Summary

This is new, completely revised edition of «Family psychotherapy» (1990, Leningrad).

The aims of this new book were to piece together main foreign and national results in family therapy, to survey some new ideas and our new experience in the area, to consider new trends both in our society and in science (especially, psychotherapy, and psychology).

Chapter 1 «The Family as a Cause of Mental Disturbance» focuses upon the ways on which the family affects the personality of its members. Some new interim links between family and personal problems are surveyed. They are a s. c. «general discontentment in the family», «general anxiety in the family», « general tension in the family», «general guilt in the family».

These are prevalent cognitive and emotional states in a family that can follow every its disorders. These states are side — effects of a family disturbance and add their own disordering effect to the main cause of a family problem. The role of these phenomena disturbing the psychic health of the family members is described and also the dynamic and development of these states.

It is shown that (as it often happens with unspecific long lasting pathology) after some time these side-effects tend to become the main source in causing psychic trauma to individual family members. Clinical and psychodiagnostical ways in assessing these phenomena are discussed.

Chapter II considers main areas in family life and their possible effect in causing and prolonging disturbances in the personality of individual family members.

First section deals with problems the family meets when one of its members has some mental disorder.

Numerous investigations in the field have demonstrated very different factors weighting down the situation in such family. These investigations also showed how diverse and contradictory are family reactions to this situation.

Considering all these reactions a general theory («Watershed - theory»), generalizing these reaction is suggested. It suggests that after meeting «mental illsituation» a family has to take a sequence of important choices. Every of these choices decides what will be the way for the further development of the family: 1. rather disintegrative one; 2. rather integrative one; or 3. unstable — an unstable balance between integrative and disintegrative forces in the family. It is highly important that the consequent choices in this sequence are interconnected. If a family steps a foot in one direction it increase the necessity to go also next steps in the same direction.

An original program and experience in education and consulting mental ill's families is discussed.

The second section deals with rather neglected but in our opinion very important «family self-image» problem. The concept assesses how precise, detailed, full, psychologically true is an image of a family on itself. Functions of the «self-image» in developing family structure, taking everyday and general decisionwasshown.

The structure development and functioning, main characteristics of «family self-image» are considered. Three types of family depending on how much developed is the family «self-image» are described: family with highly developed reflexive self-image, families with stereotyped self-image and families with unreflective primitive self-image.

It was shown that a reason for retarding the development of the self-image in a family can be a psychological resistance stemming of some hidden conflicts. But in fact this is only one of numerous other possible causes. There are also a lot of other handicapping factors — psychological family surrounding, obligation-directed role system within a family, low-level culture in the family etc.

The family self-image is shown to be important precondition predisposing a family to very broad spectrum of disturbances in its structure and functioning. The point is that most of family dysfunction described within different streams of family psychotherapy suppose that family is not able to observe itself, recognize some aspects of its life and therefore is defenseless against them. So, such very known family disturbances like «family sequences» (J. Haley), unconscious reinforcement (Azrin, Naster), «double-bind», «triangulation» etc. can persist only under condition of some «family agnosia» (family is not able to notice them). It is shown in this chapter that this «family agnosia» is most typical for families with a rather underdeveloped «self-image».

Ways and experience of investigating, diagnosing and development of the family self-image and its therapeutics outcomes are discussed.

Important component of family self-image are so called «family postulates» (close to «family myths» — Ferreira (1966), Click @ Kessler (1980)). They are some idea of family members about family life, personality of its members, interrelations that are supposed to be evident. New ways in investigation of these «family postulates» and of their interconnection with family disorders are described.

The third section deals with the family communication. The main idea is that all ample literature of the topic deals only with communication channel: — it is with; communication stages that follows after the decision to communicate some message to another family member is taken. Our idea is that the most important stage is what happens before — the «zero -stage» of communication channel, it is the stage when the decision to «send a message» still is not taken. In fact a family member takes this decision by committing some mental experiment in his mind. He 1. has to recognize a situation (a problem) as one which requires to send a message to involved family member (a communication event), 2. tries to image the whole event (how the message will be given by him and accepted by another side), 3. what change in situation and what further consequences it is going to bring.

During this stage the whole event is «rehearsed», the very possibility of it is regarded, the content and ways of communication are shaped. This «zero-stage» of communication event is an individual «communication manager», shaping both mutual expectation and ways in which these expectations are precised. So, just on this stage important prerequisites of the success or failure of a communication are laid.

So, we tried to demonstrate prospects of investigating and considering in therapy of these zero - stage processes.

To investigate these processes we have proposed the concept of «communication deficit». It means that considering any family problem we have to answer «the zero — stage question: «What message (if any) sent by one family member to another would have been able to facilitate the solution of the problem?». After answering this question reasons are regarded for which the very idea of communication does not emerged. If it emerged then how went on the «mental communication experiment» in the mind of the family member, how this experiment facilitated or stopped the communication, how it regulated way and content of a message, how a member of a family reacted to its own decision that communication is impossible.

A lot of clinic cases are considered showing ways how a communication deficit can be analyzed in different situations.

The fourth section considers ways in which the family solves its integration and re-integration problems. Three main mechanism are examined: problem- solving in the family «common-destiny» and emotional identification mechanisms.

Family problems are most important engine for a family to develop its structure. Ways family chooses to solve these problems are decisive in predicting what impact will these problems have upon its structure and functioning. Early family therapist (like Bell and Bowen) stressed this family ability to define and solve its problems in a rational and effective way and also it ability to resist factors pushing it to irrational ways in solving family problems. Later development in family therapy seems to loss these approach and to stress «less rationalistic» views of the family. Despite of this in this section we try to show how promising this neglected approach can be also for modern psychotherapy. We have developed the concept of special cognitive roles in the family.

They are ones which develop in it when it arrives a problem and tries to solve it. Problem solving behavior within the family usually is followed by development of a special cluster of cognitive roles. This cluster can be observed when family discusses its real or artificial (test) — problems. The interrelation between the structure of these cognitive roles and effectiveness of family problem solving was examined. On this bases the idea of a rather strong boundary between clusters of cognitive roles in the family and its usual permanent roles is presented. Such boundary is supposed to be the main structural precondition for effective problem solving and reintegrating a family.

Ways in which structural prerequisites for this can be created are discussed in this section. Clinical experience affecting families is surveyed.

Another important structure in integrating and re-integrating a family are emotional identification between members of a family. Relations of sympathy, emotional attraction, attachment, affection in the family can be highly important but also highly choose, capricious.

They are also highly sensitive to any incongruence between ones emotional (often unconscious) preferences, expectations, needs, on the one side, and a real personality and behavior of other family members, on the other. So, in this chapter a method is presented to analyze these emotional expectations of family memberstoeach other and to check the reactions that arise if the expectations are not met. The experience in using this method in family therapy is referred.

The nest section deals with the family role system. Concept of «pathological» (inflicting) role is discussed. It is shown that the concept has to be supplemented by concept of «latent family role». The latter means a family role that actually are not played by any family member but is highly possible to be actualized under some special conditions producing «pathological roles». These condition are surveyed and it is shown that every single of them is important for «pathological role» to survive. This is important elaborating methods counteracting these roles. The ways to deal with the «role pathology» are discussed.The chapter III considers methods of the family diagnosis and family therapy. Today a lot of family assessment measures, coding and rating schemes,self-report scales and questionnaires has been developed. Ample surveys referring them are published (H. Grotevant, C. Carlson, 1989). So the main aim of this book was to discuss the philosophy of assessment and to evaluate possible approaches.

Our experience in assessment of a family is referred and illustrated by clinical cases.

The last chapter refers some special problems that arise using the family psychotherapy dealing with special somatic and psychic diseases. Main concepts and experience in family therapy dealing with tuberculosis of the lungs, hypertensive disease, ischemic heart disease, myocardial infarction, ulcerative disease of the stomach, duodenal ulcer, diabetes, ulcerative colitis were discussed. Our long experience (both successeful and unsuccesseful) adapting and trying different family therapy approach in treatment of schizophrenia (especially considering recent successes in Expressed Emotion- ЕЕ investigation and methods), neurosis, abnormal personality in adults and adolescents is referred.

The book is completed by original family assessment methods that were developed and intensively used in our work.