Istituto di Terapia Familiare di Firenze. IASA 3rd Biennal Conference

Transcription

1 Istituto di Terapia Familiare di Firenze Rodolfo de Bernart M.D.,Psych.Director Family System Theory and DMM Introduction to the Round table IASA 3rd Biennal Conference Frankfurt,14-16 September 2012 Attachment,Assessment and Treatment : the DMM Approach

2 1. What does this theory think is the basis of psychopathology or disorder? The basis can be a block of or a distorted communication in the family. Due to unresolved elaboration of the cultural inputs from the Family of Origin. The Identified Patient (Scapegoat) has a useful function which can soften the pain of a trigenerational wound and fix a problem in the actual family, but stops his/ her own developement as a person.

3 2. How does this theory conceptualize the role of the context on disorder? The Context (not only the familiar one) define any communication. It Must be carefully observed doing the evaluation or the Hypothesis. Sometimes it has to be changed in order to have a change in the situation Example of Flomenhalf

4 3. How is this theory informed by the cognitive neurosciences? Can be interesting that Non Verbal communication and Implicit Relational Knowing (Stern) are the most important tools in our work The Mirror Neurons (Rizzolati,Gallese) explain very much of how NVL and IMPLICIT work.

5 4. How does this theory address developmental processes? The developmental process of one or more members of the family and of the family itself is blocked in the passage from the actual stage to the next one of the Family Life Cycle (FLC). This is due to the importance of the function which is in competition with the personal growth

6 May I come in bed with you,mummy? If you like. But do not expect special things

7 5. How does this theory address the role of family members? There are different positions: Contradictory behaviours and attachment styles from each parent lead to confusion in the child which is resolved in various ways of rejecting one parent and focusing on a strategy with the other, oscillating between the parents patterns possibly resulting in mixed A/C patterns Attachments in a child are formed not just to each parent but to the relationship between them R.Dallos

8 6. What does this theory attempt to do to bring about change? Change occurs through: Important Therapeutic Relation with the Family and its Members The family makes an important experience in the session, then reproduced at home. Through a new understanding of the situation (hypothesis)the Family moves to the next stage of FLC,using its own resources.

9 7. What time period does this theory suggest is needed for change to occur? The change occurs in seconds In order to stabilize it usually we need one or two years. But the number of session is low, so that SFT can be considered a brief therapy. Often a Individual Therapy can be added at the end (not always for the IP).

10 8. What aspect of treatment is expected to bring about change? Using the Non Verbal Channel in order to get into the Implicit Relational Knowledge (Stern) Building New Strong Experiences Creating new readings if the Hypothesis trough Conversation (Maturana) Always trough an important Therapeutic Relation (Bowlby, Byng Hall)

11 9. How does one identify positive or negative outcomes of treatment? We need to achieve a 2 Order Change (Bateson, Watzlawick) Possibly a Metacognition in the Family Normally the level of MC is different in the various members of the family, going from : Mentalization and emotional change to Cognitive or just Behavioural change

12 10. What sort of evidence is used & what is its quality for this treatment? Follow up to 6 months, 1 year and more With family and individuals Sometimes using tools like AAIF (Adult Attachment Interview for Families) (de Bernart and others, still in trial)

13 12. What are the 2-3 most important contributions of this theory? Importance of the CONTEXT Family as a SYSTEM: Hypothesis, Neutrality, Circularity Non Verbal Channel and Implicit Using of three parameters: Interactive, Relational, Symbolic-Metaphorical

14 13. What else is important to understanding this theory? Attachments are dynamic and can be seen as shifting and evolving especially at critical or transitional points in the family life cycle. The dynamic and maturational emphasis of DMM fits well with systemic theories emphasis on families as dynamic, shifting and continually needing to change and adapt to new demands.r.dallos Attachment strategies and family roles may be flexible and varied,e.g. children temporarily becomes attachment figures for the parents and each other through periods of crisis.r.dallos

15 Why using Attachment in SFT? Nosography and Relational Hypothesis do not drive us enough in our intervention. Our idea is that Attachment style of a Family can explain why some interventions can work in a family and not in another because of its different style.

16 Therapetic Approaches and Attachment Styles DISMISSING PREOCCUPIED Encouraging: Expr. of Feelings Cognitive Processis Enactment Genograms Role Play Life Story Lines Reflect. Funct. Quest. Tracking Circularit. Expl. Areas of Confl. Mapping Beliefs Caring and comfort. Shared Fam. Beliefs (R.Dallos,A.Vetere)

17 BOWLBY and Family Therapy In 1945 Bowlby wrote about families separated by evacuation during WW 2 In 1949 he wrote about his work with families as part of therapy with children His ideas spread to US and helped to initiate Family Therapy Did he started FT? May we consider Bowlby founder of both Family Therapy and Attachment Theory? (John Bing Hall)

18 Attachment Narrative Therapy : R.Dallos and A.Vetere (ANT) Creating a Secure Base Exploring Attachment and Narratives Within a Systemic Framework Considering Alternatives Consolidating Change

19 In Therapy: A Process of Mutual Exploration Trough establishing a Secure Therapeutic Base that enables the Family to create a Secure Family Base Will Enable change to evolve Trough : Exploring Feelings involved in Attachment Emotional Sculpting Genograms, Scripts, (Looking for)patterns of Comforting. Addressing Attachment (Family) Injury John Bing Hall

20 Attachment Injury Family Wound An Attachment Injury is a percieved betrayal of trust and/or abandonment at a crucial moment of need in a intimate relationship. It is a form of Relationship Trauma (S.Johnson EFT 2004) Family Wound is any event which will create a difficult relationship in the family and will need another member to take a function which repairs it, but keeps him/her into the Family not allowing his/her development (R. de Bernart 2008)

21 Change occurs when: Problems are seen as relational and not individuals People feels emotionally safe (?) Members of F. think feel and act differently Therapy focus not only on words and semantic processes but also on emotions and behaviours We are able to reflect on and utilise our patterns of behaviour from our attachment scripts to cope with feelings and relationaship issues (Fonagy, Crittenden)

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24 Sintonizzazione Affettiva e Dialogo Narrativo

25 Two Therapist s Agenda Explicit or Narrative Agenda Implicit or Non Verbal Agenda

26 Sintonizzazione Affettiva e Dialogo Narrativo

27 The adjusting Oscillators They are a sort of body clocks which explain the mechanisms of coordination and synchronization between two or more persons among themselves. (G.Ruggiero)

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