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The Essentialsof Family TherapyA01 NICH8097 07 SE FM.indd 130/01/2019 04:37

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Seventh EditionThe Essentialsof Family TherapyMichael P. NicholsCollege of William and MarySean D. DavisAlliant UniversityA01 NICH8097 07 SE FM.indd 330/01/2019 04:37

Director and Publisher: Kevin M. DavisPortfolio Manager: Rebecca Fox-GiegContent Producer: Pamela D. BennettMedia Producer: Lauren CarlsonPortfolio Management Assistant: Maria FelibertyExecutive Field Marketing Manager: Krista ClarkExecutive Product Marketing Manager:Christopher BarryProcurement Specialist: Deidra HeadleeCover Designer: Pearson CSC, Carie KellerCover Cover Photo: LazingBee/Getty ImagesEditorial Production and Composition Services:Pearson CSCEditorial Project Manager: Pearson CSC,Noribeth SantosFull-Service Project Manager: Pearson CSC,Billu SureshPrinter/Binder: LSC Communications, Inc./WillardCover Printer: Phoenix Color/HagerstownText Font: 10/12 Times LT ProCopyright 2020, 2014, 2011 by Pearson Education, Inc., 221 River Street, Hoboken, NJ 07030. All RightsReserved. Printed in the United States of America. This publication is protected by Copyright, and permissionshould be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, ortransmission in any form or by any means, electronic, mechanical, photocopying, recording, or likewise. Toobtain permission(s) to use material from this work, please visit htmlAcknowledgments of third party content appear on the page within the text, which constitute an extension of thiscopyright page.Unless otherwise indicated herein, any third-party trademarks that may appear in this work are the property oftheir respective owners and any references to third-party trademarks, logos or other trade dress are fordemonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship,endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationshipbetween the owner and Pearson Education, Inc. or its affiliates, authors, licensees or distributors.Library of Congress Cataloging-in-Publication DataNames: Nichols, Michael P., author. Davis, Sean D., author.Title: The essentials of family therapy / Michael P. Nichols (College ofWilliam and Mary), Sean D. Davis (Alliant University).Description: Seventh edition. Hoboken, NJ: Pearson Education, Inc., [2020] Includes bibliographical references and index.Identifiers: LCCN 2018057690 ISBN 9780135168097 (alk. paper) ISBN 0135168090 (alk. paper)Subjects: LCSH: Family psychotherapy.Classification: LCC RC488.5 .N528 2020 DDC 616.89/156—dc23 LC record available ��19ISBN 10: 0-13-516809-0ISBN 13: 978-0-13-516809-7A01 NICH8097 07 SE FM.indd 430/01/2019 04:37

This book is dedicated to the memoryof Salvador MinuchinA01 NICH8097 07 SE FM.indd 530/01/2019 04:37

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PREFACEOne thing that tends to get lost in academic discussions offamily therapy is the feeling of accomplishment thatcomes from sitting down with an unhappy family andbeing able to help them. Beginning therapists are understandably anxious and not sure they’ll know how to proceed. (“How do you get all of them to come in?”) Veteransoften speak in abstractions. They have opinions and discuss big issues—postmodernism, narrative reconstructionism, second-order cybernetics. While it’s tempting touse this space to say Important Things, we prefer to be alittle more personal. Treating troubled families has givenus the greatest satisfaction imaginable, and we hope thatthe same is or will be true for you. In addition to making the book more user-friendly,we’ve added quite a bit of new material in this edition,including: NEW TO THIS EDITIONIn this seventh edition of The Essentials of FamilyTherapy, we describe the full scope of family therapy—itsrich history, classic schools, latest developments—butwith increasing emphasis on practical issues. We’ve alsotried to make this edition more useful to students by introducing a number of new teaching points.Our focus in the seventh edition was to make thekey information from each chapter easier to capture andremember. We wanted you to come away from each chapter with a clear understanding of how each theory makessense of change, and what each theory looks like in practice. Here’s how we did that: Essential Points at the beginning of each chapter arebrief summaries of the main ideas covered in thechapter.Questions to Consider at the start of each chapterare designed to help you apply the principles in thechapter to your situation, as well as to start thinkingcritically about the concepts and techniques as youread the chapter.Key terms are highlighted throughout and are alsoincluded as an end-of-book glossary in this editionEssential Highlights of the chapter are summarizedat the end of each chapter.A Recommended Reading list is included at the endof each chapter.Review Questions and Reflection Questions at theend of each chapter are designed to help you thinkcritically about the principles in the chapter andapply them to your life.New case studies with Reflect and Reply questionsare designed to help you learn to think about how toapply therapeutic principles. All of the cases presented are drawn from our own practice or fromexperts in the field. Research findings integrated into each chapter.A new chapter about research (Chapter 14), whichincludes a discussion of why research has failed toinfluence clinical practice and offering suggestions.Additional case studies and clinical emphasisthroughout.Guidelines for productive problem-solving conversations.A more concise chapter on Bowen family systemstherapy (chapter 4).Greater focus on clinical practice.New section in Chapter 10 on working with transgender persons.Significantly revised cognitive-behavioral chapter(chapter 9), with more focus on recent trends inclinical practice.Albert Einstein once said, “If you want to learn aboutphysics, pay attention to what physicists do, not what theysay they do.” When you read about therapy, it can be hardto see past the jargon and political packaging to the essential ideas and practices. So, in preparing this edition, we’vetraveled widely to visit and observe actual sessions of theleading practitioners. We’ve also invited leaders in the fieldto share some of their best case studies with you. The resultis a more pragmatic, clinical focus. We hope you like it.ALSO AVAILABLE WITH MYLABHELPING PROFESSIONSThis title is also available with MyLab Helping Professions, an online homework, tutorial, and assessment program designed to work with the text to engage studentsand improve results. Within its structured environment,students see key concepts demonstrated through videoclips, practice what they learn, test their understanding,and receive feedback to guide their learning and ensurethey master key learning outcomes.viiA01 NICH8097 07 SE FM.indd 730/01/2019 04:37

viiiPreface Learning outcomes and standards measure student results. MyLab Helping Professions organizes all assignments around essential learning outcomes and national standards for counselors.Video- and Case-based Exercises developdecision-making skills. Video- and Case-basedExercises introduce students to a broader range ofclients, and therefore a broader range of presentingproblems, than they will encounter in their ownpre-professional clinical experiences. Studentswatch videos of actual client-therapist sessions orhigh-quality role-play scenarios featuring expertcounselors. They are then guided in their analysis ofthe videos through a series of short-answer questions. These exercises help students develop thetechniques and decision-making skills they need tobe effective counselors before they are in a criticalsituation with a real client.Licensure Quizzes help students prepare for certification. Automatically graded, multiple-choiceLicensure Quizzes help students prepare for their certification examinations, master foundational coursecontent, and improve their performance in the course.Video Library offers a wealth of observationopportunities. The Video Library provides morethan 400 video clips of actual client-therapist sessions and high-quality role plays in a database organized by topic and searchable by keyword. The VideoLibrary includes every video clip from the MyLabHelping Professions courses, plus additional videosfrom Pearson’s extensive library of footage. Instructors can create additional assignments around thevideos or use them for in-class activities. StudentsA01 NICH8097 07 SE FM.indd 8can expand their observation experiences to includeother course areas and increase the amount of timethey spend watching expert counselors in action.ACKNOWLEDGMENTSSo many people have contributed to our development asfamily therapists and to the writing of this book that itwould be impossible to thank them all. But we would liketo single out a few. To the people who taught us familytherapy—Lyman Wynne, Murray Bowen, and SalvadorMinuchin—thank you. And special thanks with deep gratitude to Douglas Sprenkle and Fred Piercy.We’d also like to thank some of the expert clinicianswho went out of their way to help us prepare this seventhedition: Yvonne Dolan, Jerome Price, Deborah Luepnitz,William Madsen, Frank Dattilio, Vicki Dickerson, andSalvador Minuchin. To paraphrase John, Paul, George,and Ringo, we get by with a lot of help from our friends—and we thank them one and all. We are especially gratefulto Rebecca Fox-Gieg at Pearson Higher Education formaking a difficult job easier.In addition, we would like to thank the reviewerswho offered suggestions for updating this edition: JosephHerzog, University of West Florida; Steve Johnson, Liberty University; Shanti Kulkarni, The University of NorthCarolina at Charlotte; and Rahbel Rahman, BinghamtonUniversity.Finally, we would like to thank our postgraduateinstructors in family life: our wives, Melody and Elizabeth,and our children, Sandy and Paul and Andrew, Hannah,Rachel, and William.30/01/2019 04:37

BRIEF CONTENTSPART ITHE CONTEXT OF FAMILY THERAPYIntroductionChapter 1Chapter 2Chapter 3PART IIBecoming a Family Therapist 1The Evolution of Family Therapy 6Basic Techniques of Family Therapy 23The Fundamental Concepts of Family Therapy40THE CLASSIC SCHOOLS OF FAMILY THERAPYChapter 4Chapter 5Chapter 6Chapter 7Chapter 8Chapter 9Bowen Family Systems Therapy 56Strategic Family Therapy 72Structural Family Therapy 89Experiential Family Therapy 105Psychoanalytic Family Therapy 119Cognitive-Behavioral Family Therapy132PART III RECENT DEVELOPMENTS IN FAMILY THERAPYChapter 10Chapter 11Chapter 12Family Therapy in the Twenty-First CenturySolution-Focused Therapy 175Narrative Therapy 189150PART IV THE EVALUATION OF FAMILY THERAPYChapter 13Chapter 14Comparative Analysis 202Family Therapy Research 219ixA01 NICH8097 07 SE FM.indd 930/01/2019 04:37

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CONTENTSPART I THE CONTEXT OF FAMILY THERAPYIntroduction Becoming a Family Therapist1The Myth of the Hero 2Psychotherapeutic Sanctuary 3Family Versus Individual Therapy 3The Power of Family Therapy 4Essential Highlights 4Review Questions 5Reflection Questions 5Recommended Readings 5Chapter 1 The Evolution of Family Therapy6The Undeclared War 6Small Group Dynamics 7The Child Guidance Movement 8Marriage Counseling 9Research on Family Dynamics and the Etiology of Schizophrenia 10Gregory Bateson—Palo Alto 10Lyman Wynne—National Institute of Mental Health 11Role Theorists 11From Research to Treatment: The Pioneers of Family Therapy 12John Bell 12Palo Alto 12Murray Bowen 14Nathan Ackerman 15Carl Whitaker 16Ivan Boszormenyi-Nagy 16Salvador Minuchin 16Other Early Centers of Family Therapy 17The Golden Age of Family Therapy 18Essential Highlights 20Review Questions 21Reflection Questions 21Recommended Readings 22Chapter 2 Basic Techniques of Family Therapy23Getting Started 23The Initial Contact 23The First Interview 24xiA01 NICH8097 07 SE FM.indd 1130/01/2019 04:37

xiiContentsThe Early Phase of Treatment 25The Middle Phase of Treatment 26Termination 27Family Assessment 28The Presenting Problem 28Understanding the Referral Route 29Identifying the Systemic Context 30Stage of the Life Cycle 30Family Structure 30Communication 30Drug and Alcohol Abuse 31Domestic Violence and Sexual Abuse 31Extramarital Affairs 31Gender 31Culture 32The Ethical Dimension 33Family Therapy with Specific Presenting Problems 35Marital Violence 35Sexual Abuse of Children 37Essential Highlights 38Review Questions 39Reflection Questions 39Recommended Readings 39Chapter 3 The Fundamental Concepts of Family Therapy40Cybernetics 41Systems Theory 42General Systems Theory 43Social Constructionism 44Constructivism 44The Social Construction of Reality 45Attachment Theory 46The Working Concepts of Family Therapy 47Interpersonal Context 47Complementarity 48Circular Causality 48Triangles 48Process/Content 49Family Structure 49Family Life Cycle 50Family Narratives 51Gender 52A01 NICH8097 07 SE FM.indd 1230/01/2019 04:37

ContentsxiiiCulture 52Essential Highlights 53Review Questions 54Reflection Questions 54Recommended Readings 55PART II THE CLASSIC SCHOOLS OF FAMILY THERAPYChapter 4 Bowen Family Systems Therapy56Evolution of the Model 57The Basic Model 58Differentiation of Self 58Emotional Triangles 58Multigenerational Emotional Processes 58Emotional Cutoff 59Societal Emotional Process 59Normal Family Development 59Development of Behavior Disorders 60How Therapy Works 60Therapy 61Assessment 61Therapeutic Techniques 64Current Status of the Model 68Essential Highlights 69Review Questions 70Reflection Questions 71Recommended Readings 71Chapter 5 Strategic Family Therapy72Evolution of the Model 72The Basic Model 73Normal Family Development 75Development of Behavior Disorders 75How Therapy Works 76Therapy 76Assessment 76Therapeutic Techniques 77Current Status of the Model 86Essential Highlights 87Review Questions 88Reflection Questions 88Recommended Readings 88A01 NICH8097 07 SE FM.indd 1330/01/2019 04:37

xivContentsChapter 6 Structural Family Therapy89Evolution of the Model 90The Basic Model 90Normal Family Development 92Development of Behavior Disorders 93How Therapy Works 94Therapy 95Assessment 95Therapeutic Techniques 95Current Status of the Model 101Essential Highlights 103Review Questions 103Reflection Questions 103Recommended Readings 104Chapter 7 Experiential Family Therapy105Evolution of the Model 106The Basic Model 106Theoretical Concepts 107Normal Family Development 107Development of Behavior Disorders 107How Therapy Works 107Therapy 108Assessment 108Therapeutic Techniques 108Current Status of the Model 116Essential Highlights 117Review Questions 118Reflection Questions 118Recommended Readings 118Chapter 8 Psychoanalytic Family Therapy119Evolution of the Model 120The Basic Model 120Freudian Drive Psychology 121Self Psychology 121Object Relations Theory 121Normal Family Development 122Development of Behavior Disorders 122How Therapy Works 124Therapy 125Assessment 125Therapeutic Techniques 126A01 NICH8097 07 SE FM.indd 1430/01/2019 04:37

ContentsxvCurrent Status of the Model 130Essential Highlights 130Review Questions 131Reflection Questions 131Recommended Readings 131Chapter 9 Cognitive-Behavioral Family Therapy132Evolution of the Model 132The Basic Model 133Normal Family Development 134Development of Behavior Disorders 134How Therapy Works 136Therapy 136Behavioral Parent Training 136Behavioral Couples Therapy 139The Cognitive-Behavioral Approach to Family Therapy 142Treatment of Sexual Dysfunction 145Current Status Of The Model 146Essential Highlights 148Review Questions 148Reflection Questions 149Recommended Readings 149PART III RECENT DEVELOPMENTS IN FAMILY THERAPYChapter 10 Family Therapy in the Twenty-First Century150Erosion of Boundaries 151Postmodernism 151The Feminist Critique 151Feminist Family Therapy 152Social Constructionism and the Narrative Revolution 154Multiculturalism 155Race 155Poverty and Social Class 156Gay and Lesbian Rights 156Advances in Neuroscience 157Sex and the Internet 158Spirituality and Religion 160Tailoring Treatment to Populations and Problems 161Single-Parent Families 161African American Families 163Gay, Lesbian, and Transgender Families 165Home-Based Services 167A01 NICH8097 07 SE FM.indd 1530/01/2019 04:37

xviContentsPsychoeducation and Medical Family Therapy 168Psychoeducation and Schizophrenia 168Medical Family Therapy 170Relationship Enrichment Programs 170Essential Highlights 173Review Questions 173Reflection Questions 174Recommended Readings 174Chapter 11 Solution-Focused Therapy175Evolution of the Model 175The Basic Model 176Normal Family Development 176Development of Behavior Disorders 176How Therapy Works 176Therapy 177Assessment 177Therapeutic Techniques 178Current Status of the Model 185Essential Highlights 186Review Questions 187Reflection Questions 187Recommended Readings 188Chapter 12 Narrative Therapy 189Evolution of the Model 190The Basic Model 190Normal Family Development 191Development of Behavior Disorders 191How Therapy Works 192Therapy 193Assessment 193Therapeutic Techniques 194Current Status of the Model 198Essential Highlights 200Review Questions 200Reflection Questions 200Recommended Readings 201PART IV THE EVALUATION OF FAMILY THERAPYChapter 13 Comparative Analysis 202Theoretical Formulations 202Families as Systems 202A01 NICH8097 07 SE FM.indd 1630/01/2019 04:37

Contents xviiStability and Change 202Process/Content 204Monadic, Dyadic, and Triadic Models 204Boundaries 205Normal Family Development 205Development of Behavior Disorders 206Inflexible Systems 206Pathologic Triangles 207Therapy 207Assessment 207Decisive Interventions 208Integrative Models 210Eclecticism 210Selective Borrowing 210Specially Designed Integrative Models 211Community Family Therapy 214Essential Highlights 215Review Questions 217Reflection Questions 217Recommended Readings 217Chapter 14 Family Therapy Research219Family Therapy Research in the Early Days 219The Search for a Winner: Randomized Controlled Trials 219The Search for Consensus: Meta-Analysis 221Effects of Family Therapy with Specific Populations 221Summary 222Family Therapy Research Today 223Common Factors 223The Search for How Change Occurs: Process and Observational Research 225Family Therapy Research in the Future 226Essential Highlights 226Review Questions 227Reflection Questions 227Recommended Readings 227Appendix Selected Readings in Family Therapy 229Glossary231ReferencesIndex235253A01 NICH8097 07 SE FM.indd 1730/01/2019 04:37

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NEW TO THIS EDITION In this seventh edition of The Essentials of Family Therapy, we describe the full scope of family therapy—its rich history, classic schools, latest developments—but with increasing emphasis on practical issues. We’ve also tried to make this edition more useful to

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