The Practice of Family Therapy Now in its fifth edition, T he Practice of Family Therapy comes at a time when traditional approaches to psychotherapy have given way to multidimensional strategies that best serve the needs of diverse groups who are grappling with the many challenges unique to family therapy practice. With expanded coverage of different models, along with new developments in evidence-based and postmodern practices, this integrative textbook bridges the gap between science and systemic/relational approaches, as it guides the reader through each stage of family therapy. Part I lays the groundwork by introducing the first-, second-, and third-generation models of family therapy, teaching the reader to integrate different elements from these models into a systemic structure of practice. Part II explores the practical application of these models, including scripts for specific interventions and rich case examples that highlight how to effectively work with diverse client populations. Students will learn how to make connections between individual symptoms and cutting-edge family practices to respond successfully to cases of substance abuse, trauma, grief, depression, suicide risk, violence, LGBTQ families, and severely mentally ill clients and their families. Also included are study guides for each model and a glossary to review main concepts. Aligned with the Association of Marital and Family Therapy Regulatory Boards’ (AMFTRB) knowledge and content statements, this textbook will be key reading for graduate students who are preparing for the national licensing exam in marriage and family therapy. Suzanne Midori Hanna, PhD, LMFT, is a licensed marriage and family therapist with over 30 years’ experience as a clinician, educator, and researcher. She is a clinical fellow and approved supervisor of the American Association for Marriage and Family Therapy (AAMFT) as well as an instructor in three graduate programs. She has also been a program developer, founding COAMFTE program director, and professor in Wisconsin, Kentucky, and California. Dr. Hanna is co-editor of The Aging Family , with Terry Hargrave, and author of The Transparent Brain in Couple and Family Therapy . The Practice of Family Therapy Key Elements Across Models Fifth Edition Suzanne Midori Hanna Fifth edition published 2019 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2019 Taylor & Francis The right of Suzanne Midori Hanna to be identified as author of this work has been asserted by her in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice : Product or corporate names may be trademarks or registered trademarks and are used only for identification and explanation without intent to infringe. Fourth edition published by Brooks/Cole, Cengage Learning 2007 Library of Congress Cataloging-in-Publication Data Names: Hanna, Suzanne Midori, 1950– author. Title: The practice of family therapy : key elements across models / Suzanne Midori Hanna. Description: Fifth edition. | New York : Routledge, 2019. Identifiers: LCCN 2018021017| ISBN 9781138484702 (hbk : alk. paper) | ISBN 9781138484719 (pbk : alk. paper) | ISBN 9781351051460 (ebk) Subjects: LCSH: Family psychotherapy. Classification: LCC RC488.5 .H337 2019 | DDC 616.89/156—dc23 LC record available at https://lccn.loc.gov/2018021017 ISBN: 978-1-138-48470-2 (hbk) ISBN: 978-1-138-48471-9 (pbk) ISBN: 978-1-351-05146-0 (ebk) Typeset in Joanna MT & Frutiger by Apex CoVantage, LLC To Masako, Joyce, Nori, Lisa, Todd, Mark, Clinton, Teruko, Junko, and Hiroki: In the midst of our generational detours, you helped me find my way back home. For your inspiration and love, domo arigato! Contents List of Figures, Tables, and Boxes xv List of Cases xvii Preface xviii Acknowledgments xxi List of Abbreviations xxii PART I How to Think Systemically 1 1 Family Therapy: The Interpersonal View 3 Prologue 4 What Is Family Therapy? 5 The Interpersonal View: Family Process, Cybernetics, and Social Ecology 6 How Did It Begin? From Freud to Minuchin 9 Why Are There So Many Models? 13 Overview of First-Generation Family Therapy 14 Structural Family Therapy 15 Organization 15 Power 16 Interactional Sequences 16 Hypotheses 16 Strategic Family Therapy 16 Systemic Meaning of Symptoms 17 Hierarchy 17 Hypotheses 17 Mental Research Institute (MRI) Model 18 Communication and Behavior 18 Anxiety 19 Hypotheses 19 Behavioral Family Therapy 19 Sequences and Reinforcements 20 Coercion Theory 20 Hypotheses 20 Psychodynamic Family Therapy 20 Past Is in the Present 21 Subjective Experience 21 Object Relations 22 Attachment 22 Hypotheses 23 viii CONTENTS Bowenian Family Therapy 23 Natural Systems 24 Eight Interlocking Concepts 24 Hypotheses 25 Contextual Family Therapy 25 Relational Ethics 26 Ledger System 26 Hypotheses 27 Experiential Family Therapy 27 The Satir Method 28 Carl Whitaker 28 Human Growth and Development 29 Hypotheses 29 So, Where Do I Start? Toward Integration 30 Organization 31 Problem-Solving 31 Emotional Climate 31 First Steps 31 Summary 32 2 The Postmodern Era and Integration 36 Constructivism and Social Construction 38 Impact of Diversity 39 Major Mental Illness and the Recovery Movement 40 Second Generation: 1970–2000 41 Solution-Focused Family Therapy 41 Narrative Family Therapy 44 Applications 49 Emotionally Focused Couple Therapy 50 Cognitive-Behavioral Couple Therapy 51 Multidimensional Family Therapy 54 Multisystemic Therapy 55 Multifamily Groups for Schizophrenia 57 M FGs and Sandy Hook 60 Applications 62 Third-Generation Emphasis on Special Populations: 2000–Present 65 Oppositional Defi ant Children and Adolescents 65 Depressed and Suicidal Youth 67 Military Personnel 68 Trauma Survivors 69 Importance of Screening 70 Trauma-Sensitive Family Therapy 71 Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) Families 73 Summary 75 3 Integration of Theory: Common Themes 79 Gender 82 Gender Politics and Family Therapy 83 Empowerment for Men 83 CONTENTS ix Empowerment for Women 84 Gender Balance 86 How to Focus on Gender 86 Race and Culture 88 Black Families 89 Just Therapy: The Therapy of Social Justice 90 Belonging 91 Sacredness 91 Justice 91 Simplicity 91 Liberation 92 Mrs. Obutu: An Immigrant’s Dilemma 92 How to Focus on Race and Culture 93 Intergenerational Relationships 95 Development in Adulthood 95 Symptoms in Context 96 How to Focus on Intergenerational Relationships 98 Transitions and Development 100 Normative Changes 101 Adolescence 102 Midlife 102 Later Life 102 Divorce or Remarriage 105 Nonnormative Changes 106 Military Service 106 Out-of-Home Placements 107 How to Focus on Transitions and Development 107 Family Structure 108 Parent Engagement 109 How to Focus on Family Structure 110 Individual Experience 113 Attachment 115 Fairness and Entitlement 115 Belonging and Identity 116 Personal Authority and Interdependence 116 Self-Esteem and Self-Acceptance 116 H ow to Focus on Individual Experience 117 Cup of Coffee Intervention 117 Tracking Personal Growth 117 Awareness Wheel 118 Reframing Anger 121 Summary 121 4 Integration of Practice: Common Factors 123 Client Attributes and Extratherapeutic Factors, 40% 125 Honor the Client’s Worldview 125 R eframe Resistance 126 Stages of Change 127 Motivational Interviewing 129