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Establishing the Parental Hierarchy: An Integration of Milan Systemic and Structural Family Therapy

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  • Insite Therapy and Consulting

Abstract

Children do best when the relationship they have with their parents provides them with an appropriate balance of warmth and control. in responding to the needs of a symptomatic or problem child. This chapter draws on: • Minuchin’s Structural Family Therapy and Haley’s Strategic Family Therapy to understand family structure; • The Milan Systemic Approach to explore family relationships; • The structural technique of ‘enactment’ to facilitate change. Using a detailed case discussion, we illustrate how a therapist can help parents respond ‘authoritatively’ to a child with behavioural difficulties.
‘Working with Families: A Practical Guide
1
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
Ch. 5 Establishing the Parental Hierarchy: An Integration of Milan Systemic and
Structural Family Therapy
Kerrie James & Laurie MacKinnon
A. Rationale
Children do best when the relationship they have with their parents provides them with
an appropriate balance of warmth and control. in responding to the needs of a
symptomatic or problem child. This chapter draws on:
Minuchin’s Structural Family Therapy and Haley’s Strategic Family Therapy to
understand family structure;
The Milan Systemic Approach to explore family relationships;
The structural technique of ‘enactment’ to facilitate change.
Using a detailed case discussion, we illustrate how a therapist can help parents respond
‘authoritatively’ to a child with behavioural difficulties.
B. Theory into Practice
The concept of ‘family structure’ has been controversial within the field of family
therapy. In the 1970’s and 1980’s, Minuchin and Haley conceptualized family
relationships in terms of ‘family structure’ describing how problems in family structure
i.e. triangles, hierarchy and enmeshed or disengaged sub-systems, contributed to
symptoms and problems of children and adults (Minuchin, 1974; Haley, 1987). 1In the
1990’s, newer ‘second order’ approaches underpinned by social constructionist ideas,
notably the Milan systemic and the Narrative approaches, challenged the notion of family
structure and its normative implications (Levy, 2006) instead emphasizing individual
1 Both Haley’s ‘Strategic Therapy’ and Minuchin’s ‘Structural Family Therapy’ refer to dyadic and triadic
patterns in families, therefore both approaches posit that family’s have ‘structure’.
‘Working with Families: A Practical Guide
2
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
experience, narratives and the construction of meaning. (Goldenberg & Goldenberg,
2008)
While debates flourished within family therapy, family researchers were identifying
family characteristics that correlated with optimal functioning in children, providing
empirical evidence for parenting characteristics that correlated with children’s
internalizing and externalizing problems and for the structural concepts of ‘hierarchy’
and ‘triangulation’. Researchers found that children who had ‘authoritative’ parents
(showing a combination of warmth, control and tolerance) fared better academically, had
fewer conduct problems and were less anxious and depressed. On the other hand,
children who had parents who were ‘authoritarian’, ‘indulgent’ or ‘uninvolved’ fared less
well (Baumrind, 1978; Fletcher, 1999). The importance of having an ‘authoritative’
parent was, in fact, found to be so strong, that researchers concluded that have one
authoritative parent was more important to a child than having two parents who were
consistent but not authoritative (Fletcher, et.al. 1999).
While it might be tempting to conclude that cooperation between parents is therefore
unnecessary, it is important to note that family researchers also found significant
empirical support for a correlation between unclear hierarchies; cross-generational
coalitions and children’s conduct problems (see Shaw, et. al. 2004; Baumrind, 1978;
Greenspan, 2006; Sells, 1998; Diamond & Liddle, 1999). Perhaps it is not possible for
one parent to remain authoritative if the other is actively undermining their efforts.
Structural Family Therapy originated with the work of Salvador Minuchin in the 1960’s
and 1970’s. Jay Haley was an early contributor to the development of Structural Family
Therapy, while his later work, known as Strategic Family Therapy, retained many
structural concepts. Both approaches conceptualized family interactions in terms of
power and hierarchy (Minuchin, 1974; Minuchin, et. al. 1967; Minuchin et.al 1978;
Minuchin & Fishman, 1981; Minuchin & Nichols, 1993; Minuchin, Lee, Simon, 1996;
Haley, 1986, 1987, 2003).
‘Working with Families: A Practical Guide
3
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
The Milan Systemic approach grew from the team work of four psychoanalysts in Milan,
Italy during the 1970’s. Their work was shaped by the systemic ideas emerging from
Gregory Bateson and the Mental Research Institute in the USA and they became known
for their style of questioning, rigorous systemic conceptualization and paradoxical end of
session interventions. The Milan approach was introduced to English speaking countries
with the publication of Paradox and Counter Paradox (Selvini-Palazzoli et.al.1978) and
their seminal paper: Hypothesizing, Circularity and Neutrality: Three Guidelines for the
Conductor of the Session (Selvini-Palazzoli et.al.1980). When the group subsequently
split and went in different directions, Selvini-Palazzoli and Prata began research into
family functioning and Boscolo and Checcin further developed the model of therapy and
travelled internationally teaching their approach (Selvini-Palazzoli, 1986; Pirrotta, S.
1984; Boscolo, Checcin, Hoffman and Penn, 1987; Tomm, 1984; Boscolo and Checcin,
1982).
Structural/Strategic family therapy and the Milan systemic approach are often regarded as
occupying opposite ends on the continuum of family therapy practices. In the literature
there is little evidence of other therapists attempting to integrate these approaches. We
appear to be unusual in our commitment to drawing from both in helping parents work
more authoritatively and more effectively as a team. Specifically, from the Milan
approach, we use hypothesizing and circular questions to explore relationships and
release information into the system. From Structural/Strategic family therapy, we
conceptualize relationships in terms of coalitions and hierarchical patterns in the family
and use the Structural technique of enactment to create change in relationships during the
session.
During our training in family therapy in the late 1970s, we had the opportunity to learn
Structural Family Therapy with George Enns from Saskatoon, who had spent several
years with Minuchin at the Philadelphia Child Guidance Clinic. A few years later, we
taught Structural and Strategic approaches in Sydney, Australia, mentored by Structural
‘Working with Families: A Practical Guide
4
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
Family Therapist and writer, Doug Breunlin. (Breunlin, et. al. 1997; James &
MacKinnon, 1986).
In the early 1980’s, Laurie returned to work at the Family Therapy Program, University
of Calgary, which at that time specialized in Milan approach and frequently hosted
Boscolo and Checcin (Tomm, 1984, 1987A, 1987B, 1988). Having immersed herself in
both Structural/Strategic approaches and then the Milan approach, Laurie became clear
about two things. Firstly, although the Milan approach was commonly considered a
"strategic" approach, Laurie argued that this view was mistaken for a number of reasons
including that the Milan approach differed from Strategic family therapy in not
conceptualizing family relationships in terms of hierarchy and in the therapist’s neutral
stance (MacKinnon, L. 1983).
Secondly, that while helpful for children with "internalizing" symptoms such as anxiety,
depression and psychosis, in Laurie’s experience, the Milan approach in its purest form
was significantly less successful with "externalizing" symptoms such as children's acting
out behavior problems (MacKinnon, et. al 1984). The elegant questioning process of the
Milan approach and the therapist’s neutral stance failed to empower parents to take
charge of children who were ‘ruling the roost’. This was a serious limitation for us as
family therapists given that a large proportion of our work involved children whose
behavior was out of control at home and at school.
In 1985, Laurie returned to Australia and she introduced the Milan Systemic approach to
organisations training family therapists in Sydney. In response to her own criticisms of
the Milan approach, however, Milan as we developed and taught it differed from its
originators in three important respects (MacKinnon & Miller, 1987). Firstly, in our work
we took into account the role of broader systemic issues such as the social context of
gender, class, ethnicity and the issue of violence and abuse (MacKinnon, 1998; James &
McIntyre, 1983; James, 1984; 2007). Secondly, we emphasized the importance of
therapist warmth in the therapist - client relationship. Thirdly, and most significantly for
the purposes of this paper, we continued to draw from the structural concepts of
‘hierarchy’ and ‘coalitions’. Because of these differences, we considered ourselves to be
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
‘Post Milan’ a term used by a number of family therapists who modified and developed
the Milan approach in their own contexts (see Jones, 1998). In this paper we illustrate
how structural concepts and the technique of enactment and Milan questioning can be
integrated to help parents become an authoritative team.
Selected Structural Ideas and Interventions
Hierarchy and coalitions Haley defined ‘hierarchy’ as family members’ different levels
of power and status conferred by generation, income, or other valued attributes. A
‘confused’ or ‘unclear’ hierarchy is one in which the ‘status positions are ambiguous as a
result of one member at one level of the hierarchy forming a coalition with against a peer
with a member at another level’ (Haley, 1987 p.110). A hierarchy is inferred by
observing the behaviour between family members: a parent asks a child to do something,
the child refuses and the parent withdraws; a children does not show respect and does not
obey a parent; one parent supports a child in disobeying the other parent; a child looks
after or dominates a parent.
Complementarity and ‘soft/hard’ splits In dyadic relationships, partners can fit together
as two opposites as if in a mold that shapes their interactions (Minuchin & Nichols, 1993)
such as in the complementary patterns of dominance-submission and over-functioning -
under-functioning. As parents, a complementary pattern is often manifested as a
‘soft/hard’ split.
When a child’s behaviour is oppositional, there may be extreme differences between the
parents often taking the form of a ‘soft/hard’ split where one parent’s ‘softness’ elicits the
‘toughness’ of the other parent in a reciprocal manner. Perceiving support from the ‘soft’
parent, the child escalates the negative behavior. The ‘tough’ parent, feeling isolated and
on the outside of the triangle, increases their critical or controlling behaviour, which in
turn further elicits the softer parent taking the side of the child. The ‘soft’ parent
disagrees with the ‘hard’ parent but is either afraid of or unsuccessful in challenging the
other parent, perhaps even angry at the ‘hard’ parent, and using the coalition with the
child to undermine him or her. Looking at it in another way, the structure of these family
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
relationships is that of a confused hierarchy and interventions to increase parental
consistency and promote authoritative parenting are warranted.
We are not referring to ‘softness’ and ‘toughness’ as primarily individual personality
characteristics but as tendencies or traits that are elicited and reinforced by the effect on
the parent of responding to the child’s behavior over a considerable time period, the
parent being undermined by the other parent and concurrent actual or avoided marital
conflict (Takeuchi & Takeuchi, 2008).
Structural enactment An enactment is an intervention in the session where the therapist
instructs two or more family members to interact, enabling the therapist to see the
‘family dance’, elicit or coach new behaviours and shift negative relationship patterns
(Minuchin & Fishman, 1981; Nichols & Fellenberg, 2000). Therapists can use
enactments to support and coach parents to discuss and resolve difficult parenting and
marital issues.
In setting up an enactment, the therapists explains the purpose of the enactment, specifies
the specific content and organizes the physical space so that the partners are sitting close
together, able to maintain eye contact. The therapist sits back, avoids eye contact and
stays out of the interaction until it seems useful or necessary to interrupt an evolving
negative interaction. The therapist makes brief, specific and process oriented comments
to help the couple stay on track, avoid interruptions and maintain the content focus. When
the couple have finished the dialogue, the therapist reviews with them the process of what
has occurred, helping them notice what they did well and learn from what they did not do
well (Davis and Butler 2004; Butler, Davis & Seedall 2008; Nichols & Fellenberg 2000;)
The therapist’s directive style in creating enactment contrasts with the therapist’s more
neutral and impartial position in the Milan approach.
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
Selected Milan Ideas and Interventions
As originally defined by the Milan team, an hypothesis is the therapist’s formulation
..based upon the information he (sic) possesses regarding the family he is interviewing.
The hypothesis establishes a starting point for his investigation as well as his verification
of the validity of this hypothesis…’ (Selvini-Palazzoli, et. al. 1980, p.4) Hypotheses are
‘more or less useful’ and if disconfirmed, new hypotheses are developed as the therapy
progresses (ibid, p. 4).
Circularity is the capacity of the therapist to conduct his (sic) investigation on the basis
of feedback from the family in response to the information he solicits about relationships
and, therefore, about difference and change.” (ibid. p. 8). To solicit information about
relationships, the therapist uses circular questions which ask one person about the
interaction or relationship between two or more others (MacKinnon, 1988; Tomm,
1987B; 1988; Brown, 1997A; 1997B.).
In this questioning process, the therapist maintains a neutral stance, balancing family
members’ participation in the session and remaining impartial but curious about each
person’s perspective. Neutrality is the ‘pragmatic effect… (the therapist’s) total
behaviour.. has on the family… not his intrapsychic disposition(Selvini-Palazzoli, et.
al., 1980, p.11)2.
The Milan session consists of a pre-session, the session, the intervention and the post-
session. In this paper we focus on pre-session hypothesizing. Structural family therapists
do not hypothesize in a deliberate way as the therapist gathers information in the session
by interacting with family members. The benefits of pre-session hypothesizing include:
- the therapist having clear hypotheses about family relationships in order to guide
his or her questions during the session
- the therapist retaining flexibility in conceptualizing the family, thus avoiding
‘marrying the hypothesis’
- the therapist preparing for the session, thus maximizing the opportunities
2 In response to criticism that therapists cannot and should not always be ‘neutral’ Cecchin introduced
‘curiosity’ as a more accurate depiction of the therapist’s stance (Cecchin, 1987; Cecchin et. al. 1992).
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
presented within each session and not overlooking important areas.
C. Application
Before meeting with the family for the first time, the therapist, using basic genogram
information, hypothesizes about boundaries, triangles, coalitions and hierarchy, asking
questions such as:
What do the ages of family members tell us about their individual and family life
stages?
Given their life stage, what would we expect of the relationships between parents
and children, between the father and mother, between this family and the parents'
families of origin?
How closely involved or autonomous are family members likely to be?
Is there anything special or unusual about the number of children, the spread in
ages between the children, the difference in age between the parents or between
the parents and children?
What might be the impact of events on the family such as job loss, disability,
illness, loss, separation and divorce or death?
What sense do we make of why this family would have this problem at this time?
D. Case example
The therapist received the following intake information.
The mother phoned for an appointment3. She was in her early 50s, worked full time as a
beautician. The father, in his 60s had worked for many years in a struggling small
business. Four children ranged in age from 13 to 26 with an age gap of eight years
between the 13 year-old girl and the next eldest. The two eldest children, a male and a
female, were not living at home. The maternal grandmother, in her 80s, had a terminal
illness. The presenting problem was the behaviour of the 13-year-old girl, Sophie, who
3 This case is a compilation of several cases. Any similarity to actual families is coincidental. The transcript
is continued in Chapter 6.
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
was failing school, truanting and charged with stealing from a shop. The therapist noted
that the family had an Italian surname.
Pre-session - Hypothesizing
In the pre-session, the therapist drew on her understanding of individual and family
development to formulate structural and systemic hypotheses about family relationships
which would guide her questioning in the session to follow.
From the intake and genogram information, the therapist and her team speculated about:
Cultural stereotypes. Italian families often have close relationships, greater
emotional expression and, under stress, emotional volatility. They often privilege
male children.
Life stage, noting the age difference between the parents. The father may be
nearing retirement and the mother may still see herself as relatively young. How
much do they have in common at this stage of their lives? How able are they to
cooperate in setting and following through with clear limits?
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
Sibling position, noting a significant age difference between 13 year old Sophie
and her sibling, her position being more like that of a single child. Perhaps the
parents did not expect to have their last child. Are they tired of parenting, giving
up on having authority? Is one or are both parents softer with Sophie or treat her
as special because she is the youngest of the children, “the baby”? Is Sophie
closer to one parent than to the other?
Issues of loss and change noting that the older children have moved away. This is
likely a loss for one or both parents, perhaps more for the mother. Perhaps it is
also a loss for Sophie who may have tried to fill this gap by either a coalition with
one parent or, alternatively, by investing in her peer network and pulling away
from the family.
Family life cycle, noting the illness of the maternal grandmother. The mother may
be facing the anticipatory loss and current demands of caring for her own mother.
If she is preoccupied, who feels her absence most acutely, her husband or her
young daughter? Who do they turn to fill the absence?
The nature of the presenting problem noting that it is an "externalizing" rather
than "internalizing" problem. This suggests a lack of consistent rules and
boundaries and the likelihood that there is a coalition with a "soft" parent. A
"soft" parent often perceives the other parent as too harsh and is trying to
compensate. Perhaps the father, hurt and angry at his wife's preoccupation, is the
soft one who turns to his daughter. Perhaps the mother is the soft one, left feeling
overwhelmed with loss and family responsibilities and unsupported. Perhaps
there is a shifting coalition with both parents, the girl intermittently receiving
support for her misbehavior from each parent.
The role of the older siblings. Perhaps one of them sides with Sophie against her
parents, enabling her misbehavior. Alternatively, one of the siblings may have
become ‘parentified’, trying to take on the parent’s role of disciplining Sophie.
The involvement of larger systems. The family would have had news from the
school and the police about the girl’s behavior. Perhaps they sided with the girl
against the outsiders, forming a coalition that allows the girl’s misbehavior.
‘Working with Families: A Practical Guide
11
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
Alternatively, the parents may have felt criticized by the outsiders and has this
decreased their confidence and effectiveness in setting limits for their daughter.
With these ideas in mind, the therapist began the first session with the family, curious to
find out which of these ideas would find support as the interview unfolded.
Observing the family process as it unfolds in the room.
As the family entered the room and sat down, the therapist took note of their spontaneous
interactions - everyone talked at once and there was laughter. When they sat down, the
father made a point of sitting beside the mother. The 13-year-old, Sophie, then moved to
sit on the other side of the father, while the older 21-year-old son, Peter, sat in a chair
next to the mother.
When the therapist asked about their concerns, the father took the lead, expressing
concern for his daughter’s "mental health", mentioning that in his own large extended
family they were others with mental health problems. The therapist noted that he framed
the problem as involuntary and internal to the daughter.
The 21-year-old brother, his tone angry and critical, interrupted the father, "You let her
get away with murder. You never let us get away with anything. I wasn't out past 10 until
I was 18".
When it was the mother’s turn to speak, her voice was hard, "Sophie has embarrassed and
humiliated us. Our older children were never like this. We've tried everything and I'm at
my wits end".
Sophie glared at her mother: "You hate me, don't you? You wish I'd never been born".
As the mother and Sophie began arguing, the father interrupted the mother, telling her not
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
to get worked up, and then turned to Sophie, his voice softer, "Don't get like that now.
We’re here to help you. You know we love you". He turned to the therapist and said,
"She's very upset. She has had a lot of trouble sleeping at night".
As the interview progressed, the therapist asked about the problem that brought them to
therapy. While the parents described the problems with Sophie, the father mentioned that
the mother was too harsh while the mother described how the father made excuses for
Sophie, releasing her from consequences and talking to Sophie behind her back about the
mother's moodiness.
In these opening minutes, the behavior of family members already revealed a great deal.
On the positive side, there was warmth, a sense of connection, and all family members
seemed able to speak openly. There was evidence of complementary pattern, a ‘hard –
soft’ split between the parents, and the possibility that the father was in a coalition with
the daughter against the mother. The hierarchy was unclear – Sophie challenged her
mother as though they were peers.
The triangle of mother, father and daughter could be conceptualized as a cross-
generational coalition, with the father and daughter aligned against the mother. The
therapist wondered if there was also a coalition between the older brother and the mother
against Sophie.
Scanning the Relationship Web
Using circular questions, asking one person about the relationship between two others,
the therapist asked a series of overlapping questions using a technique we have called the
relationship scan. The relationships scan maps the intensity of dyadic relationship bonds,
and compares one relationship to another. The relationship scan gives an indication of
key triangles of who is most central and who is most peripheral in family relationships.
‘Working with Families: A Practical Guide
13
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
Scan of dyadic relationships.
The therapist asked Peter, the brother, "How do you see the relationship between your
father and Sophie?"
"Quite close”, Peter said. “She’s always been the baby. He favours her over the rest of
us".
"If you gave their relationship a rating out of 10, 10 being the highest what number would
you give them?"
“Probably an eight. They’re close”, he said.
The therapist then asked the mother a similar set of questions about the father – Sophie
relationship and she said that also saw them as close, giving them a 7.
"How do you see the relationship between your mother and Sophie?" therapist asked
Peter.
“They used to close be when she was little but it's changed since she started high
school”, he said.
"What number would you give their relationship?”
“Now it's about a four".
The therapist then asked the father the same set of questions about the mother – Sophie
relationship and he gave ther relationship a 2, saying, ‘They argue all the time’.
"How would you compare your father and Sophie’s relationship with your mother and
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
Sophie’s relationship?” the therapist asked Peter.
"The big difference is that Sophie and Dad don't argue that much because Dad gives into
her”, said Peter. “And they talk more. With Mum, Sophie is rude back. She answers back
and really stresses Mum”.
The therapist then asked Sophie questions about the relationship between Peter and each
of his parents.
"Dad and Peter argue a lot”, said Sophie. “Peter says he's too old for Dad to be telling
him what to do". She rated the relationship a 5. On the other hand, she said that Peter and
his mother were “Much closer, a nine. He always takes her side. Even against Dad".
When the therapist asked the mother about the father – Peter relationship, she gave the
relationship a 4, describing how Peter would often avoid his father who tended to
criticize him. In contrast, the father described the mother Peter relationship as very close,
8 out of 10.
The therapist then asked the each parent about how they perceived the relationship
between Sophie and each of her older siblings.
‘Sophie doesn’t have much to do with them since they moved away from home” said the
mother, “but she used to be quite close to her sister who doted on her when she was little.
They used to be a 9/10 but now it's probably only a five".
When the therapist asked about the relationship between Peter and Sophie, the mother
said "About a five. They don't have a lot to do with each other now that Peter is working
and has a girlfriend".
"More like a three”, said the father. “Peter used to be kinder, like a big brother should be.
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
Now he’s critical and bossy and Sophie hates it. I wish he would spend more time with
her and talked to her more".
"Why would I want to talk to him?" Sophie interrupted and sneered, tears welling up.
“How do you see your relationship with Peter?” asked the therapist.
“ I don’t want to talk about him. Alright?” , Sophie said, turning her face away.
The therapist asked Peter and then Sophie: "How do you see the relationship between
your mom and dad?"
Peter shrugged, "All right. Maybe a 5".
“A six”, said Sophie.”They argue but like don’t most parents argue?”
“What do you see your parents arguing about, Sophie?”
"Me mostly. Sometimes about Nana and how much time Mum spends over there ".
The therapist then asked Sophie and Peter, "When you compare your parents’
relationship to other parents you know, say your friends’ parents or your cousins’ parents,
how do you see their relationship?"
Sophie rolled her eyes and said, “ How would I know? I don’t have anything to do with
my friends parents”.
"In some ways they're closer”, said Peter. “Dad sticks up for Mom. But they do argue
more than other parents do".
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
The mother explained that her own mother was ill with cancer and her health had been
failing in the last year. Tearing up, she said that three years ago her father, the
grandfather, had died suddenly of a stroke leaving the grandmother bereft. As her only
daughter, it was now up to her support and care for the grandmother.
The therapist explored relationships in the family prior to the onset of Sophie’s problems
and before the death of the grandfather. They described the mother -- Sophie relationship
as much closer at that time, Peter less close to the mother, and the parents arguing less.
Sophie's older siblings had lived at home then and the older sister had had a particularly
close relationship with the mother.
The therapist wondered about the effect of the grandfather's death and the grandmother's
illness on both the mother's well-being and on her emotional availability to Sophie. She
knew it would be important to assess whether or not the mother was depressed and the
degree to which the father was supporting her through this difficult time. She was
concerned that if she were to ask these questions in the whole family session that the
mother might not be completely open or might resent being exposed in front of her
children. The therapist decided to wait and assess the mother for depression when she
saw the parents alone.
Comparing and ranking dyadic relationships.
The therapist then asked relationship questions comparing one relationship to another,
and ultimately to rank order them in terms of closeness.
First she asked Sophie, "Of all the relationships in the family living at home now, which
relationship would you say is the closest?”
"Peter and Mum", said Sophie.
‘Working with Families: A Practical Guide
17
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
“And then which relationship?"
"Dad and Mum".
“And then?” asked the therapist.
"Dad and Peter"
“And then?”
"Dad and me"
“And who after you and your Dad?”
"Me and Mum and very last of all me and Peter".
Except for the father who challenged the notion that Peter was closer to the mother than
he himself, family members agreed on the following ranking of relationships from closest
(top) to the most distance:
Mother and Peter
Mother and Father
Father and Peter
Father and Sophie
Mother and Sophie
Peter and Sophie
The therapist then asked Sophie where her older siblings fit into this picture. Other family
members were asked similar questions to rank order the relationships. Compiling the
multiple layers of their answers, the therapist developed her own picture of the
‘Working with Families: A Practical Guide
18
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
relationship bonds within the family. She seemed to have a distant and conflictual
relationship with Peter and to be isolated from her other siblings. Once, before her
grandmother’s illness, Sophie and her mother had been close, now Sophie seemed least
connected to her mother. She had a closer relationship with her father, but this
relationship was not nearly as close as the relationship between Peter and the mother or
even between the mother and the siblings who had left home. Sophie was “low man on
the totem pole”, the least important or lowest-ranking person in the family, who had to
answer to everyone above her.
At this point, the therapist conceptualized the key triangles as follows:
Mother, father and Sophie in which the father and Sophie are in a coalition
against the mother. This could even be a shifting coalition, with the father
sometimes siding with the mother against Sophie.
Mother, Peter and Sophie in which the mother and son are in a coalition against
Sophie
Grandmother, mother and father in which the father is on the outer.
Exploring complementarity, hierarchy and control
To explore the dimension of hierarchy and control in the relationship between Sophie, her
mother, father and brother, the therapist explored each of these relationships using the
metaphor of "boss" and "friend".
To introduce this idea, the therapist spoke first to the father, saying, “The relationship
between children and parents is in some ways like that of friends - sharing special
moments, talking, having fun together, and in other ways more like a boss -- employee
relationship where the parent must lead with directions and the young person must follow
those directions. That tends to change over time as young people become more their own
boss, making their own decisions and taking responsibility for themselves. When you
look at the relationship between Sophie and her mother currently, what percentage is
Anna a friend to Sophie and what percentage a boss?”
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
“There isn't much friend, right now”, said the father. “Maybe 10% friend, 90% boss.”
“I see. And right now, given Sophie's age and stage in life, what would you think would
be ideal percentage boss - friend in her relationship with her mother?”
“I'd say 70% friend, 30% boss”.
The therapist asked the mother, “How do you see your relationship with Sophie in terms
of boss, friend?”
“I guess we are not friends right now. But I’m not much of a boss either”, she said. “I try
but I can’t get her to do anything. Probably 90% boss and only 10% friend. That's not
because that's how I want it to be. She pulled away from me and so it doesn't leave a lot
of room for being friends left.”
“What would your ideal be?”
“At her age, right now, she still needs a lot of direction. So I’d say 50/50 ”.
“And how do you see the relationship between Sophie and her father in terms of
boss/friend?”
“Probably the exact opposite of mine. He tries to be her friend. 90% friend. Maybe only
10% boss”
“And your ideal? What should it be for Sophie and her father?
“Same as mine. 50-50. Sophie needs her Dad to be stronger, a stronger leader not just a
friend.”
‘Working with Families: A Practical Guide
20
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
Turning again to the father, the therapist asked, “How do you see your relationship with
Sophie ? More boss? More friend? What percentage?”
“70- 30. I think I'm 70% friend 30% boss”, said the father. “And that's how I think it
should be.”
“What about you,Sophie, how do you see your relationship with your dad in terms of
boss and friend?”
“Like he says, about 70% friend.”
“And how do you think it should be, at your age now?”
“Probably 60% friend. I don't think he should be a boss, though. Maybe he should be
40% leader.”
“And with your mother?
“She's a hundred percent boss or at least she tries to be.”
“And how do you think it should be at your age?”
“60% friend, 40% boss.”
“Was there a time it was more like that?”
“Before I went to high school. Before Nono got sick.”
‘Working with Families: A Practical Guide
21
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
The therapist looked towards Peter and said, “In all families one parent is a little bit softer
or tougher than the other parent in terms of discipline with the kids. In your family, who
is the softie and who is the toughie?”
“Mum makes up the rules and Dad is softer. He just goes along with her” said Peter.
“What would you say, Sophie?” asked the therapist. “Who do you think is the softie and
who is the toughie?”
“Well isn't it obvious? Mum is a Sergeant Major and Dad is softer. He is like normal
“He's a marshmallow” interjected the mother. “He may not look it on the outside but
that's what he is. He was that way with all the kids, but he’s especially soft with Sophie”.
“Sophie, when you compare your parents to say the parents of your friends, do you think
on average they are softer or tougher than your friend’s parents?” the therapist asked.
“Do I have to answer that one?” Sophie sighed. “Dad is way more understanding than
my friends’ dads so I guess you'd say a lot softer. Some of the other mothers are less
strict than Mum. Some aren’t.”
The therapist then asked the mother, “How do you compare yourself to other parents in
terms of how soft you are about rules, consequences, follow-through?”
“I can yell up a storm”, she said. “I guess if that makes me tough then I am. But the
reality is our kids have had it pretty easy. We were never big on rules and consequences.
Until now. Until we were be driven to this”.
“What about between Peter and Sophie? How much is Peter boss and how much is a
friend to Sophie?”
‘Working with Families: A Practical Guide
22
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
“I think Peter wants to be more of a friend but Sophie pushes him away”
“Just answer the question”, said Sophie.
“Perhaps 40% friend. 60% boss”, said the mother.
“And what do you think it should be ideally at their ages?”
“80% friend. 20% boss
The therapist turned to Sophie. “And how do you see your relationship with Peter,
Sophie?”
“He wants to be my boss, 100%. But I don't want him as my boss. I hate him ", said
Sophie and she threw a cushion across the room at Peter.” I hate you”. Then she turned
to her parents and shouted, "Why don't you tell her the truth. Tell her the truth about what
he did to me. And you just watched, you just let it happen".
‘What happened?’ asked the therapist, turning to face the parents.
"A few months ago", said the father, "after the police to came to our house, Annie told
Sophie she was grounded. That she couldn't go anywhere after school or on the
weekends. But she found a way to get out the window and we chased her and brought her
home. Then one night when I was out at a meeting she tried to sneak out again and Peter
caught her and gave her belting…”.
"A belting?’Sophie shouted. “ He used his fists. He hit me in the face and the guts. He
beat me up", she cried, pointed at her mother "And you were in the next room and you
knew he was doing it and you let him do it".
‘Working with Families: A Practical Guide
23
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
"I didn't know then that he was hurting you badly", said the mother.
"You did so. You wanted him to do it". Sophie pulled her legs up to her chest, buried her
face and sobbed.
Peter had taken on at "parental" role in "disciplining" his sister, evidence that he was in a
coalition with his mother, supporting her against Sophie. Sophie felt betrayed by her
mother’s failure to stop the brother’s abuse. This betrayal meant that it would be difficult
for the therapist to help the parents set limits for Sophie because she would reject their
authority as undeserved. Sophie's sense of hurt and betrayal would block her from seeing
her parents as genuinely caring about her and acting in her best interests
Earning back Sophie’s trust was an important first step in restoring the parents to an
appropriate hierarchy. They had to listen to Sophie’s anger and respond with empathy
and remorse. In subsequent sessions, the therapist created an enactment between Sophie
and her parents where Sophie sobbed out her anger and sense of betrayal at how the
parents had allowed her older brother to hurt her so badly. At the end of that session, the
therapist helped themother and Sophie arrange twice weekly mother daughter times,
during which they would do an activity that they would both enjoy. Immediately
following this first session, Sophie became less argumentative, she began to sleep at
night, stopped waking and stopped pacing around the house.
Next the therapists met with Peter and the parents, a session in which the parents told
Peter that under no circumstances was he to hurt, restrain, or discipline his sister. From
now on, they said, dealing with Sophie’s behaviour was the parents responsibility, not
his.
Creating an enactment to restore the parental hierarchy
‘Working with Families: A Practical Guide
24
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
The goal for the next session was for the parents to agree upon some rules and
expectations for Sophie's behavior. The therapist gave each parent a piece of paper,
asking them to write down the top ten behaviors that they would like to see Sophie
change. When they had written their lists, the therapist asked them to compare their lists
to see if they had three issues in common which they did: school attendance, Sophie's
whereabouts after school, and speaking disrespectfully.
The therapist instructed the parents to sit in chairs next to each other so that they were
able to see each other as they spoke. Asking them to come to an agreement about the
rules concerning these three issues, the therapist emphasized the importance of them
working out a plan they could both agree to. She then pulled her own chair back and
looked down at the floor.
The father spoke first but he addressed the therapist. She did not look up but simply
gestured towards the mother. He turned back towards the mother.
"The most important thing is that she goes to school every day", said the mother,
speaking directly to the father.
"Of course she should go to school every day”, he answered. “But how are we going to
make her?"
"If she is going to get out of bed in the morning, she has to go to bed at night on time.....
Sophie interrupted, "You treat me like a little kid. You can't tell me what time to go to
bed anymore".
".... and that means that she needs to be off the computer by 10 o'clock", the mother
continued.
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
"10 o'clock -- you're so stupid..........”
"Sophie! Don't call your mother stupid.........”, said the father, turning towards Sophie.
“I wasn't just calling her stupid. You want to cut me off from all my friends, don't you?
You want me to be a loner, don't you?”
“Sophie, you know that’s not true”, said the father. “We want you to have friends. I
know it’s important at your age.”
“Sophie’, said the mother, her voice rising, “You have to go to bed on time.
It became evident that the parents could not hold a conversation with Sophie present
without her interrupting and escalating the interaction, detouring the parents in their
struggle to reach agreement. Each time, the therapist intervened to keep the parents
talking to each other,
‘She's got you off track now. Ignore her”, said the therapist. “Talk to each other. What
are the rules?”
“So how do we get her off the computer by 10?” asked the father, turning back towards
the mother.
The interaction in the room between the parents and Sophie revealed the following
sequence: the parents talk to each other; Sophie interrupts; the father responds to Sophie;
Sophie talks more. The father talks to Sophie. The mother talks to Sophie. This sequence
repeated through the session and each time the therapist focused the parents back to their
own conversation, strengthening their ability to resist Sophie’s interruptions.
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
With the therapist’s support, the parents resisted Sophie’s interruptions and after a while
Sophie stopped interrupting.
“There has to be a rule about what time the computer is off and lights are out and then
we have to stick to it”, said the mother.
“But how can we make her do that? The last time you tried she got out the window and
stayed out all night.”
“I'm sick of arguing with her. You have to get involved in following through more. You
always leave it all up to me.”
“I don’t always leave it up to you”.
“You do, Tony. I’m asking you to just work with me on this”.
”So what do you want me to do?”
“I want you to go into her room at 10 o’clock and take away the modem, pull out the
cable.”
“ I said I would back you up. But maybe we don't have to start with taking away the
modem. Why can’t we start with me just going in and telling her it is time.”
Glancing over at Sophie who had been sitting quietly, listening, the father invited Sophie
into the parent’s conversation. “What do you think Sophie? Are you willing to be that
more cooperative? Get ready for bed when I come in and tell you it is 10 o'clock?”
“I told you. 10 o'clock is lame. I'm old enough to decide for myself.”
‘Working with Families: A Practical Guide
27
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
“Sophie, why do you have to be like that?” said the father “Can’t you see we're trying to
get somewhere here?”
This time it was the father who had reactivated the triangle giving evidence to the
therapist that when the conflict between the parents intensified, the father triangulated
Sophie.
Exploring successes and failures between sessions
The parents eventually reached an agreement about three basic rules and the
consequences for breaking the rules. In the following session, however, they reported that
Sophie had defied the rules. When the mother had tried to follow through with the
consequences, the father had overruled her, allowing Sophie to evade the consequences
both parents had agreed to in the previous session.
“What happened? What happened that you went back on what your agreement?” asked
the therapist.
The father threw up his hands and then ran his fingers through his hair. “Look”, he said,
his voice getting louder. “I know I agreed when we were here. But when it happened at
home, Sophie got so upset and she”, he paused, pointing to the mother, “she was
screaming at her and I can't stand it when she treats her like that. There’s no point. It gets
us nowhere…”
“…Treats her like what? You mean makes her stick to the rules?....” said the mother.
“...She comes down on her like a ton of bricks
“...Like a ton of bricks? Really? Because it is always all up to me. Because you refuse to
do anything.”
‘Working with Families: A Practical Guide
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James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
The therapist expected this "setback" and welcomed the opportunity it presented in
revealing the underlying conflict in the relationship between the parents. It took a few
more sessions, some in which the therapist saw the parents alone to deal with couple
issues, before both parents were able to clearly stick to their agreements and follow-
through in a calm, consistent and authoritative manner in parenting Sophie. By the end
of therapy, Sophie’s behavior was no longer a concern and she enjoyed happy times with
her mother who was calmer and less stressed. The father no longer undermined the
mother and took on a more active role in the household and in helping care for the
grandmother.
Conclusion
This paper has demonstrated how aspects of the Milan approach and of
Structural/Strategic Family therapy can be integrated providing the therapist with a view
into family relationships that uses both family members' verbal descriptions of their own
perceptions as well as therapist direct observations of family process in the session.
The case example illustrated using the Milan questioning method to scan relationships in
terms of bonds and hierarchy, revealing the underlying structure of family relationships:
a coalition between the father and daughter and an escalating complementarity between
the parents – a ‘soft-hard’ split indicative of unresolved couple conflict. The questioning
process also brought to light the daughters hurt and anger at her parents for failing to
protect her. The therapist used the Structural Family Therapy technique of ‘enactment’
with the daughter and her parents and then with both parents. An enactment allowed the
daughter to give voice to her experience and receive validation and remorse from the
parents. Enactments involving both parents highlighted their difficulties in working
together, revealed how their daughter becomes involved in their conflicts and ultimately
helped them resolve differences and work together effectively. How this came about is
described in more detail in the next chapter which addresses why, when and how the
therapist would meet separately with the parents in family therapy.
‘Working with Families: A Practical Guide
29
James, K. & MacKinnon, L. (2010) The Why and How of Separate Parent Sessions
in Family Therapy in P. Rhodes and A. Wallis (Eds.) Working With Families: A Practical
Guide, IP Communication, East Hawthorn, Victoria.
Please do not quote from this paper, ask author for final copy: laurie@insiteconsulting.com.au
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A distinguishing feature of family therapy is the default position that everyone in the household attends the therapy sessions. Holding to this position avoids the tendency to slide into what is an apparently easy but in the long run problematic practice: conducting sessions with only those family members who can attend at times convenient for the therapist and only those most motivated to come. In many settings this slide means that therapists only see the mother and problem child, leaving out key actors in the family drama-the disengaged father, the older parentified sibling or the favoured child. While holding to this default position family therapists may also decide at times that it is important to work with a subsystem, very often the parental subsystem. Knowing why and how to meet with parents separately, and the risks involved in doing so, is the focus of this chapter.
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Completely up-to-date, this engaging and practice-oriented text is your complete resource to help students master the many facets of family therapy. In this ninth edition, the authors provide practice-oriented content in a more concise format that will help students become empathic and effective family therapists. New material focuses on how students can practice systemic thinking and on how to develop core competencies in family therapy. There is also increased attention to LGBTQ families and alternative forms of family life, and to gender, culture, and ethnic considerations. Color-coded boxes highlight key aspects of family therapy, such as family diversity, evidence-based practice research, "Thinking Like a Clinician" student exercises, case studies, clinical notes, and therapeutic encounters. Examples illustrate family therapists from many professions, including social work, MFT, psychology, and counseling. Learning objectives focus students' attention on key concepts.
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