Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

TABLE 29-4. Rationale for Family-Life Chronology The family therapist enters a session knowing little or nothing about the family. The therapist may know who the identified patient is and what symptoms the patient manifests, but that is usually all. So, the therapist must get clues about the meaning of the symptom. The therapist may know that pain exists in the marital relationship but needs to get clues about how the pain shows itself. The therapist needs to know how the mates have tried to cope with their problems. The therapist may know that the mates both operate from models (from what they saw going on be tween their own parents), but needs to find out how those models have influenced each mate’s expec tations about how to be a mate and how to be a parent. The family therapist enters a session knowing that the family, in fact, has had a history, but that is usually all. Every family, as a group, has gone through or jointly experienced many events. Certain events (eg, deaths, childbirth, sickness, geographical moves, and job changes) occur in almost all families. Certain events primarily affect the mates and only indirectly the children. (Maybe the children were not born yet or were too young to fully comprehend the nature of an event as it affected their parents. They may have only sensed periods of parental remoteness, distraction, anxiety, or annoyance.) The therapist can profit from answers to just about every question asked. Family members enter therapy with a great deal of fear. Therapist structuring helps decrease the threats. It says, “I am in charge of what will happen here. I will see to it that nothing catastrophic happens here.” All members are covertly feeling to blame that nothing seems to have turned out right (even though they may overtly blame the identified patient or the other mate). Parents, especially, need to feel that they did the best they could as parents. They need to tell the thera pist, “This is why I did what I did. This is what happened to me.” A family-life chronology that deals with such facts as names, dates, labeled relationships, and moves, seems to appeal to the family. It asks questions that members can answer, questions that are relatively As far as family members are concerned, past events are part of them. They now can tell the therapist, “I existed.” And they can also say, “I am not just a big blob of pathology. I succeeded in overcoming many handicaps.” If the family knew what questions needed asking, they would not need to be in therapy. So the ther apist does not say, “Tell me what you want to tell me.” Family members will simply tell the therapist what they have been telling themselves for years. The therapist’s questions say, “I know what to ask. I take responsibility for understanding you. We are going to go somewhere.” emphasis on the “sick” or “bad” family member to an emphasis on the marital relationship. The family-life chronology serves other useful therapy purposes, such as providing the framework within which a reeducation process can take place. The therapist serves as a model in checking out information or correcting communication techniques and placing questions and eliciting answers to begin the process. In addition, when taking the chronology, the therapist can introduce in a relatively nonfrightening way some of the crucial concepts to induce change. Adapted with permission from Satir V. Conjoint Family Therapy . Science and Behavior; 1967:57. nonthreatening. It deals with life as the family understands it. Family members enter therapy with a great deal of despair. Therapist structuring helps stimulate hope.

Copyright © 2024 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. The family therapist also knows that, to some degree, the family has focused on the identified patient to relieve marital pain. The therapist also knows that, to some degree, the family will resist any effort to change that focus. A family-life chronology is an effective, nonthreatening way to change from an