The genogram, or family tree, is a critical tool for family therapists. So much of our behavior can be understood as a result of intergenerational family dynamics. Just think about how much you have been impacted by the actions of prior and current relatives. A genogram will often be the first thing a therapist will have the family do as part of their initial assessment. In addition to exhibiting general family relations, some elements of a genogram may include divorces, stepchildren, and deaths. The more detailed the genogram, the more it helps someone understand how they came to be in their present situation.
As the name implies, a structural map—also called a family floor plan—demonstrates the structural dynamics between family members. It may look like a genogram except it focuses on the boundaries and hierarchies within a family. If a parent, for example, is seen as the head of the family, they would be marked at the top of the hierarchy. Filling out a structural map as a family therapy activity helps family members understand how they relate to each other.
Another associated family therapy activity is tracking. During the tracking process, the therapist listens to the family describe their interactions, and records the sequence of events. They are then able to identify how the order of events leads to certain behaviors and maintains the family system. Tracking the sequence of events can be especially helpful when designing interventions aimed at changing behavioral patterns.
Directives are one of the main techniques of strategic family therapy. After assessing family behavioral patterns, a therapist may order a family to perform a certain behavior. These assignments are aimed at changing problematic interactions within the family. For example, a therapist may task a parent with giving their child a consequence after finding out they do not regularly hold them accountable for their behavior.
At times, giving a family a direct order does not work. Instead, they resist the instructions and don’t perform the behavior. In those cases, paradoxical intention may be more effective. Instead of asking a family to do something new, they are asked to do nothing differently. This is called “prescribing the symptom”. Because the family is resistant, the hope is that they will end up doing something different to oppose the therapist’s instructions. Even if they do nothing different, the therapist can then point out the ineffectiveness of their continued current behavior.
Enactment can be a powerful family therapy activity. Otherwise known as role-playing, enactment is a way to address difficult family situations more realistically and experientially. The therapist asks the family to act out a specific family conflict instead of just talking about it. Enactments have both an assessment and treatment purpose: they help the therapist see how family members interact and then new interventions can be suggested. For example, a therapist may ask someone to role-play a new way to communicate to deescalate an aggressive situation.
Family sculpting is a technique that is similar to a non-verbal enactment. One family member is tasked with arranging their family according to a specific situation that has occurred in the past. As the sculptor, they can create every aspect of the situation, from location placement to posture to facial expressions. This allows the therapist and other family members to see how they are viewed by particular members in the family system. Because it is non-verbal, it is not as threatening and may allow less powerful family members (e.g., children and teens) the freedom to honestly express how they see their family. In another variation, the sculptor can “sculpt” how they would like their family interactions to be different, leading to improvement in overall functioning.
Circular questions have a similar aim to family sculpting: they allow someone to view the connections and distinctions between family members from another perspective, hopefully spurring a change toward more adaptive behavior. As opposed to a linear question, which is primarily concerned with how person A affects person B, circular questions point to the importance of interactions between multiple people. For example, a therapist might ask each family member “who shows the most concern about Johnny’s problems?” Each person’s perspective is then illuminated for the family to understand the roles each person plays in creating and maintaining family dynamics.
Reframing Family Behavior
Reframing is not specific to family therapy but it takes on added significance when you are exploring family interactions. People often come to therapy because they are experiencing conflict with other family members. As a result, they depict others’ actions in a negative light. A therapist can reframe the behavior and point out its positive aspects. For instance, a mother’s nagging behavior can be reframed as caring and concern. This gives a beneficial meaning to family relations that were previously viewed as negative.
Forming a strategic alliance involves meeting with one family member to institute an individual change that is expected to affect the entire family. This individual may be seen as a family leader or a member with little influence. The therapist attempts to have this individual alter their behavior in a way that will cause a ripple effect across the system, changing it for the better.
The Family Meeting
What happens in a session is important but what happens outside is even more valuable. Family meetings are organized to provide time for the family to meet and address issues. The therapist may prescribe these meetings as homework and set a time and place for them to occur. The meeting should include the entire family or as many as possible. Specific rules can be outlined during the session but one rule has to be that there is no criticism allowed. The family meeting serves as a non-judgmental environment for the family to hash out their problems without fostering further conflict. Its ultimate goals are to enhance communication and problem-solving.
Family therapists recognize that families are systems with many active parts. It is their job to implement movement that will alter maladaptive behavior patterns. The above techniques and family therapy activities are used to change the system in a way to benefit all involved.
Family therapy can be easily conducted via telehealth and TheraPlatform (practice management software with integrated telehealth) is here to help you meet your families any time. TheraPlatform’s built in teaching aids such as a whiteboard; ability to organize your own therapy resources and videos can make your therapy family activities engaging and dynamic.
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