Genograms family therapy
Genograms for Psychotherapy (Guide) | Therapist Aid
Every generation, families pass a piece of themselves to their kin. The things that are passed down can be beautiful or valuable, like stories, culture, knowledge, and belongings. Or, they can be mostly insignificant, like a cowlick and green eyes from one's grandfather.
Other times, more insidious traits can be passed through generations. Sometimes there's a genetic predisposition to addiction or depression. Other times, unhealthy ways of thinking and behaving are passed down socially, through example.
Genograms provide a way for us to examine these patterns. They bring a family's strengths and weaknesses out into the open. Genograms set the foundation for nurturing generational strengths and overcoming weaknesses.
What is a Genogram?
A genogram is structurally similar to a family tree, but serves a very different purpose. A genogram includes information about relationships and interactions between family members, while a family tree only depicts lineage.
Imagine a genogram as a family tree with much more detail about how the family members interact with one another. For example, a family tree might show us that "Emily and Kevin are married", while a genogram could tell us that "Emily and Ken are married, but they are emotionally distant from one another".
A genogram becomes most valuable when it includes information about several generations. Patterns that are usually hard to decipher seem to jump out once they've been mapped on paper. Maybe you've already noticed a trend of marital trouble in a family's history, but a genogram can highlight the pattern of aloofness and anger that's at the root of those marital problems.
Tip: It's worth noting that genograms are written through the lens of their creator. Everyone will interpret their family's relationships at least a little bit differently, and that's OK. As a clinician, this bias must be taken into account when using genograms during therapy.
How to Create a Genogram
Genograms use a combination of special rules and symbols to depict a lot of information about families as succinctly as possible. Some of these rules and practices have been standardized, and should be followed so future readers can understand your documentation.
Other rules and symbols used in genograms differ depending on who you ask, or what reference you use. It isn't a big deal what symbols you use, as long as you are consistent. This will allow you to look at a genogram from any client—even those you don't know as well—and still glean useful information about their family.
We've also created a genograms symbol sheet for you to keep handy, and to share with clients. We suggest including one of these printouts with any copies of genograms you share with clients.
Genogram Symbol Sheet
worksheet
Tip: Try to include at least three generations when you create a genogram.
You can include more generations if they are relevant to treatment, but any less will make the genogram significantly less helpful.
Gender
Men are depicted by a square and women are depicted by a circle.
Family Relationships
Family relationships are depicted by two gender symbols connected by a line beneath them. Men should always appear on the left, and women on the right.
Descriptive symbols, which are placed on top of the family relationship line, give more detail about the relationship's status. Each of these symbols can be placed over any type of line (for example, the "separated" symbol could be placed over the "committed relationship" line or the "marriage" line).
Emotional Relationships
Emotional relationships are depicted with a line directly connecting two gender symbols (different from family relationship connections, where the line is beneath them). These lines can be used to connect any two people on the genogram.
Tip: Your genograms will be very complicated if you connect every person to everyone else with emotional relationship lines. Try asking about each relationship, but only mark areas that are noteworthy or relevant to treatment.
Children
Children are placed beneath their parents, with a line stemming from the parents' family relationship line. Children should be listed from left to right, oldest to youngest.
Lifespan
Deaths are indicated with an "X" inside the person's symbol. In some cases it may be important to add extra information such as a person's age, or dates related to birth and death.
Additional Information
You can use genograms to depict just about anything that you think might be relevant to treatment. Feel free to create additional markers to fit your needs. For example, you might use an asterisk to indicate "difficulty with anger", or a squiggly line above a gender symbol to indicate "alcohol addiction".
Tip: Include a key whenever you use custom markers. Future you probably won't remember what the jumble of asterisks, squiggles, and diamonds mean.
Putting it All Together
Using the symbols and rules above, you should be able to construct a genogram that any other clinician can pick up and understand. Here's an example of completed genogram along with some commentary.
Using Genograms in Psychotherapy
Assessment
Genograms fit in naturally during the assessment portion of treatment. Not only can genograms provide great information about your client, they can also inform you about family history of mental illness, which can give insight into possible diagnoses.
During family therapy, a genogram can also be used as a way to measure progress. Completing genograms at various points throughout treatment may help you and your clients see when and where there have been improvements to relationships.
Tip: Creating a genogram doesn't have to be a chore. Many people love to talk about their family, and will jump at the opportunity to share a few stories. This is a great opportunity to build rapport and get to know your client at the beginning of treatment.
Individual Therapy
All too often the importance of family is ignored during individual therapy, and genograms are a great way to make sure that your client's roots are not forgotten. In the same way that a person's ethnic or religious culture can shape their thoughts, feelings, and behaviors, so can their family culture. For this reason, clients struggling with a wide range of issues can benefit from learning about their family.
Family Therapy
The use of genograms in family therapy can be tricky because family members may see their relationships very differently from one another. However, these discrepancies can also be very telling. Consider the following example:
Example: A family consisting of two parents (Kori and Jason) and their daughter (Magnolia) come to your office for family therapy.
While creating genograms, you notice that the parents both say Magnolia is distant, while Magnolia indicates that her parents are very close to one another, but distant from her.
In this example, it could be hypothesized that Magnolia and her parents both feel excluded from the other's world. Magnolia may feel that her parents care more about one another, yet the parents seem unaware of this. Kori and Jason might benefit from seeing that their daughter isn't just trying to be difficult. Instead, she might be afraid that her parents don't want her around.
Of course, these are just hypotheses. However, this example shows ways in which a genogram can act as a starting point for further exploration, and as a tool for initiating communication between family members.
Don't Forget Strengths
It's easy to get wrapped up in the negative traits that are passed down in families, so don't forget to spend some time on the strengths (especially during family therapy). If every session is spent railing on how dysfunctional a family is, why should they believe things can improve?
Sometimes, even the negative traits in a genogram can have a positive basis.
Consider this example:
Example: Katy and her daughter Taylor both reveal through their genograms that they have an anger-fueled relationship with one another, as did Katy and her own mother. Now, Taylor is beginning to rebel.
After further exploration, Katy reveals that she rebelled against her own mother because she couldn't stand the constant lectures. However, Katy says she only lectures Taylor because she wants to help her avoid the same mistakes she made.
In this example, despite some noticeable issues with anger, we also see strengths. Katy is trying to help her daughter, although she seems to be going about it poorly. Her intentions come from a place of love. Focusing only on the anger would be likely to cause further division between Katy and Taylor.
Genograms are a great fit with many types of treatment, and many problem areas. Below, we've included a few references used for this guide, and further reading if you would like to continue learning about this subject.
1. McGoldrick, M., Gerson, R., & Petry, S. S. (2008). Genograms: Assessment and intervention. WW Norton & Company.
2. Milewski-Hertlein, K. A. (2001). The use of a socially constructed genogram in clinical practice. American Journal of Family Therapy, 29(1), 23-38.
3. Paradopoulos, L., Bor, R., & Stanion, P. (1997). Genograms in counselling practice: A review (part 1). Counselling Psychology Quarterly, 10(1), 17-28.
What Is A Genogram In Family Therapy
A genogram is a popular tool among therapists delving in family therapy. The graphic tool provides detailed information on the interpersonal relationship within a family. It takes into account the past and present aspects that impact the current situation.
As a therapeutic instrument, a genogram can be utilized to better assess the circumstances and the reaction of the people involved in a problem. In formulating interventions and devising ways for reconciliation, mending family relationships has never been easier, thanks to genograms.
What is a Genogram?
A genogram illustrates not only the medical history but also the relationship of the family members across generations. It can reveal generational wounds that have strained the relationship of the family members. Hereditary patterns and psychological factors which both play a role in the current state of affairs can also be identified through a genogram.
Basic genogram symbols for family relationshipsEach line and symbol in a genogram represent the emotional connection between each family member.Color-coded lines differentiate marriage, divorce, separation, and engagement from one another.
Using a timeline alongside a genogram can help psychiatrists and clients get a better perspective on family relations and understand how every piece of the puzzle falls into place.
Using Genograms in Family Therapy
According to the Bowen Family Systems Theory, the family functions as an emotional unit – an individual is better assessed and understood not in isolation, but rather in association with the family unit.
Based on this, it’s natural for the members of the family to be strongly connected emotionally and show interdependence in their thoughts, actions, and feelings.
Bowen’s Theory states that the action of one family member is affected and affects the reaction of another. The balanced behavior of each member creates harmony within the family unit. On the other hand, dysfunctional behavior can disrupt the equilibrium and lead to a series of reactions that may affect the whole family.
Considering the Bowen Theory, genograms undoubtedly play a huge role in understanding the interconnectivity of the relationships of family members. This is why the genogram is the main tool of therapists in the arena of family therapy.
The therapeutic benefits of creating a genogram vary from person to person. Here are the ways it’s used in different situations.
Uncover the root cause of issues
Changes in the behavior of an individual can be caused by problems unknown to even the closest family members.
For instance, a child who used to be a stellar performer at school suddenly became moody, rebellious, and unenthusiastic. The child may hesitate from sharing their problem in the presence of a therapist.
The child may have witnessed their father leave the family, obliging the mother to take up both roles to maintain stability. The added responsibility may affect the attitude of the mother, as well as the children, introducing problems not present before.
By allowing the child to draw a genogram, therapists will be able to identify the reason behind the change in behavior without forcing the child to talk about it.
Promotes better understanding
Genograms depict how a problem has evolved and how it continues to affect the whole family. The genogram can introduce cognitive change as it develops insight, provides awareness, and expands understanding of the causality of long-standing issues within the family.
Creating a genogram has been reported to promote empathy and intimacy as clients understand more about the narrative behind a family member’s current attitude and the issues they face.
As a result, they develop a better understanding of the situation and formulate ways to change their behavior toward the problematic relative.
Oftentimes, family members tend to judge a relative based on the latter’s current behavior toward the former. They forget to consider the events that caused the change in attitude and led to the situation everyone is in.
A genogram helps clients gain a wider perspective in tackling their family problems. Instead of viewing a member as someone problematic that needs to be cut off, clients will be able to see them as individuals facing their battles – that they need the same support everyone is getting even if they don’t seem to ask for it.
Genogram symbols for denoting addictions and illnesses(Source: GenoPro)
Drawing a genogram requires research and interviews, which are activities that can assist in deciphering the reasons behind behavioral transformations. The perspective of relatives and friends will help clients grasp the situation better.
Initiates a change in behavior
One of the reasons why patients feel powerless to take control of their family relationship is due to the way they react to the things their relatives say or do. In mending family relationships, it’s recommended that each member avoid attacking, defending, or disregarding others.
Relational differences are often met with emotional reactivity, leading to unresolved issues that continue to grow. A genogram will help clients see that the hindrance to a peaceful resolution is their attitude and overreaction.
Revealing behavioral patterns that repeatedly lead to the same problems the clients face can help widen their perspective. With this, they’ll be more open to change their behavior, take control of their emotions, and experiment on a new lifestyle.
Makes it easier to talk about hard issues
Drawing a genogram can lighten the mood on a serious issue. It removes the intensity from the topic, allowing patients to divert their attention on the drawing and not on the emotions that often burst out when thinking about the problem.
This makes them feel safe and better prepared to discuss things face-to-face.
Sometimes, issues arise from the influences and belief systems of past generations. Topics that are hard to discuss in person, especially if they’re secrets or considered taboo within the family, can be disclosed through drawing a genogram. Clients may feel more comfortable expressing their views on a piece of paper than talking about it.
Points out strengths
A genogram isn’t all about pointing the weaknesses in the family relationship. It can also be used to identify strengths that will act as the client’s support toward recovery from trauma or similar stressful circumstances.
Drawing genograms can help reignite communication within the family since the activity requires some questions that only family members can answer. This action helps strengthen the relationship between the members as they discover new things about themselves and their bond with each other.
Regularly reviewing the genogram can aid patients in remembering past experiences that led them to current situations. This is especially helpful in resolving issues occurring in a recurring pattern. Doing this also empowers patients by reiterating that they’re the experts who understand their family’s dynamics; that they have the capacity to change things on their own.
A major element in the success of family therapy is not the completeness of a genogram alone; it’s the active participation of each member to genuinely resolve family problems and strengthen their relationship with each other.
A genogram acts only as a reference point that can help therapists and patients see the bigger picture. Collaboration among members is the necessary ingredient for achieving successful family therapy.
Conclusion
A genogram plays a vital role in family therapy as it reveals the status of the relationship between each member. It provides a wider perspective on how issues have evolved, leading to a better understanding of the situation.
With the comprehensive information a genogram provides, together with the proactive participation of family members, it’s not impossible to resolve relationship issues and strengthen the bond of the group.
GenoPro is a software perfect for creating genograms with ease. Users can create multi-generational genograms and include information like emotional relationships, social connections, and key life events relevant to understanding where the issues arise.
GenoPro makes it easier for patients and therapists to identify behavioral patterns and dysfunctional relationships by presenting a clean-cut genogram. The software is currently available for a free trial and can be purchased for personal, academic, and enterprise use.
Family Therapy: Approaches, Techniques and Methods
FIND A PSYCHOLOGIST
alter
DIRECTIONS GUIDE
Family therapy is not only work with marital relationships.
If one of the family members has problems, their roots can go deep into family history and habitual behavior patterns. So, the problems of a child are often offered to be solved not in a children's, but in family psychotherapy.
There are two main approaches: Systemic Family Therapy and Emotionally Focused Therapy. The first considers the family as a whole and adjusts the system itself. The second works mainly with relationships within a couple, helps partners get out of an impasse, restore intimacy and trust.
Contents
1. Systemic family therapy: the family is a single organism
2. What is the family system
3. How CCT works
4. Genogram
5. Circular interview
6. Positive reformulation
7. What problems are solved at SST
8. Emotionally Focused Therapy: staging a “pair dance”
9. Basic principles of EFT
10.
How EFT works
11. When is it time for therapy?
12. Case study
13. What to read?
Systemic family therapy: the family is a single organism
Systemic family therapy (SFT) does not consist of individual therapy for each family member. The client in this case is the family as an organism, a single whole. In the system, everyone is connected with everyone, so any violations in one of the family members can lead to disharmony for everyone else.
“Family is a system. Each person is an element of this system that influences it. Relationships between elements also affect the system. If one family member has a symptom - for example, alcoholism - this will be reflected not only in him, but also in his family. His relationship with his wife will also be special, and will also affect the entire system. If his wife protects and protects him, there will be one relationship in the family, if she gets angry and makes scandals, it’s completely different. ”
Olesya Kruglushina, Systemic Family Therapist
Unlike other therapeutic approaches, CCT did not grow out of philosophy or medicine. It is based on biology and cybernetics. In the 1930s, L. von Bertalanffy introduced the concept of "General Systems Theory". Its idea is based on an organismic view of the world:
- The whole is greater than the sum of its parts
- All parts and processes influence each other
Family counseling existed before, it just happened within existing schools : for example, psychoanalytic, humanistic, gestalt therapy. In the 1970s, the concept of systemic-family views on therapy began to develop. Subsequently, FTA developed differently in the US and Europe. Now this approach is recognized at the state level in many countries.
Historical background
What is the family system
According to the SST, the life of the family system is subject to two laws: Any changes are perceived as a threat to the system. Therefore, in SST it is important to work with the resistance that inevitably arises. In order to preserve the order of things, the family is ready to endure any restrictions. The client wants the problem to leave the family, but is not ready to change for this.
Development Law
However, the family system cannot be frozen. The age of family members changes - accordingly, their relationships also change. Children are born, and then grow up and begin to live independently.
Murray Bowen, one of the well-known CCT practitioners, formulated 8 concepts of the family system. They are interconnected - to understand how the system works, you need to see the essence of each concept and its impact on the others.
Differentiation "I"
A person with a high level of differentiation can build emotional contact with the family without losing the boundaries of personality. If the level is low, then the person will be inclined to merge and symbiosis with the family. From a therapeutic point of view, this is not the best model. The therapist teaches each family member to separate from the rest while maintaining good contact.
Emotion Triangle
When there is conflict between two people, they often use a third person to find a way out of the conflict. As a rule, in this way parents use the child to influence each other. This creates a "pathological emotional triangle". In fact, the conflict cannot be resolved in this way. But, according to the law of homeostasis, the family continues to support it. For this, someone may even act to their own detriment (for example, a child maintains poor school performance, because because of this the whole family gets together, does homework with him and solves a common problem).
Projective processes
Children involved in the emotional triangle often begin to “repeat” after their parents. They react similarly to stressful situations, experience similar emotions: for example, anxiety, resentment or aggression.
The process of transmission of negative patterns from generation to generation
If parents had a low level of differentiation, children are likely to adopt it. And later they will pass it on to their children. So dysfunctional patterns of behavior can "live" in the family for so many generations that it will be difficult to change them.
Emotional break
Some family members decide to break emotional contact with the family in order to resolve their problems. This does not always help: sometimes a broken relationship brings even more discomfort. The therapist will teach this family member the differentiation of the Self: it is not necessary to break the connection in order to maintain individuality.
Sibling position
Older, middle and younger children behave differently because of different expectations from their parents. Subsequently, this behavior can become part of their character and influence the rest of their lives.
For example, older children often start behaving like "little adults" from an early age, which can lead to hyper-responsibility and anxiety.
Social emotional process
Social changes affect the institution of the family. Also, different social currents and opinions can affect the atmosphere in a single family. Therefore, in therapy it is very important to look at the social context.
The emotional process of the nuclear family
"Everyone affects everyone." If there are disagreements, conflicts or violence between some family members, this is reflected in the rest and can even lead to mental disorders.
The goal of systemic family therapy is to highlight negative patterns of behavior. find their roots, work through and help the family find a balance between emotional contact and individualization.
How the CCT works
In the first session, the therapist clarifies the problem and the history of the family.
It focuses on the main points:
Relationships of all family members
Relationships and communication features appear in significant situations. The therapist asks family members to take turns describing an event and looks at their interactions—in the stories themselves and in the course of therapy.
Public and unspoken rules in the family
Rules are how a family lives, how responsibilities are distributed in it, how family members communicate with each other. Examples of a family rule: "The woman is responsible for all housework", "Children have no right to argue with their elders." Not everyone may agree with the rule, but they still abide by it.
Family myths
A family myth is an unspoken image of a family that is supported by all its members. For example: “We are a friendly family and never swear.” Conflicts and contradictions in such a family can be hushed up so as not to destroy the myth. For the sake of the myth “Mom is our savior”, all other family members will constantly get into trouble so that there is someone to save.
Anyone who threatens the myth with his behavior can be severely punished - up to and including exclusion from the system.
Family boundaries
Each family member has an idea of who belongs to the family. This representation can be different: for example, the wife includes her parents in the system, while the husband does not consider them members of the family. This discrepancy leads to serious disagreements.
“Before the family comes to the session, I form a hypothesis: what is happening to these people that brought them to therapy. At the session, the first stage is the collection of information and acquaintance. I ask about professions, education, background. This is very important and affects relationships. After all, if he is a professor of mathematical sciences, and she is a manicurist, most likely they speak different languages. I ask if the person has “his” place in the apartment where he can be alone. Information that at first glance has nothing to do with a family problem can be very important.
”
Olesya Kruglushina, systemic family therapist:
“The systems approach can work with the whole family, with a couple and even individually. Sometimes not all family members want to come to therapy. It happens that a client stays or comes to individual work - and becomes an agent of change in his family. SST allows you to build a line of therapeutic work quite flexibly. For example, in working with a family where there is a teenager, family meetings can be sequentially organized, paired, individual with a teenager and each parent, and then again joint sessions. This is decided on a case-by-case basis."
Anna Guseva, systemic
family therapist:
As a rule, work in the STS is divided into 4 stages:
Making a family diagnosis
"Family diagnosis" is not a medical term and not a psychiatric conclusion. This is the reason why there is a problem in the family.
Elimination of the conflict
After clarification of the main conflict, it must be eliminated.
To do this, the therapist uses specific techniques to reduce the anxiety associated with the problem and teach family members to respond differently.
Reconstruction
Reconstruction is a change in the dysfunctional model itself, which causes conflicts. If you don't change it, it's a problem. most likely to return some time after therapy.
Support
Discussing the results, expressing thoughts and feelings on the subject reinforces the effect of therapy. So after the request is satisfied. it is helpful to have a few supportive sessions. There are cases when the family visits the therapist regularly - to prevent subsequent problems.
In the course of his work, the systemic family therapist uses various techniques that are unique to this type of therapy.
Genogram
The easiest way to trace the history of a family is to use the genogram technique. The therapist draws a detailed family tree with the family. On it, he notes the ties between relatives and important moments in history: marriage and divorce, the peculiarities of raising children and communicating with parents.
The genogram clearly shows what expectations each spouse has from family life.
“From childhood, we adopt certain family rules. How a family should function, how a wife and husband should behave, how to raise children, how to distribute finances. This is passed down from generation to generation. When we draw a genogram, a family symptom is immediately visible. There is always a relationship: some generations already had the same symptom. It is also seen that family rules in one and the other genus may not coincide.
For example, in the family the boys' wives were very protective, relieved of any work, "fed" and took care of them. And in the husband's family there was a rule "You are a man, you must help." Such a couple will quarrel even because of mopping: each will strive to do it on their own. As a result, the wife will feel rejected (“He doesn’t need my care and love”), and the husband will feel humiliated (“Is there nothing I can do?”).
Olesya Kruglushina, systemic family therapist:
Circular interview
Circular interview is a technique that is widely used in family therapy. The therapist takes turns asking all family members the same question—sometimes worded differently. A circular interview helps to clarify the attitude of each family member to a problematic situation - as well as to show everyone the hidden motives of their actions and words. However, the therapist usually does not ask about the thoughts and feelings of the client. It only shows how the whole situation looks from the outside, what patterns it reflects - and it becomes clear to everyone why this situation is happening.
Examples of questions in a circular interview:
— How does the situation look like now?
— When did the situation first arise? Why do you think this happened?
— How do you deal with this situation?
- What do you get when this situation occurs?
— If the situation continues in the future, what will it lead to?
Positive reformulation
Once the therapist has made a "family diagnosis", he helps the client change his attitude towards the problem.
First, he tells the family that their problem is not unique and that many are experiencing it. It takes some of the stress off. Then he draws attention to the advantages of the situation and positive motives for behavior. For example, “you are so protective of your son because you are a very caring person, and you are afraid of losing him.” Then he draws attention to the fact that the chosen behavior does not correspond to the motives that prompt it - it even contradicts them. For example, by overprotecting the child, the mother does not contribute to his safety - because in this way he does not learn to cope with difficult situations.
The last step of this work is prescription . The therapist helps the family formulate a new rule and gives homework to follow it.
What problems are solved at SST
SST deals with any problems related to family relations. You can contact a therapist if:
You find it difficult to negotiate and resolve conflicts within a couple (even if you are not officially married)
One of the family members has an emotional or mental disorder that affects relationships within the family
The child has problems with socialization, academic performance or health (especially for psychogenic illnesses)
You cannot find a common language with the child or teenager
The composition of the family has changed: a new child has appeared or, on the contrary, the child has grown up and started an independent life.
All family members need to adapt to new conditions
You are going through a divorce and creating new families
You are experiencing the death of a family member
“Most requests are related to marital and parent-child relationships. Individual clients come with very different questions: difficulties in creating long-term relationships, dissatisfaction in relationships with a partner and the world, experiencing crises and losses, the inability to decide on some important life choices, addictions.
Perhaps the most complex requests for each specialist will be different. Someone is better at dealing with divorces or parent-child relationships - and he will “transfer” clients with addiction to colleagues. Some find it difficult to work with conflicting families, while others find it difficult to work with distant ones. But for difficult cases, there are always supervisions and personal psychotherapy.”
Olesya Kruglushina, Systemic Family Therapist:
CCT may be short-term: some problems can be solved in a few sessions.
This usually refers to problems that have arisen recently. If the tension has built up over the years, more time will be needed. But it is impossible to accurately determine the required number of sessions - it is individual for each family.
Emotion Focused Therapy: Couple Dance
Emotion Focused Therapy (EFT) is designed for couples. It helps to overcome the crisis of relations, to make them closer and more trusting. One of the founders of the approach compared EFT to choreography: "the therapist acts as a choreographer for staging a pair dance."
EFT was based on the attachment theory of psychoanalyst John Bowlby. He worked with children - in particular, he observed how children develop and behave in orphanages. Bowlby noted that these children often suffer from emotional problems and find it difficult to establish contacts and long-term relationships. He suggested that this is due to the lack of experience of close attachment to the mother.
Then John Bowlby began to develop his theory of attachment, according to which the behavior of people in relationships depends on what kind of contact they had in childhood with their parents (in particular, with their mother). The fear of loneliness or overprotection is formed in childhood and remains with people for life. Because of this, they develop insecure attachment styles that prevent them from building strong close relationships.
EFT was created by Canadian psychologists Susan Johnson and Leslie Greenberg. They started developing the approach in the 80s. Methodologically, it is similar to the synthesis of Rogers' client-centered therapy and CCT. From client-centered therapy, EFT took the emotional involvement of the therapist and the nonjudgmental acceptance of the client. From SST, the idea that relationships are affected by negative patterns.
The approach has been constantly developed and improved. In 1998, Susan Johnson created The International Center for Excellence in Emotionally Focused Therapy, which trains and certifies EPT therapists and conducts clinical research.
It is now an internationally recognized method of couples therapy.
Historical background
Basic principles of ETF
Bowlby found that many people develop insecure attachment styles that interfere with relationships. The goal of EFT is to help change the attachment style to one that is secure and secure. A person with a secure type of attachment is not afraid of being abandoned or "strangled" by love, does not control a partner and does not manipulate him. He enjoys an emotional connection, a relationship for him is a “safe bay”, where you will always be accepted and supported.
Emotions are the key to creating a secure attachment
As the name implies, EFT focuses on emotions. Through emotions we perceive and evaluate reality. Negative emotions once led to the formation of an insecure attachment style.
The need for affection is healthy and natural
All people desire affection: it is genetically determined.
Historically, those who knew how to call for help and accept support survived. Only the ways in which people try to satisfy the need for attachment can be maladaptive.
Interaction is cyclical and patterns
One reaction provokes another. The behavior of the couple “enters” a cycle from which it is difficult to break out.
Change occurs through new emotional experience
In therapy, the couple receives new emotions - from communication with the therapist and with each other. This experience provokes change.
How EFT works
Johnson and Greenberg formulated 3 stages of work in EFT, each of which consists of several steps:
Step 1. Form a therapeutic alliance and discuss the request.
Step 2: Finding the Negative Cycle
Step 3: Dealing with the Emotions That Triggered the Cycle
Step 4: Redirecting the Problem: Common Enemy – Negative Cycle that Causes Stress and Conflict
Step 5: Articulating Needs and Emotions .
Partner interaction.
Step 6: Work on acceptance: The therapist teaches partners to express empathy and support, to accept each other's needs and emotions.
Step 7. Work on the style of attachment: the “withdrawal” partner learns to engage in an emotional connection, and the “accusing” partner learns to behave more freely.
Step 8. Form new ways to behave and discuss problems.
Step 9. Use the skills learned in therapy outside the office. Consolidation of results.
At each stage, the therapist uses techniques specific to EFT.
Reflection Technique
This technique is borrowed from Rogers' client-centered therapy. The therapist "returns" to the client his vision of the situation. He literally repeats the words of the client, highlighting the most emotional and significant moments with intonation. This contributes to the creation of a therapeutic alliance.
Confirmation Technique
Therapist accepts the client's thoughts and feelings; shows that they are completely normal and natural.
Confirmation is not approval. It is important for the therapist to remain neutral and not take sides with either partner. Its purpose is to show partners that their emotions are important and their reactions are understandable.
Empathic Suggestion Technique
The therapist guesses what deep emotions may lie behind the client's story. Sometimes we mask true, primal emotions with ones we have "learned" to experience—more socially acceptable and less traumatic. In therapy, it is important to “raise” the primary emotions and work through them.
Feeling Questions
When a therapist notices a particular reaction in a client, he may ask, "What did you feel at that moment?" "What prompted you to do this?" By asking questions, he invites the client to explore his own emotional world.
Amplification Technique
When during therapy it is possible to identify the primary emotion, the therapist deliberately focuses the client's attention on it, asks clarifying questions, provokes introspection.
As a rule, the client in this case resorts to an avoidance strategy: it is difficult and uncomfortable to discuss the primary emotion. The task of the therapist is to carefully work with resistance, not to put pressure on the client and support him.
The therapist may use a metaphor to ask the client what this emotion looks like, what it is like. If the client responds to the process, the therapist asks the client to share the experience with a partner.
Restructuring Interactions
Using the circular interview (a technique borrowed from CCT), the therapist finds negative cycles in partners' interactions and draws their attention to these cycles. Partners see how they themselves create conflict.
Reframing the problem
When a cycle is found, it is presented in therapy as a common enemy. The partners team up to defeat him. They no longer feel guilty or angry - they just got into a cycle that needs to be broken.
Enactment Technique
The therapist sets a certain topic of conversation and asks the partners in the session to discuss it.
In doing so, the therapist prompts some cues and interactions, guiding the conversation. Often, the acting-out technique provides clients with a strong emotional experience that helps them open up and moves them towards a stronger relationship.
EFT is suitable for all couples who want to strengthen their relationship: learn to hear each other better, spend more time together, stop quarreling, restore the freshness of feelings.
Studies show that up to 75% of couples overcome relationship difficulties after EFT. The effect of therapy lasts for a long time, because partners receive an effective tool to cope with further crises. They no longer return to the negative cycle.
When is it time for therapy?
There is a sad statistic: families come to therapy when they are already talking about divorce or separation. In this case, building relationships can be very difficult. Many therapists even refuse to work with couples who have decided to separate.
“There is a habit in the Russian mentality “not to wash dirty linen in public”. People are afraid or ashamed to seek help from a therapist. And they turn already when the point of no return has been passed. In my practice, there was a case: a client called with a request to improve relations. In the course of questioning, it turned out that his wife had been living with another person for six months and had sent documents for divorce. When I said that my maximum in this situation was to help them divorce less traumatically, he refused and decided to look for another therapist. Apparently, with a “magic pill” for his wife.”
Olesya Kruglushina, systemic family therapist:
Indications for therapy are not necessarily protracted serious problems. It will be useful for many families to take a course in order to establish contact, identify hidden negative emotions and work through them, raise happier children. After all, therapy is always not only a solution to problems, but also personal growth.
Case study
“The parents of a five-year-old girl applied. The girl could not adapt to kindergarten: she did not want to go, she was sick all the time. Parents were at the doctors, they did not find a somatic cause - and they were sent to a family therapist.
In the first session, I started asking parents what kindergarten means to them. The answer was: "This is the place where children are handed over." They conveyed this idea to the child. But not a single person wants to be “handed over” somewhere. It turned out that dad's family had a traumatic story with a terrible kindergarten. Therefore, at first we worked with dad's beliefs: what can be interesting and fun in the garden.
I gave homework: to follow exactly how parents talk about this topic with their daughter. After a few sessions, this problem was solved, and she began to go to the garden with pleasure, she ceased to be afraid of it.
Olesya Kruglushina, systemic family therapist:
What to read?
Introduction to Systemic Family Therapy.
Anna Varga
A book for psychologists who would like to master the methods of systemic family therapy, as well as for everyone who is interested in this topic. Examples from practice, description of work techniques, disclosure of concepts - this will help to form a complete picture of the approach.
"Hug me tight."
Sue Johnson
Sue Johnson is one of the founders of Emotionally Focused Therapy. She writes about how to form a secure attachment in a couple, develop empathy and build strong long-term relationships.
FIND A FAMILY PSYCHOLOGIST
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Family Therapy: Approaches, Techniques and Methods
FIND A PSYCHOLOGIST
alter
DIRECTIONS GUIDE
Family therapy is not just about marital relationships. If one of the family members has problems, their roots can go deep into family history and habitual behavior patterns.
So, the problems of a child are often offered to be solved not in a children's, but in family psychotherapy.
There are two main approaches: systemic family therapy and emotion-focused therapy. The first considers the family as a whole and adjusts the system itself. The second works mainly with relationships within a couple, helps partners get out of an impasse, restore intimacy and trust.
Contents
1. Systemic family therapy: the family is a single organism
2. What is the family system
3. How the CCT works
4. Genogram
5. Circular interview
6. Positive reformulation
7. What problems are solved at SST
8. Emotionally Focused Therapy: staging a “pair dance”
9. Basic principles of EFT
10. How EFT works
11. When is it time for therapy?
12. Case study
13. What to read?
Systemic family therapy: the family is a single organism
Systemic family therapy (SFT) does not consist of individual therapy for each family member.
The client in this case is the family as an organism, a single whole. In the system, everyone is connected with everyone, so any violations in one of the family members can lead to disharmony for everyone else.
“A family is a system. Each person is an element of this system that influences it. Relationships between elements also affect the system. If one family member has a symptom - for example, alcoholism - this will be reflected not only in him, but also in his family. His relationship with his wife will also be special, and will also affect the entire system. If his wife protects and protects him, there will be one relationship in the family, if she gets angry and makes scandals, it’s completely different. ”
Olesya Kruglushina, Systemic Family Therapist
Unlike other therapeutic approaches, CCT did not grow out of philosophy or medicine. It is based on biology and cybernetics. In the 1930s, L. von Bertalanffy introduced the concept of "General Systems Theory".
Its idea is based on an organismic view of the world:
- The whole is greater than the sum of its parts
- All parts and processes influence each other
Family counseling existed before, it just happened within existing schools : for example, psychoanalytic, humanistic, gestalt therapy. In the 1970s, the concept of systemic-family views on therapy began to develop. Subsequently, FTA developed differently in the US and Europe. Now this approach is recognized at the state level in many countries.
Historical background
What is the family system
According to the SST, the life of the family system is subject to two laws: Any changes are perceived as a threat to the system. Therefore, in SST it is important to work with the resistance that inevitably arises. In order to preserve the order of things, the family is ready to endure any restrictions. The client wants the problem to leave the family, but is not ready to change for this.
Development Law
However, the family system cannot be frozen. The age of family members changes - accordingly, their relationships also change. Children are born, and then grow up and begin to live independently.
Murray Bowen, one of the well-known CCT practitioners, formulated 8 concepts of the family system. They are interconnected - to understand how the system works, you need to see the essence of each concept and its impact on the others.
Differentiation "I"
A person with a high level of differentiation can build emotional contact with the family without losing the boundaries of personality. If the level is low, then the person will be inclined to merge and symbiosis with the family. From a therapeutic point of view, this is not the best model. The therapist teaches each family member to separate from the rest while maintaining good contact.
Emotion Triangle
When there is conflict between two people, they often use a third person to find a way out of the conflict.
As a rule, in this way parents use the child to influence each other. This creates a "pathological emotional triangle". In fact, the conflict cannot be resolved in this way. But, according to the law of homeostasis, the family continues to support it. For this, someone may even act to their own detriment (for example, a child maintains poor school performance, because because of this the whole family gets together, does homework with him and solves a common problem).
Projective processes
Children involved in the emotional triangle often begin to “repeat” after their parents. They react similarly to stressful situations, experience similar emotions: for example, anxiety, resentment or aggression.
The process of transmission of negative patterns from generation to generation
If parents had a low level of differentiation, children are likely to adopt it. And later they will pass it on to their children. So dysfunctional patterns of behavior can "live" in the family for so many generations that it will be difficult to change them.
Emotional break
Some family members decide to break emotional contact with the family in order to resolve their problems. This does not always help: sometimes a broken relationship brings even more discomfort. The therapist will teach this family member the differentiation of the Self: it is not necessary to break the connection in order to maintain individuality.
Sibling position
Older, middle and younger children behave differently because of different expectations from their parents. Subsequently, this behavior can become part of their character and influence the rest of their lives. For example, older children often start behaving like "little adults" from an early age, which can lead to hyper-responsibility and anxiety.
Social emotional process
Social changes affect the institution of the family. Also, different social currents and opinions can affect the atmosphere in a single family. Therefore, in therapy it is very important to look at the social context.
The emotional process of the nuclear family
"Everyone affects everyone." If there are disagreements, conflicts or violence between some family members, this is reflected in the rest and can even lead to mental disorders.
The goal of systemic family therapy is to highlight negative patterns of behavior. find their roots, work through and help the family find a balance between emotional contact and individualization.
How the CCT works
In the first session, the therapist clarifies the problem and the history of the family. It focuses on the main points:
Relationships of all family members
Relationships and communication features appear in significant situations. The therapist asks family members to take turns describing an event and looks at their interactions—in the stories themselves and in the course of therapy.
Public and unspoken rules in the family
Rules are how a family lives, how responsibilities are distributed in it, how family members communicate with each other. Examples of a family rule: "The woman is responsible for all housework", "Children have no right to argue with their elders." Not everyone may agree with the rule, but they still abide by it.
Family myths
A family myth is an unspoken image of a family that is supported by all its members. For example: “We are a friendly family and never swear.” Conflicts and contradictions in such a family can be hushed up so as not to destroy the myth. For the sake of the myth “Mom is our savior”, all other family members will constantly get into trouble so that there is someone to save. Anyone who threatens the myth with his behavior can be severely punished - up to and including exclusion from the system.
Family boundaries
Each family member has an idea of who belongs to the family.
This representation can be different: for example, the wife includes her parents in the system, while the husband does not consider them members of the family. This discrepancy leads to serious disagreements.
“Before the family comes to the session, I form a hypothesis: what is happening to these people that brought them to therapy. At the session, the first stage is the collection of information and acquaintance. I ask about professions, education, background. This is very important and affects relationships. After all, if he is a professor of mathematical sciences, and she is a manicurist, most likely they speak different languages. I ask if the person has “his” place in the apartment where he can be alone. Information that at first glance has nothing to do with a family problem can be very important.”
Olesya Kruglushina, systemic family therapist:
“The systems approach can work with the whole family, with a couple and even individually. Sometimes not all family members want to come to therapy.
It happens that a client stays or comes to individual work - and becomes an agent of change in his family. SST allows you to build a line of therapeutic work quite flexibly. For example, in working with a family where there is a teenager, family meetings can be sequentially organized, paired, individual with a teenager and each parent, and then again joint sessions. This is decided on a case-by-case basis."
Anna Guseva, systemic
family therapist:
As a rule, work in the STS is divided into 4 stages:
Making a family diagnosis
"Family diagnosis" is not a medical term and not a psychiatric conclusion. This is the reason why there is a problem in the family.
Elimination of the conflict
After clarification of the main conflict, it must be eliminated. To do this, the therapist uses specific techniques to reduce the anxiety associated with the problem and teach family members to respond differently.
Reconstruction
Reconstruction is a change in the dysfunctional model itself, which causes conflicts. If you don't change it, it's a problem. most likely to return some time after therapy.
Support
Discussing the results, expressing thoughts and feelings on the subject reinforces the effect of therapy. So after the request is satisfied. it is helpful to have a few supportive sessions. There are cases when the family visits the therapist regularly - to prevent subsequent problems.
In the course of his work, the systemic family therapist uses various techniques that are unique to this type of therapy.
Genogram
The easiest way to trace the history of a family is to use the genogram technique. The therapist draws a detailed family tree with the family. On it, he notes the ties between relatives and important moments in history: marriage and divorce, the peculiarities of raising children and communicating with parents.
The genogram clearly shows what expectations each spouse has from family life.
“From childhood, we adopt certain family rules. How a family should function, how a wife and husband should behave, how to raise children, how to distribute finances. This is passed down from generation to generation. When we draw a genogram, a family symptom is immediately visible. There is always a relationship: some generations already had the same symptom. It is also seen that family rules in one and the other genus may not coincide.
For example, in the family the boys' wives were very protective, relieved of any work, "fed" and took care of them. And in the husband's family there was a rule "You are a man, you must help." Such a couple will quarrel even because of mopping: each will strive to do it on their own. As a result, the wife will feel rejected (“He doesn’t need my care and love”), and the husband will feel humiliated (“Is there nothing I can do?”).
Olesya Kruglushina, systemic family therapist:
Circular interview
Circular interview is a technique that is widely used in family therapy. The therapist takes turns asking all family members the same question—sometimes worded differently. A circular interview helps to clarify the attitude of each family member to a problematic situation - as well as to show everyone the hidden motives of their actions and words. However, the therapist usually does not ask about the thoughts and feelings of the client. It only shows how the whole situation looks from the outside, what patterns it reflects - and it becomes clear to everyone why this situation is happening.
Examples of questions in a circular interview:
— How does the situation look like now?
— When did the situation first arise? Why do you think this happened?
— How do you deal with this situation?
- What do you get when this situation occurs?
— If the situation continues in the future, what will it lead to?
Positive reformulation
Once the therapist has made a "family diagnosis", he helps the client change his attitude towards the problem. First, he tells the family that their problem is not unique and that many are experiencing it. It takes some of the stress off. Then he draws attention to the advantages of the situation and positive motives for behavior. For example, “you are so protective of your son because you are a very caring person, and you are afraid of losing him.” Then he draws attention to the fact that the chosen behavior does not correspond to the motives that prompt it - it even contradicts them. For example, by overprotecting the child, the mother does not contribute to his safety - because in this way he does not learn to cope with difficult situations.
The last step of this work is prescription . The therapist helps the family formulate a new rule and gives homework to follow it.
What problems are solved at SST
SST deals with any problems related to family relations. You can contact a therapist if:
You find it difficult to negotiate and resolve conflicts within a couple (even if you are not officially married)
One of the family members has an emotional or mental disorder that affects relationships within the family
The child has problems with socialization, academic performance or health (especially for psychogenic illnesses)
You cannot find a common language with the child or teenager
The composition of the family has changed: a new child has appeared or, on the contrary, the child has grown up and started an independent life. All family members need to adapt to new conditions
You are going through a divorce and creating new families
You are experiencing the death of a family member
“Most requests are related to marital and parent-child relationships. Individual clients come with very different questions: difficulties in creating long-term relationships, dissatisfaction in relationships with a partner and the world, experiencing crises and losses, the inability to decide on some important life choices, addictions.
Perhaps the most complex requests for each specialist will be different. Someone is better at dealing with divorces or parent-child relationships - and he will “transfer” clients with addiction to colleagues. Some find it difficult to work with conflicting families, while others find it difficult to work with distant ones. But for difficult cases, there are always supervisions and personal psychotherapy.”
Olesya Kruglushina, Systemic Family Therapist:
CCT may be short-term: some problems can be solved in a few sessions.
This usually refers to problems that have arisen recently. If the tension has built up over the years, more time will be needed. But it is impossible to accurately determine the required number of sessions - it is individual for each family.
Emotion Focused Therapy: Couple Dance
Emotion Focused Therapy (EFT) is designed for couples. It helps to overcome the crisis of relations, to make them closer and more trusting. One of the founders of the approach compared EFT to choreography: "the therapist acts as a choreographer for staging a pair dance."
EFT was based on the attachment theory of psychoanalyst John Bowlby. He worked with children - in particular, he observed how children develop and behave in orphanages. Bowlby noted that these children often suffer from emotional problems and find it difficult to establish contacts and long-term relationships. He suggested that this is due to the lack of experience of close attachment to the mother.
Then John Bowlby began to develop his theory of attachment, according to which the behavior of people in relationships depends on what kind of contact they had in childhood with their parents (in particular, with their mother). The fear of loneliness or overprotection is formed in childhood and remains with people for life. Because of this, they develop insecure attachment styles that prevent them from building strong close relationships.
EFT was created by Canadian psychologists Susan Johnson and Leslie Greenberg. They started developing the approach in the 80s. Methodologically, it is similar to the synthesis of Rogers' client-centered therapy and CCT. From client-centered therapy, EFT took the emotional involvement of the therapist and the nonjudgmental acceptance of the client. From SST, the idea that relationships are affected by negative patterns.
The approach has been constantly developed and improved. In 1998, Susan Johnson created The International Center for Excellence in Emotionally Focused Therapy, which trains and certifies EPT therapists and conducts clinical research.
It is now an internationally recognized method of couples therapy.
Historical background
Basic principles of ETF
Bowlby found that many people develop insecure attachment styles that interfere with relationships. The goal of EFT is to help change the attachment style to one that is secure and secure. A person with a secure type of attachment is not afraid of being abandoned or "strangled" by love, does not control a partner and does not manipulate him. He enjoys an emotional connection, a relationship for him is a “safe bay”, where you will always be accepted and supported.
Emotions are the key to creating a secure attachment
As the name implies, EFT focuses on emotions. Through emotions we perceive and evaluate reality. Negative emotions once led to the formation of an insecure attachment style.
The need for affection is healthy and natural
All people desire affection: it is genetically determined.
Historically, those who knew how to call for help and accept support survived. Only the ways in which people try to satisfy the need for attachment can be maladaptive.
Interaction is cyclical and patterns
One reaction provokes another. The behavior of the couple “enters” a cycle from which it is difficult to break out.
Change occurs through new emotional experience
In therapy, the couple receives new emotions - from communication with the therapist and with each other. This experience provokes change.
How EFT works
Johnson and Greenberg formulated 3 stages of work in EFT, each of which consists of several steps:
Step 1. Form a therapeutic alliance and discuss the request.
Step 2: Finding the Negative Cycle
Step 3: Dealing with the Emotions That Triggered the Cycle
Step 4: Redirecting the Problem: Common Enemy – Negative Cycle that Causes Stress and Conflict
Step 5: Articulating Needs and Emotions .
Partner interaction.
Step 6: Work on acceptance: The therapist teaches partners to express empathy and support, to accept each other's needs and emotions.
Step 7. Work on the style of attachment: the “withdrawal” partner learns to engage in an emotional connection, and the “accusing” partner learns to behave more freely.
Step 8. Form new ways to behave and discuss problems.
Step 9. Use the skills learned in therapy outside the office. Consolidation of results.
At each stage, the therapist uses techniques specific to EFT.
Reflection Technique
This technique is borrowed from Rogers' client-centered therapy. The therapist "returns" to the client his vision of the situation. He literally repeats the words of the client, highlighting the most emotional and significant moments with intonation. This contributes to the creation of a therapeutic alliance.
Confirmation Technique
Therapist accepts the client's thoughts and feelings; shows that they are completely normal and natural.
Confirmation is not approval. It is important for the therapist to remain neutral and not take sides with either partner. Its purpose is to show partners that their emotions are important and their reactions are understandable.
Empathic Suggestion Technique
The therapist guesses what deep emotions may lie behind the client's story. Sometimes we mask true, primal emotions with ones we have "learned" to experience—more socially acceptable and less traumatic. In therapy, it is important to “raise” the primary emotions and work through them.
Feeling Questions
When a therapist notices a particular reaction in a client, he may ask, "What did you feel at that moment?" "What prompted you to do this?" By asking questions, he invites the client to explore his own emotional world.
Amplification Technique
When during therapy it is possible to identify the primary emotion, the therapist deliberately focuses the client's attention on it, asks clarifying questions, provokes introspection.
As a rule, the client in this case resorts to an avoidance strategy: it is difficult and uncomfortable to discuss the primary emotion. The task of the therapist is to carefully work with resistance, not to put pressure on the client and support him.
The therapist may use a metaphor to ask the client what this emotion looks like, what it is like. If the client responds to the process, the therapist asks the client to share the experience with a partner.
Restructuring Interactions
Using the circular interview (a technique borrowed from CCT), the therapist finds negative cycles in partners' interactions and draws their attention to these cycles. Partners see how they themselves create conflict.
Reframing the problem
When a cycle is found, it is presented in therapy as a common enemy. The partners team up to defeat him. They no longer feel guilty or angry - they just got into a cycle that needs to be broken.
Enactment Technique
The therapist sets a certain topic of conversation and asks the partners in the session to discuss it.
In doing so, the therapist prompts some cues and interactions, guiding the conversation. Often, the acting-out technique provides clients with a strong emotional experience that helps them open up and moves them towards a stronger relationship.
EFT is suitable for all couples who want to strengthen their relationship: learn to hear each other better, spend more time together, stop quarreling, restore the freshness of feelings.
Studies show that up to 75% of couples overcome relationship difficulties after EFT. The effect of therapy lasts for a long time, because partners receive an effective tool to cope with further crises. They no longer return to the negative cycle.
When is it time for therapy?
There is a sad statistic: families come to therapy when they are already talking about divorce or separation. In this case, building relationships can be very difficult. Many therapists even refuse to work with couples who have decided to separate.
“There is a habit in the Russian mentality “not to wash dirty linen in public”. People are afraid or ashamed to seek help from a therapist. And they turn already when the point of no return has been passed. In my practice, there was a case: a client called with a request to improve relations. In the course of questioning, it turned out that his wife had been living with another person for six months and had sent documents for divorce. When I said that my maximum in this situation was to help them divorce less traumatically, he refused and decided to look for another therapist. Apparently, with a “magic pill” for his wife.”
Olesya Kruglushina, systemic family therapist:
Indications for therapy are not necessarily protracted serious problems. It will be useful for many families to take a course in order to establish contact, identify hidden negative emotions and work through them, raise happier children. After all, therapy is always not only a solution to problems, but also personal growth.
Case study
“The parents of a five-year-old girl applied. The girl could not adapt to kindergarten: she did not want to go, she was sick all the time. Parents were at the doctors, they did not find a somatic cause - and they were sent to a family therapist.
In the first session, I started asking parents what kindergarten means to them. The answer was: "This is the place where children are handed over." They conveyed this idea to the child. But not a single person wants to be “handed over” somewhere. It turned out that dad's family had a traumatic story with a terrible kindergarten. Therefore, at first we worked with dad's beliefs: what can be interesting and fun in the garden.
I gave homework: to follow exactly how parents talk about this topic with their daughter. After a few sessions, this problem was solved, and she began to go to the garden with pleasure, she ceased to be afraid of it.
Olesya Kruglushina, systemic family therapist:
What to read?
Introduction to Systemic Family Therapy.
