and interrupts them
 “Does anyone have questions?”
 When no one responds “Students are so
passive!”
 An atmosphere maintained by family members in
which surface harmony hide deep and destructive
intrapsychic and interpersonal conflicts.
 The family acts as if it is close and happy when in
fact it is not.
◦ For example: In alcoholic families:
 Heroes: pick up responsibility,
parentified
 Scapegoat: Respond to negative
environment, they become losers
 Report vs. Command
 Every message has a stated content and
 How it needs to be done
◦ Metacommunication
 Wife yells at husband for doing the dishes
 He says he will do it and doesn’t
 What is the report? What is the command?
 Content vs. Process
 Wife: “Do the dishes”
 Husband: “Don’t tell me what to do?”
 Wife: “Maybe if you were more responsible, I
wouldn’t have to”
 Husband: “I am out of here”
 1930’s First professional centers for marriage
counseling were established in LA, NY and
Philadelphia.
 1948: First publication on marital therapy by
Bela Mittleman
◦ She determined that spouses can be treated by same
analyst
◦ It is possible to reexamine couples’ irrational perceptions
of each other.
◦ The couple's reactions to each other may stem from their
relationships with their parents.
 Marriage counseling was absorbed/included
into the family therapy movement.
 Marriage seen as a subsystem of the family
that needs to be treated.
 For this course:
 Marital therapy family therapy
 1942: American Association of Marriage and
Family Therapy was established.
 www.aamft.org
 AAMFT today has more than 27,000
members, 1500 training programs