Conjoint treatment as described in my model draws on family systems therapy
techniques combined with violence-eliminating strategies. Family therapy techniques
form the framework for this method. A knowledge of family therapy, however, is
not in itself sufficient for treating couples where violence is present. In addition,
one must be equipped with a cadre of violence-eliminating strategies used in concert
with family therapy techniques.
Identify the Patient
therapy, the emphasis shifts from an individual to a family focus. That is, the
family, not the individual, is identified as the patient or problem. According
to the family therapy systems theory work of Jay Haley, the reasons for this shift
in focus have to do with the fact that families have a history and a future together.
Families follow organized ways of behaving together, and each person has
a place in a familys hierarchy; some above and some below the others. Everyone
helps to maintain this hierarchy, and the family members step in to restore the
hierarchy when someone steps out of order, a process often referred to as maintaining
the homeostasis. Roles have been established, and every member has a relationship
to every other member. One persons stepping out of order affects everyone
else. In unhealthy families, the hierarchy needs to be shifted, but there is a
resistance to change because of comfort with the familiar, even if it is dysfunctional.
The resistance to change is not conscious or deliberate, however.
In families with problems, the hierarchy is, in Haleys
parlance, confused. Roles are unclear, and one member at one level
of the hierarchy may form a coalition against a peer with a member at another
level of the hierarchy. In couples therapy when violence is present, it is common
for each partner to try to form a secret coalition with the worker. The task for
the worker is not to side consistently with any one member against another, which
forms another coalition. The worker must join in different coalitions at different
times while ultimately not siding with anyone against anyone else. The need to
maintain a neutral position is critical when treating couples of violence. (Being
neutral does not mean to be cold or unfeeling.) These couples are enemies living
in a war zone; as part of their arsenal, they are seeking to get the worker to
side with one against the other. Although it is natural to side with the obviously
injured party, the worker must resist this tendency. The batterer feels he is
wrong, and the workers siding with the woman confirms that feeling. A batterer
cannot lend himself to treatment if he feels the worker is against him.
Observe Family Sequences
The worker can map out the hierarchy by observing
the sequences that occur in a family; for example, when A tells B to do something,
B consistently complies. The conclusion is that A is higher in the hierarchy than
B. Sequences have a repetitive and cyclical nature; that the same pattern happens
every time in the same way. For example, every time Susan tries to discuss how
their money is being spent, it leads to an escalating argument, culminating in
Jims becoming violent, which ends the discussion. Because it has been unresolved,
the issue arises again. Jim gets angry again and escalates to violence, which
ends the discussionand the cycle begins again. The task for the worker is
to change the sequence by intervening in such a way that the pattern cannot continue.
Agree to Control Anger
In couples with violence present, helping
the batterer agree to control his anger rather than let it explode into violence
is a major step in breaking the pattern of violence. Teaching couples when to
table a discussion because the topic becomes too volatile intervenes in the repetitive
and cyclical sequence. In addition, families collude to sabotage efforts at change
in the service of maintaining the unconscious need for homeostasis. With couples
where violence is present, the collusion often takes the form of broken agreements
in the form of what I am calling a contract or not showing up for appointments.
Workers need to take an active role in reviewing contracts and directing that
they be enforced, as well as pursuing couples who have missed appointments.
Reluctance to Change
Understanding that families form hierarchies
that they are reluctant to change, that change will be resisted through collusions
and sabotage in order to maintain homeostasis, that families form coalitions and
experience sequences that are repetitive and cyclical in nature, and that the
task of the worker is to maintain neutrality and intervene in the dysfunctional
patterns of behavior forms a foundation of how to approach fighting families.
- Geller, J. A., PhD. (2002). Breaking Destructive Patterns. The Free Press: New York.
Online Continuing Education QUESTION
How does Haley describe the hierarchy of the family with problems?
Record the letter of the correct answer the .