Assimilative family therapy model

Type of psychology: Clinical; Consulting; Counseling; Family; Psychopathology

This approach to family therapy focuses on clients' developing understanding of the origins of their dilemmas as stemming from patterns that were developed and modeled within their family of origin. With this perspective of families as high dynamic systems, clients take responsibility for their behaviors, thoughts, and feelings and in doing so take an important step toward healing. The family therapist integrates interventions and concepts from other therapies (cognitive behavioral, psychodynamic, communications) within clients' unique system perspectives enabling effective change to occur.

Introduction

The modern family presents many new challenges for mental and behavioral health providers because new family structures require a reformulation of strategies and interventions that differ from those employed when working with “traditional families.” Traditional models of family therapy no longer adequately address the dilemmas brought to consultation rooms. A treatment model sensitive to the many unique contexts presented by the modern family is needed. A new model, the assimilative family therapy model, is an attempt to meet this need by shaping the inclusion of necessary interventions to address the specific dilemmas of a client or family. This therapy addresses the many dilemmas that are faced throughout the life cycle: differentiation of the individual, parenting and couple relationship issues, midlife issues, and caring for the elderly.

What is the assimilative family therapy model? It is an integrative, as opposed to eclectic, approach. An eclectic eater goes to a buffet and chooses several items, combining different food items at times while at other times eating one food by itself. An integrationist goes to the buffet, selects ingredients, and combines them together to create a new dish (Goldfried & Norcross, 2005). Thus, the integrationist evaluates a client's dilemmas and combines approaches, concepts, and other variables to create the most effective treatment to enable clients to heal.

The assimilative approach falls within the field of integration (Messer, 1992). In an assimilative approach, the therapist chooses a home theory that becomes the focal therapy of the approach. Then the therapist integrates other concepts and interventions from other theories to meet the goals of the home theory and goals set by the therapist and client(s). In the assimilative family therapy model (AFT), the home theory is a systems theory. Family therapists consider clients' dilemmas from a systems point of view. They focus on the patterns of interaction of the family of origin and extended family. They also evaluate families' physical and psychological vulnerabilities, how members connect to each other and negotiate conflict) and those patterns of behavior that get transmitted from generation to generation. For example, say Bobby is a child who suffers from anxiety. His paternal family members also struggle with anxiety. Is this a pattern that has been transmitted to Bobby through genetics or is it learned by repeating his father's behaviors? The family therapist looks at an individual's or family's dilemmas by systematically considering where the behaviors and adjustments occurred in past generations.

In AFT, family therapists rely on the Bowen family systems therapy model as the home theory. They then integrate other concepts and interventions from other therapies such as psychodynamic, cognitive behavioral, communications, and other systems therapies to better meet the needs and goals of the clients. The goals of the Bowen approach are to reduce anxiety, lower emotional reactivity, and increase differentiation among all family members.

Lowering emotional reactivity is an important goal for individuals to be able to problem solve and think rationally when one is being emotionally challenged by a situation, event, feeling, or person. In the process of learning to control reactions to situations, family members also learn how to state their positions in a respectful manner even when emotions are charged or there is pressure from another to change a position. By working this way, clients' anxiety levels are lowered, enabling them to think, act, and feel in a modulated manner. In Bobby's case, the AFT therapist realizes that Bobby needs to separate his behaviors from those of his anxious father. The therapist will also incorporate mindfulness strategies and relaxation exercises to help Bobby differentiate himself from his father's behaviors and adjustments.

The individual or family context is another important concept that informs AFT therapists' work with clients. Our context sets the stage for how we view the world we live in, how we interact, and what we value. Context includes age, sex, sexual orientation, religion, spirituality, ethnicity, culture, socioeconomic level, level of attachment, and level of resilience and optimism. These contexts all contribute to clients' adjustment to life's circumstances. The more therapists understand clients' contexts, the more helpful they are in enabling them to affect change in behaviors, thinking, and actions. Because Bobby's parents come from a strict German family where children “should be seen and not heard,” his level of attachment to his parents is avoidant. He does not feel safe expressing his feelings which further increases his anxiety. The family's more stoical outlook works against their ability to enjoy the positive parts of their lives which also contributes to Bobby's anxiety. If Bobby's attachment to his parents were close and warm, even though he has a genetic propensity for anxiety, he might not become symptomatic due to feeling supported. As a result, he would be more resilient and less apt to become anxious. Therefore, as therapists integrate clients' context with the theory, they begin to conceptualize the best way to help clients change their thinking, feelings, and behaviors to solve the presented dilemmas.

The assimilative family therapy model is useful in treating individuals suffering from anxiety and depression and for child and adolescent centered issues where adjustment to school, friends, or family relationships is compromised. AFT may also be effective with couple dilemmas and midlife and end of life issues and, in fact, dilemmas throughout the life cycle. The best way to understand how to use AFT is to apply it with different populations.

Many couples that come to treatment are anxious, angry, and frightened that their marriage may end, but they cannot mobilize their emotions, thoughts, and actions to do something constructive to start saving the relationship. Others enter therapy, and they desperately work at saving their relationships and are committed to each other and the process. In AFT, it is essential to help couples realize that their behaviors are most likely a repeat of their parent or family patterns in some capacity. Many clients state that they want a relationship different from their parents, but they repeat behaviors without being aware that they are doing so. The next step is enabling couples to take responsibility for their individual behaviors. With therapists' help, they jointly decide what needs to be changed within each individual and in their manner of interacting between each other. Social scientist John Gottman, who is known in family therapy circles for his work on marital stability and relational analysis, has rightly stressed the need to communicate in a more respectful manner with lowered emotional reactivity and anxiety. The couple is encouraged to develop a more differentiated stance on what each needs and wants as individuals and as a couple unit (or dyad). Once this process begins, and not until it begins, can the couple learn to create a more intimate and satisfying relationship.

Meet Kayla and Joe who have been married for six years. Kayla identified with her very strong and angry mother and was repeating these patterns when dealing with her husband. Though Joe also came from a family where his mother was dominant, he consciously decided that he would never become like his dismissed and diminished dad. When Kayla expressed anger at Joe, Joe responded with so much anger that it would exacerbate Kayla's anger. Soon, they both would be shouting at each other until battle fatigue set in and they retreated. A cessation of hostilities was achieved, but Kayla and Joe never solved their issues. At some point, they would again begin this cycle and ignite anger. Once the AFT therapist could point out patterns, it was easier and safer for Kayla and Joe to accept responsibility for their own behavior and reactions to the other. Each understood how he or she was a catalyst for the other to become increasingly angry, because each was actually, though not consciously planning to do so, repeating patterns in their family of origin. For this couple, the AFT therapist also integrated mindfulness techniques developed by Professor Emeritus of Medicine, Jon Kabatt-Zinn, who founded Mindfulness-Based Stress Reduction (MBSR). These techniques enabled each to change the way he or she reacted to the other by using role-play and other effective communication techniques (e.g., teaching them to listen, validate each other feelings by repeating them, and respond empathetically to the other) to help enable each one to feel heard and cared for. As a result, Kayla and Joe were able to change the way they viewed their own behaviors and create an identity that was different from their parents. The couple began to feel more connection and enjoyment with each other. When situations arose that ignited their mutual angers, they were able to modulate the way they interacted, avoid escalating the dilemmas, and resolve the issues presented.

A stressful time of life is midlife when caretaking responsibilities can become paramount to anything else. Many midlifers, particularly women, find themselves caring for elderly parents as well as being parents to adult children. Some midlifers become the caretakers for grandchildren as well. These midlifers are known in social science research as the “sandwich generation.” The elderly population is increasing as individuals live longer and the need for informal caregiving (i.e., without pay or compensation) is growing. How the family interacted before the elderly became a pressure in the system will determine how the family is able to deal with the needs and desires of the elderly. The more connected the generations, the better they will be able to deal with the elderly member's needs and decline. Family caregivers have more mental health issues, with depression being the most common. The mortality rate of caregivers of elderly spouses (ages 66–96) is 63% higher than among non-caregivers in the same age bracket (Family Caregiving Alliance, 2006). The family history of elder care will likely be repeated from the previous generation with a new twist.

The therapist can help the adult children work through the mourning process of denial, bargaining, anger, depression, and acceptance. Feeling sad, helpless, and ashamed are normal feelings when interacting with our onetime strong parent who is losing his or her abilities. Adult children and elderly parents are both mourning in different ways, but both generations need to face their sadness and celebrate their function so they can establish new patterns to help the elderly and for the elderly to receive help in this difficult stage of life. In the final stage of a parent's life, the patterns that were developed over the course of a lifetime continue. Caregivers have the responsibility to change their positions within the family while working through feelings and dysfunctional individual and family patterns.

AFT also offers a practical approach to managing relationships between adult children and elderly parents. The therapy enables the caregiver and elder (if able and appropriate) to deal with feelings, identify dilemmas, and find solutions. Meet Selma, a midlife woman who has adult children and a 92-year-old mom. Selma's mom has been a widow for more than 40 years. Selma has been the backbone for her mom since her father's untimely death. Even though Grandma has been independent until the last five years, the strain of Selma's roles as an employee, wife, parent to adult married children, and caregiver of her elderly mom has taken a toll on Selma's health and sense of well-being in the form of heightened anxiety and inability to sleep. The therapist looked at the family patterns of how Selma with her siblings became the caretaker of her mom. It became obvious that this was a repeated pattern from Selma's mother's family of origin. However, today's longevity means this pattern will persist far longer and has overwhelmed Selma. The therapist was able to identify the family patterns and coach Selma to approach her siblings to ask for help in dealing with their mom. Rather than caring for her adult children, she was instructed to ask them to help with Grandma. Selma also hired some outside help within the monetary ability of Grandma's funds. Her husband, relatively absent in helping, was asked to step in. This was very difficult for Selma to learn to ask for help and let go of control as she began to take control of her own life. Along with family members, Selma needed to mourn the loss of her mother rather than avoid these feelings while caring for her. This enabled the family to be a support for Grandma who was also mourning the loss of her abilities and the eventual ending of her life. Being able to do this provided stability for the family and healthier individual functioning. By making the mourning process visible and identifiable, Selma could free her repressed anger, sadness, and energy to enable her to start caring for herself by communicating appropriately with family members, going to the doctor for check-ups, exercising, losing weight, going out with her husband, and enjoying her midlife years while at the same time continuing to balance her many responsibilities.

Bibliography

Chisholm, J. F. (1999). “The Sandwich Generation.” Journal of Social Distress and the Homeless, 8(3), 177–191.

Gottman, J., & Declaire, J. (1996). The Heart of Parenting: Raising an Emotionally Intelligent Child. New York, NY: Simon & Schuster.

Gottman, J., & Declaire, J. (2001). The Relationship Cure: A Five-Step Guide to Strengthening Your Marriage, Family, and Friendships. New York, NY: Three River Press.

Johnson, M. (2005). Religion, Spirituality and Older People. In M. Johnson (Ed.). Age & Aging. New York: Cambridge University Press.

Kabat-Zinn, J. (2005). Coming To Our Senses: Healing Ourselves and the World through Mindfulness. New York, NY: Hyperion Books.

Messer, S. B. (1992). “A Critical Examination of Belief Structures in Integrative and Eclectic Psychotherapy.” In J.C. Norcross and M.R. Goldfried (Eds.). Handbook of Psychotherapy Integration (130–168). New York, NY: Basic Books.

Messer, S.B. (2001). “Assimilative Integration”. Journal of Psychotherapy Integration, special edition, 11(1).

Mozdzierz, G. J., Peluso, P. R., & Lisiecki, J. (2014). Principles of Counseling and Psychotherapy: Learning the Essential Domains and Nonlinear Thinking of Master Practitioners. New York: Routledge.

Norcross, J.C. (2005). A Primer on Psychotherapy Integration (2nd ed.). New York: Oxford University Press.

Pitta, P. (l995). “Adolescent-Centered Family Integrated Philosophy and Treatment.” Psychotherapy, 3(1). Washington, DC: American Psychological Association.

Pitta, P. (2003). Parenting Your Elderly Parents. (Video). Washington, D.C.: American Psychological Association.

Pitta, P. (2005). “Integrative Healing Couple's Therapy: A Search for the Self and Each Other”. In M. Harway (Ed.). Handbook of Couples Therapy. New York, NY: Wiley.

Pitta. P. (2014). Solving Modern Family Dilemmas: An Assimilative Therapy Model. New York, NY: Routledge.