Psycho-educational Models of Family Therapy and Transgenerational Models of Family Therapy in Correlation to Physical and Sexual Violence and Abuse

Molestation, commonly known as sexual abuse, is defined as forced sexual behavior by one individual with another. However, sexual assault is one which is not so frequent, lasts for short duration, and is immediate. Pejoratively, sexual abuser or offender is referred as a molester. It also means any act on behalf of an adult in order to arouse child or adult sexually. Any sexual act is referred as child sexual abuse if the age of victim is below the age of consent. Mentioned below are the acts that are included in sexual abuse:

Sexual assault and rape, which is forced and non-consensual.

When a child or adult touches without any need.

Exhibitionism, genitalia’s exposure, fondling, sexual kissing, or sexual assault.

Showing pornography to a child.

Child molestation, in which child is interacted with sexually suggestive statement.

When an adult is interacted with non-consensual verbal sexual demands.

Using trust to motivate other to have sex, otherwise, it may be done forcefully resulting in sexual assault or rape.

Sexual deviancy, such as incest.

Other kinds of sexual harassment.

Another type of domestic violence is the spousal sexual abuse. In this, the spouse may be raped or forcefully sexed, and may result into assault if jurisdictions are taken into account.

Physical abuse and violence

When the purpose of an abuse is to harm someone’s body, let him/her go through physical sufferings, cause injury, or intimidate others, it is known as physical abuse. Physical abuse and violence may be tripping, kneeing, kicking, pinching on body unnecessarily, whipping, slapping, puling, pushing, belting, punching, or striking via object, etc.

In this paper the researcher analyzes psycho-educational family therapy and transgenerational models as they relate to physical and sexual violence and abuse in families. Subsequently, cultural considerations are highlighted and empirical studies on culture related to physical and sexual violence and abuse in families are analyzed. Lastly, the paper provides a Psychiatric Diagnosis based on PTSD criteria for diagnosis by the American Psychiatric Association.

Chapter II: Comprehensive Coverage

Numerous researches have supported the use of family therapy structures to be the appropriate way to intervene and help those families who have trouble dealing with mentally ill or disturbed members of the family. The family therapy setup helps educate and train the family members to deal with the mentally challenged members on a one-on-one format as well as in a social gathering. People having mental illnesses, like schizophrenia (McFarlane, 2002) or those having violent or abusive streaks (Henggeler et al., 1998) or those suffering from drug or alcohol abuse (Ozechowski et al., 2003) or even those families who are suffering from chronic diseases (Rolland, 2003); have been better off by going through the program of family psycho-education (taken from chapter 8).

Trans-generational model:

The trans-generational model, as the name suggests, is a model that interlocks the historical aspects with the individual growth and continuity of family problems together in order to determine patterns and then uses four crucial elements to help the mentally ill individuals and their families to cope with whatever emotional and social deficiencies exist. The four elements for the trans-generational model are emotional triangles, the concept of differentiation of self, family patterns, and problem’s time frame. The important thing to note here is that the trans-generational model does not look to point blame and claim that prior or current generations and their activities were the basis for the problems that they were facing. Furthermore, the trans-generational models utilize the help of family therapists and the theories that they present so as to tackle the general issues that the families and individuals face. Another emphasis in the trans-generational models is on the relationships and associations that exist between family members. This is perhaps why the model utilizes family therapy so that they can have family sessions whereby these relationships can be improved and enhanced. Most often, a trans-generational model is used to deal with a differentiated individual whose mental capability allows him or her to think, analyze and ponder over events but be incapable of automatically responding to the external and internal environments that surround him. Therefore, one of the first things to analyze here for the family therapist becomes the existence of self-recognition from the patient. Once, the family therapists are able to define whether or not the patient has a structure of self-recognition or self-identity, the overall family model and system that influences the patient becomes easier to recognize and treat thereof (taken from chapter 8).

Bowen’s family theory

Bowen’s family theory is also one that engages the therapy with factors like self-development, intergenerational issues, prior familial relationships as well as prior familial interactions. He focused minimally on the emotional stances of the families or couples he was providing therapy to, instead he chose to focus on tangible and logical aspects individually (at first) and then together in order to present a controlled therapeutic session that tackles each individual’s deficiencies without creating an environment of blame placements and finger pointing. Bowen’s family therapy is one that was ahead of his time, as he did not confine himself to the traditional theories available, instead he expanded his theory into balancing the togetherness of a family dynamic and an individual’s freedom within that dynamic. He believed this approach of creating balance must be instigated at the teaching levels so that clinicians and their remedies provided, especially to schizophrenics, were ones that propagated this balance when dealing with emotional or problematic familial situations (taken from chapter 8).

Bowen was a leading figure and pioneer in the realm of family therapy. His experiences during war served as the prelude to his interest in the psychoanalysis of individuals. It was his research and efforts back in 1954 that encouraged him to take forth his ideologies into clinical practice and analyze the impact made thereof. Bowen first perceived the mother-child relationship to be unbalanced and thus the cause of problematic situations but then moved his focus on the entire family as an unbalanced unit made up of people who were incapable of recognizing their own individuality and thus incapable of separating themselves even in the familial dynamic. This he believed was the case due to the emotional imbalance and inconsistency at the individual and group level. To counter this, Bowen started focusing on what he called family emotional system. This was by far the biggest point of growth for Bowen as it opened new doors to his clinical approach. Bowen now incorporated in his clinical practice the aspect of emotional human intelligence to be part of a natural system that was structured along similar laws and regulations as every other aspect within the natural system. Hence, it can easily be said that Bowen was pioneering a new theory of human behavior. In support of Bowen’s approach, there were other leading figures that took the same route. These included: Michael Kerr, Edwin Freidman, Phillip Guerin, Peter Titelman, Betty Carter, amongst others (taken from chapter 8).

Family system theory

Family system therapy has gained popularity over the years and newer techniques are emerging and adopted extensively as useful therapeutic procedures to deal with the mentally ill and help their families develop coping strategies. Family system therapy primarily focuses on the strengths and skills of the family members and polishes those to deal with the mentally ill members especially those who have been disregarded by their society due to their mental illnesses. Some of the therapeutic methods applied in this structure include: family systems theories; cognitive behavior therapy; theory of planned behavior; structural therapy; educational psychology, amongst others. All of these methods and therapies are complemented with the use of psycho-pharmacological therapies and are primarily aimed to assist the mentally ill people and their families to create a sustainable environment whereby they can rejoin their occupational and social life. In this regard, family system therapy provides strategies to the family members regarding how to cope with other family member’s attitude behavior – which is going through a particular menial illness (Herbert et al., 2008). In the same paper, the authors emphasize on how the purpose of family system therapy is not only to cater psychiatric treatment of an ill family member, but to uplift family’s social, economic, psychological position in the community too and build whatever relationships had been tainted. This is an extremely important aspect of the family system therapy structure as it helps in allowing the families and the mentally ill individuals to develop a socially strong relationship which is then used as the springboard to a healthier social and mental lifestyle (Herbert et al., 2008; taken from chapter 8).

Eight interlocking theoretical concepts

Differentiation of self

Bowen’s theory of differentiation of self claims that an individual must differentiate between feelings and thinking and, while he dies not explain the difference between the two, the important thing to note here is that he claims that all individuals must separate their emotions and make decisions based on what they think is the most logical and appropriate thing to do. Hence, the individual must differentiate between the intellectual self and the emotional self; he focuses on how the recognition of the self must occur first before differentiation can take place. This also engages other separations like from parents, women, friends, etc. (taken from chapter 8).

Triangles (Brief summary)

Bowen asserts that the triangles are used as a 3-person relationship structure that embodies the expansive emotional structures and is usually structured whereby two persons emotionally involved or in a problematic emotional state are put in a controlled environment using a third person as the interventionist. The third person then serves as the source of reason and one who finds common ground and serves as the link that helps separate the intellect and the emotions (taken from chapter 8).

Nuclear family emotional system

An emotional structure in a nuclear family can only remain stable if and when every individual recognizes the self and remains differentiated in every aspect. An important aspect of the nuclear family emotional setup is that the reason behind the use of multigenerational theories for this structure lies in the fact that most severe problems that occur in the nuclear families are mainly because of the roots of differentiation and generation deep issues (taken from chapter 8).

Family Projection Process

The concept of self program and the way people interact is a major part of the family projection process as every individual interacts differently with a member of the family; even parents interact differently with each child. This is also quiet obvious in the spouse selection process. This is also where differentiation plays a huge part as once the individuality in each person is recognized, the projection would become more equal and fair (taken from chapter 8).

Emotional cut-off

The fact is that if and when parents are able to disengage the process of fusion (i.e. focus on one child approach), they are most likely to help the children attain a more balanced approach between intellect and emotion. However, Bowen emphasizes that if this fusion is completely ignored, emotional cut-off can take place whereby children will cut-off any and all emotional ties to parents and/or family in order to maintain their individuality (taken from chapter 8).

Multi-generational Transmission Process

The theory comprised of multigenerational transmission procedures which entails the fact of differences witnessed among offspring lead and their parents that is spread over many generations to be labeled as marked differences between the members. The main roots causing the difference are carried forward through solid connections. There are quite a few combined levels with which the transmission takes place ranging from the conscious methods of teaching to the sub-conscious automated programming tools judging the behavior and emotions. Genetically and from a logical perspective an individual’s self existence is shaped through the interaction of transmitted information (taken from chapter 8).

Sibling Positioning

The efforts of parents in determining the upbringing of their offspring is a major factor in determine the amount of differentiation of self that is attained. Individuals’ response towards their siblings and how their parents treat their siblings, attitudes, moods, and their dependant nature all these combine together and results in differentiated levels being developed for people with respect to signs of similarity between their parents levels (Toman, 1961 taken from chapter 8).

Societal Regression (brief)

The societal regression is the hindrance that one faces towards differentiation on a much larger social scale then in the familial structures. Once these forces like increasing population, decreasing employment, economic strains etc. take over, differentiation is hard to achieve and higher levels of anxiety are created (taken from chapter 8).

Evaluation Interview

Evaluation interview, as the name suggests is basically an update taken from the therapist on the potential progress that has been made by the individual in question and his family since therapy had begun. This process is completed to not only underline the positive but also the negative and the shortcomings that still exist despite the use therapy theories (taken from chapter 8).

Genogram

Genogram are used primarily for identifying family origin; measure self-differentiation; determine patterns of triangle and behavior. This helps family in fulfilling primary objective of therapy i.e. de-triangulation and differentiating. Third and even fourth generation can also use the family map of Genogram (taken from chapter 8).

Therapeutic goals

The therapeutic goals that can thus be achieved include: identification of behavioral patterns; emotional structures of the nuclear families are recognized; family history is understood as well (taken from chapter 8).

Contextual therapy

The primary aspect that plays an integral part in contextual therapy includes the focus on the rational ethics structures whereby justice is attained in the long run through the use of logical thinking as opposed to emotional reasoning. In contextual therapy, the focus is on the analysis of prior family interactions used as the basis to form decisions on the therapeutic theories used thereof (taken from chapter 8).

Psycho-educational model

Family psycho-education has different models. The models have similar elements, but may be categorized as: single and multiple family groups; mixed groups, which are comprised of patients (consumers) and family members; groups according to the duration required (9months-5years); and groups that works phase by phase for treating patient’s illness (taken from chapter 16).

Family and mental disorders

Family and mental disorders can disrupt an entire structure of the family and hinder any and all progress made. Family and mental disorders like grief, chronic depression or sorrow, relapse and remission of an individual and the emotional distress caused thereof, the challenges of a day-to-day life are all examples of things that the families have to deal with consistently (taken from chapter 16).

Expressed Emotion and Schizophrenia

While, the medical cause of schizophrenia elude the professionals, many therapist have linked how the expression of familial and peer emotion can elevate or decrease the symptoms. The theory of expressed emotion thereof is designed to analyze how the schizophrenic can be extremely responsive towards the expression of a negative or positive emotion of a family member or friend. The level of responsiveness is directly proportional to the level of closeness between the ill individual and the particular family member/friend. It is also viewed as the most reliable element for indicating relapse of schizophrenics (taken from chapter 16).

Therapeutic Process

According to various research evidences, single-family psycho-education group is not better in terms of results when compared with multi-family groups dealing with schizophrenic children or family members, as this involves working closely with numerous individual traits of families and patients. In the late 1950s and early 1960s, multiple-family group therapy was initiated, and their first task was to look at the psychiatric hospital’s ward-management problems and solve them. During 9 months program, participants were able to learn techniques useful in solving problems mutually; dealing with crisis intervention strategies; how to interact with a mentally ill person; side effects involved in medication; and treatment and symptoms of mental illness (taken from chapter 16).

Leading Figures

Some of the leading figures in this domain include: George Engel, John Rolland, Thomas Campbell, Susan McDaniel, William Doherty, MacAran Baird, amongst others (taken from chapter 16).

Chapter 3: Cultural Considerations

The ever increasing observed impact on culture and other facets of the environment have also been noticed on the therapy process and this impact is one of the most significant recent developments in the field of therapy (Ingraham, 2000, 2003 as cited in Holcomb-McCoy and Bryan, 2010; Pinto, 1981 as cited in Holcomb-McCoy and Bryan, 2010; Tarver-Behring & Ingraham, 1998 as cited in Holcomb-McCoy and Bryan, 2010). Indeed, when parents from a culturally varied background are part of the therapy process, therapists need to take into account the influence of culture on the process, along with its influence on the client (Moseley- Howard, 1995 as cited in Holcomb-McCoy and Bryan, 2010).

In one of Gibbs (1980)’s article, addressing multicultural therapies, she emphasized on the variation of the process between European-American and African-American subjects. She discovered that the European-American teachers paid more attention and raised relevant questions about the objectives of the initiative while African-American teachers did not respond much and depicted little concern for the process, initially. Thus it was concluded by Gibbs, that the latter group be made accustomed to an interpersonal style while the European-American teachers be exposed to the instrument therapy style which was task-led. Later, Duncan and Pryzwansky (1993) contradicted the research and discovered that the African-American teachers wanted the instrumental style (as cited in Holcomb-McCoy and Bryan, 2010).

Often, parents might consider cultural variations the problem themselves as Sheridan (2000; as cited in Henderson et al., 2007) puts forth that the factors such as class, race and religion are sometimes considered to be the origin of the child’s issues. According to Davies (1993; as cited in Henderson et al., 2007), families who were poor and uneducated did not want to make an effort to assist their children in their school related problems while empirical studies have revealed instances where it is poor and uneducated families that are adamant about getting the children what is best for them and encouraging their learning (Henderson, Mapp, Johnson, & Davies, 2007).

There are two types of strategies implemented in family therapy: the ones that emphasize on the depiction of fresh ideas, as a part of the primary change and agent, and, the ones that emphasize on the relationship that exists between the therapist and the respective family members as the origin of change. Therapy that premised only on educating might neglect to take into consideration the significance of factors, like interactional trends, cultural value systems and family structure (as cited in Holcomb-McCoy and Bryan, 2010).

Chapter 4: Empirical Research

Many research studies on culture define it in relation to other related concepts and in doing so make attempts to separate it from the others. Almost every researcher creates new boundaries, in relation to other related concepts and thereby redefines this term (Snyder and Mitchell, 2008). Regardless, there are three broad meanings of the term culture, with one being historical in nature. The historical use of the term, which is being used even today, is ethnicity. What is significant is the fact that culture has been categorized with ethnicity up till the recent past as most of the intercultural interactions have been about communicating with various ethnic groups (Snyder, 2006). Even if other nuances of culture have attracted attention, the ethnic communication paradigm is still considered the major underlying aspect of cultural study (Nichols, 2009)

Of the two broad meanings of the term culture, one of it is mentalist. The theory assumes that main points of culture are present in the mind even though they are experienced in the world. They revolve around our value systems, beliefs, our thinking, notions, concepts, rules and policies that we have made for ourselves. The second theory however takes into account the consequent behavioral patterns that we are led to from the notions and value systems that we entertain. These can also include the physical artifacts (Sprenkle, Davis, and Lebow, 2009).

A common example is of Read of Samovar and Porter’s. They identify culture as the combination of information, practice, philosophy, principles, approaches, meanings, hierarchies, faith, concept of time, roles, spatial relations, concepts of the universe, physical items and belongings attended by a group of individuals during generations by means of personal and collective endeavoring . Noteworthy is that the differences between these groups is very little. Thus defining less of what actually culture is and more about what would interest certain people, thereby reflecting the objectives of various authors ( as cited in Sprenkle, Davis, and Lebow, 2009).

One of the best examples detailing the intricacies of cultural member is the book of Ben Rampton, titled Crossing: Language and Ethnicity among Adolescents that was published in 1996. This book gives an in-depth analysis about the importance of communicating socially and evaluates the part and objectives of culturally marked types of communication (Sparks and Duncan, 2010).

The fieldwork of the author was carried out on small groups of adolescents who were ethnically diverse in urban areas of Britain. He found a hugely intricate and consistent link between ethnicity and language, where units of these groups would have high mobility from in and out of various ethnically marked types. Varying with the situation, the respective ethnically marked language and symbolic collection was utilized in different ways to depict unity or segregation, to rediscover cultural fences and redevelop cultural identity. These conclusions depending on huge fieldwork are quite useful in their purpose (Sparks and Duncan, 2010).

The analysis of Rampton displays that culture doesn’t have to be based on traditions. It also may not be observed as something that should be present in every individual of a certain society. It can be manifested, altered, distorted and eliminated at any point in time. The culture that came in from the adolescents works as a collective and shared set of resources, a portion of which works automatically and the rest of which works strategically during times of unity and competition (Wood et al., 2005). Ben Rampton’s book can be used as a statistical basis for what has been discussed earlier in the paper, providing the basis for the theory that culture is more complicated than what it is made out to be. Where theorists have considered this they have compromised the rationality and theoretical potential of the research.

Chapter 5: Psychiatric Diagnosis

The PTSD criteria for diagnosis was reviewed by the American Psychiatric Association in the year 2000 in the fourth edition released for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The specifications of the diagnostics are given below (American Psychiatric Association, 2000):

The requirements for diagnostics in PTSD cover the history of how exposure to the traumatizing event actually took place and how the event was met with two separate requirements as well as what the symptoms signify among the three basic ones which are avoidant and numbing signs, symptoms of hyper arousals or recollections of intrusions. The fifth requirement is that of looking over at the symptoms and their time of lasting and the sixth one is focused on the analysis of the functioning (American Psychiatric Association, 2000).

Criterion A: stressor

Under this criterion, the individual has had contact with the following instances (American Psychiatric Association, 2000):

1. There has been a life threatening, serious injury or any other traumatizing incident that has come to have such an impact on the person as to question his own integrity as well as that of others.

2. The reaction of the individual was an extreme case of fear, confusion, helplessness and horror. Among young people and in children, this may be judged by a constant show of agitation or being extremely disorganized (American Psychiatric Association, 2000).

Criterion B: intrusive recollection

The implications of that particular traumatizing incident are long lasting and may recur in the several ways, some of which are (American Psychiatric Association, 2000):

1. Constant recollections of the past, thinking about the event, having perceptions, images and constant thoughts centering the incident. Generally among the children, it can be noticed that their ways of playing signify how they took the impact and the themes and events are noticeable in their conduct.

2. Frequent dreams that a child has of a particular event of which some of them may have incoherent content. They could be scary for the child.

3. Have a disturbing feeling as if that event was persistent (it includes expressions of hallucinations, reliving and illusions. It also includes flash back of the scenes when in a situation of intoxication or waking up after a sleep. It should also be noted that children may have to face reenactment of trauma-specific.

4. A similar feature of that particular event because of the powerful psychological distress which could be because of the external or the internal reminder.

5. Physiologic reactivity because of the external or the internal reminders that either indicates or is similar to any of the feature of that disturbing event (American Psychiatric Association, 2000).

Criterion C: avoidant/numbing

Continuously avoiding stimuli that is related with trauma along with a dull response (presented after trauma). It can be revealed with minimum three following symptoms (American Psychiatric Association, 2000).

1. A feeling of an unordinary future ( such as not getting married, a proper life span or not having a career)

2. Have a sense of not getting involved with others.

3. Not having the ability to bring to mind a significant feature of trauma

4. Ability to forget the feelings, conversations or the thoughts that are related with trauma

5. Not having a normal affect range (not having the ability of having the normal feelings of love)

6. The people that provoke recollection of trauma, their activities and places are avoided

7. Not showing interest in participating in important activities (American Psychiatric Association, 2000).

Criterion D: hyper-arousal

From the following symptoms at least two are indicate the increase of arousal (presented after trauma) (American Psychiatric Association, 2000):

1. Greater astonishing response

2. Not finding easy to concentrate

3. Facing problems in sleeping or remain sleeping

4. Hyper-vigilance

5. Having a bad temper and getting angry quickly (American Psychiatric Association, 2000).

Criterion E: duration

When more than a month is passed with the disturbance (indicators in B, C and D) (American Psychiatric Association, 2000).

Criterion F: functional significance

Occupational, social are other significant functioning areas are affected as a result of disturbance. It also causes considerable distress (American Psychiatric Association, 2000).

Chapter 6: Conclusion

Both psycho education models and transgenerational models can assist victims of physical and sexual violence and abuse in a number of ways. The consultancy process, described above, has been assessed and investigated upon rigorously, particularly over the last three decades. Being a part of the increasing amount of the respective literature has meant that the function of consultations, especially in respect to their dealings with families has attracted considerable attention and has entailed emphasizing the function of consultants to collaborate with the families, especially the ones who work in educational institutions. The phenomena which has been termed psycho-education and transgenerational therapy is now increasingly becoming the focus of community therapy practices, given the ever growing demands of modern families and the observed advantages that result whenever schools and parents interact, collaborate and work together.

Lastly, the aforementioned research can be used in practice of counseling in a number of ways. From the aforementioned research it is clear that the consultants should go farther away from the function and tasks of a research, analysts or an expert and instead recognize the body of knowledge and information that the families contribute to the process of consultation and therapy and use this knowledge and information to being about a change in their lives.

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