Advanced Methods in Counseling and Psychotherapy PART 2 Revised Feb 04 2018 part 2

WESTERN TIDEWATER COMMUNITY SERVICES BOARD
PART 2
Notes on the Philosophy and Practice of
Individual, Couple and Family Therapy
Demetrios Peratsakis, LPC, ACS
Revised February 04, 2018
Advanced Methods in
Conseling and
Psychotherapy©

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CLINICAL SUPERVISION
Chapter
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Purpose of Clinical Supervision
“No significant learning occurs without a significant relationship” - Dr. James Comer
The Client, Counselor, and Supervisor form an intimate relationship system called the Supervisory Triad.

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A unique arrangement, its principle purpose is the acquisition of insight as to the process of change.
Just as therapy provides the opportunity to examine one’s own beliefs and thereby modify one’s own
behaviors, so too supervision is a reflective process of self-examination, insight and growth. A core
function of supervision is evaluation & feedback to the supervisee(s) on their strengths and weaknesses
and areas that need to be developed, enhanced or improved (Watkins, 1997).
 To teach, train, and empower the supervisee on their route to becoming an effective clinician able
to serve as a positive agent for change with their clients.
 To continually assess the supervisee’s skills and provide learning experiences that upgrade their
knowledge and experience, such as live supervision and various treatment modalities.
 To empower the supervisee to assume professional and personal risk for their professional growth
and development in a confidential, safe and supportive environment.
 To help protect the welfare of clients and ensure the supervisee is practicing within the guidelines
of the profession. The supervisor’s role includes responsibility as a gatekeeper for the profession.
 To help the supervisee improve self-awareness and taking responsibility for their clinical practice
by adhering to a framework for clinical supervision.
 To challenge the supervisee’s thinking about the profession, including theoretical premises, the
roots of clinical syndromes and the nature of change.
 To work with the supervisee to maintain the quality of the process of clinical supervision.
As with all intimate relationships, the Supervisory Triad is prone to “blind-spots”, areas around which one
avoids, denies, or transfers the true nature of their feelings or beliefs to others. Typically, these are the
areas of high sensitivity within ourselves that are resistant to insight.
Reflection & Resonance
The Transference and Counter-transference processes are specific expressions of unresolved issues
between the client and therapist. Similar processes occur between the supervisee and supervisor (parallel
process) and within the supervisor-supervisee-client triad (isomorphism). Often used interchangeably,
Isomorphism is a construct with philosophical roots in structural and strategic family systems theory that
focuses on inter-relational aspects of supervision, whereas Parallel Process is a construct coined by the
psychodynamic school of thought and focuses on unconscious, intrapsychic occurrences in supervision.
 Parallel Process
Parallel process is an intra-psychic or internal, interpersonal dynamic that occurs in both
counseling and supervision (Bradley & Gould, 2001). It is the transference/counter-transference

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of feelings and attitudes between individuals: it occurs when the emotional resonance expressed
between the client and the therapist is reflected in the therapist-supervisor relationship.
 Isomorphism
Echoing within inter-relational transactions that “presents itself as replicating structural patterns
between counseling and supervision” (White & Russell, 1997). When replicating patterns
between counseling and supervision occur, the role of the supervisee and supervisor duplicate the
role of client and counselor (White & Russell, 1997): 1) the counselor brings the interaction
pattern that occurs between themselves and the client into supervision and enacts the same pattern
but in the client's role, or 2) the counselor takes the interaction pattern in supervision back into
the therapy session, now enacting the supervisor's role.
Attributes of a Good Supervisor
 A clinical supervisor must be open, honest, and aware of her own strengths and weaknesses. She
must be willing to share her own uncertainties and failures.
 She must see her role as a teacher and mentor, and value the relationship and provide support
 She must be self-reflecting, able to give and receive constructive feedback, empathy, and support,
as well as be comfortable with direct challenge and the expression of frustration, anger and fear.
 She must possess advanced knowledge of a variety of clinical methods and technique,
demonstrate them and be open to the supervisee witnessing (and critiquing) her work.
 She must provide a variety of clinical learning experiences, including live consultation, live
supervision and small group case consultation and training.
 She must understand the underpinnings of isomorphism & parallel processes in supervision.
 She must be willing to hold the therapist accountable, require that they be prepared, and work in
tandem to identify what may be working in therapy and what has not, and why.
 She must monitor the limitations of the counselor and be willing to intervene to protect the client.
 She must value the supervision process as a medium for personal transformation & growth
Counselor Preparation for Supervision
1. Counselor-supervisees are students; as such, they should be prepared with all necessary
documentation and client materials, have completed their assignments and forged a bond with
their immediate instructor.
2. They should keep an up to date list of Active Clients and a history of session and supervisory
meeting dates.
3. Each New Case presented should include, at minimum, the following information
a. Referral source, date and initial reason. If client initiated, their stated purpose for seeking
treatment.

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b. Genogram, socio-gram or summary of relational issues or snap-shot of the client system,
including individual backgrounds, such as medical conditions; medications;
presentation/hygiene; occupation/education level; and living arrangements; as well as more
dynamic artifacts, such as life-cycle issues; deaths, births and anniversary dates; family
roles, rules, myths and legacies; trauma events and cut-offs and sources of support and
distress
c. The Presenting Problem, including the contract for therapy goal(s), participants and
expected duration
d. An analysis of who needs to participate and why; what’s the hypothesis on reason from
seeking treatment.
e. Number of sessions to date, frequency of treatment and format
5. Active Case presentations should include the information above as well as a summary of
treatment to date:
a. Overview of treatment goal (s), number of sessions and progress or change to date
b. Relationship with counselor
c. Details on how the Presenting Problem, Symptom(s) or Pain has changed
d. Plans for Termination date and work
6. Counselors are also expected to
a. Follow directives, study assignments, as appropriate to their level demonstrate a working
knowledge of counseling theory, core theoretical constructs, basic counseling techniques
and the major elements inherent in specialty issues
b. Join with the client(s), use one’s self in therapy, bond with the client(s)assume risk
c. To be receptive to feedback on clinical work, progress and personal growth, including
receptivity to supervision
d. To participate in professional training, conference development, peer supervision, and
community-wide presentations
Case Overview for Presentation in Supervision
1. If more than one participant indicates seating pattern and who spoke first.
2. Presenting Problem/Reason for seeking treatment (include each member’s belief).
3. When did the Presenting Problem first appear (Dates/Reoccurrences)?
4. Related or correlating events to date of first appearance/Life-cycle issues.
5. Previous Action Taken; track interactional pattern (who does what and when?).

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6. Who else does the problem affect? How?
7. Has anyone else exhibited this (include all families and intergenerational)?
8. What does the client/couple/family see as the most important concern to first begin work on?
9. If counseling was successful and this problem no longer existed, how would life be different --per
the client(s)?
10. Family “spokesperson”” member(s) most apt to work for change? Member(s) most concerned
about change?
11. Conceptual Summary
a. Genogram
b. Predominant Issues/Life-cycle
c. Structural mapping
d. Presenting Problem and Purpose of Symptom(s)
e. Factor(s) motivating treatment at this time?
f. Specific strategy/interventions made to date and client(s) reactions?
12. Treatment recommendation
a. Method: modality, participants, frequency, and duration
b. Goal(s) (short-term/long-term)
c. Therapist’s expectations for change
Common Problems in Supervision
There are times when problems arise in the supervisory process which could be an indication of concerns
that may indicate the Counselor is experiencing difficulties:
General Process
 conflict or boredom with the supervisor
 ambivalence about the field or frustration with one’s own personal abilities
 problems at work or of a personal nature
 conflicting directives from peers and others, or
 unidentified resonance or “blind spots” resulting from Parallel Process and Isomorphism
Indicators

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 recent change in supervisee behavior, especially withdrawal, aloofness, or avoidance.
 decreased participation in meetings, quality of interaction becoming poor or guarded.
 change in overall style of interaction, such as combativeness or sullenness.
 over-compliance with supervisor suggestions.
 supervisee appearing preoccupied, seeming distant or annoyed, seeming stressed or nervous.
 supervisee confusion or passive-aggressive responses to directives and recommendations
Specific Problems
 Isomorphism/Parallel process resonance : unresolved personal conflict or trauma activated by the
treatment (counselor-client) or supervisory relationship (supervisee-supervisor) that goes
unrecognized or unaddressed, resulting in “blind spots”, transference/counter-transference and the
replication of intergenerational patterns, rules, and roles.
 Skewed power dynamics of the relationship (one-up, one-down as norm, especially for beginning
practitioners)
o Supervisee continually feeling over-powered; high reactivity to limit-setting and rule and
role enforcement by the supervisor
o Misuse of power by the supervisor; fostering feelings of inadequacy, inferiority or shame
(abuse)
 Putting the supervisor on a pedestal: idealization of the supervisor or continual need for
acceptance or approval
 Supervisor having a continual need to be seen as knowledgeable and competent
 Personal dislike or disdain for the client, supervisee or supervisor
 Sexual or romantic attraction by to the client, supervisee or supervisor
 Cultural bias (over-identification or under-sensitivity) between the counselor and client or
counselor and supervisee due to age, gender, religion, political viewpoints, sexual orientation or
personal beliefs
 Shame: feeling ashamed or guilty that one is unable to treat or guide successfully
 Using one’s own personal philosophy or our world-view as the default perspective in treatment
The supervisor should raise their concerns and be open to the need to modify their own style of teaching
as well as the need to re-evaluate the growth of the counselor and target their training more appropriately
Sample Models of Supervision
Chapter 3 of the Clinical Supervision Guidelines for the Victorian Alcohol and Other Drugs and
Community Managed Mental Health Sectors; prepared for Mental Health, Drugs & Regions Division
Department of Health, November 2013:

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3.1 Psychoanalytic Foundations of Clinical Supervision
Psychoanalysis as a discipline was founded by Sigmund Freud towards end of the 19th century. From the
beginning of his working life, Freud was discussing his ideas and practices with others and they with him,
although the terms clinical consultation and clinical supervision had not yet been adopted. As far back as
1902, he was involved as teacher, mentor and observer in the work of young doctors practicing to become
psychoanalysts. This early type of supervision was didactic in form and the work centered on the patients’
dynamic processes.
Other helping professions began to develop their own supervision practices at this time and it is difficult
to know who influenced whom, or precisely in what order events unfolded. Social workers in the U.S.
were introducing supervision as a “supportive and reflective space” (Carroll, 2007, p. 34) and other types
of welfare workers were picking up these ideas at, or around the same time.
No matter which discipline or what form of clinical supervision one practices, psychoanalytic concepts have
brought much richness to clinical supervision in all its phases. Freud’s psychodynamic ideas of parallel process
and creating a working alliance are foundational across models of clinical supervision, having “informed the
work of supervisors of all orientations” (Bernard & Goodyear, 2009 p. 81). It is believed that Max Eitington of
the Berlin Institute of Psychoanalysis first made supervision a formal requirement for psychoanalytic trainees
in the 1920s, just as mandatory standards for both coursework and observational treatment of patients were
established by the International Psychoanalytic Society (Carroll 2007; Bernard & Goodyear, 2009).
The two schools of thought on clinical supervision that competed for dominance in the 1930s were the Budapest
School and the Viennese School. The former held the concept of clinical supervision as a “continuation of the
supervisee’s personal analysis” (Bernard & Goodyear, 2009, p. 82) which meant having the same analyst
(supervisor) performing dual roles as both therapist and supervisor. In therapy, the focus would be on the
supervisee’s transference issues in relation to the analyst; in supervision, the focus would be on the supervisee’s
countertransference issues in relation to his or her own clients. The latter school held the idea that the
supervisee’s transference and countertransference issues were both to be processed in therapy, so that
supervision was retained as a teaching forum.
A psychodynamic model which emerged later on, in the 1970s, had a wide resonance for many practitioners
both inside and outside psychoanalytic circles. This work marks the beginning of the supervisee as the center
and focus of the supervision process. Ekstein and Wallerstein conceptualized clinical supervision as both “a
teaching and learning process that gives particular emphasis to the relationships between and among patient,
therapist and supervisor and the processes that interplay among them” (Bernard & Goodyear, 2009, p. 82).
Thus, the focus was on teaching rather than providing therapy, with the aim being for the supervisee to
understand the overt and covert dynamics between supervisor and supervisee; to learn how to resolve
difficulties which arose, and to develop the skills necessary to help his or her clients in the same fashion.
In the past decade, two psychodynamic therapists and supervisors, Mary Gail Frawley-O’Dea and Joan E.
Sarnat, introduced a fresh psychodynamic supervision model in their book The Supervisory Relationship:
A Contemporary Psychodynamic Approach (O’Dea, M.G. and Sarnat, J.E. , 2001, New York: Guilford
Press), which suggested a new philosophical and practical position for the supervisor in relation to the
supervisee. Previously viewed as an objective expert with a mastery of theory and technique, the

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supervisor in this model is afforded space to act less the dispassionate expert and more an active
participant in the unfolding process of supervision. Thus, his or her authority “resides in the supervisor-
supervisee relational processes” (Bernard & Goodyear, 2009, p. 82), rather than in the absolute,
immutable position of the all-knowing superior. In such a relationship, both parties acknowledge a mutual
influence and the supervisory stance shifts effectively from that of outside, reflective observer to
informed and purposefully influential insider.
Points to remember about psychodynamic supervision:
 Process and relationship oriented, with a focus on intrapsychic phenomena and
interpersonal processes, in order to develop insight and provide containment
 Close parallels between therapy and supervision
References for this section: Bernard & Goodyear (2009); The Bouverie Centre (Moloney,
Vivekananda & Weir, 2007); Carroll (2007).
3.2 Clinical Supervision Based on Counseling Models
In the 1940s - 1950s, there was another shift in the delivery of clinical supervision. The new models
which emerged were based upon and tightly bound to the counseling theories and interventions of the
practicing supervisor.
3.2.1 Person-Centered Supervision
Carl Rogers, the founder of a humanistic, person-centered model of therapeutic practice, did not
differentiate greatly between therapy and supervision, but simply shifted his role during sessions
depending upon what his supervisees required at the time - personal therapy, or professional supervision.
As with the psychodynamic models, the person-centered model, to be effective, relied upon a strong and
trusting relationship between supervisor and supervisee.
Rogers was among the first to use electronically recorded interviews and clinical transcripts in supervision
(Bernard & Goodyear, 2009, p. 83), rather than relying only on the self-report of those he supervised. Carl
Rogers’ influence on both therapy and clinical supervision practices has been profound. Though Rogers’
approach is less focused upon today in the U.S., it is still widely taught in the UK and many of the skills
learnt by new practitioners world-wide can be traced back to him.
Points to remember about person-centered supervision:
 Process and relationship focused, with genuineness, warmth and empathy being
imperative relational traits
 Exploration of self, both personally and in the context of the work, is essential to the process,
with movement towards differentiation and self-actualization the goal of both therapy and
supervision
 Encompasses both teaching and therapy:

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“I think my major goal is to help the therapist to grow in self-confidence and to grow in the
understanding of himself or herself, and to grow in the therapeutic process...Supervision for
me becomes a modified form of the therapeutic interview” (Rogers, cited in Bernard &
Goodyear, 2009, p. 83).
3.2.2 Cognitive-Behavioral Supervision
Cognitive-Behavioral Supervision, like the various models of therapy related to it, emerged in the 1960s.
It was a far cry from what had come before, in that the focus shifted dramatically away from the
relationship and dynamic processes existing between supervisor and supervisee (or therapist and client) to
the development of practice skills. Becoming an effective therapist, like becoming an effective person,
involved mastering specific tasks and learning to think in ways which were beneficial to the personal or
professional self, whilst taking actions to extinguish (in CBT terms) unhelpful thinking and behaviors that
create problems. Thus, success as a therapist depended upon one’s ability to learn the work and to do it
well, rather than on a good fit between therapist and client.
The tasks assigned to supervisees in clinical supervision would mimic that offered to clients in therapy,
such as imagery exercises and role playing. As with cognitive behavioral therapy, this type of clinical
supervision would hold that it is the intervention which counts, and specific interventions lead to specific
outcomes, if followed precisely and faithfully. Assessment and close monitoring of supervisees was
routine, as it was considered essential to the work that they both understood and properly utilized the
theory and practice of the therapy, as expressed in the treatment manuals.
CBT in its current form, or forms, is more variable and open to influence than fifty years ago. For
instance, more attention is now paid to relationship than in the past, and ideas from Eastern philosophy
have been incorporated into the work by some practitioners (e.g., mindfulness, meditation). Similarly,
these ideas tend also to be incorporated into clinical supervision and training in CBT work.
Points to remember about cognitive behavioral supervision:
 Instructional and skills-based (or strategy-based), with focus on achieving technical
mastery, e.g., how to challenge negative automatic thoughts
 Explicit and specific goals and processes followed, e.g., negotiating agendas at the
beginning of each session
 Use of behavioral strategies with supervisee, e.g., role play and visual imagery
3.2.3 Family Therapy (Systemic) Supervision
Family Therapy (Systemic) Supervision theory and practice has been documented since the 1960s, with
family therapists taking the unique step of making therapy a highly interactive and involved team
effort, by observing their colleagues’ clinical work with families and engaging with them and the client
family as part of the treatment team.
Although family therapy had been emerging for several decades, it broke through as a formal discipline

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with its own clear set of ideas in the 1950s, as a direct result of the work of an anthropologist named
Gregory Bateson, and his colleagues at the Palo Alto Institute. Findings from The Bateson Project created
a paradigmatic shift in the field of family therapy and refocused the energies of its practitioners. Family
therapists began to understand the family as an interactive system; to pay close attention to
communications between family members; to view causality as circular rather than linear and to believe
that change could start with any member of a family, thereby impacting the whole. These ideas influenced
the way in which family therapy clinical supervisors approached their work with supervisees, as
supervisees were themselves understood to be part of an interlocking group of systems, all of which
affected how they performed their work (e.g., family of origin; interaction with the client’s family system
and the supervisory system).
There were several models of family therapy and it was considered essential that clinical supervision be
consistent with the model of therapy that the supervisee was learning to practice. Despite differences in
opinion regarding how problems emerged and what might help to solve them, all models held in common
the role of the therapist as “active, directive and collaborative” (Liddle et al., cited in Bernard &
Goodyear, 2009). This was also the case with clinical supervision, in which supervisors were highly
engaged with their supervisees.
It was then and is now common practice for clinical supervisors to observe the work of their supervisees.
Sometimes this was (and is) done live, as in training programs, with the supervisor offering interventive
suggestions via phone through a one-way mirror to the supervisee during sessions. This is a unique
contribution of family therapy to the practice of clinical supervision that is called simply “live
supervision.” More common is for supervisees to present recorded sessions of their work with clients
and/or to offer written transcripts of sessions, which are then reviewed and discussed in clinical
supervision sessions.
Another unique contribution of family therapy to clinical supervision is the reflecting team, a therapeutic
model introduced by Norwegian family therapist Tom Andersen in 1985. A reflecting team is a group of
therapists who observe a colleague conducting a family session, then have an open conversation with one
another, observed by the colleague and client family, about what they noticed in the session. This is done
respectfully and thoughtfully, with great care and consideration taken in relation to the possible impact of
their observations. The idea is to generate fresh possibilities for the clients and to offer multiple
perspectives and a sense of hopefulness. In the same way, a reflecting team can observe a family session
facilitated by a supervisee, focusing their reflective comments on what they noticed in the supervisee’s
work. This is common practice in training programs, where a group of supervisees might act as a
reflecting team, under the guidance of a clinical supervisor.
Points to remember about systemic supervision:
 Focus on relational approach to understanding of and intervention in presenting problems
 Makes explicit connections between people and the wider social context
 Greater use of direct observation and live supervision (compared to other supervision models)
 Supervisor’s role is that of director or consultant

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 Focus on the supervisee’s position within the broader system
 Principles and techniques used in therapy are congruent with those used in supervision and may be
applied to supervisee, e.g., strategic interventions, family of origin exploration
3.3 Developmental and Social Role Model Approaches to Clinical Supervision
Developmental and social role model approaches to clinical supervision have been in use since the
1950s, but began to gain great popularity during the 1970s and 80s.
Developmental models
There are many models of clinical supervision that can be defined as developmental, which can be
further categorized into three types: stage developmental models; process developmental models and
life-span developmental models. These focus on the developmental stages of the supervisee in relation
to the clinical supervision process. Clinical supervisors are also understood to go through developmental
stages as they hone their talents and skills in their work with supervisees.
Stage developmental models describe supervisees moving through progressive stages in their professional
maturity and within the supervisory relationship. The beginning counselor is seen as highly motivated, but
with only limited awareness and quite dependent on the supervisor. Over time and through experience
gained, the counselor becomes more consistently motivated, more fully aware, but less self-conscious, and
more autonomous. An example of a stage developmental model is The Integrated Developmental Model
(IDM) developed by Cal Stoltenberg, Brian W. McNeill and Ursula Delworth.
Process developmental models are those which focus on processes in the supervisee’s work which “occur
within a fairly limited, discrete period” (Bernard & Goodyear, 2009, p. 92).
Examples include:
 Reflective models of practice - models which encourage the use of reflection to improve practice,
by focusing on an experience in a counselor’s professional practice which is having an emotional
or intellectual impact that requires deeper understanding. Originally based on the concepts of
John Dewey in the 1930s, these models continue to be developed and widely used today.
 The Loganbill, Hardy and Delworth model - a counselor development model based on processes
which are “continually changing and recursive” (Bernard & Goodyear, 2009, p. 94) and
expressed by characteristic attitudes towards the work, the self and the supervisor. A key
difference in this model is that it dismisses ideas of linear progression through stages in favor of
continual cycling through “with increasing.... levels of integration at each cycle” (Bernard &
Goodyear, 2009, p. 94).
 Event-based supervision - a task focused model in which the supervisor and supervisee focus on

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analyzing how the supervisee has managed particular discrete events in his or her work.
Supervisee and supervisor decide where to focus their attentions by either a direct request of the
supervisee, or by the supervisor picking up on subtler, or less direct, cues.
Task-focused developmental models of clinical supervision, such as Michael Carroll’s, break down
supervision into a series of manageable tasks. In Carroll’s integrative model (which is also a version of
social role model), he suggests the following seven central tasks of clinical supervision: creating the
learning relationship, teaching, counseling, monitoring (e.g., attending to professional ethical issues),
evaluation, consultation and administration.
Lifespan developmental models, such as The Ronnestad and Skovholt Model, focus on the development
of counselors across the lifespan, rather than just the few years when they are new to their work. This
six-stage model begins with “The Lay Helper Phase” and ends with “The Senior Professional Phase”
(Bernard & Goodyear, 2009, p. 98), and is unique in articulating the differing needs in clinical
supervision for counselors at each stage of their professional lives.
Social models
Social role model approaches to clinical supervision focus on the roles, tasks, foci and functions of
clinical supervision. Two examples are Hawkins and Shohet’s “Seven-eyed Model,” (originally called the
“Double Matrix Model”) and Holloway’s “Systems Approach to Supervision (SAS).”
The “Seven-Eyed Model” (Hawkins and Shohet) recognizes that the clinical supervisor employs different
roles or styles at different times, but also concedes that the role or style, is likely to be most influenced
by the particular focus of the work at the time. This is a process model, which stresses attending to the
processes that occur during supervision and within the supervisory and therapy relationships. Hawkins &
Shohet coined the term the “good enough” supervisor, alluding to the object-relations idea of the “good
enough” mother (i.e. one does not have to be perfect, or get everything right). They believe that a
primary and consistent role of the supervisor is that of providing containment for the supervisee.
The “Seven-Eyed Model” of supervision is called such because it recommends seven areas of focus for
exploration in supervision: (1) content of therapy session; (2) supervisee’s strategies and interventions with
clients; (3) the therapy relationship; (4) the therapist’s processes (e.g., countertransference or subjective
experience); (5) the supervisory relationship (e.g., parallel process); (6) the supervisor’s own processes (e.g.,
countertransference response to the supervisee and to the supervisor-client relationship), and (7) the wider
context (e.g., organizational and professional influences).
Holloway’s “Systems Approach to Supervision Model” is integrative and comprehensive, taking into
account a number of factors which impact upon supervision. Holloway recommends that five systemic
influences and relationships be considered: (1) the supervisory relationship (phase, contract and structure);
(2) the characteristics of the supervisor; (3) the characteristics of the institution in which supervision
occurs; (4) the characteristics of the client, and (5) the characteristics of the supervisee.
Holloway then offers a task and function matrix for conceptualizing the supervision process, in which the
five functions are: monitoring/evaluating, instructing/advising, modeling, consulting/exploring, and
supporting/sharing. The five tasks of the matrix are: counseling skills, case conceptualization, professional

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role, emotional awareness and self-evaluation. The matrix provides twenty-five task-function combinations.
The tasks and functions together are said to equal process, and all are conceptualized to be built around the
“body” of supervision, the relationship.
Points to remember about developmental and social role model approaches to clinical supervision:
 Historically, a point of transition when the focus of supervision shifted from the person of the
worker to the work itself
 Conceptualize clinical supervision as related to, but separate from, counseling, and as a unique
process requiring its own practice principles, knowledge base, and skill set
 Focus on the tasks, roles and behaviors in clinical supervision
3.4 Postmodern Approaches to Clinical Supervision
Postmodern approaches (a.k.a. Social Constructionist or Post-Structural models) to therapy and clinical
supervision have been emerging since the 1980s and include narrative therapy models, solution-focused
models and feminist-influenced models. The therapeutic models built upon postmodernist ideals began to
have a heavy influence on the practice of therapy in general and on family therapy, specifically, in the 1990s,
which inevitably changed the practice of clinical supervision for those involved. This was considered to
represent a major paradigm shift in the practice of systemic therapies in particular. The philosophical
perspective of postmodernists, in their various disciplines, is that:
“Reality and truth are contextual and exist as creations of the observer...grounded in their
social interactions and informed by their verbal behavior” (Philp, Guy, & Lowe, cited in
Bernard & Goodyear, 2009, p. 86).
Thus, there is no objective, observable reality or one truth, but multiple realities and truths based on a
wide range of human experience and interpretation, expressed predominantly through language - itself a
tool with which we construct our worlds.
Anyone practicing narrative, solution-focused, or any other type of therapy underpinned by a postmodern
world view, would give a strong emphasis to language and would understand the power implicit in
words. Practitioners of these models attempt to understand the client’s world as the client understands it
and do not assume a shared reality or truth between themselves and others. Since knowledge is not held
as absolute, open and reflective questions which maintain a stance of curiosity in relation to the client is
a hallmark of the work. These traits would be apparent in clinical supervisors as well as therapists.
Although there are significant differences in the various models of clinical work and supervision which
fall under the umbrella of postmodernism, they have some shared qualities which are distinctive to them.
Firstly, the role of the clinical supervisor is more consultative than supervisory, with the relationship
being valued as a collaboration and dialogue being guided by questions rather than answers. There are
some clinical supervisors working from these modalities, in fact, who refer to themselves as consultants
and their supervisees as colleagues, no matter the difference in their levels of experience.

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This leads to the second distinctive feature of these models, which is that there tends to be a very
conscious effort to avoid emphasizing hierarchical differences between supervisor and supervisee and in
fact, to minimize those differences in status as much as possible. Thirdly, there tends to be a strong focus
on the strengths and successes of the supervisee, with a view to building upon those, rather than close
analysis of perceived failures or faults.
Special mention should be made here of Johnella Bird, from The Family Therapy Centre in Auckland,
New Zealand, who has emphasizes the use of relational language and what she calls “prismatic
dialogue” in evoking directly the voices of all the participants (including the client) in counseling and
supervision. To this end, a thirty to forty minute long prismatic interview (that is, one in which the
counselor is invited to consider aspects of the situation from the position of client) is audio-taped, and
the tape taken back to the client for comment and reflection. According to Bird (2006) counselors:
“...experience a sense of movement as they engage in prismatic dialogue. Invariably this movement
produces awareness of new possibilities for therapeutic directions and conversations. I believe one of
the principal tasks of super-vision is to liberate the mind in order to foster the counselor’s sense of
creativity.”
Points to remember about postmodern models of supervision:
 Focus on subjective experience
 Multiple truths are understood in relation to context
 Strong emphasis on language and its relationship to power (dominant discourse)
 Supervisor’s role is that of consultant
 Effort to subvert hierarchy; striving towards equality between supervisee and supervisor
 Focus on the supervisee’s strengths
 The client’s perspective is included directly where possible
References for this section: Bernard & Goodyear (2009); Bird (2006); The Bouverie Centre (Moloney,
Vivekananda & Weir, 2007); Carroll (2007
Counselors at Different Levels of Clinical Development
The counselor needs be a transformation agent. This must be done with immeasurable caring and respect,
perhaps even love.
Consider-
“ ...if the therapist doesn’t change, then the patient doesn’t, either” -Carl Jung
“Psychoanalysis is in essence a cure through love” -Sigmund Freud (1906)

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“The greatest privilege is to share in the unspeakable dread and heartache of another” - D. Peratsakis
Therapy allows for the continuous possibility of a genuine, human-to-human encounter. As the counselor
develops greater “therapeutic relational competence” (Watchel, 2008), their power as an agent for change
grows. Both the therapist and client grow together through their authentic encounter with each other
(Connell et al.,1999; Napiers & Whitaker, 1978):
 Be authentic and fully accept and care for the person, not despite their foibles and imperfections,
but because of them.
 Push for the outpouring of shame, sadness or rage, despite your own primal fear of losing control
or being consumed.
 Find compassion for the vileness of another’s thoughts, actions or past and discover “What is not
so terrible about them?”
 Fully embrace that the outcome of therapy is your responsibility and that clients do not fail but
are failed by therapy.
 Make session a safe haven in which to practice new ways of thinking, feeling and interacting. Do
so by your own willingness to experiment, be in the moment, and experience risk.
 Whenever possible, pull clients into your own energy, optimism and sense of hope.
 Self-disclose; it is “an absolutely essential ingredient in psychotherapy – no client profits without
revelation” (Yalom).
 Freely step into the abject terror of another’s pain knowing that for at least those few moments,
the other is no longer alone.
First Level Counselors/Beginning Practitioners
Common Characteristics
 Lacks integrated perspective on human nature, including ethical, legal, occupational, and familial
considerations. Tendency to oversimplify the development of self-process.
 Tendency to match theories against their own personal experiences; this tends to develop a
prejudice for the model that merely fits their own experiences best.
 Tendency to overuse one model, developing an over-simplistic understanding of complex
structures. This generalizes behaviors and creates “types” of clients, thereby minimizing
individual differences.
 Tendency to minimize importance of self-awareness and personal growth.
 Tendency to over-focus on learning new information and performing newly acquired skills, in
lieu of understanding the process of therapy and the client’s unique perspective and story.

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 Tendency to over-focus on self, including own anxiety about being a clinician, lack of skills and
knowledge, and the likelihood that they are being regularly evaluated; preoccupations detract
from treatment with cookbook answers and session-to-session planning; less energy for study.
 Tendency to be fearful of more genuine, intimate contact with client, to smooth over volatile
issues, to avoid inclusion of more volatile members and to minimize issues that resonate within
one’s own life. Reluctance to engage client material at a deeper level, especially pain and shame.
Training Issues in Clinician Supervision
 Practical concerns: supervision requirements; caseload size/mix; treatment space; clinical forms
and documentation; etc.
 Supervisee anxiety: provide support and encouragement; promote autonomy and risk-taking;
continuously monitor potential risks to clients; be available to consult or co-facilitate.
 Target overall development in understanding of human nature, culture, and clinical theory and
practical skills:
o Train on various theoretical approaches; purpose and process of treatment; symptom
development and management; role of therapist; intervention tactics and techniques;
therapy modalities (individual, couple, family, group); etc.
o Train on Practical Skills: authenticity and personal risk; accommodation and joining;
assessment; challenging; contracting; assigning tasks and directives; assigning
homework; teaching problem-solving and resolving conflict; etc.
o Train on High-risk concerns: threats; trauma; harm to self or others; depression &
anxiety; domestic violence; etc.
 Observe work using role-plays, case presentation, two-way mirror, videotape, and live
supervision
 Self-growth: use of self in session; comfort with intensity as well as intimacy; personal issues that
impact client care; cultural competency and sensitivity to difference; the supervisory triad
(isomorphism and parallel process); burn out and self-care; etc.
 Legal and ethical issues: mandated reporting,; duty to warn; civil commitment orders; NGRI;
subpoenas; confidentiality (42CFR2/HIPAA); separation, divorce and child-custody decrees;
Advanced Directives; Human Rights laws; etc.
 Professional development, including current events and policies related to the counseling field;
Second Level Counselor/Moderately Experienced Practitioners
 Demonstrated continuation of proficiencies in theoretical premises and core skill competencies.
 Clear growth across various domains, including greater preoccupation with client centered care
(versus self as counselor); a greater sense of independent functioning and autonomy from the
supervisor; broader use of a range of technique; improved use of self; longer-term strategizing in
client care; and improved understanding of the therapy process from contracting to termination.

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 Caution: this period often evidences fluctuating levels of motivation by the counselor, including
periods of resistance, ambivalence, and lethargy. This can lead to conflict between the supervisee
and supervisor and may also result in a deeper understanding of clinicians’ skills and personal
characteristics; typically, therapist confidence is shaken by an increased knowledge of the
complexity of the recovery process; frustrations with client progress and satisfaction; treatment
failure; etc. Supervisee tendency to lay more blame on client for lack of change.
Training Issues in Clinician Supervision
 Encourage broader experimentation; reduce frequency of supervisor directives; allow counselor
to propose and select interventions. Require supervisee demonstrate technique and present to
peers on cases and clinical issues. Arrange peer co-facilitation.
 Encourage more open dialogue and cooperative planning between counselor and clients. Require
treatment planning in stages.
 Increase caseload size and complexity of assigned clients; challenge supervisee’s work by forcing
them to articulate their conceptualizations of the client, the interventions they chose, and possible
alternatives and their predictable outcomes.
 Vary treatment modalities (ie. couple, family therapy); encourage presentations select topic areas
to various audiences; increase outside training and reading assignments; arrange peer case
supervision and (limited) clinical supervision under guidance
Level Three Counselors/Advanced Practitioners
 Counselor is able to fully empathize with, and understand the client’s perspective on the world,
their goals and desire for change and has a better understanding of human behavior and the
therapeutic process.
 Counselor motivation has stabilized with an improved appreciation of their own skill ability and
limitations. Improvement in skill should have reduced treatment outcome variability, improved
dexterity in contracting, and promoted more sophisticated challenging.
 Autonomy increases: counselor has a deeper understanding of treatment methods, accepting of
supervisor with different orientation, broad ethical knowledge, is able to switch tracks with
clients, and appropriately uses self in therapy.
 Is able to lead clinical discussion, supervise Level One counselors, present subject matter
expertise, able to present in court and to law enforcement, comfortable ease in individual, group,
couple family and multi-family therapy modalities. Able to handle high risk and extremely
complex client profiles and syndromes.
Clinician Supervision Issues
 Role of supervisor is to guide the supervisee toward mastery and integration of all domains, from
assessment to treatment to aftercare. Supervision becomes considerably more collegial, and there
becomes a much less differentiation of expertise and power in the supervisory relationship.

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 Structure in supervision usually comes from the supervisee, rather than the supervisor. That is,
this level of clinician knows what they need from supervision at any given time. Supervision
takes on the facilitative tone (support, caring, confrontation when needed) as opposed to the
structured one (specific interventions such as live observations). A common form of supervision
with Level 3 therapists is collegial, informal group supervision. While they can work with a level
2 or even 1 supervisor, they really need a level 3 supervisor.
 Supervisor develops preference for Level One counselors (“open and eager”) and Level Three
counselors (collegial); greater reluctance to accept and work with Level 2
 Need for therapist to move toward supervision of peers and Level 1 supervisees
Group Supervision
“Group supervision is the regular meeting of a group of supervisees (a) with a designated supervisor or
supervisors, (b) to monitor the quality of their work, and (c) to further their understanding of themselves
as clinicians and the clients with whom they work, and of service delivery in general. These supervisees
are aided in achieving these goals by their supervisor(s) and by their feedback from, and interactions with,
each other.” Bernard and Goodyear (2009)
 Types: 1) Case consultation: one member presents for the purpose of feedback, support and
discussion of theory and technique; 2) Peer supervision: a group of similarly trained or skilled
individuals (e.g., all addiction counselors, clinicians at a certain developmental level), meeting
regularly for mutual supervision and support, which may or may not include a group leader or
supervisor; and 3) Team supervision: typically a mixed group with a defined leader or leaders,
often with intra-disciplinary or interdisciplinary members at various skill levels (e.g. students to
level 3 clinicians).
 Size: Groups should not be so large that members are shortchanged nor so small to be unduly
impacted by disruptions such as absences or dropouts. The average group should be no less than
4-6 supervisees and no greater than 12.
 Benefits:
o Economics of time, costs and expertise.
o Skill improvement through vicarious learning, as supervisees observe peers
conceptualizing and intervening with clients.
o Group supervision enables supervisees to be exposed to a broader range of clients and
syndromes than any one person’s caseload
o The normalization of supervisees’ experiences
o Supervisee feedback of greater quantity, quality and diversity; other supervisees can offer
perspectives that are broader and more diverse than a single supervisor
o Quality increases as novice supervisees are likely to employ language that is more readily
understood by other novices
o The group format enriches the ways a supervisor is able to observe a supervisee
o The opportunity for supervisees to learn supervision skills and the manner in which
supervisors approach providing guidance
 Limitations:
o The group format may not permit all individuals to get what they need.

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o Less skilled members may monopolize the available time.
o Group dynamics, such as personality conflicts and inter-member competition, can
negatively affect learning.
o The group may devote too much time to issues of limited relevance to, or interest for
some group members;
o Group supervision does not have a parallel process to individual supervision. While
group supervision could potentially help one out with their group processes, (depending
on the modality) a large portion of discussions in group supervision is regarding
individual work with clients.
 Group Supervision Supervisory Tasks
o Assume an active stance in the group; one that steers a careful course between over- and
under-control
o Assert yourself as necessary to redirect the group; impose limits, set Agenda, etc.
o Listen to and then following the group, challenging direction as necessary
o Be able to choose the right fights when inevitable conflicts emerge between supervisees
or within the group itself
o Communicate clearly just what you want to happen. Be confident, but not autocratic
o As the leader be able to process the groups interaction style and level of development to
understand where members are, rather than where you wish them to be.
Conflicts in Supervisory Directives
It is very common for counselors to receive conflicting feedback from supervisors and peers. This may
broaden one’s insight or create confusion and paralysis.
 There is rarely only one way of interceding; alternatives provide flexibility and spontaneity
 Peer observation may have as much (or more) validity and should not be discounted
 Paralysis often results from a fear of doing, the desire to please, or anxiety about being wrong
 Supervisees are responsible for following the directive of their assigned ‘primary’ supervisor
 Counselors, as well as supervisors, should pay attention to the suggestions they like the least
 Counselors must accommodate feedback to their own language, tempo, and way of working
 Counselors should avoid a method simply because it “feels safer” or is more “comfortable”
 If one is truly “stuck” or confused as to how to proceed, ask the client
 Learning to “trust one’s gut instincts” is the beginning of independence in counseling

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 As counseling is only as good as the counselor, supervision is only as good as the supervisor
 Counselors should be coached on responsible spontaneity
o if one is clear on the plan for the session, one is free take whatever step fits best at the
moment and fully experience the journey;
o one must always be willing to abandon the plan, to go where one must be.
Supervision Formats
 In-supervision formal and informal case presentations
 Review of session progress note(s) and/or case file
 Review of video or audio recordings
o Supervisor reviews and provides feedback
o Supervisor and supervisee review in tandem and discuss

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 Consultation; prearranged intervention with counselor and client(s)
 Group supervision; Peer supervision; Multi-supervisor supervision
 Post-session interview(s) or treatment review(s) with client(s) directly
 Live supervision (supervisor is responsible for treatment outcome; J. Haley, 1996)
 Two-way mirror, tele-med link, monitor, or audio link
 Co-facilitate or supervisor in session as observer
 Greek Chorus arrangements
Live Supervision and Tasks Common to the Lead Supervisor
 In Live Supervision, you are in charge and responsible for the outcome of therapy/treatment
 Ensure an agreed upon format and have everyone follow the same model of treatment
 Decide, in advance, the extent of disclosure with clients of the team’s strategies and techniques
 Be prepared to redirect, block, reframe, or side-line directives by non-lead counselors
 Formats may include Supervisor/Counselor(s) alternating, Lead, Tag-team, Good Cop/Bad Cop
 Require that all participants must be prepared to practice before the group; they must practice
 Require that supervisee is fully prepared to present their case (see next slide)
 Do not permit mocking, horse-play or ridicule of clients or other counselors (either side of mirror)
 Follow 1 or 2 cases from first session to termination, whether the supervisee sees a concern or not

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 Demonstrate: how to effectively interview (therapy is competent interviewing; J. Haley)
 Demonstrate: how to move into the client’s emotional sphere, and then keep inching forward
 Demonstrate: how to introduce in-session tasks and force work by remaining undistracted/on-task
 Demonstrate how to introduce and reach agreement on the need to bring in critical participants
 Demonstrate: how to push for the pain, -the worry, the guilt and shame, the anger, the sorrow
 Demonstrate: how to button-up after each hard push and then at the end of a session
Team Supervision
December 12, 2016 Meeting
Common Group Problem Scenarios
Member roles and participation issues
 Dominating
 Mute
 “Expert” group members
 Echoing the leader
 Inattentive/disengaged
 Defiance
Feedback issues
 Overly critical
 Lack of constructive criticism
 “Deaf” participants (not receptive to feedback)
 Subgrouping (ganging up)
 Challenging the leader
Casework issues
 Button pushing (hitting on personal issues)

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 Time-wasting on irrelevant issues
 Collusion with the client
 Presenting insufficient information
 Ethical impropriety/placing consumer at risk
Feedback to the Case Presenter
Topics of feedback may include:
 Commentary of overall treatment strategy
 Focus on “blind spots”
 Areas for clinical improvement (professional development)
 What would I do? (And how would I get there? See Contracting and Refocusing; page 15
and 45)
Case Presentation: OP Case Sample
Contracting
 What is the chief complaint (presenting problem or symptom)
 What is the desired goal (s) or outcome of treatment
 How is success to be understood or measured, in behavioral terms, and
 Who is to participate and under what terms
Interviewing & Tracking
PP and It’s History
 When did it start? What else was happening then?
 What attempts have been made to fix it? What worked? What did not work?
 What exactly happens? “…and then what happens?” (sequencing)
 Who participates: who does what, when? (transactional pattern)
 What does it prevent or safe-guard from happening: “what would happen if this was no
longer a problem?” = purpose of PP or symptom
 Beware of the search for insight as a means to success
Typical Goal-setting Problems
Common problems that occur during early contracting

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 Cancellations and No-shows
 Too many PPs, too many IPs
 Disagreement on PP or IP
 Commitment to Tx is vague
 Client(s) refuses to do task or is belligerent to directive
Common problems that occur once treatment is underway
 Therapist finds themselves spinning in session or confused as to direction of treatment
 PPs/IPs continually shift; new “emergencies”
 Attendance gets “spotty”; misses homework
 Members change or refuse to attend
 Therapy is stalled, stuck or slow as molasses
Case Overview for Presentation in Supervision
1. If more than one participant indicates seating pattern and who spoke first.
2. Presenting Problem/Reason for seeking treatment (include each member’s belief).
3. When did the Presenting Problem first appear (Dates/Reoccurrences)?
4. Related or correlating events to date of first appearance/Life-cycle issues.
5. Previous Action Taken; track interactional pattern (who does what and when?).
6. Who else does the problem affect? How?
7. Has anyone else exhibited this (include all families and intergenerational)?
8. What does the client/couple/family see as the most important concern to first begin work on?
9. If counseling was successful and this problem no longer existed, how would life be different -
-per the client(s)?
10. Family “spokesperson”” member(s) most apt to work for change? Member(s) most concerned
about change?
11. Conceptual Summary
a. Genogram
b. Predominant Issues/Life-cycle
c. Structural mapping
d. Presenting Problem and Purpose of Symptom(s)
e. Factor(s) motivating treatment at this time?

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f. Specific strategy/interventions made to date and client(s) reactions?
12. Treatment recommendation
a. Method: modality, participants, frequency, and duration
b. Goal(s) (short-term/long-term)
c. Therapist’s expectations for change
Family Therapy Training Syllabus
1. Clinical Supervision and Case Consultation
2. Working From a Systemic Family Therapy Perspective
a. Structures: Rules, Roles, Subsystems And Boundaries
b. Genogram
c. Mapping
d. Family Life-Cycle and Leaving Home and the Individuation Process
e. Triangles
f. Presenting Problems, IPs and Symptom Development
3. Contracting: Establishing Rapport, Interviewing, Problem Delineation And Agreement To Work
4. Giving In-Session And Homework Directives And Working With Client Resistance (Fear)
a. Direct Tasks
b. Ordeals
c. Rituals
d. Techniques
i. Enactment and Working in the Here-and-Now
ii. Challenging the World View
iii. Empty Chair
iv. Fantasy and Guided Imagery
1. Acting As If
2. Time Travel
3. Push Button
4. Sculpting
5. Early Recollections
v. Revenge and Forgiveness
vi. Paradox
vii. Misc
5. Termination
6. Specialties
a. Couple Therapy
i. Problem-Solving And Conflict Resolution
ii. Infidelity
iii. Separation And Divorce
iv. Remarriage and Blended Families
b. Consulting, Co-Therapy And Team Therapy Approachs
7. Special Issues
1. Trauma: Loss, Tragedy and Betrayal

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2. Depression And Suicide
3. Domestic Violence and Abuse
4. Addictions
5. Paraphelia
6. Eating Disorders: Anorexia, Obesity and Bulimia
7. OCDs / Obsessions, Compulsions, Anxieties and Phobias
8. LGBTQ Issues / Gender Identity And Sexual Orientation
9. Criminal Justice
10. Etc

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Demetrios Peratsakis, LPC, ACS and Natalia Tague, LPC
A Model of Evolutionary Psychology
Bowen described an evolutionary process of natural selection over generations of family functioning,
fueled by two primal, counterbalancing forces, the need for intimacy and belonging (fusion) and the
need to be separate and individual (differentiation of self).
Psychological problems are viewed as rooted in the family system’s inability to effectively reconcile
stress. As anxiety increases, relationships become increasingly reactive, deepening the emotional
fusion between members while decreasing their respective differentiation (of self). Unresolved, anxiety
and trauma result in chronic tension expressed as “physiological symptoms, emotional dysfunction,
social illness or social misbehavior” (M. Bowen).
Much of Bowen’s theory retains broad applicability as evidenced by core assumptions common to the
cognitive–behavioral, attachment and interpersonal therapies (the importance of interpretation and the
ability to demarcate between feeling and thought and between one’s own convictions and those of
another), the family therapies (triangulation, family structure and functioning) and the biomedical, on
the role of stress in primary and behavioral health symptom formation.

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1. Differentiation of Self
2. Triangles
3. Nuclear Family Emotional System
4. Family Projection Process
5. Multigenerational Transmission Process
6. Emotional Cutoff
7. Sibling Position
8. Societal Emotional Process
8 Interlocking Concepts
Note: Some of the description of the eight concepts of Bowen Theory are modified excerpts from the Bowen Center for Family Studies and from a literature review by Vermont
Center for Family Studies faculty member, Monika Baege, referencing the following sources: Bowen, 1978;Gilbert, 1992, 1999;Kerr & Bowen, 1988, and Noone, 1995.
1. Differentiation of Self
 Differentiation of self is a measure of the degree of integration of self, describing how people cope with life's demands and
pursue their goals on a continuum from most adaptive to least
 Variations in this adaptiveness depend on several connected factors, including the amount of solid self, the part of self that is not
negotiable in relationships. Greater differentiation = strength of convictions; less solid self = feels more pressure to think, feel,
and act like the other.
 Fusion between people generates more chronic anxiety
 Level of differentiation refers to the degree to which a person can think and act for self while in contact with emotionally
charged issues. It also refers to the degree to which a person can discern between thoughts and feelings.
o Higher levels of differentiation: manages stress, anxiety and reactivity; choose thoughtful action
o Lower levels of differentiation: increased dependence on others to function; increased likelihood of developing severe
symptoms under stress; They act, often destructively, based on anxious reactions to the environment. Their intellectual
reasoning fuses with emotionality. Even highly intelligent people can be poorly differentiated.
 The process of differentiating a self involves a conscious effort at strengthening or raising the amount of solid self by defining
beliefs and principles, managing anxiety and reactivity, and relating differently to the family system; the level of differentiation
is raised in the whole system.
 On a scale of 0-100, most of the population scores below 30; 50 is unusual and 75 occurs rarely within several hundred years

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Relationships function as if they are governed by
two equally intense counterbalancing life forces
- Bowen Family Systems Theory
Individuality/Individuation
“Derived from the drive
to be a productive,
autonomous individual, as
defined by self rather
than the dictates of
the group.”
Differentiation
Togetherness
“Derived from the
universal need for love,
approval, emotional
closeness, and
agreement.”
Fusion
Slide courtesy of Michael E. Kerr, MD
Five Characteristics of Self-differentiation
(Definition of Self Within Relationships; adapted)
Differentiation of Self is a life-long process of developing two essential capacities, between autonomy (separation) and connection
(togetherness), self-definition and self-regulation. The actual process of increasing self-differentiation requires progressive
demarcation of the elements that comprise the Self (self-definition) and the courage and determination to develop responsibility for the
management of one's own anxiety and reactivity (self-regulation). Differentiation is a measure of one’s solidity and centeredness.
SELF-DEFINITION
1. A Mature Understanding of One’s Own Limits and of the Limits of Others
 A clear understandingof where one ends and somebodyelse begins
 Respect for the right of others to be who and how they wish to be while refusing to allow them to define or intrude upon one’s own rights
 The defining characteristic is to have oneself defined from within, rather than adapting to please others or simply to avoid conflict
2. Clarity as to One’s Own Beliefs
 What do I believe, why do I believe it to be so, and from whence does this belief come from?
 How strong are my convictions?
 Of what am I certain, and of what am I not so certain?
SELF-REGULATION
3. Courage to Take Stands
 Defining where one stands on issues and the courage to affirm those beliefs in the face of disapproval
 Refusing to give in to another when it is a matter of principle
 Capacity to stand firm in the face of strong reactions! -ie. “You can't think, act, or feel that way and remain a part of this family!'
4. The Ability to Retain Integrity
 Resolve to follow through on a vision or toward a goal or outcome despite threats or sabotage from others
 Emotional and spiritual stamina to stick with a plan or goal and not let the reactions of others redefine its course
5. Staying Connected
 Maintaining a relatively non-reactive give-and-take with those who are reacting to you
 Resisting the impulse to attack or cut off from those who are most reactive to you.

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Patterns of interaction that reduce conflict and duress within the dyad
Triangles: Problem Solvers and Creators
Triangle Theory
1. Conflict is a continuous condition of human interaction
2. Triangulation is a pattern of interaction that reduces conflict and distress; it is a process whereby anxiety is decreased and
tension dissipated through emotional interaction with others
“The (Bowen) theory states that the triangle, a three-person emotional configuration, is the molecule or the basic building block of
any emotional system, whether it is in the family or any other group. The triangle is the smallest stable relationship system. A two-
person system may be stable as long as it is calm, but when anxiety increases, it immediately involves the most vulnerable other
person to become a triangle. When tension in the triangle is too great for the threesome, it involves others to become a series of
interlocking triangles.” M. Bowen. “Family Therapy in Clinical Practice.” Aronson New York. 1976. P373
3. Unmediated, conflict results in chronic tension expressed as “physiological symptoms, emotional dysfunction, social illness
or social misbehavior” - M. Bowen
4. The resulting conditions are characterized by “1) marital (or partner) discord; 2) dysfunction in a partner; 3) impairment
in one or more of the children; or 4) severe emotional “cut-off”, including isolation, abandonment, betrayal, or expulsion
5. Triangulation may also result in preferred patterns of interaction that avoid responsibilityfor change –Alfred Adler
8

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Triangle’s Simplified
 Two-person dyads become unstable once anxiety increases
 A third persons is pulled into the conflict, creating more space for anxiety and relieving some of the pressure
 When the triad can no longer contain the anxiety, more people are triangulated, forming a series of
interlocking triangles
 If one member of the triangle remains calm and in emotional contact with the other two, the system
automatically calms down.
 When stress and reactivity intensify and remain chronic, members lock into a triangular position which
solidifies and develops symptoms.
dyad
third person or subject of mutual, concern or interest
anxiety
closeness may increase as
anxiety is reduced
10

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dyad
Anxiety decreases in dyad
 Third party helps mediate conflict or remedy problem in the two-person relationship (dyad). For example:
 siblings cease their disagreement over chores to actively chide their younger brother
 co-workers are unclear on best approach to an issue and seek guidance from their supervisor
11
1. Greater anxiety = more closeness or distance
dyad
third person or subject of mutual,
concern or interest
Alliance
increases trust
and intimacy
 Two members (or all three) are drawn closer in alliance or
support. For example:
 Separated or divorced husband and wife come together as parents
for their child in need
 sisters share greater intimacy after one has been the victim of a
crime (the triangulated my be a person or an issue, such as “work”,
the “neighbors” or in this example, the “crime”)
anxiety is reduced
12

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Over time
 Triangulation begins as a normative response due to stress or anxiety
caused by developmental transition, change or conflict
 The pattern habituates, then rigidifies as a preferred transactional
pattern for avoiding stress in the dyad
 The IP begins to actively participate in maintaining the role due to
primary and secondary gains
 The “problem”, which then serves the purpose of refocusing attention
onto the IP and away from tension within the dyad, becomes an
organizational node around which behaviors repeat, thereby governing
some part of the family system’s communication and function
 Over time, this interactional sequence acquires identity, history and
functional value (Power), much like any role, and we call it a
“symptom” and the symptom-bearer, “dysfunctional”
 A key component in symptom development is that the evolving
pattern of interaction avoids more painful conflict
 This places the IP at risk of remaining the “lightning rod” and
accelerating behaviors in order to maintain the same net effect
 When this occurs, it negates the need to achieve a more effective
solution to some other important change (adaptive response) and
growth is thwarted. The ensuing condition is called “dysfunction”.
- d. peratsakis
14
3. Nuclear Family Emotional Process
How members adjust roles and responsibilities in their relationships to mediate tasks and reconcile stress and anxiety
The mechanism by which symptoms develop in families
 Four basic relationship patterns that operate in intact, single-parent, step-parent, and other nuclear family configurations.
 Problems or symptoms develop during periods of heightened and prolonged family tension
 Effects of tension depends on the stress event, family resiliency, and supports from extended family and social networks.
 The higher the tension, the more chance that symptoms will be severe and that several people will be symptomatic
Partner/Maritalconflict As tension increases partners become more anxious, externalizing their anxiety into the couple relationship.
 Partners focuses on what is wrong with the other, each tries to controlthe other, and each resists the other’s efforts at control.
 Partners and members who distance render themselves emotionally unavailable; avoid potentially uncomfortable, though important, topics.
 Reciprocity in relationships occurs when one person takes on responsibilities for the twosome. With chronic tension, the two people slide into
over-adequateand under-adequateroles. This can result in failure or inadequacy in one of the partners.
Dysfunction in one partner One partner pressures the other to think and act in certain ways and the other yields to the pressure
 Partners accommodate to preserve harmony; typically, more one-sided
 When tension rises, the roles intensify, the subordinate partner yield’s more self-controlescalating their anxiety
 Over-functioningand under-functioningreciprocityintensifies, resulting in greater emotional fusion
Impairment of one or more children Partners focus their anxieties on one or more of their children.
 Excessive worry, rigid convictions and beliefs or very negative view of a child results fixed targeting
 Increased attention creates heightened sensitivity and reactivity. Child becomes more reactive to their attitudes, needs, and expectations
 The process undercuts the child’s differentiation from the family, increasing vulnerability to act out or internalize family tensions
 The child’s anxiety can impair schoolperformance, social relationships, and health
Emotional distance Family members distance to reduce the relationship intensity, but risk becomingtoo isolated and avoidant
 Common coping style that concentrates anxiety in other relationships; the more anxiety one person or one relationship absorbs, the less other
members must absorb. This means that some family members maintain their functioningat the expense of others
 While harm may be unintended, distancing pools anxiety in the remaining members increasing emotional fusion
.

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4. The Family Projection Process
“The primary manner in which parents transmit their emotional problems to a child. The projection process can impair the functioning of
one or more children and increase their vulnerability to clinical symptoms. Children inherit many types of problems (as well as strengths)
through the relationships with their parents, but the problems they inherit that most affect their lives are relationship sensitivities such as
heightened needs for attention and approval, difficulty dealing with expectations, the tendency to blame oneself or others, feeling
responsible for the happiness of others or that others are responsible for one’s own happiness, and acting impulsively to relieve the
anxiety of the moment rather than tolerating anxiety and acting thoughtfully. If the projection process is fairly intense, the child develops
stronger relationship sensitivities than his parents. The sensitivities increase a person’s vulnerability to symptoms by fostering behaviors
that escalate chronic anxiety in a relationship system.
The projection process follows three steps:
(1) the parent focuses on a child out of fear that something is wrong with the child
(2) the parent interprets the child’s behavior as confirming the fear; and
(3) the parent treats the child as if something is really wrongwith child.
These steps of scanning, diagnosing, and treating begin early in the child’s life and continue. The parents’ fears and perceptions so shape
the child’s development and behavior that he grows to embody their fears and perceptions. One reason the projection process is a self-
fulfilling prophecy is that parents try to “fix” the problem they have diagnosed in the child; for example, parents perceive their child to
have low self-esteem, they repeatedly try to affirm the child, and the child’s self-esteem grows dependent on their affirmation.
Parents often feel they have not given enough love, attention, or support to a child manifesting problems, but they have invested more
time, energy, and worry in this child than in his siblings. The siblings less involved in the family projection process have a more mature
and reality-based relationship with their parents that fosters the siblings developing into less needy, less reactive, and more goal-directed
people. Both parents participate equally in the family projection process, but in different ways. The mother is usually the primary
caretaker and more prone than the father to excessive emotional involvement with one or more of the children. The father typically
occupies the outside position in the parental triangle, except during periods of heightened tension in the mother-child relationship. Both
parents are unsure of themselves in relationship to the child, but commonly one parent acts sure of himself or herself and the other parent
goes along. The intensity of projection process is unrelated to the amount of time parents spend with a child.” –the Bowen Center
5. Multigenerational Transmission Process
Transmission of information across generations on several interconnected levels, ranging from the conscious teaching and
learning of convictions, rules and regulations, to the automatic and unconscious programming of emotional reactions and
behaviors that, collectively, define the individual’s view of the world and shapes their sense of self.
 Parent and child interactions over a prolonged period of dependency and early development results in differentiation at level of parents’
 The nuclear family emotional process results in variability in differentiation, with one sibling developing a greater sense of “self”
(increased differentiation) while another develops less, providing siblings practice in role reciprocity (over- and under-functioning)
 Multigenerational transmission follows a predictable path to mate selection with similar levels of differentiation of self.
 Where siblings with higher differentiation levels from different families mate, their most differentiated offspring foster a line of progeny
with greater differentiation; over multiple generations, the differences between family lines grow increasingly marked
 Level of differentiation of self “can affect longevity, marital stability, reproduction, health, educational and occupational accomplishments
 Bowen theorized that highly differentiated persons developed stable, productive nuclear families that contributed to society, whereas, low
differentiated individuals raised children over the generations who were more susceptible to social illness and psychological problems*
* Note: “Some concerns have been voiced over what is perceived as an overly deterministic or fatalistic perspective on social growth in
Bowen’s Theory. Perhaps, one could argue, some form of resiliency factor is conveyed as an inheritable trait, making such transmission a
predisposition, rather than a prescriptive condition. One could also argue that this is a critical mechanism in evolutionary psychology and
important to the furtherance of reasoning and innovation in the species”. - d.peratsakis

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6. Emotional Cutoff
Emotional cut-off is a preferred method of coping by which the individual reduces the anxiety and stress of unresolved conflict with
parents, siblings, and other family members by reducing or totally cutting off emotional contact with them.
 Increase risk of a mismatch between physical proximity and emotional closeness, thereby avoiding sensitive issues
 Increases risk of avoidance as a preferred coping strategy with others
 Cut-off may occur by moving away, abandonment or expulsion
 Distance from family members may be offset with exaggerated closeness with other, non-family member relationships, creating
substitute “families” with social and work relationships
 Unresolved attachment issues can take several forms:
o Feeling infantilized when at home with parents, who are prone to make decisions for them
o Feeling responsible for solving parents’ conflicts or mediating the nuclear family’s distress
o Anger at not being fully accepted as an adult with differences by parents
o Unresolved attachment breeds more immaturity in parents and children
o Siblings foster anger at distancing sibling; adds to household tension
7. Sibling Position
Sibling position, a concept which Bowen adopted from the research of Walter Toman, affects variation in basic
and functional levels of differentiation as well. Oldest, youngest, and middle children tend toward certain
functional roles in families, influenced also by the particular mix of sibling positions in it and the sibling positions
of parents and other relatives.
From Alfred Adler:
1. The psychological situation of each child in the family is different.
2. The child's opinion of himself and his situation determines his choice of attitude.
3. If more than 3 years separate children, sub-groups of birth order may form.
4. A child's birth order position may be seized by another child if circumstances permit.
5. Competition may be expressed in choice of interests or development of characteristics.
6. Birth order is sometimes not a major influences on personality development. The other potentially significant
influences are: organ inferiority, parental attitudes, social & economic position, and gender roles.
POSITION FAMILY SITUATION CHILD'S CHARACTERISTICS
ONLY
Birth is a miracle. Parents have no previous experience. Retains 200% attention from both parents. May become rival of
one parent. Can be over-protected and spoiled.
Likes being the center of adult attention. Often has difficulty sharing with siblings
and peers. Prefers adult company and uses adult language.
OLDEST
Dethroned by next child. Has to learn to share. Parent expectations are usually very high. Often given resposnsibility and
expected to set an example.
May become authoritarian or strict. Feels power is his right. Can become helpful if
encouraged. May turn to father after birth of next child.
SECOND He has a pacemaker. There is always someone ahead.
Is more competitive, wants to overtake older child. May become a rebel or try to
outdo everyone. Competition can deteriorate into rivalry.
MIDDLE Is "sandwiched" in. May feel squeezed out of a position of privilege and significance.
May be even-tempered, "take it or leave it" attitude. May have trouble finding a
place or become a fighter of injustice.
YOUNGEST Has many mothers and fathers. Older children try to educate him. Never dethroned.
Wants to be bigger than the others. May have huge plans that never work out. Can
stay the "baby." Frequently spoiled.
TWIN One is usually stronger or more active. Parents may see one as the older. Can have identity problems. Stronger one may become the leader.
"GHOST CHILD" Child born after the death of the first child may have a "ghost" in front of him. Mother may becime over-protective.
Child may exploit mother's over-concern for his well-being, or he may rebel, and
protest the feeling of being compared to an idealized memory.
ADOPTED CHILD
Parents may be so thankful to have a child that they spoil him. They may try to compensate for the loss of his biological
parents.
Child may become very spoiled and demanding. Eventually, he may resent or
idealize the biological parents.
ONLY BOY AMONG GIRLS Usually with women all the time, if father is away. May try to prove he is the man in the family, or become effeminate.
ONLY GIRL AMONG BOYS Older brothers may act as her protectors.
Can become very feminine, or a tomboy and outdo the brothers. May try to please
the father.
ALL BOYS If mother wanted a girl, can be dressed as a girl. Child may capitalize on assigned role or protest it vigorously.
ALL GIRLS May be dressed as a boy. Child may capitalize on assigned role or protest it vigorously.

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8. Societal Emotional Process
Societal emotional process describes how the emotional system governs behavior on a societal level, promoting both progressive and
regressive periods in a society.
It refers to the tendency of people within a society to be more anxious and unstable at certain times than others. Environmental stressors
like overpopulation, scarcity of natural resources, epidemics, economic forces, and lack of skills for living in a diverse world are all
potential stressors that contribute to a regression in society.
“This premise, like the Multigenerational Transmission process, has serious implications for evolutionary psychology. The tenet, that
society mirrors the nuclear family process which, in turn, reflects the norms, morays and cultural artifacts of the societal whole posits an
interactive relationship with negative as well as positive trends. Community institutions, such as schools, courts, news outlets and political
bodies reflect the collective tension of a peoples and move to implement measures to reduce stress and reconcile anxiety. The ensuing
trends attempt to regulate broad tension within society and define what is permissible and acceptable at given times.” –d.peratsakis

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Slide 1
Structural-Strategic Couple and Family Therapy

43
Slide 2
Presenter's Notes
1. Slide Notes: This PowerPoint provides information that will not be covered during the presentation, so please review
the material at your convenience and contact me directly for further clarification.
2. Role-Play Demonstration: A structural-strategic family therapy session will be demonstrated; while styles vary broadly,
it will punctuate some common, simple rules that can advantage family practice.
3. F/C Specialization (1980-1995): This was a very active period in my own practice of marriage and family therapy;
while I benefited from my work with many, I am particularly indebted to
- AAMFT Supervisor Robert Sherman, co-founder of Adlerian Family Therapy and developer of the Marriage and
Family Therapy programs at Queens College. From 1980 until 1992 he supervised my training, adjunct faculty work,
and involvement in the department’s annual MFT Founder Series, sponsoring such notable theorists as M. Andolphi,
J. Framo, M. McGoldrick, C. Whitaker, M. Bowen, J. Haley, and the Minuchins;
- AAMFT Supervisor Neil Rothberg for our work together at the ASPECTS Family Counseling Center (1982 to 1992);
- Richard Belson, Director, for a 2-year intensive at the Family Therapy Institute of Long Island in live-supervision and
strategic family therapy (1990 to 1992). Richard collaborated with Jay Haley and Cloe Madanes as faculty at the
Family Therapy Institute of Washington, D.C. from 1980 to 1990 and served on the editorial board of the Journal of
Strategic and Systemic Therapies, from 1981 to 1993;
- Strategic Impact (1992-1995), a professional cooperative for advanced training methods in couple and family therapy.
- Demetrios Peratsakis, LPC, ACS

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Slide 3
A New Understanding of Human Nature and How to Treat its Problems

45
Slide 4
Rubin Vase
Family Systems Therapy forced a new insight into our customary
view of the individual and their relationship systems.

46
Slide 5
Family Systems Therapy expanded on the belief
that psychological symptoms were the creation of the
individual in service to their family.
IP: Lightning Rod? Scape-goat? Sacrificial Lamb?

47
Slide 6
IMHO, there are three (3) very significant perspectives
that have reshaped our understanding of the purposiveness of human behavior:
1. Psychological symptoms are the creation of the individual in service to their family
2. Thought creates feelings which drive behavior; all reaffirm one’s world-view
3. Psychological symptoms are an excuse, a pretext, for avoiding responsibility

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Slide 8
1. Families have Purpose
Individuals in trust relationships acting alone and in concert to accomplish and obtain individual and collective
purposes and needs:
 Basic Needs
1) Safety: food; drink; shelter, warmth and protection from the elements; safety and security and freedom from fears
2) Belongingness: nurturance, intimacy, friendship, affection and love; sex. Meaningful connection with community
3) Esteem and Self-Actualization: achievement, mastery, independence, status, dominance, prestige, self-respect,
respect from others; realizing personal potential, self-fulfillment, seeking personal growth and peak experiences
 Life Tasks
a) larger processes that the family, as a group, must accomplish (Life-cycle Tasks); and
b) those each individual must master (Developmental Tasks) and reconcile (Adler Life Tasks/Existential Anxiety)
Structural Family Therapy
8

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Slide 9
2. Families have Structures - they define Who does What, When, How, and with Whom
 These define the operational organization and atmosphere of the family system
 They define the manner in which transactions occur around tasks, functions and responsibilities.
 They are partly universal (cultural) and partly idiosyncratic (intergenerational): information (rules and myths) on how to
accomplish tasks and assume responsibility; how gender, roles, and functions are defined; how power and emotion is
expressed; how loyalty, intimacy and trust are conveyed; and so on.
Structures
a. Sub-systems: Temporary or enduring subgroupings within the family based on age or generation, gender, and interest or
function:
1) Executive Subsystem;
2) Couple or Marital;
3) Sibling;
4) Grandparental;
5) Extended (cousins, uncles and aunts; 6) Friends/Neighbors/Work
b. Roles: Who does what? What are the established assignments for performing specific functions and tasks?
c. Rules: What is done and how? What are the routine procedures and interactional patterns (transactions) --and their
accompanying rules, which define behavior surrounding functions and tasks of importance?
d. Relationship Boundaries: the degree of reactivity, communication and emotional exchange between
members, subsystems and the system as a whole with the outside world

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Slide 10
3. Family Structures have Power - the ability to influence the outcome of events
Members have power based on status and prestige and authority to fulfill or direct assignments for performing specific functions
and tasks. Power must accompany responsibilities otherwise failure and conflict occur.
Executive Subsystem
No matter the configuration, is the recognized authority responsible for the decision-making and problem-solving capacity of
the family. Core responsibilities include
 to effectively manage stress and conflict as individual members and the group adapts to change.
 define the relationship between the family and the community
 parenting / child rearing
Specialized Individual Family Member Roles
 Family Spokesperson: family member elected to serve as the representative of the family to the outside world. Often most
controlling or member ascribed the most authority/power
 “Enabler”, “Family Hero”, “Mascot”, “Lost Child” (from Addiction theories): roles adopted to mediate stress and help
bind the family cohesion
 Identified Patient (I.P.) or Symptom Bearer: member that controls (and organizes) the family’s behavior by virtue of their
own problems or behaviors

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Slide 11
1. Symptoms (excluding organic illness) are purposive; they are voluntary and under the control of the individual
2. While the Identified Patient (IP) may be appear helpless to change, the helplessness is actually a source of power over others
whose lives and actions are restricted and even ruled by the demands, fears, and needs of the symptom bearer (Madanes, 1991)
3. Symptoms are metaphors for the family disturbance and may express the problem(s) of another, non-IP, family member
(example: child IP with school failure expresses mom’s rage against father)
4. Benevolence drives family interaction; interactions must be described in terms of love
5. Problems arise when the family hierarchy, or power allocation is incongruous; re-aligning power remedies the problem
6. Conflicts arise when the intent of the interaction is at cross-purposes; personal gain versus benefit to the group
 if a person is hostile, he or she is being motivated by personal gain or power
 if the person is concerned with helping others or receiving more affection, he or she is being motivated by love
The motivation helps define the treatment strategy or intervention: the therapist targets the same outcome or the identical
pattern of interaction (sequence) without the problematic symptom; when either occur without the symptom occurring the
problem behavior should abate. (Madanes, 1991).

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Slide 12
Structural-Strategic Therapy Synthesis
Therapy involves disengaging power-struggles that occur in relationships and structures due to
power imbalances, and redirecting them through decision-making and the problem-solving process
Structural: structures are organized constructions of power
 change the Structure in order to change the System
in order to change the Symptom
Strategic: processes are methods by which power is employed
 change the Symptom in order to change the System
in order to change the Structure

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Slide 14
Overview of
1. Symptoms: how they originate and how to challenge them
2. Life-cycle: its role in family development and problem origination
3. Family Constellation and Atmosphere
4. Triangulation: process of stress reduction and problem origination
5. Boundaries: how to define them and how to manipulate them

57
Slide 16
 Symptoms are the Result of Problems with Power
1. inappropriate alliances, such as cross-generational alliances;
2. inappropriate hierarchies, such as parents ceding excess authority to children; or
3. inappropriate boundaries, such as marked enmeshment or disengagement between members
 Symptoms Originate when the Executive Subsystem is Ineffectual -excessive rigidity or diffuseness
1. difficulty reconciling stress and mending trauma or severe impairment in one of its members
2. difficulty responding to maturational, developmental (life-cycle) and environmental challenges
3. difficulty mediating conflict in the couple or partner relationship resulting in power-struggles and their aftermath
Note:
o unresolved, problems become symptoms characterized by power-struggles and improper methods of resolving them; this includes
betrayal, domestic violence, emotional cut-off or expulsion, infidelity, incest, and severe passive-aggressive acts such as eating
disorders, catastrophic failure, depression and suicide
o when the identified patient (IP) is a child, the problem is a failure of the Executive Subcommittee to effectively parent
1. Triangulation of the child due to marital or couple conflict, including parents who are separated and estranged;
2. Triangulation of the child in a cross-generational coalition (child enlisted to take sides in a in loyalty dispute, ie. parent against parent;
grand-parent (s) against parent(s); in-law(s) against parent(s)
 Symptoms are Maintained by Faulty Convictions and Concretized Sequences of Thoughts and Behaviors
 Interrupting these will necessarily disrupt their power and meaning
16

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Slide 17
17
1. Create a new symptom (ie. “I am also concerned about
________; when did you first start noticing it?”)
2. Move to a more manageable symptom (one that is
behavioral and can be scaled; ie. chores vs attitude)
3. I.P. another family member (create a new symptom-
bearer or sub-group; ie. “the kids”, “the boys”)
4. I.P. a relationship (ie. “the marriage/relationship makes
her depressed”)
5. Push for recoil through paradoxical intention
6. “Spitting in the Soup” –make the covert intent, overt
7. Add, remove or reverse the order of the steps (having the
symptom come first);
8. Remove or add a new member to the loop
9. Inflate/deflate the intensity of the symptom or pattern
10. Change the frequency or rate of the symptom or pattern
11. Change the duration of the symptom or pattern
12. Change the time (hour/time of day/week/month/year) of the
symptom or pattern
13. Change the location (in the world or body) of the
symptom/pattern
14. Change some quality of the symptom or pattern
15. Perform the symptom without the pattern; short-circuiting
16. Perform the pattern without the symptom
17. Change the sequence of the elements in the pattern
18. Interrupt or otherwise prevent the pattern from occurring
19. Add (at least) one new element to the pattern
20. Break up any previously whole elements into smaller
elements
21. Link the symptoms or pattern to another pattern or goal
22. Reframe or re-label the meaning of the symptom
23. Point to disparities and create cognitive dissonance
Note: 1-4, Minuchin/Fishman; 5-6, 22, 23, Adler; 7-21, O’Hanlon.
Pattern or element may represent a concrete behavior, emotion, or family member
Challenge the Meaning and Power of the Symptom

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Slide 18
The Process of Challenging
Three Key Concepts
A. “Functional Value” -operational purpose of symptomatic behaviors and conditions
Irrespective of the source or etiology of a symptom or condition, it acquires meaning and power to the individual and the relationship
system when it aides in the ability to function and operate (“functional value”). This will rigidify over time and become a preferred
transaction pattern that defines rules and roles of interacting.
1. The History of the Presenting Problem clues you in to the purpose of the symptom. “Why now?” “Why that?” “Why her?”
2. The sequence and pattern of interaction clues you in to how the symptom is maintained and what triggers it.
3. Noting who participates, who is affected by the symptom and how, will clue you in as to its meaning.
Miscellaneous on Symptoms
1. Symptoms are purposive; moreover, they are metaphors for the family’s disturbance or failure to adequately adapt to change
2. Symptoms are stop-gap measures that preserve a level of safety between the imperative to change and the desire to remain the same
3. Symptoms are maintained by a rigid pattern of convictions and their corresponding feelings and behaviors
4. Symptom recurrence, or substitution, is due to replication of the same pattern of convictions and behaviors
B. Tracking or Sequencing -degree of effectiveness, 1, 2, 3; from lesser to greater 
1. Interviewing client about experience “A” (self-report)
2. Interviewing (family) members about their respective perspective about experience “A” (group report)
3. Enactment or role-play of experience “A”: directive to re-enact problem transaction in session

60
Slide 19
C. Prescribing or Giving Directives
Prescribing or assigning tasks provide practice in new ways of thinking and behaving. It includes simple tasks or assignments as
well as complex sequences of behavioral interactions designed to foster change, such as Re-enactments (repeating pattern with
modifications), Ordeals (patterns designed to be burdensome), and Rituals (ceremonies). In this regard, therapy is nothing more
than a long series of creating deliberate opportunities for change!
1. Give task
Simple introductions include: “Let’s try something…”; “Most/Some people find this helpful…”; “Let’s do an
experiment”; “I’m going to have you do something that may be very difficult/uncomfortable… ”
2. Encourage work by not rescuing
Once a task has been assigned, the therapist's job is to continually redirect straying or direct back to task, while working on
their own anxiety, impatience and need to rescue
3. Work through power-struggles and challenges to therapeutic alliance
Resistance to a task should be expected, but NOT tolerated (see “notes” on client-therapist power struggles)
4. Recap and button-up
a) Explore experience: “Was this worst than you thought it would be?” If the task was not completed, explore a) what would
happen had the task been accomplished? and b) what was going on for the person while struggling with the task?
b) Examine therapeutic alliance for possible back-lash, anger, resentment or fear
c) Predict residual anger
d) Predict back-sliding due to difficulty of change
e) Assign homework
 must be “safe”
 Must anticipate failure or sabotage
 Client must be free to abandon task, unless it is a specific “test” of client’s investment in change

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Slide 21
Life-cycle
Life-cycle is the context within which developmental change occurs. Stress develops into symptoms at points of intersection when
family of origin rules (Vertical stressors) are too rigid and insufficiently flexible to adapt smoothly to trauma or normative
developmental change. This is illustrated in the diagram below which denotes the concentric context we are each embedded within
(Systems Levels) and the merging pressure to remain the same (Vertical Stressors) and the imperative to change (Horizontal
stressors):
Carter and McGoldrick identify six family life cycle stages and their respective processes and tasks, somewhat modified herein.
Because the processes are universal, understanding the Stages helps identify and predict inherent in the developmental changes each
family undergoes.
Factorsthatdecreaseadaptabilitytochange
ChangeEvents

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Slide 22
Stage 1: Launching the Young Adult/Differentiation of Self in Relation to the Family of Origin
Each member is born into a uniquely formed inter-generational social group (family of origin) that defines their identity and
remains an integral part of their life until death. The challenge is for each member to retain the benefits of remaining an integral
part of their birth family while sufficiently separating to form one’s own adult life and new social unit, a process that the entire
family contributes to and supports and paves the way for how other siblings may “graduate”. While a culminating event,
separation occurs incrementally through childhood and accelerates through adolescents. Most problems intensify if not wholly
originate, from difficulties encountered during this stage (and adolescents). Barring childhood trauma from sexual abuse or
catastrophe, this period is prone to trauma as power struggles intensify between the executive subsystem and the young adult.
Tasks:
 due to greater autonomy and independence, parents can no longer require compliance or obedience; power must be
renegotiated; threat and shame are less effective, requiring greater mutual agreement the young adult must separate
without becoming cut-off, fleeing or getting themselves ejected
 the young adult must accept emotional responsibility for self and clarify own values & belief system
 the young adult must develop intimate peer relationships with the prospects of pair-bonding and sex
 the young adult must establish self in work/higher education and a path to financial independence
 family members provide support by accommodating to change in roles, functions, and chores
 family members provide flexibility to allow movement in and out of the family
 parents (executive subsystem) must provide continued support without enabling
Problems occur when young adults fail to differentiate themselves from their family of origin and recreate similar, typically
flawed emotional transaction patterns in their own adult social relationships and in their family of formation. While work,
school and adult peer relations can provide an opportunity to reconcile unresolved issues these also provide a venue in which to
reaffirm them. Serious problems occur when families do not let go of their adult children encouraging dependence, defiance or
rebellion.
Stage 2: Developing the Couple Relationship: Vulnerability, Trust and Intimacy
 The task of this stage is to accept new members into the system and form a new family separate and distinct from the couple’s
families of origin.
 Couples may experience difficulties in intimacy and commitment. The development of trust and mutual support is critical
 Negotiation of the sexual component of the relationship system
 Negotiation of Power, boundaries and rules of the marriage; identifying/protecting against threats
 Problems consist of enmeshment (failure to separate from a family of origin) or distancing (failure to stay connected)

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Slide 23
Stage 3: Parenting (Establishing the Executive Subsystem)/Families with Young Children
 Child-rearing and the task of becoming caretakers to the next generation
 Adjusting marital system to make space for child (ren)
 Joining in childrearing, financial, and household tasks
 Realignment of relationships with extended family to include parenting and grand-parenting roles
 Couples must work out a division of labor, a method of making decisions, and must balance work with family obligations and leisure pursuits.
 Problems at this stage involve couple and parenting issues, as well as maintaining appropriate boundaries with both sets of grandparents.
Stage 4: Families with Adolescents: Transition of Power
 In stage four, families must establish qualitatively different boundaries for adolescents than for younger children. Individuation
accelerates and movement in and out of the family increases.
 Problems during this period are typically associated with adolescent exploration, friendships, substance use, sexual activity and school;
peer relations take a primary place as does self-absorption
 Parents may face a mid-life crisis as they begin to regard their own life accomplishments and foresee the promise of an empty
nest or diminishment of the parenting role; refocus on midlife marital and career issues
 Increasing flexibility of family boundaries to include children's independence and grandparent's frailties; joint caring for older generation
Stage 5: Launching Children and Moving On
 The primary task of stage five is to adapt to the numerous exits and entries to the family
 Renegotiation of marital system as a dyad
 Development of adult to adult relationships between grown children and their parents
 Realignment of relationships to include in-laws and grandchildren
 Dealing with disabilities and death of parents (grandparents)
 Problems may arise when families hold on to the last child or parents become depressed at the empty nest or due to loss. Ease of
separation tied to contentment in the marriage/adult life and future plans
 Problems can occur when parents decide to divorce or adult children return home
Stage 6: Families in Later Life
 The primary task of stage six is adjustment to aging and physical frailty, Life review and integration
 Maintaining own and/or couple functioning and interests in face of physiological decline; exploration of new familial and social role options
 Making room in the system for the wisdom and experience of the elderly, supporting the older generation without over-functioning for them
 Dealing with loss of spouse, siblings, and other peers and preparation for own death
 Problems consist of difficulties with retirement, financial insecurity, declining health, dependence on others, loss of a spouse and others

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Slide 25
Use of the Genogram
1. Places the Individual in a Family Context
2. Tracks Familial Trends and Characteristics
3. Makes the Client a Co-therapist
How to Use
 Intergenerational Issues and Trends; display Information; for at least three generations show:
o the client's name, age, gender , occupation, spouse/partner, children, parents and siblings
o the wider family such as grandparents, uncles, aunties, and their pairings and children (include names, birth dates, a
occupation , highest level of education, dates of marriage, divorce, death, etc)
o how persons are related and the relationship between family members (adoptions, marriages, sources of str
alliances/collusions, etc)
o Clinical and health issues such as child/partner abuse, drug and alcohol dependency, anxiety, depression, heart conditic
diabetes, etc.
o ethnic and cultural history of the family
o socioeconomic status of the family
o major nodal events and recent trigger issues, such as pregnancies, illnesses, relocations, or separations
 Tracking and Interpreting
o post the client's symptoms/concerns and trace similar patterns across member relationships
o look at roles and rules that may have bearing on the presenting problem (s); post myths, legends and value statements
o look at life-cycle, nodal events and triggers for timing surrounding the presenting problem(s)
o demarcate, by dotted inclusion lines, members who participates/in the presenting problem
o client(s) and therapist (s) share observations and interpretations from the genogram

68
Slide 27
Triangle Theory
5. Triangulation may also result in preferred patterns of interaction that avoid responsibility for change –Alfred Adler
27

69
Slide 28
dyad
anxiety
anxiety is reduced
28

70
Slide 29
dyad
29

71
Slide 30
dyad
concern or interest
Alliance
increases trust
and intimacy
anxiety is reduced
30

72
Slide 31
Conflict in the dyad goes
unresolved as attention is drawn
away from important issues
AdultAdult
child
# 2. Collusion and Cross-generational Coalitions
# 1. Detouring or “Scapegoating”
(problem avoidance)
 Collusion: Two members ally against a third, such as when a friend serves as a confidant
with one of the partners during couple discord or siblings ally against another. The third
member feels pressured or manipulated or gets isolated, feels ignored, excluded, or rejected
as a result of being brought into the conflict
 Cross-generational Coalition: The third party is a child pulled into an inappropriate role
(cross-generational coalition) such as mediator in the conflict between two parents. This
could include parent-child-parentand parent-child-grandparent triangles.
31
# 1
# 2

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Slide 32
Over time
- d. peratsakis
32

75
Slide 34
Boundaries
Invisible barriers that regulate a) contact between members and b) flow of information in and out of the system.
Boundaries pertain to adaptability, the degree of openness and flexibility to change in relationships.
 Enmeshment: exceedingly porous boundary between members resulting in hypersensitivity to each other’s thoughts and feelings
 Disengagement: exceedingly rigid boundary between members resulting in inadequate support and indifference to each other’s
thoughts and feelings
The “Goldilocks” Principle -problems arise when boundaries are too rigid or too diffuse
 Diffuse, too weak, too open, or “enmeshed”; mapped as “ .........................”
 Rigid, too fortified, too closed, or “disengaged”; mapped as “________________”
 Appropriate boundaries; mapped as “ ___ ___ ___ ___ ___ ___ “
Key: ………………..……….……. ___ ___ ___ ___ ___ ___ ___ ______________________________
Enmeshed Clear Boundaries Disengaged
(inappropriately diffuse boundaries) (normal range) (inappropriately tight boundaries)

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Slide 36
Boundaries are Reciprocal and Complimentary
 Enmeshment in one relationship usually means disengaged from someone else
Example: parents disengaged from one another and enmeshed with child
Mapped as: M F
..................
C
Process
1. Mark boundaries between partners, subsystems, or entire groups; examine skewed boundaries
2. Give directives and assign tasks that push individuals with diffuse boundaries closer, enmeshed further
apart. Firm up individual or relational identities and point to disparities or similarities
3. Partner enmeshed persons with others in and members outside the nucleus; partner peripheral or
disengaged persons through teamwork, alliances and collusions
Rule of Thumb: to restructure a boundary create tasks that push it to the opposite extreme
For example:
M F ta s k M F
K i ds p u s h t o o p p o s i t e K i ds

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Slide 37
Sample Mapping Directives for Nudging Boundaries
Problem Boundary Pattern: Dad is very peripheral; Mom is over-enmeshed with Daughter and Son
M F
……… ______
Kids (D & S)
M F
………………
D S
“The Girls versus the Boys”
- Relatively “safe”; keeps Mom attached
M F
______ .............
Kids (D & S)
“Mom’s is on vacation from doing laundry” “ Us” versus “Them”
Riskier task; removes Mom M F - Riskiest; mirrors the Marital
_________________
Kids
37
# 1
# 2
# 3

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Slide 39
39
1. Join Executive Subsystem as Coach; Assume Leadership
 Important to join with angry and powerful family members; determine the source of power and who can mobilize the family to
action (and to bring them back to session)
 Examine the interactions around the Presenting Problem: “who does what?” Note the history and pattern of the Presenting problem
(PP); this will define the sequence of interactions that uphold the symptom and give it purpose to the individual and to the family.
Immediately challenge assumptions; broaden narrow problems/narrow broad problems
 Need to build an alliance with all, especially the Identified Patient, accommodate to family’s temperature, style and current
hierarchy. Accept current world-view, question workability and suggest alternatives to modify world-view
 Need to foster intimacy through use of self, own history, family bragging, praise, celebrations, rituals and story-telling
 Continually monitor impact of tasks and directives for possible collusion against therapy or the therapist
 Continually reaffirm family’s power; take one-down and reframe progress as family’s love/commitment to each other
 Continually expresses appreciation for sharing their pain, secrets and shame
2. Force Enactment
 Examine family’s view of the problem; track the sequences of behaviors; ie. “...and then what happens? Who does what next?’
 Re-create the presenting problem in session; role-play a typical scenario or the most recent argument or frustration
 Examine how it works and how it fails
 Explore new possibilities and direct new transactions
 Practice new behavior patterns and new forms of expression (behavior rehearsal is critical to solidify new ways
Methods
o Use of reframing to illuminate family structure
o Use of circular perspectives, e.g. helping each other change
o Boundary setting
o Unbalancing (briefly taking sides)
o Challenging unproductive assumptions
o Use of intensity to bring about change
o Shaping competencies
o Not rescuing: refusing to answer questions or to step in and take charge when it’s important for the family members to do so

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Slide 40
3. Build Up the Executive Subsystem, Address Power Inequities and Realign the Power
 Get Adults to Accept Responsibility and Authority, Problem Solve and Remedy Power Inequities
o Partners must be equal; may need to address how each expresses power or controls the outcome of decisions. Must develop a
boundary that separates parent(s)/couple (executive subsystem) from children, in-laws and outsiders.
o Must clarify Roles, Rules and Responsibilities: Who has the power to do what with whom? Authority and responsibility must
match; tasks must be hierarchy and age appropriate. Disengage power-plays, alliances, collusions and triangles that interfere with
functions.
o Must Balance Boundaries: Boundaries must be strengthened in enmeshed relationships, and weakened (or opened up) in
disengaged ones. Address trust, loyalty and betrayal issues; look to affection, tenderness and mutual support. Bridge disengaged
members and cut-offs and create breathing room and independence for enmeshed members.
 Get Parents to Parent
o The therapist must assume that the parents are capable of effectively parenting unless they are abdicating their authority;
accordingly, the role of the therapist is to reconcile the existing family-of-origin concerns; work through trauma, hurt, betrayal
and trust issues; and remedy personal and interpersonal barriers to effective governance and growth
o Makes kids age appropriate; throw them out of spousal alliances; match authority, responsibilities and benefits by age; promote
(or demote) older teens and young adults with “parental” responsibilities
o Resolving differences in temperature and parenting styles; developing team-work as core to problem-solving and decision-making
o Agreeing on family goals and aspirations
 Get Family to Address Individuation Issues with Teens and Young Adults. New power alignments and readiness to launch
 Get Family to Examine and Confront Ghosts (family myths, cut-offs, or other legacy issues) that interfere or are used as road-
blocks to effective problem-solving or growth.
4. Assign Homework for Practice
o Should be practice of newly explored changes in sequence, roles or responsibilities
o Should be crafted to increase contact between disengaged parties and to reinforce boundaries that have grown enmeshed
o Should be something that is not too ambitious, “dooming” the members to success
o Caution family members to expect setbacks in order to prepare them for a realistic future

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Slide 42
Simple Genogram of a Blended Family
Presenting Problem: Don took Ben (17 yo) on a drinking spree; when stopped, police found two open
bottles and a bag of pot in the car. Step-dad wants Don to leave the house; mom (Katal) claims that Don is
depressed and upset about the anniversary of his father’s death
Assignment:
1. What Questions jump out at you? Form some initial hypothesis that should be tested.
2. Who should participate in session and why?
3. List some of the more significant issues that may be concerns
Reminder:
1. Always track who participates in the problem and how
2. Look for themes and patterns, such as roles, boundaries and conflicts
3. Examine cut-offs
Drug Use;
Depression;
Attempted
suicide;
multiple
hospitalizations
Alcoholism;
Depression;
Suicide
22 yo
Drug Use
Bad Temper
Recent crime: petty
theft; assault
D.= Overdose
Alcoholism
Domestic Violence
Local Pastor; got
custody of
children while
mom is in rehab
16 yo; straight
“A” student;
model child

84
Slide 43
“There is no coming to consciousness without pain”
- C. Jung

85
Couple and Family Therapy
Demetrios Peratsakis, LPC; December 2015
Family Systems Therapy
“Seeing” is the insight that occurs when the therapist transcends their singular perspective and views
the individual and the family as inseparable, interdependent systems occurring within the same space and time… --dperatsakis
Note: How to Develop Super-Vision
1. Look from a System’s Perspective
2. Look at the Purpose of the Problem Behavior (how is it empowered;how is it connected to the tasks of life)
3. Look at how and where the system resonates for the clinician

86
 Power (Hierarchy; Decision Making)
 Boundaries (closeness/distance; independence) and Intimacy (trust)
 Conflict (Cooperation, Problem-resolution)
 Coalitions (ie Triangle)
 Roles
 Rules
 Complementarities and Differences
 Similarities
 Myths
 Patterns of Communication
 Effective Parenting
 Warmth (Nurturing, Boundaries)
 Control
1. Inflexible response to maturational (developmental) and environmental
challenges leads to conflict avoidance through enmeshment or disengagement
(Goldilocks Rule on Emotional Distance: Too Much vs Too Little)
2. Disengagement and Enmeshment tend to be compensatory (“I’m close here to
make up for being distant elsewhere”)
3. Patterns of Disengagement or Enmeshment lead to Cross-generational
Coalitions (triangulation/triangularstructures)

87
1. Families are comprised of individuals in trust relationships acting alone and in concert to accomplish
and obtain their individual and collective purposes and needs.
• Basic Needs
1) Bio-physiological and Safety needs - food, drink, shelter/warmth and protection from the elements, safety and
security/freedom from fears;
2) Love and belongingness needs - friendship, intimacy, affection and love, sex; and
3) Esteem needs and Self-Actualization needs - achievement, mastery, independence, status, dominance, prestige, self-respect,
respect from others; realizing personal potential, self-fulfillment, seeking personal growth and peak experiences
• Life Tasks include those larger processes that the family, as a group, must accomplish (Life-cycle Tasks) and that each
individual must master (Developmental Tasks) and reconcile (Adler Life Tasks/Existential Anxiety)
2. Families have organized operational structures that include sub-systems, roles and interactional
patterns that aide the group and its individuals in achieving these outcomes and define the manner in
which interaction occurs around tasks functions and responsibilities.
These are partly universal (cultural) and partly idiosyncratic (intergenerational): information (rules and myths) on how to
accomplish tasks and assume responsibility; how gender, roles, and functions are defined; how power and emotion is expressed;
how loyalty, intimacy and trust are conveyed; and so on.
Core Structural-Strategic Family Therapy Tenets
Demetrios N Peratsakis, LPC 5
3. Elements of the Family Organization include:
• Power: the ability to influence the outcome of events
• Hierarchy: established levels of authority and responsibility (executive subsystem at the top)
• Roles: established assignments for performing specific functions and tasks
• Subsystems: subgroupings within the family based on age (or generation), gender and interest (or function); ie.
parenting, spousal; sibling
• Boundaries: invisible barriers that regulate contact between members and regulate the flow of information in and out of
the system. Structural therapists use a “Goldilocks” approach to seeking moderation.
 Diffuse, too weak, too open, or “enmeshed”; mapped as
 Rigid, too fortified, too closed, or “disengaged”; mapped as
 Appropriate boundaries retain a healthy balance; mapped as
◦ boundaries are reciprocal
 That means that a weak boundary (enmeshment) in one relationship usually means that the same person is
disengaged from someone else.
 Example is wife who is enmeshed with child and disengaged from husband. Mapped as M F
C
 Example is father who is very close and enmeshed with older son who hunts with him, and disengaged
with daughter who is quietly depressed and cutting herself. Mapped as F
S D
4. The executive sub-system (no matter the configuration) is the recognized authority responsible for the decision-
making and problem-solving capability of the family. It’s core responsibility is to effectively manage stress and
negotiate conflict as individual members and the group adapts to change.

88
Problem Origination/Symptom Development
5. Problems occur when the executive subsystem is ineffective at fulfilling its function, typically due to
1. a power-play between its members;
2. dysfunction within one of its members; or
3. incapacity due to trauma, disaster or catastrophe
6. This typically occurs at the confluence of vertical and horizontal stressors
• Vertical stressors are emotional norms and rules transmitted across generations. Examples are family secrets, attitudes,
taboos, labels, legacies, myths, loaded issues.
• Horizontal stressorsrefer to predictable (developmental crises) and unpredictable current events (life threatening illness,
divorce, etc).
7. Under duress the family intensifies its excessive rigidity around a key interactional pattern, rule or
role (structures) thereby developing a recurring or nodal problem (Symptom)
In essence, the family becomes insufficiently flexible to adapt to change, mend trauma or respond to maturational (or
developmental) and environmental challenges intensifying its stress and conflict.
8. The family adapts measures in response to the intense or prolonged conflict that exacerbate the
problem:
a. conflict avoidance through disengagement or enmeshment
1. Disengagement and enmeshment tend to be compensatory (I’m close here to make up for my distance elsewhere.)
2. This leads to what is called the cross-generational coalition, which is a triangular structure
b. power-struggles, marked by improper alignments, such as collusions, coalitions, alliances and triangulations
c. emotional cut-offs, disavowing contact with key members or supports
d. failure or dysfunction in one or more of its members
9. Therapeutic Goals: Intervention to transform the structure (restructuring)
• Join family: assume position of leadership
o Important to join with angry and powerful family members
o Important to build an alliance with every family member
o Important to respect hierarchy
 Help the Couple or Executive Subsystem form a healthy (Spousal/Parental) Subsystem:
1. Must develop complementary patterns of mutual support, or accommodation (compromise)
2. Must develop a boundary that separates couple from children, parents, in-laws and outsiders. May need to
reconcile family-of-origin issues and concerns.
3. Must claim authority in a hierarchical structure. Partners must be equal and may need to address how each
expresses power or controls the outcome of decisions.
4. Must learn to problem-solve in order to effectively navigate conflict
5. Must reconcile Life-cycle Task processes:
 Readiness to move from Couple to Family
 Decision about Parenthood
 Contending with pregnancy or birth-related concerns, such as difficulty conceiving or pregnancy complications
 Integrating the child while negotiating space with in-laws, etc.
 Child-care arrangements , separations and concerns
 Child-rearing –resolving differences and adopting parenting styles that are balanced and complimentary
 Agreeing on family goals and aspirations
 Reconcile Power: hierarchy and age appropriateness; responsibility matched with authority; disengage power-plays,
alliances, collusions and triangles
 Balance Boundaries: Boundaries must be balanced; strengthened in enmeshed relationships and weakened (or
opened up) in disengaged ones. Clarify Roles and Rules: Who is to do what and when and how? Matching
authority match responsibility.
 Help Family Comfort and Care: Members support one another’s growth and encourage affection, tenderness and
mutual support.

89
10. Structural (Strategic) Therapeutic Interventions
1. Working with Interaction by inquiring into the family’s view of the problem, and tracking the
sequences of behaviors that they use to explain it.
2. Mapping underlying structure in ways that capture the interrelationship of members -- A structural map
is essential!)
1. Family structure is manifest only with members interact
2. By asking everyone for a description of the problem, the therapist increases the chances for
observing and restructuring family dynamics.
3. Highlighting and modifying interactions
1. Spontaneous behavior sequences (interrupt, re-play, highlight/embellish)
2. Enactments (directives and tasks) -- directed by therapist
4. Restructuring
1. Use of reframing to illuminate family structure
2. Use of circular perspectives, e.g. helping each other change
3. Boundary setting
4. Unbalancing (briefly taking sides)
5. Challenging unproductive assumptions
6. Use of intensity to bring about change
7. Shaping competency
8. Not doing the family’s work for them (refusing to answer questions, or to step in and take charge
when it’s important for the family members to do so.
5. Homework
1. Should be to increase contact between disengaged parties
2. To reinforce boundaries between individuals and subsystems that have been enmeshed
3. Should be something that is not too ambitious
4. Caution family members to expect setbacks in order to prepare them for a realistic future.
Simple Genogram of a Blended Family
Presenting Problem: Don took Ben (17 yo) on a drinking spree; when stopped, police found two open
bottles and a bag of pot in the car. Step-dad wants Don to leave the house; mom (Katal) claims that Don is
depressed and upset about the anniversary of his father’s death
Assignment:
1. What Questions jump out at you? Form some initial hypothesis that should be tested.
2. Who should participate in session and why?
3. List some of the more significant issues that may be concerns
Reminder:
1. Always track who participates in the problem and how
2. Look for themes and patterns, such as roles, boundaries and conflicts
3. Examine cut-offs
Drug Use;
Depression;
Attempted
suicide;
multiple
hospitalizations
Alcoholism;
Depression;
Suicide
22 yo
Drug Use
Bad Temper
Recent crime: petty
theft; assault
D.= Overdose
Alcoholism
Domestic Violence
Local Pastor; got
custody of
children while
mom is in rehab
16 yo; straight
“A” student;
model child

90
1. Use of Boundary Mapping: problems may be the by-products of inappropriate boundaries
(emotionality); manipulate boundaries with tasks that push to its opposite extreme.
Ie.
M F task M F
.….…… ______ ______..............
Kids ‘push’ to opposite Kids
Key: ……………….………_ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _____________________
Enmeshed Clear Boundaries Disengaged
(Inappropriately diffuse boundaries (Normal Range) (Inappropriately tight boundaries)
◦ Mark boundaries between partners, subsystems, or entire groups; examine skewed
boundaries
◦ Give directives and assign tasks that push individuals with diffuse boundaries closer,
enmeshed further apart. Firm up individual or relational identities and point to disparities
or similarities
◦ Partner enmeshed persons with others in and members outside the nucleus; partner
peripheral persons through teamwork, alliances and collusions
Sample Mapping Directives for Nudging Boundaries
Problem Boundary Pattern: Dad is very peripheral; Mom is over-enmeshed with Daughter and Son:
M F Note: “Risk” comparison for three simple options for testing boundaries
……… ______
Kids (D and S) M F
………………
D S
“The Girls versus the Boys” (relatively “safe” task;
keeps mom attached)
1. Join the executive subsystem as a coach or mentor, build an alliance with each member and accommodate to the
family’s temperature and style:
1. Determine the source of power and who can mobilize the family to action
2. Immediately challenge assumptions about the Identified Patient (and Presenting Problem)
3. Examine the Presenting Problem and what interactional pattern supports it; examine the purpose of the symptom to the family
4. Continually check reactions and comfort with tasks, directives and challenges to the symptom or presenting problem
5. Continually reaffirm family’s power: take one-down and re-frame progress as family’s love and commitment to each other
6. Create intimacy through use of self and personal history, family bragging, praise, celebrations and story-telling
7. Continually validate privilege of working with family, their acceptance and their permission to share pain, secrets and shames
2. Build the executive subsystem: work with the couple as parents and address power-plays, old betrayals and trust issues, personal
dysfunctions with relational components, family-of-origin problems, in-law/friend interferences; help members practice expressions of
mutual support and tenderness
3. Get parents to parent
4. Make kids age appropriate: throw kids out of spousal alliances; match authority, responsibilities and benefits by age; promote (or
demote) older teens and young adults with “parental” responsibilities
5. Get parents to address individuation issues with teens and young adults
6. Challenge power inequities:
1. dis-engage and redirect power-plays toward common purpose task or problem
2. Ensure that functions are clarified, roles are assigned and that authority (power) matches responsibility
3. Bridge disengaged members and cut-offs and create breathing room and independence for enmeshed members; interrupt/block
inappropriate communications and direct proper exchanges
7. Address hurt and betrayal and trauma and trust issues as major barriers to effective governance and growth
8. Examine ghosts: confront family myths, cut-offs, or other legacy issues that interfere or serve as road-blocks to effective problem-
solving or growth. Do this verbally, through imagery and through empty-chair techniques.
9. Force enactment: encourage in-session practice of new behavior patterns and new forms of expression; assign related homework,
continually reaffirming that behavior rehearsal is critical to solidify new ways of being.
10. Have fun and get the family to laugh!
Slide 1

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Slide 3
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Slide 4
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Slide 5
3 Patterns of Marital Distress
1. Trauma or crises overwhelms a stable, satisfying relationship: natural recuperative elements, strengths and trust is present
2. Trauma or crises overwhelms a stable, unsatisfying relationship:
 pattern of bickering and fighting; underlying hurt and lack of trust
 mutual caring and trust but lack of passion or “zing”3.
3. Cyclic pattern of stability and instability: excitement and drama and secondary gains
Chief Complaints
1. Trauma or Distress from a major life transition: birth, death, job change/retirement, illness, moving, bankruptcy, “empty nest”
2. Sore Points: affair; sex; money; parenting; in-laws; communication/bickering; lack of intimacy
3. Dysfunction in One Partner (ie. sexual dysfunction; depression/suicidality; phobia; ).
Complex Syndromes
 Infidelity/Extra-marital Relations
 Addiction: Alcoholism, Drug Abuse, Gambling
 Depression/Suicidality, Phobias, Eating Disorders
 Incarceration
 Incest
 Violence and Rape/Sexual Abuse
 While these typically result in marital distress, they are most often symptoms of it; they emerge from power-struggles
 It is important to understand if the behavior results from the relationship or predates it
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Slide 6
a) Partners come to the relationship shaped by their individual Family of Origin (FO) rules, roles, myths, prejudices, etc
b) Partners bring their unresolved issues (ie. trauma) and unfinished business with others into the relationship
c) Partners establish their own roles (reciprocity/complimentarity), and rules around intimacy, tasks, conflict and power
d) Despite how it appears the power between the partners is equally balanced; when it is NOT, violence, betrayal or passive-
aggressive acts such as infidelity, illness or failure are used to add or subtract power from the relationship.
e) Problems result from the couple’s inability to effectively mediate
1. Normative, developmental changes and tasks of the life-cycle (setting boundaries, parenting, “empty next”);
2. Trauma, such as victimization, illness, bankruptcy, or premature loss of a child; and
3. Power struggles that result in breaches to the “marital contract” , such as treachery or betrayal
f) Triangulation, a natural stress reducer, can rigidify into dysfunctional patterns with chronic tension
1. Cross-generational alliances
2. Scapegoating or
3. Problem avoidance
g) The therapist immediately becomes the third “leg” of the couple’s triangle
h) Symptoms typically fall into one of 4 categories of dysfunction (Bowen):
1. Marital discord/marital distress
2. Dysfunction in a partner (ie. depression, infidelity, abuse)
3. Dysfunction in one or more of the children
4. Extreme cut-off, avoidance or separation
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Slide 7
Tasks of the Therapist
1. Disengage and Re-direct the Inherent Power-play
 Obtain commitment to work as a team
 Implement a truce and exchange “acts of good faith”. Push off final decisions about the fate of the relationship
 Turn the dyad’s energies toward a common purpose, goal or problem
2. Implement Effective Teamwork
 Obstacles to effective teamwork
o Power-plays; over-powering and passive-aggressive sabotage to get one’s way or one’s ends met
o Traumatizing; wounding the partner or self-injury; picking the scabs off trauma
o Collusions and Triangles with third-party issues or players (affairs, in-laws, kids, work, etc)
 Supports to effective teamwork
o Conflict-resolution skills: decision-making, problem-solving, planning for outcome
o Forgiveness and Repairing Trust: tenderness, affection, appreciation and respect (Intimacy)
o Experiencing success working as a team (pride, resiliency)
3. Continuously De-triangulate and Re-direct the Couple to Teamwork
 Restrain progress, predict relapses, accentuate what works
 Encourage alliances and collusions by couple against others, even the therapist
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Slide 8
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Slide 9
Triangle Theory
5. Triangulation may also result in preferred patterns of interaction that avoid responsibility for change –Alfred Adler
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Slide 10
dyad
anxiety
anxiety is reduced
10
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Slide 11
dyad
11
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Slide 12
dyad
concern or interest
Alliance
increases trust
and intimacy
anxiety is reduced
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Slide 13
Conflict in the dyad goes
unresolved as attention is drawn
away from important issues
Adult
Adult
# 2. Collusion and Cross-generational Coalitions
# 1. Detouring or “Scapegoating”
(problem avoidance)
 Collusion: Two members ally against a third, such as when a friend serves as a confidant
with one of the partners during couple discord or siblings ally against another. The third
member feels pressured or manipulated or gets isolated, feels ignored, excluded, or rejected
as a result of being brought into the conflict
 Cross-generational Coalition: The third party is a child pulled into an inappropriate role
(cross-generational coalition) such as mediator in the conflict between two parents. This
could include parent-child-parentand parent-child-grandparent triangles.
13
# 1
# 2 child
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Slide 14
Over time
- d. peratsakis
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Slide 15
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Slide 16
 Begin here or here 
1. “Tell me about your relationship and what brings you to see me” (Symptom)
2. “Tell me how it starts, who gets involved, and how it ends” (Sequence that maintains the Presenting Problem)
3. “I usually tell couples that I can help them either to stay together or separate, but that they should put off in a final decision until
we see how things work. Obviously, when there are kids parents have to work extra hard to keep them out of their adult business”
Descriptors & History (information gathering before or during the first session)
1. Partners: Brief description of partners/partnership, including names; ages/DOBs; occupations/work
histories; educational background; race, religion and cultural factors; Family of Origin 3-generation data;
physical appearances; history of relationship, including children, previous “marriages”, separations,
“divorces”, etc. ;illnesses/medical conditions; income/finances; resources, including transportation, home
ownership/rental arrangements; major family cut-offs
2. History: Brief history of relationship including onset and chronology of couple events; family of
origin, extended family and partner’s family; friends and other sources of stress and support; re-locations,
neighborhood/landlord issues
3. Process: Explore what happens with differences, problems and conflicts; inquire as to how the couple
make decisions, who participates and how; explore issues of attraction and mate selection, parenting
styles, individual and couple ways of dealing with anger, grief and so on.
Joining and agreement to work toward separation or repair of the relationship
16
Here and Now
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1. Deficient strategies for adapting to developmental changes (life-cycle transitions; individual life tasks)
2. Nodal events leading (correlating) to the onset of seeking therapy (Why now?)
3. Observable pattern of interaction characteristic of the couple
4. Couple’s attitude and responsiveness to the therapist; assessment of the triad
5. Presenting Problem (PP) as a metaphor; symptom as a response to transition
6. PP History: specific sequence of interactions surrounding the chief complaint; who is involved and how?
7. How is Power shared? How does each partner display it overt? Covertly?
8. History of trauma within the couple’s relationship? For each of the partners?
9. Boundaries between and surrounding the couple? Enmeshments/Disengagements? Pursuer/Distancer?
10. Alliances and Coalitions that are supportive? Collusions and Triangulations that are corrosive?
11. General strengths, abilities and resiliency of each partner and of the couple as a whole?
Words of Caution
The job of the therapist is to challenge the couple into prioritizing a single goal or problem; the therapist must trust that all clinical
issues of relevance, both personal and relational, will surface along the way. In the interim, the couple should
1. Work toward “marriage” or “divorce”; either direction will provide clarify as to interest or intent
2. Postpone a final decision about the relationship until a later time
3. Avoid legal council (exception: protection of self or children)
4. Avoid major, unilateral decisions or actions (new job, relocating, large purchase, separating, sale of house or car)
5. Avoid working individual therapy, unless both are doing so or it is a precursor to couple work for problem delination
6. Avoid triangulating the children
7. Avoid alliances and collusions with in-laws, family and friends
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Slide 18
Power: influence and control within the relationship system
 Conflict is always about power; it occurs around issues of money, work, sex, children, chores, and “in-laws”
 Determines style of communication and how love, caring, anger, and other emotions are expressed and understood
 Determines style of decision-making and problem-solving
 Defines level of trust for meeting or not meeting needs
 Establishes rules for interdependence and independence and for distance and closeness between members (attachment/mutual
accommodation; affection/expressing and experiencing love)
 Defines roles, or positions, -reciprocal, interactive patterns of behavior typically from the Family of Origin (they possess an
intergenerational quality), taken or assigned that the individual is expected to maintain. They are relatively enduring (permanent) and
acquire “moral character” and have “status”, thereby determining placement on the power hierarchy.
Chronic conflict results in a stalemate or power-struggle
 Failed Remedies: previous counseling, mediation, consultation with attorney, legal separations
 Power-less Power: One partner becomes dysfunctional, fails or becomes the Identified Patient (I.P.)
 Equal but Separate: solo activities, hobbies or individual interests; mutual or solo acts of defiance, selfishness, or betrayal
 Combat: fighting, forcing, hurting, beating, withholding, stealing, etc. often involving outside groups (triangulation) such as the police, the
courts or spouse abuse programs/shelters
 Alliances, Coalitions, Collusions and Triangles/Triangulation: patterns of adding power or deflecting anxiety through the inclusion of a
third-party, such as friends, family, children or extra-marital affairs or relationships
 Caution on Violence: fear of being together or separate; extreme swings between fear of abandonment and fear of engulfment  Equated
with loss of identity
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Slide 19
Overview of Basic Assumptions
 Primary job of the therapist is to help the couple experiment with new alternatives
 Behavior oriented; insight not emphasized as a means to behavioral change
 Behavior change outside therapy is essential; in-session practice critical precursor
 Therapist is active and directive, creates the context but minimizes instruction and preaching
 Symptoms are presumed to serve an adaptive function but at the expense of preventing the system from adapting
more successfully to changing circumstances
 New solutions tend to be self-maintaining
1. Join couple: assume position of leadership
 Therapy can assist the couple in remaining together or separating to divorce; the therapist must challenge the couple
into prioritizing a single goal or problem to resolve; issues of relevance, both personal and relational, will surface
 Important to join and build an alliance with each but beware of alienating the one who can get them to return
 Important to respect rules, roles, and power
2. Caution the Couple
 postpone a final decision about the relationship until a later time
 avoid legal council
 avoid major, unilateral decisions or actions (new job, relocating, large purchase, separating, sale of house or car)
 avoid working individual therapy, unless both are doing so
 avoid triangulating the children
 avoid alliances and collusions with in-laws, family and friends
19
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Slide 20
3. Help the Couple or Executive Subsystem form a Healthy (Spousal/Parental) Subsystem:
a) Must develop complementary patterns of mutual support, or accommodation (compromise)
b) Must develop a boundary that separates couple from children, parents, in-laws and outsiders. May need to reconcile
family-of-origin issues and concerns
c) Must claim authority in a hierarchical structure. Partners must be equal and may need to address how each expresses
power or controls the outcome of decisions
d) Must learn to problem-solve in order to effectively navigate conflict
e) Must reconcile Life-cycle Task processes:
 Readiness to move from Couple to Family
 Decision about Parenthood
 Contending with pregnancy or birth-related concerns, such as difficulty conceiving or pregnancy complications
 Integrating the child while negotiating space with in-laws, etc.
 Child-care arrangements, separations and concerns
 Child-rearing –resolving differences and adopting parenting styles that are balanced and complimentary
 Agreeing on family goals and aspirations
4. Reconcile Power: hierarchy and age appropriateness; responsibility matched with authority; disengage power-plays,
alliances, collusions and triangles
5. Balance Boundaries: Boundaries must be balanced; strengthened in enmeshed relationships and weakened (or opened up)
in disengaged ones.
6. Clarify Roles and Rules: Who is to do what and when and how? Matching authority match responsibility.
7. Help Family Comfort and Care: help each other’s growth and encourage affection, tenderness and mutual support.
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Slide 21
Typical Sequence/Phases of Treatment
I. Contracting: joining; presenting problem/chief complaints; agreement on direction of work (marriage vs divorce)
terms of treatment; homework or assignment: 1-3 sessions
II. Subsequent Sessions: 10-15 sessions
a) homework review and review of significant events since preceding session
b) gathering new data; generating new ideas related to overall strategy and goals
c) having couple interact in session with coaching by therapist
d) directing new homework
III. Achievement of Goal
IV. Termination (variable schedule of defined end point)
Typical Problem Scenarios 1) ambivalence about therapy; 2) power struggle with therapist
1. Sets appointment, cancels/no-shows; sets appointment, cancels/no-shows
2. Spouse/Partner sets appointment, partner refuses to attend
3. One sets appointment, then sabotages their partner’s participation
4. Both attend, one sees a problem, one does not
5. Both attend, both agree that one partner is the problem (identified patient/I.P.)
6. Both attend, agenda moves to Individual Counseling (I/C) or child focus (F/C)
7. Both attend, one begins to No-show (leaving therapist with partner/spouse)
8. Both attend, one drops a “bomb” (ie. sexual affair, drug abuse, major illness)
9. Both attend, one discloses their desire to separate or divorce
10. Both attend, one or both unclear on commitment (separate or remaining together)
11. Both attend, one or both continually triangulate the therapist
12. Both attend, the agenda and goal of therapy continually changes or vacillates
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1. Communication Work -Sampler
 Allow each to tell their story; what they see as the pain in the relationship. Let hurt get aired without over-indulging.
 Block interruptions, gate-keep dominating conversations, reframe minuses to pluses or ascribe noble intent to bad habits; no blame or shame
 Redirect conversation toward each partner: “Tell her/him”. Reverse if couple is highly reactive: “I want each of you to tell me”
 “I Messages”: “I feel_______when s/he___________”.
 “What first attracted you to him/her?” “What is it about him/her that makes you proud? What is she/he good at?” Practice “New Talk”
 Bring situations to immediacy and enact them in session: “Don’t tell me, show me what happens; do it now”
 Simple Ordeal: “You both need to get your frustrations out. Let’s vent for 10 minutes on day 1, then 15 on day 2, 20 on day 3…”
 Wills, Letters and Funerals to celebrate death of marriage, remorse over what was, or loss of freedom and independence
2. Disengage power-plays and redirect toward common goal. Stop corrosive acts to devalue partner; rebalance relationship
 Making invisible: To silence or otherwise marginalize persons in opposition by ignoring them.
 Ridicule: In a manipulative way to portray the arguments of, or their opponents themselves, in a ridiculing fashion.
 Withhold information: To exclude a person from the decision making process, or knowingly not forwarding information so as to make the
person less able to make an informed choice.
 Double bind: To punish or otherwise belittle the actions of a person, regardless of how they act.
 Heaping blame/putting to shame: To embarrass someone, or to insinuate that they are themselves to blame for their position.
 Objectifying/Objectification: To discuss the appearance of one or several persons in a situation where it is irrelevant.
 Force/threat of force: To threaten with or use one's physical strength towards one or several persons.
 Pirating proposals: stealing another’s thunder/credit
 Underrating and insults: variation of bullying, deliberate underrating partner's ability to understand or insults them
 Interruptions: monopolize agenda, conversations and debates
 Withdrawing or leaving as punishment
 Betrayal or treachery; sabotaging the contract and relationship: infidelity,
 Sabotage, failing or displays of inadequacy to passive-aggressively control
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Slide 23
3. Truce and Acts of Good Will
4. Genogram Work; Early Recollections; Projective Work: exploring Family of Origin/Origins of attitudes and convictions
5. Role Reversal: amplification/exaggeration of partner attributes
6. Empty Chair Techniques: 1) Third-party Chair (triangle); 2) Chairs of Indecision (stay/go); 3) Alter Ego
7. Sculpting and Family Choreography (sculpting particular scene, battles, etc)
8. Family Council / Festivus Night: airing of grievances, followed by fight, flight or sex
9. King/Queen for a Day: the baton of absolute power
10. Acting As If: honeymoon or divorce; Time Travel to Better Time
11. Structured Separation
12. Paradoxical Interventions: 1) prescribing symptom; exaggerating symptom; 2) restraining change; 3) prescribing indecision
13. Unite Against a Common Foe (work, affair, in-laws, children, symptom)
14. Revenge and Reparation (for betrayals/infidelity): work through punishment to forgiveness and redemption
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Slide 24
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Slide 25
Life-cycle
Life-cycle is the context within which developmental change occurs. Stress develops into symptoms at points of intersection when
family of origin rules (Vertical stressors) are too rigid and insufficiently flexible to adapt smoothly to trauma or normative
developmental change. This is illustrated in the diagram below which denotes the concentric context we are each embedded within
(Systems Levels) and the merging pressure to remain the same (Vertical Stressors) and the imperative to change (Horizontal
stressors):
Carter and McGoldrick identify six family life cycle stages and their respective processes and tasks, somewhat modified herein.
Because the processes are universal, understanding the Stages helps identify and predict inherent in the developmental changes each
family undergoes.
Factorsthatdecreaseadaptabilitytochange
ChangeEvents
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Slide 26
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Slide 27
Stage 1: Launching the Young Adult/Differentiation of Self in Relation to the Family of Origin
Each member is born into a uniquely formed inter-generational social group (family of origin) that defines their identity and
remains an integral part of their life until death. The challenge is for each member to retain the benefits of remaining an integral
part of their birth family while sufficiently separating to form one’s own adult life and new social unit, a process that the entire
family contributes to and supports and paves the way for how other siblings may “graduate”. While a culminating event,
separation occurs incrementally through childhood and accelerates through adolescents. Most problems intensify if not wholly
originate, from difficulties encountered during this stage (and adolescents). Barring childhood trauma from sexual abuse or
catastrophe, this period is prone to trauma as power struggles intensify between the executive subsystem and the young adult.
Tasks:
 due to greater autonomy and independence, parents can no longer require compliance or obedience; power must be
renegotiated; threat and shame are less effective, requiring greater mutual agreement the young adult must separate
without becoming cut-off, fleeing or getting themselves ejected
 the young adult must accept emotional responsibility for self and clarify own values & belief system
 the young adult must develop intimate peer relationships with the prospects of pair-bonding and sex
 the young adult must establish self in work/higher education and a path to financial independence
 family members provide support by accommodating to change in roles, functions, and chores
 family members provide flexibility to allow movement in and out of the family
 parents (executive subsystem) must provide continued support without enabling
Problems occur when young adults fail to differentiate themselves from their family of origin and recreate similar, typically
flawed emotional transaction patterns in their own adult social relationships and in their family of formation. While work,
school and adult peer relations can provide an opportunity to reconcile unresolved issues these also provide a venue in which to
reaffirm them. Serious problems occur when families do not let go of their adult children encouraging dependence, defiance or
rebellion.
Stage 2: Developing the Couple Relationship: Vulnerability, Trust and Intimacy
 The task of this stage is to accept new members into the system and form a new family separate and distinct from the couple’s
families of origin.
 Couples may experience difficulties in intimacy and commitment. The development of trust and mutual support is critical
 Negotiation of the sexual component of the relationship system
 Negotiation of Power, boundaries and rules of the marriage; identifying/protecting against threats
 Problems consist of enmeshment (failure to separate from a family of origin) or distancing (failure to stay connected)
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Slide 28
Stage 3: Parenting (Establishing the Executive Subsystem)/Families with Young Children
 Child-rearing and the task of becoming caretakers to the next generation
 Adjusting marital system to make space for child (ren)
 Joining in childrearing, financial, and household tasks
 Realignment of relationships with extended family to include parenting and grand-parenting roles
 Couples must work out a division of labor, a method of making decisions, and must balance work with family obligations and leisure pursuits.
 Problems at this stage involve couple and parenting issues, as well as maintaining appropriate boundaries with both sets of grandparents.
Stage 4: Families with Adolescents: Transition of Power
 In stage four, families must establish qualitatively different boundaries for adolescents than for younger children. Individuation
accelerates and movement in and out of the family increases.
 Problems during this period are typically associated with adolescent exploration, friendships, substance use, sexual activity and school;
peer relations take a primary place as does self-absorption
 Parents may face a mid-life crisis as they begin to regard their own life accomplishments and foresee the promise of an empty
nest or diminishment of the parenting role; refocus on midlife marital and career issues
 Increasing flexibility of family boundaries to include children's independence and grandparent's frailties; joint caring for older generation
Stage 5: Launching Children and Moving On
 The primary task of stage five is to adapt to the numerous exits and entries to the family
 Renegotiation of marital system as a dyad
 Development of adult to adult relationships between grown children and their parents
 Realignment of relationships to include in-laws and grandchildren
 Dealing with disabilities and death of parents (grandparents)
 Problems may arise when families hold on to the last child or parents become depressed at the empty nest or due to loss. Ease of
separation tied to contentment in the marriage/adult life and future plans
 Problems can occur when parents decide to divorce or adult children return home
Stage 6: Families in Later Life
 The primary task of stage six is adjustment to aging and physical frailty, Life review and integration
 Maintaining own and/or couple functioning and interests in face of physiological decline; exploration of new familial and social role options
 Making room in the system for the wisdom and experience of the elderly, supporting the older generation without over-functioning for them
 Dealing with loss of spouse, siblings, and other peers and preparation for own death
 Problems consist of difficulties with retirement, financial insecurity, declining health, dependence on others, loss of a spouse and others
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Slide 29
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Slide 30
Phase
1. Decision to Divorce
2. Planning the Breakup of the
System
3. Separation
4. The Divorce
Emotional Process
of Transition
Acceptance of inability to resolve “marital”
tensions sufficiently to continue
Supporting viable arrangements for all parts of
the system
a) Willingness to continue cooperative
co-parenting
b) Work on resolution of attachment to spouse
More work on emotional divorce: Overcoming
Hurt, Anger, Guilt, Shame, etc.
Developmental
Issues
Acceptance of one’s own part in the failure
a) Working cooperatively on problems of
custody, visitations, finances, etc;
b) Dealing with extended family about divorce
a) Mourning loss of intact family
b) Restructuring of marital and parent-child
relationships;adaptation to living apart
c) Realignment of relationships with extended
family; staying connected with spouse’s
extended family
a) Mourning loss of intact family; giving up
fantasies of reunion
b) Retrieval of hopes, dreams, expectations
from the marriage
c) Staying connected with extended families
Post-Marriage/Partnership Emotional Processes and Developmental Tasks
Separation and Divorce
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Slide 31
Type
Single Parent Family
Single-Parent Non-Custodial
Emotional Process
of Transition
Willingness to maintain
parental contact with
ex-spouse and support contact
of children with ex-spouse
and his/her family
Willingness to maintain
parental contact with
ex-spouse and support
custodial partner
Developmental
Issues
a) Making flexible visitation
arrangements
b) Rebuilding own social
network
a) Making flexible visitation
arrangements
b) Rebuilding own social
network
Post-Divorce Family
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Slide 32
Steps
1. Entering the New Relationship
2. Conceptualizing and Planning
New Marriage and Family
3. Remarriage and Reconstitution
of Family
Prerequisite Attitude/
Emotional Process
of Transition
Recovering from loss of first/last marriage/adequate
“emotional divorce”
a) Accepting one’s own fears and those of the new
spouse and kids about remarriage/step-familyhood
b) Accepting need for time and patience for adjustment:
1) Multiple new roles
2) Boundaries: space, time, membership and
authority
3) Affective issues: guilt, loyalty conflicts, desire f
or mutuality, past hurts
a) Final resolution of attachment to former
spouse/partner and ideal of “intact family”
b) Acceptance of different model of family with
permeable boundaries
Developmental
Issues
Recommitment to marriage and to forming a family;
readiness to deal with complexity and ambiguity
a) Work on openness to avoid pseudomutuality
b) Plan for maintenance of cooperative co-parental
relationships with ex-spouse(s)
c) Plan to help children deal with fears, loyalty
conflicts, and membership in two or more systems
d) Realignment of relationships with extended family to
include new spouse and kids
e) Plan maintenance of connections for children with
extended family of ex-spouse(s)
a) Restructuring family boundaries to allow for
inclusion of new spouse/step-parent
b) Realignment of relationships throughout subsystems
to permit interweaving of several systems
c) Making room for relationships of all kids with
biological(non-custodial) parents, grand-parents and
extended family
d) Sharing memories and histories to enhance step-
family integration
Remarried Family Formation
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Slide 33
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Demetrios Peratsakis,LPC, ACS
Natalia Boyanirova, LPC
April 05, 2017

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Goals of Contracting
 To establish the role of the therapist
 To establish the rules and format of session
 To establish, by agreement, the work to be done
 To establish the therapeutic alliance
Initial Goal-setting
 Exploring the Presenting Problem (PP) and Identified Patient (IP)
 Why this particular problem or symptom?
 Why now?
 Why this particular symptom bearer or Identified Patient (IP)
 Who else is affected by the problem and how? Who participates in the behavioral loop and how?
 If this/she was NOT the problem what/who would be?
On-going Goal Refinement
 Reduces the “carousel effect”
 Reduces “blind-spots”
Human Nature
 People prefer to remain the same and have others or circumstances change; change is thrust upon us
 Change is fraught with pitfalls and uncertainties, including the need to surrender ideologies and abandon biases
 We desire freedom from pain, so long as it doesn’t take work
 We like to pick and choose the parts of things we like and don’t like
 Therapy can be an admission of failure and inadequacy
The Nature of Therapy
1. Client desires relief from pain but may be fearful and ambivalent about change
2. As the therapist “pushes” for work, one of three things occurs
1. Legitimate confusion over the task or its instructions
2. Agreement/Compliance with the task
3. Defiance over the task (power-struggle)

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1. Not talking
2. Not following advice or suggestions
3. Non-disclosure [Selective disclosure] or not answering questions
4. Taking notes or recording sessions
5. Coming late or leaving sessions early
6. Non-payment/Non-compliance with Required releases and Paperwork
7. Stalking, Threatening, or Intimidating
8. Change seating or other office arrangements
9. Provocative or threatening clothing
10. Provocative or threatening language
11. Use of language
12. Belligerence and Rage
13. Dominating the conversation
14. Inappropriate touching, hugging, etc
15. Inappropriate gifts
16. Inappropriate or offering incentives
17. Acting seductively, coy or unduly vulnerable
1. Shot-gunning/Carpet-bombing: too many Presenting Problems and Identified Patients
2. Fugue over selecting Presenting Problem
3. Sets appointment, cancels/no-shows; sets appointment, cancels/no-shows
4. Spouse/Partner sets appointment, partner refuses to attend
5. One sets appointment, then sabotages their partner’s participation
6. Both attend, one sees a problem, one does not
7. Both attend, both agree that one partner is the problem (identified patient/I.P.)
8. Both attend, agenda moves to Individual Counseling (I/C) or child focus (F/C)
9. Both attend, one begins to No-show (leaving therapist with partner/spouse)
10. Both attend, one drops a “bomb” (ie. sexual affair, drug abuse, major illness)
11. Both attend, one discloses their desire to separate or divorce
12. Both attend, one or both unclear on commitment (separate or remaining together)
13. Both attend, one or both continually triangulate the therapist
14. Both attend, the agenda and goal of therapy continually changes or vacillates
6

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 Do they need to control everybody or simply “slay the therapist”?
 Is the client angry or upset with the therapist?
 Is the client second-guessing the utility or effectiveness of treatment?
 Has the therapist behaved in a manner that is suspect or that has damaged the trust?
 Does the therapist misuse their power and belittle, shame, or induce guilt in the client, especially by
moralizing, lecturing or assuming a haughty or “parental” attitude?
 Is the client frightened?
 Is the client reacting to anger or counter-transference material from the therapist?
 Is the emotional pain associated with unresolved feelings of Loss, Trauma or Chronic Discord?

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ALFRED ADLER & ADLERIAN INDIVIDUAL PSYCHOLOGY
By Gregory Mitchell
Alfred Adler was born in the suburbs of Vienna on February 7, 1870, the third child, second son, of a
Jewish grain merchant and his wife. As a child, Alfred developed rickets, which kept him from walking
until he was four years old. At five, he nearly died of pneumonia. It was at this age that he decided to be a
physician. He began his medical career as an ophthalmologist, but he soon turned to psychiatry, and in
1907 was invited to join Freud's discussion group. After writing several papers which were quite
compatible with Freud's views, he wrote a paper concerning an aggression instinct which Freud did not
approve of, and then a paper on children's feelings of inferiority, which suggested that Freud's sexual
notions be taken more metaphorically than literally.
Although Freud named Adler the president of the Viennese Analytic Society and the co-editor of the
organization's newsletter, Adler didn't stop his criticism. A debate between Adler's supporters and Freud's
was arranged, but it resulted in Adler, with nine other members of the organization, resigning to form the
Society for Free Psychoanalysis in 1911. This organization became The Society for Individual
Psychology in the following year.
During World War I, Adler served as a physician in the Austrian Army, first on the Russian front, and
later in a children's hospital. He saw firsthand the damage that war does, and his work turned increasingly
to the concept of social interest. He felt that if humanity was to survive, it had to change its ways.
Adler's work has been largely absorbed into psychotherapeutic practice and contemporary thought
without retaining a separate identity. Some of his terminology, such as "compensation" and "inferiority
complex," are used in everyday language. Individual Psychology still has its own centers, schools and
work groups, but Adler's influence has permeated other psychologies. His "aggression drive" reappeared
in the Ego psychology of orthodox psychoanalysis; other Adlerian echoes are found in the work of Karen
Horney, Harry Stack Sullivan, Franz Alexander and Ian Suttie. Those who try to see the backward child,
the delinquent, the psychopath or the psychiatric patient as a whole person are sharing Adler's viewpoint.
Adler was the grandfather to Humanistic Psychology. In his later writings Adler made a shift never
managed by Freud but later repeated by Maslow: he wrote less about pathology and more about health,
and the Nietzschean striving for superiority and compensation, mutated into a unifying directional
tendency toward self-mastery and self-overcoming in the service of social interest (Gemeinschaftsgef hle),
the opposite of self-boundedness (Ichgebundenheit). The healthy person neither loses himself in his ideal-
self fictions or lives through others, the two faces worn by neurotic selfishness; the healthy person makes
his deepest goals conscious while integrating them into activities that improve family and community.
Here Adler anticipates Fromm's dictum that self-love and other-love arise together and support one
another.
Alfred Adler's theory is at once a model of personality, a theory of psychopathology, and in many cases
the foundation of a method for mind development and personal growth. Adler wrote, "Every individual
represents a unity of personality and the individual then fashions that unity. The individual is thus both
the picture and the artist. Therefore if one can change one's concept of self, they can change the picture

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being painted." His Individual Psychology is based on a humanistic model of man. Among the basic
concepts are:
1. Holism. The Adlerian views man as a unit, a self-conscious whole that functions as an open
system (see General Systems Theory), not as a collection of drives and instincts.
2. Field Theory. The premise is that an individual can only be studied by his movements, actions
and relationships within his social field. In the context of Mind Development, this is essentially
the examination of tasks of work, and the individual's feelings of belonging to the group.
3. Teleology ("power to will" or the belief that individuals are guided not only by mechanical forces
but that they also move toward certain goals of self-realization). While Adler's name is linked
most often with the term 'inferiority-complex,' towards the end of his career he became more
concerned with observing the individual's struggle for significance or competence (later discussed
by others as self-realization, or self-actualization, etc.). He believed that, standing before the
unknown, each person strives to become more perfect, and in health is motivated by one dynamic
force - the upward striving for completion - and all else is subordinated to this one master motive.
Behavior is understood as goal-directed movement, though the person may not be fully aware of
this motivation.
4. The Creative Self. The concept of the creative self places the responsibility for the individual's
personality into his own hands. The Adlerian practitioner sees the individual as responsible for
himself, he attempts to show the person that he cannot blame others or uncontrollable forces for
his current condition.
5. Life-Style. An individual's striving towards significance and belonging can be observed as a
pattern. This pattern manifests early in life and can be observed as a theme throughout his
lifetime. This permeates all aspects of perception and action. If one understands an individual's
lifestyle, his behavior makes sense.
6. Private intelligence is the reasoning invented by an individual to stimulate and justify a self-
serving style of life. By contrast, common sense represents society's cumulative, consensual
reasoning that recognizes the wisdom of mutual benefit.
The 'Individual Psychologist' works with an individual as an equal to uncover his values and assumptions.
As a person is not aware that he is acting according to misperceptions, it becomes the task of the
practitioner to not only lead the individual to an insightful exposure of his errors, but also to re-orient him
toward a more useful way of living.
The practitioner seeks to establish a climate in which learning can take place. Encouragement and
optimism are his key concerns. Adlerian therapy permits the use of a wide variety of techniques, for
example, Drama Therapy and Art Therapy. Despite the methods used, techniques are used first to help
relieve suffering and second, to promote positive change and empowerment. From the point of view of
Mind Development, the most important constant factor is the stress on social interactions and social
contribution; the more outgoing social interest, the less feelings of inferiority the individual has.
A technique unique to Adlerians that we have preserved in Mind Development is the formulation of the
life-style and the constant use of the information gathered to demonstrate the individual to himself. It is
the particular interpretation of the person's behavior and the teaching of a certain philosophy of life, to
prod the person into action, which is both uniquely Adlerian and at the same time has wide application in
Mind Development. This is a brief introduction to Adlerian principles and desirable life-style.
Man as a Social Being
Man is a social being. Nature is fierce and he is relatively weak and needs the support of communal
living; of course he needs to be interested in the society around him. His capabilities and forms of

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expression are inseparably linked to the existence of others. From the sociological point of view, the
normal man is an individual who lives in society and whose mode of life is so adapted that society derives
a certain benefit from his life-style. From the psychological point of view, he has enough energy and
courage to meet the problems and difficulties of life as they come along.
Social interest is the inevitable compensation for all the natural weaknesses of human beings. Social
interest is a way of life; it is an optimistic feeling of confidence in oneself, and a genuine interest in the
welfare and well-being of others. The human being is clearly a social being, needing a much longer
period of dependence upon others before maturity than any animal. As long as the feeling of inferiority is
not too great, a person will always strive to be worthwhile and on the useful side of life, because this
gives him the feeling of being valuable which originates from contribution to the common welfare.
Adler writes: "Since true happiness is inseparable from the feeling of giving, it is clear that a social person
is much closer to happiness than the isolated person striving for superiority. Individual Psychology has
very clearly pointed out that everyone who is deeply unhappy, the neurotic and the desolate person stem
from among those who were deprived in their younger years of being able to develop the feeling of
community, the courage, the optimism, and the self-confidence that comes directly from the sense of
belonging. This sense of belonging that cannot be denied anyone, against which there are no arguments,
can only be won by being involved, by cooperating, and experiencing, and by being useful to others. Out
of this emerges a lasting, genuine feeling of worthiness." (From "Individual Psychology," 1926).
The child soon learns that his aims and goals in life are not attained without movement, striving and
effort. Thus in order to reach fulfillment, the child adopts a strategy. Inferiority feelings influence the
adoption of misguided and limiting safe solutions as survival strategies. The child's attitude towards the
problems of life is governed by this early 'life script'. The preliminary social problems met in childhood
(friendships, schooling and relationship to the other sex) provide tests of the individual's preparation for
social living, and these may reinforce the life script or cause it to be adjusted in positive or negative
directions.
In recent research, the relationship between life satisfaction, social interest, and participation in
extracurricular activities was assessed among adolescent students. They were asked to list the number of
extracurricular activities that they participated in since their enrollment in high school. Higher social
interest was significantly related to higher levels of overall satisfaction, as well as satisfaction with friends
and family.
The social problems of adulthood are the realities of friendship, comradeship and social contact; those
of one's occupation or profession; and those of love and marriage. It is failure to face and meet them
directly which results in neurosis, and perhaps in mental ill-health (which has been defined in simple
terms as: madness, badness and sadness). It has been well said that the neurotic turns half-away from life,
while the insane person turns his back on it; it may be added that those possessed of sufficient social
courage face it!
Happiness in life depends to a considerable extent on the degree of social interest and ability to cooperate
which the child has developed, with the help and encouragement of his parents and teachers. Successful
men and woman are those who have learned the art of cooperation, and who face life with that attitude -
an attitude born of courage and self-confidence. Such a person faces difficulties head-on, but is not
plunged into despondency and despair by defeat or failure. His life- style is characterized by an easy
approach to life, the absence of over-anxiety and a friendly tolerance towards his fellows. The need to
escape into neurosis is very small.

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There is only one reason for a person to side-step to the useless side: the fear of defeat on the useful side -
his flight from the solution of one of the social problems of life. If the person is unprepared for social
living he will not continue his path to self-actualization on the socially useful side; instead of confronting
his problems he will try to gain distance from them. Those who fail socially in life are not ready to
cooperate; they are too self-centered - they think always of themselves, and they do so because they lack
confidence and courage - in other words, they are afraid of life. Such individuals do not feel able or
prepared to deal with their problems. Because of a sense of inadequacy and inferiority they lead unhappy,
incomplete, frustrated and unsatisfactory lives. Fear, then, is at the root of all such misery in life.
The seeking of distance from problems (through hesitating, halting and detouring) at various stages of
life and in the face of social problems, results in striving directed at exaggerated private goals of personal
superiority, to make up for the felt inferiority. Artists provide a compensatory function for society by
illustrating for us in their fiction how to see, feel and think in the face of the problems of life, and how to
turn from denial to face challenges anew, in order to eventually succeed. The neurotic aims for a goal of
personal superiority, without handling the upsets of his work, his home life and his various personal
relationships. Such neurosis is sustained by misunderstandings acquired by assimilation, particularly
during the first five years, but also through the many ways that misguided ideas can be identified with
throughout one's development. The fixity of such ideas may result in a refusal to observe objectively in
the present time - which is the only way to solve life's problems in an open-minded manner and succeed
in a socially beneficial way.
The Adlerian Unconscious
"There appears to be no contrast between the conscious and the unconscious, that both cooperate for a
higher purpose, that our thoughts and feelings become conscious as soon as we are faced with a difficulty,
and unconscious as soon as our personality requires it." (From "Individual Psychology," 1930.)
The unconscious-to-conscious relation is as "photo-to-negative": by just one lie to oneself, the
unconscious can support and realize the ideal or goal determined by consciousness, e.g. "I am the victim
in this situation," "I deserve better," "My violence was well justified." Once such a simple re-draft of the
plain experience has been made, it continues unconsciously to take over one affect and behavior, whether
one is awake or asleep. In dreams, the Adlerian unconscious can sometimes be caught engaged in the very
same problem-solving work as goes on in daily life, yet without the constraints of reality. Thus dreams
become a continuation of daytime speculations and anxieties and a re-organizing of conflicts between
values, ideals and actual experience.
Fictional Finalism
Adler was influenced by the philosopher Hans Vaihinger who proposed that people live by many fictional
ideals that have no relation to reality and therefore cannot be tested and confirmed. For example, that all
men are created equal; women should always bow to the will of their husband; and the end justifies the
means. These fictions may help a person feel powerful and justify the rightness of their selfish choices,
although at the same time cause others harm and injustice and destroy relationships. Adler took this idea
and concluded that people are motivated more by their expectations of the future than they are by the past.
If a person believes that there is heaven for those who are good and hell for those who are bad, it will
probably affect how that person lives. An ideal or absolute is a fiction.
Fictional Finalism proposes that people act as much from accepted ideals as they do from observed
reality. Whatever the subconscious mind accepts as true, it acts as if it is true whether it is or not - it does
not have the benefit of the conscious mind's ability to observe independently and check with real
experience. From the point of the view of the person, such a fiction may be taken as the basis for their
orientation in the world and as one aspect of compensation for felt inferiority.

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The Adlerian Ego
Hans Vaihinger described how every discipline - psychology, sociology, philosophy, law, and even the
sciences - establishes fictions to try to describe the reality. And after a while, we tend to think of these
fictions as having reality to them, so that when we talk about a part of the mind such as Ego, Libido or
Higher Self, we're basically trying to hone in on a region of functioning that in fact doesn't exist as a
separate entity. Adler disagreed with Freud on a number of issues, particularly regarding the division of
the personality into Ego, Id and Superego - he preferred to consider the entire person, as they function.
Freud hypothesized a division of the personality into these so-called segments or dynamic parts, but
Adler said that there is no division, that the personality is a complete unity. Adler believed that you could
not accurately look at the personality as subdivided, that you had to look at it only as a whole, as an
organized whole without contradictions. Even when distinguishing between conscious and unconscious,
Adler felt that there was a kind of fluidity there, because what seems to be unconscious can be raised to
consciousness very rapidly under certain circumstances. Freud indicated that there was a conflict or war
between the parts of the personality, between the Id and the Ego and the Superego. But Adler said that
that is an erroneous assumption. He felt that there is no internal war or conflict, and that the individual
moves only in one direction... Adler believed that the personality was organized around a single "fictional
final goal."
Henry Stein, when interviewed in What is Enlightenment magazine, describes the fictional final goal... "It
is unique to each person and pretty much guides and dictates most of the individual's actions. So you
might say it defines the Ego and sense of self. Adler said that everything within the personality, whether
it's thinking, feeling, memory, fantasy, dreams, posture, gestures, handwriting - every expression of the
personality - is essentially subordinate to this goal, which gets formulated even without words in early
childhood and becomes what Adler called the 'childhood prototype.' The child imagines sometime in the
future when they will grow up, when they will be strong, when they will overcome insecurity or anything
else that bothers them. So if they feel that they are ugly, they will be beautiful. If they feel that they're
stupid, they will be brilliant. If they feel that they're weak, they'll be strong. If they're at the bottom, they'll
be at the top. All of this is conceived without words as a way of living in the insecurity of the present that
may be uncomfortable or unbearable. It would be unbearable to say that these feelings of insecurity or
inferiority are a permanent condition for you. So, what the child does, and eventually what the adult does,
is they imagine that the future will bring a redemption, will bring relief from the inferiority feeling. The
future will bring success, significance, a correction - a reversal of everything that's wrong. It's very
purposeful. This fictional final goal is an embodiment of their vision of the future."
Heinz Ansbacher, in The Individual Psychology of Alfred Adler, talks about the many differences
between Freud and Adler. "Freud's defenses provide protection of the Ego against instinctual demands.
Whereas Adler's safeguards protect the self-esteem from threats by outside demands and problems of
life." It is not against instinctual demands that people must safeguard themselves, it is that their self-
esteem is suffering, because they have a feeling that they cannot meet the demands of life that come from
the outside.
"We see how, for the safeguarding of his picture of the world and for the defense of his vanity, the patient
had erected a wall against the demands of actual community life. In a difficult situation, he felt himself
too weak to arrive at the high goal which he, in his vanity, had set for himself; when he felt too weak to
play a pre-eminent role commensurate with that which should be his according to his picture of the world.
Thus he was able to avoid the shock of imminent problems, and could relegate those problems to the
background." Such a procedure of exclusion naturally appeared to him the lesser of two evils." (Adler in
"The Neurotic's Picture of the World, in "The International Journal of Individual Psychology, v. 1, no 3,
pages 3-13).

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"The neurotic actually is not as convinced of his uselessness or worthlessness as is generally assumed. He
does not feel inferior, but fears being discovered as inferior, not being able to meet the demands of life.
Some of his traits, such as hesitancy, avoidance, withdrawal from difficult tasks, and his fear of losing,
make sense only when understood as safeguards which preserve his self-esteem. What difference would
his defeat make to him had he already given up, or had he already resigned himself to it? Only as long as
he still has his ambition, does security from defeat make sense. Adler himself always emphasized that
neither lack of courage nor ambition alone will mark the neurotic; the neurotic is identified by the
concurrence and the mutual aggravation of these two traits." (Adler in "Principles of Individual
Psychology," an unpublished manuscript in the AAISF/ATP archives.).
I feel both Freud and Adler are correct. Defenses are used both to provide protection of the Ego against
instinctual demands (the Freudian idea is that the Id doesn't want to feel pain, so it motivates the Ego to
use defense mechanisms to defend it from anxiety), and as a safeguard to protect the self-esteem from
threats by outside demands and the many problems of life. Defense mechanisms are ways in which the
Ego deals with conflicts within the psyche. Freud and Adler are each only looking at part of the picture.
Adler believed that feelings of inferiority, mostly subconscious, combined with compensatory defense
mechanisms played the largest role in determining behavior, particularly behavior of the pathological sort.
Adler's theory of individual psychology stressed the need to discover the root cause of feelings of
inferiority, to assist the development of a strong Ego and thereby help the individual eliminate neurotic
defense mechanisms.
Inferiority complex
Adlerian psychology assumes a central personality dynamic reflecting the growth and forward movement
of life. It is a future-oriented striving toward an ideal goal of significance, mastery, success or completion.
Children start their lives smaller, weaker, and less socially and intellectually competent than the adults
around them. They have the desire to grow up, to become a capable adult, and as they gradually acquire
skills and demonstrate their competence, they gain in confidence and self-esteem. This natural striving for
perfection may however be held back if their self-image is degraded by failures in physical, intellectual
and social development or of they suffer from the criticisms of parents, teachers and peers.
If we are moving along, doing well, feeling competent, we can afford to think of others. If we are not, if
life is getting the best of us, then our attentions become increasingly focused on our self; we may develop
an inferiority complex: become shy and timid, insecure, indecisive, cowardly, submissive, compliant,
and so on.
The inferiority complex is a form of neurosis and as such it may become all-consuming. A person with an
inferiority complex tends to lack social interest; instead they are self-interested: focused on themselves
and what they believe to be their deficiencies. They may compensate by working hard to improve in the
skills at which they lack, or they may try to become competent at something else, but otherwise retaining
their sense of inferiority. Since self-esteem is based on competence, those who have not succeeded in
recovering from this neurosis may find it hard to develop any self-esteem at all and are left with the
feeling that other people will always be better than they are.
The fictional goal is, in many ways, a device of the individual to pull himself up by his bootstraps, as it
were. In addition to serving the useful purpose of orienting the individual in the world, it is a
compensatory defense: it creates positive feelings in the present which mitigate the feelings of inferiority.
As a further compensation, we may also develop a superiority complex, which involves covering up our
inferiority by pretending to be superior. If we feel small, one way to feel big is to make everyone else feel

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even smaller! Bullies, big-heads, and petty dictators everywhere are the prime example. More subtle
examples are the people who are given to attention-getting dramatics, the ones who feel powerful when
they commit crimes, and the ones who put others down for their gender, race, ethnic origins, religious
beliefs, sexual orientation, weight, height, etc. Some resort to hiding their feelings of worthlessness in the
delusions of power afforded by alcohol and drugs.
Private intelligence
In the case of a neurotic failure in life, his reasoning may be 'intelligent' within his own frame of
reference, but is nevertheless socially insane. For example, a thief said: "The young man had plenty of
money and I had none; therefore, I took it." Since this criminal does not think himself capable of
acquiring money in the normal manner, in the socially useful way, there is nothing left for him but
robbery. So the criminal approaches his goal through what seems to him to be an 'intelligent' argument;
however his reason is based on private intelligence, which does not include social interest or
responsibility. Reasoning which has general validity is intelligence that is connected with social interest.
Whereas isolated private intelligence may seem 'clever' to the individual concerned but if it conflicts with
social needs it is of little value. Adler says it's a matter of being overwhelmed by the inferiority complex.
Neurotics, psychotics, criminals, alcoholics, vandals, prostitutes, drug addicts, perverts, etc are lacking in
social interest. They approach the problems of occupation, friendships and sex without the confidence that
they can be solved by cooperation. Their interest stops short at their own person - their idea of success in
life is self-centered, and their triumphs have meaning only to themselves.
From The Collected Works of Lydia Sicher: An Adlerian Perspective... "People learn to think in terms of
their own private logic and will say, 'I'm different from others.' Everyone is different because no two
people in the world are alike. But the difference that they mean is a difference that begs justification. "I
am different from the others and, therefore, you cannot expect me to do insignificant jobs.' Or, 'I cannot
finish what I have started because if I finish you might discover that what I did was not marvelous.' Thus,
people create their own formulas with their private intelligence or logic according to which they live.
They expect themselves to be far beyond their present point of development. They expect others to see
them as having already arrived at the endpoint of their own capabilities. They then go through life
begging for excuses because they have not reached this endpoint of evolution, of perfection."
The early childhood feeling of inferiority, for which one aims to compensate, leads to the creation of a
fictional final goal which subjectively seems to promise total relief from the feeling of inferiority, future
security, and success. The depth of the inferiority feeling usually determines the height of the false goal -
a "guiding fiction" - which then becomes the "final cause" of behavior patterns.
As Adler described, "Every psychological activity shows that its direction is governed by a predetermined
goal. However, soon after a child's psychological development starts, all these tentative, individually
recognizable goals, come under the dominance of the fictitious goal, a finale that is regarded as firmly
established. In other words, like a character drawn by a good dramatist, the individual's inner life is
guided by what occurs in the fifth act of the play. This insight into any personality that can be derived
from Individual Psychology leads us to an important concept: If we are to understand the nature of an
individual, then every psychological manifestation should be perceived and understood as only
preparatory for a particular goal. Everyone develops a final goal, either consciously or unconsciously, but
ignorant of its meaning." [The Practice and Theory of Individual Psychology, by Alfred Adler.]
Private intelligence is a form of negative intelligence, a negative intelligence that includes all the
distortions of analytical thinking that may occur, such as justifications, excuses, rationalizations,
generalizations - all ways to be 'right', to provide a safe solution. In each case, there is a failure to observe,

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a refusal to notice. The goal of striving for self-expression has been misdirected to a goal for personal
superiority. They may be correctly coordinated in a frame of reference on the useless side of life, but the
person lacks the courage and the interest that is necessary for the socially useful solution of the problems
of life.
True intelligence is IQ multiplied by the degree of social involvement in life (through sex, family, work,
play, education and all kinds of local, national and international groupings and involvements) which in
turn requires personal stability and social skills, the facets of emotional intelligence. When the
individual's interest is too self-centered, he feels that he is socially impotent or a nobody; he feels
alienated from his fellow man. The person who is socially integrated feels at home in this world, and this
gives him courage and an optimistic view. He does not regard the adversities of life as a personal
injustice; he is not alone.
Lev Vygotsky says, "Every function in ... cultural development appears twice: First, on the social level,
and later on the individual level; first between people (interpsychological), and then inside
(intrapsychological). This applies equally to voluntary attention, to logical memory, and to the formation
of concepts. All the higher functions originate as actual relationships between individuals."
Not all of one's intelligence occurs in one's own head; it needs to be combined with external resources of
knowledge and understanding. This latter, external and distributed type of cognition is
termed Extelligence. Extelligence contrasts with intelligence (the use of knowledge through cognitive
processes within the brain). Further, the combination of Extelligence and Intelligence is fundamental to
the development of consciousness in both evolutionary terms for the species, and also for the individual.
Our Extelligence is growing and maturing all the time, it is the way that society grows, children get taught
and culture evolves. It's what allows humans to think outside the box, develop imagination, overcome
their fears, and evolve both intelligence and consciousness. A person who only has Private Intelligence is
probably not very Extelligent nor an effective member of society, because he has withdrawn from life and
the larger picture. All the Extelligence in the world is useless if you lack the intelligence to use it.
Conclusion
Disguised under a different terminology, Freud in reality accepted many basic Adlerian postulates.
Adlerian Psychology has had a tremendous effect on Freudian ideas as they are used now, because the
neo-Freudians come very close to the neo-Adlerians. The inclusion of social forces on personality by neo-
Freudians seem to come more from Adler than Freud. There was a time in which Adler's views
corresponded with Freud's thinking, but Freud disapproved of the aggression instinct when Adler
introduced it in 1908. Later, in 1923, long after Adler had discarded instinct theory, Freud incorporated
the aggression instinct into psychoanalysis.
Instead of delving into the unconscious, Adler sticks to "surface phenomena;" he finds no contradiction
between these ideas and Freudian theory. However, where Freud may have searched for and identified
certain agents as determining the individual's maladjustment, Adler thought that such factors were not
causal but rather that they influenced the individual's sense of self through the conclusions he draws from
them. Adler's popularity was related to the comparative optimism and comprehensibility of his ideas
compared to those of Freud or Jung. And there was never a "cult of personality" around Adler as there
was around Freud and Jung (and more recently, Perls and Berne). Along with Freud and Jung, Adler was
one of the founding giants in the field of ideas. Adler, Freud, and Jung were the key figures in the
development of psychology as we know it.

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Lecture Notes
Instructor: Jeff Garrett Ph.D.
Text: Counseling Techniques
Chapter 1 - Professionalism in Counseling and Psychotherapy
Author: Rosemary A. Thompson
INTRODUCTION
This course aims at helping students develop the following clinical competencies.
1. Communicate verbally and nonverbally a sincere interest in and caring for others.
2. Explain how differences (e.g., cultural, age, gender, race, ethnicity, sexual orientation, or
socioeconomic status) may influence client perceptions of the counseling process.
3. Communicate an understanding of the client’s world-view as a perceived by the client.
4. Formulate verbal responses that accurately and concisely reflect the content and feeling of clients’
verbal and nonverbal messages.
5. Avoid ridicule, destructive criticism, and passive hostility in interactions with clients.
6. Demonstrate and convey a warm and caring attitude toward clients.
7. Recognize and show acceptance of differences between the counselor’s and clients’ subjective
viewpoints.
8. Always attempt to remain objective toward client opinions, practices, values, and emotional reactions
that differ from those of the counselor.
9. Avoid prejudicial attitudes and stereotypical thinking regarding clients and never impose personal
values on a client.
10. Realize how personal values may influence counselor responses.
11. Communicate hope: express belief in clients’ capacity to solve or resolve problems, manage their
lives, and grow.
12. Validate client concerns. Discuss and facilitate a counseling process and procedures consistent with
the counselor’s guiding theory.
13. Communicate genuine warmth by expressing an attitude of non-possessive caring for the client and
the client’s welfare.
14. Communicate genuine respect for the client’s inherent worth by discriminating among and between
the client as a person and specific client behaviors that may be maladaptive.
15. Communicate genuine respect for the client’s freedom of choice and belief in the client’s capacity for
responsible choice.
16. Communicate genuine empathy by being able to see the client’s world from the client’s perspective,
without over identifying the client.
17. Communicate nonjudgmental openness and receptivity to ideas and behaviors similar to and different
from those valued by the counselor.
18. Communicate hope by expressing belief in the client’s capacity and potential.
19. Create appropriate structure by setting and maintaining the boundaries of the helping relationship.
20. Develop an awareness of power differential in the therapeutic relationship and manage this issue

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therapeutically.
21. Use appropriate attending behavior and nonverbal communication-demonstrate effective use of hands,
feet, posture, voice, laughter, smile, attire, and so forth.
22. Use brief verbal and nonverbal responses that constitute minimal encouragement for the client to
continue.
23. Adapt terminology to the developmental level of the client.
24. Succinctly convey an understanding of the content of the client’s story.
25. Communicate in specific and concrete terms, including use of appropriate open-ended questions.
26. Exhibit congruence and genuineness in verbal and nonverbal communication (i.e., counselor’s
external behavior is consistent with internal affect).
This course aims at helping students develop the following micro skills competencies.
Basic Counseling Skills
a. Use open-ended questions
b. Paraphrase content
c. Summarize content
d. Reflect emotions
e. Reflect non-verbal behaviors
f. Demonstrate adequate empathy
g. Begin interview smoothly
h. Describe confidentiality and other legal issues clearly
i. Explain the nature and objectives of counseling when appropriate
j. Relaxed and comfortable in the session
k. Communicate interest in and acceptance of the client
l. Recognize and deal with positive and/or negative affect in client
m. Use silence effectively in the session
n. Communicate own feelings to client when appropriate
o. Recognize and handle covert client messages
p. Employ appropriate timing and use of a variety of techniques in session
Conceptualization Skills
a. Recognize and clarify client’s inconsistencies
b. Use relevant case data in considering various strategies and their implications
c. Evaluate effects of own counseling techniques
d. Generate theoretically sound hypotheses about the case
e. Demonstrate effective individual counseling techniques.
COUNSELING THEORY, PHILOSOPHY, OR CONCEPTUAL MODEL?
The pervasive question:
Do practicing counselors and therapists clearly understand how they use counseling theories to guide their
therapeutic perspective and their therapeutic techniques?
The pivotal debate:
Should one use a single theoretic model?
Should one integrate two or more theoretical models?
Should one adopt a more eclectic approach?

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What is theory?
A theory is a formally organized collection of facts, definitions, constructs, and testable propositions that
are meaningfully related.
Therapy with Theory?
Grinter (1988) believed that “therapy cannot exist without theory”.
What does a theory provide?
A conceptual map
A fundamental foundation
A framework for understanding psychological problems and counseling intentions
A frame for understanding desired clinical outcomes
Six Functions of Theory That Make Counseling Pragmatic
It helps counselors find unity and relatedness within the diversity of existence.
It compels counselors to examine relationships they would otherwise overlook.
It gives counselors operational guidelines for therapy and professional development.
It helps counselors focus on relevant data.
It helps counselors assists clients in modifying behavior.
It helps counselors evaluate both old and new approaches to counseling.
Four Requirements of an Effective Theoretical Approach
It is clear and understandable (not contradictory)
It is comprehensive and can explain a wide variety of problems.
It is explicit and generates research because of its design.
It is specific in that it relates methods to outcomes.
The ultimate criteria
The ultimate criteria for all counseling theories is how well they provide explanations of what occurs in
counseling.
THE THEORETICAL VOID: VALIDATING RESEARCH AND PRACTICE
Counseling research based on theory has not demonstrated outcome accountability.
The problem (according to Strupp and Bergin, 1969) – The problem of psychotherapy research in its most
general terms should be reformulated as a standard scientific question: ‘What specific therapeutic
interventions produce specific changes in specific patterns under specific conditions?’
Patterson (1986) responded to this dilemma in the profession and outlined the specifics for such a
proposal. As a frame of reference, counselors or therapists would need:
• A taxonomy of client problems or a taxonomy of psychological disorders (a reliable, relevant diagnostic
system).
• A taxonomy of client personalities.
• A taxonomy of therapeutic techniques or interventions.
• A taxonomy of therapists (therapeutic style).

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• A taxonomy of circumstances, conditions, situations, or environments in which therapy is provided.
• A (set of) guiding principles or empirical rules for matching all these variables. (p. 146)
*C. H. Patterson asserted that it is not feasible to identify which forms of psychotherapy produce changes
in specific clients under specific conditions because the statistical design of such a study requires
unachievable complexity
At present, skeptics continue to note that clinical research in counseling and psychotherapy has had little
or no influence on clinical practice.
Outcome studies are important (e.g., evidenced-based treatment) but their limitations should be
acknowledged.
Psychotherapy is an art based on science, and as is true for any art, there can be no simple measures of so
complex an activity.
“Learn your theories as well as you can, but put them aside when you touch the miracle of the living
soul.” (Carl Jung)
LIMITATIONS OF EMBRACING THE CLASSICS
Counselors are trained in the classics.
The Evolution of Therapy
1960s – the decade of Person-Centered Therapy
1970s – the decade of Behavior Therapy
1980s – the decade of Cognitive Therapy
1990s and on – the emphasis was on Eclectic Therapy
Adhering to exclusive models in psychotherapy could limit therapeutic options when working with
clients, especially when options are considered in the context of culture, ethnicity, interpersonal
resources, and systemic support.
Any single theory, including its associated set of techniques, is unlikely to be equally or universally
effective with the wide range of client characteristics or dysfunctions. This is illustrated from a
multicultural perspective i.e., the values, beliefs, family structures, religion, ethnic background and
historical experiences of clients vary greatly.
THEORETICAL INTEGRATIONISM, PLURALISM OR SYSTEMATIC ECLECTICISM
Theoretical Integrationism – integrating theoretical concepts from other theories based on the premise
that when various theories converge therapeutic procedures will be enhanced.
Pluralism – acknowledges the equal value of different models, takes personal preferences into account,
and encourages a careful assessment of what model is best utilized for what person with what problem in
particular circumstances.
Systematic Eclecticism – the perspective that no single theory-bound approach has all the answers to all
the needs that clients bring to counseling. Eclectic practice should resemble a “systematic integration” of

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underlying principles and methods common to a wide range of therapeutic approaches, integrating the
best features from multiple sources.
GOALS OF PSYCHOTHERAPY
Six Categories for the Goals of Psychotherapy
Crisis stabilization – e.g., suicidal intent
Symptom reduction – e.g., depression
Long-term pattern change – e.g., women in successive abusive relationships
Maintenance of change, stabilization, and prevention of relapse – chronic mental illness
Self-exploration – e.g., health clients who want to grow or develop.
Development of coping strategies to handle future problems – e.g., substance abuse.
The General Principle
Theory and technique are molded to the individual personality of each therapist.
Critical Client Variables
Readiness to change.
Strength of social network.
Indexes of severity, chronicity, and complexity.
Strength of therapeutic relationship (client-therapist working alliance)
Number of sessions.
Perseverance, depth of affective experience, specific problem versus pervasive problem, and acute
difficulties versus chronic problems, well-established correlates of potential improvements.
Three Meta-Strategies Guide the Application of Change Strategies
Key-change strategies – Sometimes the available evidence suggests that one strategy offers the quickest,
most efficient avenue to change.
Shifting-change strategy – Therapy begins with the most easily used change strategy. If it is not effective,
the therapist switches to another strategy.
Maximum-impact strategy – With some complex cases, therapists must work simultaneously on several
patterns.
FIVE FORCES INFLUENCING THE COUNSELING PROFESSION
A growing demand for quality
Increasing public awareness of mental health issues.
Increasing demands for quality assurance, accountability, and containment of mental health care costs.
Progressing state-by-state wave of credentialism and licensure laws.
Increasing national emphasis on counselor professionalism – e.g., existing laws, standards of practice, and
codes of ethics.
AT MINIMUM, STANDARDS INCLUDE
Professional disclosure statements
Treatment plans
Clinical notes
Formative evaluation
Documentation of consultation or supervision.
Professional performance evaluation and peer review.

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Psychotherapy for impaired practitioners
Awareness and responsive to ethical and legal foundations of the profession.
Richard Belson
In 1990, I had the good fortune to join a two-year apprenticeship with Richard Belson while he was
Director of the Family Therapy Institute of Long Island. At the time he was on faculty at the Adelphi
University School of Social Work and had recently been at the Family Therapy Institute of Washington,
D.C (1980 to 1990), on the editorial board of the Journal of Strategic and Systemic Therapies (1981 to
1993) and the Department of Psychiatry at NYU Medical Center.
I have yet to experience a more gifted tactician.
The following tid-bits are from those sessions:
 Richard had spent the better part of an entire session trying to persuade a reticent father into
accepting responsibility for a task with his family to no avail. Finally, in near exasperation he
turned to the father and asked: “Would you do me a personal favor? I would appreciate it if you
could help me by….”. The father turned to him and replied “Sure, I’d be happy to!”
 When you reach an impasse, move to paradox

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 The therapist’s own body language cues the client into reacting and perpetuating the symptom
 Sex, is understated; sex is an antidote for depression. The more sex, the more the problem
alleviates.
 Bottoming Out: proclamations on the crux of change/mild hypnotic suggestion
o “The problem is severe, but is bottoming out”
o “It sounds like it’s just about ready to turn a corner”
o “Who else should get credit for this (change)?”
 “What can you do to get that person to be more the way that you want them to be?”
 Rehearsal/”Acting As If”: this is actually a highly effective Adlerian technique that can be
developed into many forms of behavior and thought rehearsal: “Don’t be ‘X’; think of someone
that you admire and be them! Do it as if they would”.
 Prescription to a depressed individual who found it difficult to “get out of bed each day”. Richard
elected to change the meaning of the bed, a form of “spitting in the soup” by Alfred Adler:
o “I want you to pleasure yourself/masturbate (in bed) two times daily, at 3 am and again in
the pm (bed = sexual thoughts);
o “You must also sit in a “depression chair”, 2 times a day for twenty minutes (inoculation
tactic). By requiring that the depression occur on demand, the client acquired control over
it. This form of “prescribing the symptom, is a highly effective strategic ploy.
 Ordeal Therapy; use of absurdity: aka “Gary and the Hat”. Belson instructs a client to select the
most ridiculous hat he can find and to wear it each time he has the recurring thoughts.
 Husband had an affair; couple in session. Richard explained that the husband needed to make
amends and asked them to work out some form of penance, an act of restitution. To wife: “you
need to give it (punishment) all at once, instead of in drips and drabs…”
 Reframing; common to most therapy models:
o Client: “I was binging…”
o Belson: “You were celebrating…”
o Client: “No; when I ate slowly at dinner that felt more like a celebration; I got heartburn,
really badly…”
o Belson: “Then you overdid the celebrating…”
 More Reframers
o “You might be right, perhaps there’s another possibility…”
o “Now if that’s the case, what’s another possibility?”

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o “Suppose your problem was not psychological but was poor vocational planning; what
would you have to do…?”
o “Let’s break that habit and start a new habit…”
o “What are you good at?/What’s your best personal characteristic? -How can we use that
here?”
o “If you had a friend with a similar problem, what would you tell them?”
o “Suppose you and I were co-therapists…”
 With trauma, move to mentioning the worst scenario and how this would be if this is what they
had to live with. Let the client move back from the worse option (worse-case scenario): “You
may NOT be able to get over this, some people can’t!”
 Play out revenge with reparations: “If this person was here, I would have that person get on their
knees in front of you and have them apologize…” With one couple suffering from an affair,
Belson did just that and had the husband prostrate himself at his wife’s knees and beg her
forgiveness. This was very powerful to witness and very cathartic for the couple.
 Clients (and therapist) against the symptom: family directed to plot a plan of attack against the
symptom. In work with children, create a persona for the symptom (ie. encopresis = “Mr. Mess”)
and set up challenge between the family and the symptom. Results:
o Reframe/detox: removes blame and guilt;
o Unites the family
Standard formula from Michael White and the Australian School:
1. Externalize the symptom or problem
2. Create a persona
3. Unite members to do “battle” against it
4. Predict setbacks and counterattacks
 Always predict relapse whenever there has been progress, particularly with couples
 Characterological attributes: instead of “you are depressed”, “they are depressing you”
 Always utilize what already exists!
 Working with a man burdened by his deceased father, he set up a “contest” and instructed the
client to defy his father’s “ghost”:
o “Do the ‘new’ way half of the time and the ‘old’ way the other half. In fact, when you do
it the ‘old’ way, the way your dad would have done it, then you could set up a little score
card, “one for me”, “one for you dad”.
o This is highly effective when the individual does NOT want to have this part of their
parent identified with them.

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 Having them go over the details and re-discuss the story helps detoxify the trauma
 Client: “I’m not going to change….”; Th: “You don’t have to, you already have that in you; what
can I do to help emerge that more?”
 “Tell me how I can persuade you…”
 “It’s not that he was bad, he was limited…”
 “You know, most of us are weak, so if you find yourself strong (doing new behavior) every once
in a while that’s pretty good!”
 Moving Hurt and Pain to Anger:
o More accurate for many
o More active
o More interactive/transactional; hurt is “by”, anger is “at”
 Ordeal with bulimic: purchase goods (groceries), prepare food, and throw it in the garbage (by-
pass the “middle-man”. Usurping sequence in the pattern of symptomatic behavior.
 Ordeal writing Assignment:
o Day 1: write for 1-1 ½ hours all arguments “to be” with him
o Day 2: write for 1-1 ½ hours all arguments “to NOT be” with him
o Day 3: burn the papers
 Flip a Coin: use a coin flip to decide how to behave: “like Dave or like David”. Provides control
over symptom without assuming responsibility for the change
 Both are true:
o “When I meet the right guy, I’ll be able to work on myself”
o “When I work on myself, I will meet the right guy”
 The mind continues to work toward rejecting the “new picture” by moving back to “the old”
 Always define childhood problems in terms of “foolish” behavior
 Prescribe the problem: establish a ritual; ie. “be angry with your husband for 10 minutes”
 Ordeal: “try it again; it may get worse. That won’t last more than ‘X’ amount of times. If that
doesn’t work we may have to increase the frequency”.
 Change criticism to request; ie. “from now on would you…”
 Ordeals and Paradox are viewed are viewed as “hostile”; there must be benevolence attached to
it: with explanation, with apology, with humor, with common knowledge or with expertise.

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 Joining: problem solving with the patient as team-mates. The therapist remains comfortable and
at ease; immerses self with patient: session is a collaboration event; use of first names, eating
together, encouraging laughter, etc.
 Revenge: only primitive solutions can relieve feelings of hurt and betrayal.
The Queens College MFT Founder Series
I’m not sure that anyone actually cares, but I felt compelled to note this for prosperity’s sake.
It’s by way of kudos to CUNY at Queens College, New York, department of Education, for
supporting Drs. Robert Sherman and Norman Fredman in the founding of the graduate and post-
graduate programs in Marriage and Family Therapy. Among Bob and Norm’s many
accomplishments, they sponsored an innovative series of lectures in family systems therapy, from
1980 until 1992, after which Bob retired from the College. These were somewhat rare
opportunities to hear from notable practitioners on their style, theory and technique and then to
observe them working directly with a couple or family. As was customary in academic circles at
the time, each was followed by a more intimate meet-and-greet, often followed with further
discourse on their methods and principles.
 1st
Annual MFT Conference; October 24, 1980: "Family Therapy: An Approach for the
Eighties". Keynote by Robert Sherman, ED.D
o Robert (Bob) Sherman was an Adlerian by training, a fact that colored much of his
work and interest in family systems. Today, many do not realize that Adler was one
of the early founders of what was later to become cognitive behavioral therapy and
family systems therapy. Bob founded the MFT programs at Queens and then went
on to write extensively on Family System theory and Adlerian Family Therapy.
 2thl
Annual MFT Conference; October 1981: "Family Therapy: an Interactional Approach".
Keynote by Maurizio Andolfi
 31d
Annual MFT Conference; October 08, 1982: "Divorce and Remarriage: American Style".
Keynote by Adaia Shumsky, ED.D
 4th
Annual MFT Conference; October 28, 1983: "Keys to Success: Unlocking the Middle Phases of
Therapy". Keynote by Carlos Sluski, MD. Conference Committee Member: D. Peratsakis

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 5th
Annual MFT Conference; October 12, 1984: " Dr. Murray Bowen...Evolution of a System's
Thinker". Keynote by Murray Bowen, MD
o The most elegant of the family therapy models, Bowen gave us triangulation, individuation,
the family projection process, and a simplified system for understanding the roots of
symptom development. His three-generation perspective, while too deterministic for my
taste, is the corner stone of the genogram and much in the field of counseling. Frankly, I
was a bit disappointed when first I met him, a fact perhaps attributable to the circumstances.
I found him to be somewhat aloof and disengaged.
 6th
Annual MFT Conference; November 22, 1985: "Meeting of the Generations: Doorway to
Change". Keynote by James Framo. Of interest, my place of employment, ASPECTS Family
Counseling, served as a sponsoring organization.
 7th
Annual MFT Conference; October 31, 1986: "What is Today's Dogma Was Yesterday's
Invention". Keynote by Bunny Duhl
 8th
Annual MFT Conference; November 11, 1987: "Allies for Change". Keynote by Monica
McGoldrick.
o Monica wrote the book, in fact several, on genograms and intergenerational processes. So,
you can imagine my surprise (and embarrassment) when she elected to join my workshop on
"Family Life Cycle: Dynamic Struggle for Stability and Change". This was a breakout session
during the afternoon portion of the conference. Needless to say, I invited her to join in my
presentation which, good sport that she is, she gladly acceded to do. For a young clinician,
this was the cat’s meow!
 9th
Annual MFT Conference; 1988. Keynote by Carl Whitaker
o I recall that several of us were backstage awaiting the arrival of Carl Whitaker, who was
inexplicably delayed. As the start-time inched closer we started to get a bit anxious as
Whitaker was a very large draw and the crowd was growing. We kept scanning the
audience and registration tables to no avail. Of a sudden, we notice this guy in a plaid
jacket apparently sitting atop the lap a young man in the audience. It was a rather odd and
surreal moment, one of those that are very clear and distinct against the muted background
of a bunch of milling people. That was our first introduction to Carl Whitaker; as it turned
out, the young man was the Identified Patient from the family Whitaker was to meet with.
Whitaker’s style was to work in a co-therapy format. During this particular session, he sat
chatting with the family as then began to slowly slide the side. He leans a bit further and
then places his hand to the floor, all the while speaking with the family, and then, without
interruption, begins to lie down on the floor on his side. Having heard of this tactic, I was
nonetheless mesmerized to see it unfold before me. The entire family continued in its
dialogue, without missing a beat, as if nothing had actually changed. But it had. Through
this simple, albeit unconventional, action, Whitaker had forced cognitive dissonance, doing
so as a precursor to moving in and introducing a suggestion for change. This is akin to the
start sequence conducted by some forms of hypnosis. His choice of disruption was equally
of interest as it mirrored the one-down he was echoing in his narrative; in essence, making
himself more diminutive while placing the family, symbolically, in a position of higher and

149
greater status: “I’m not really sure how best to proceed; maybe you can suggest some ways
that we can change this…”. It was an excellent lesson in the intense immediacy and
deliberate focus of good clinical work. It highlighted the value of upending customary
routine in tandem with introducing or fostering components of change, making for a more
creative and spontaneous style of work.
 10th
Annual MFT Conference; 1989. Keynote by Jay Haley
o While not the flair in technique of his wife, Cloe Madanes, Haley had remarkable insight
into the change process and took an extremely normative view on problem origination. This
was undoubtedly because he did not suffer the myopia we acquire through coursework;
Haley had no formal training in the field prior to his start in psychotherapy.
 11th
Annual MFT Conference; March 8 and 9, 1991: " A Framework for Family Therapy". Two-day
Workshop Training with Salvador Minuchin, MD
o I recall with great expectation this first of several encounters with Minuchin. His small,
slight build underscored the immense power he conveyed when in direct work. He moved
continuously back and forth from a one-down to a coaching position: do this/I’m not
sure/don’t do this, do this/I don’t know how you wish to say it/tell him now…. He directed
task and then refused to budge until it was done. He let the clients work and insisted it be
done through his silence. His reputation is very well deserved.
 12th
Annual MFT Conference; March 06, 1992: "The Changing Family in Crisis: Systemic
Interventions". Keynote by Peggy Papp;

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ADLER'S CONTRIBUTIONS TO CONTEMPORARY PSYCHOLOGY Rudolph
Dreikurs, M.D. Evaluating a man's contribution to a given field is always a hazardous
assignment. The significance of a person's work often becomes clear only with the
passing of time. Has enough time passed to permit an accurate assessment of Alfred
Adler's contribution? A great deal depends on the attitude of the observer and analyst,
for his own orientation is bound to color the results of his inquiry. The measure of a
man's contribution can be based on three aspects of his activities. First, which
influences did he oppose; second, which trends did he reinforce; and third, what were
his original contributions, discoveries providing knowledge which previously did not
exist? I shall discuss these three areas in my attempt to assess Adler's growing
significance, as it may become clearer in the ensuing years. The influences that Alfred

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Adler opposed in the field of psychology were so strong that they almost prevented the
recognition of Adler's genius and his crucial contributions. First, there was Freud's
dominating influence over the psychiatry of his time, psychoanalysis with its incessant
search for the deep unconscious processes, and Freud's fundamentally biological and
asocial postulations. Freud's followers are trying hard to make us forget the
fundamentally anti-social orientation of Sigmund Freud, most clearly expressed in his
book, Civilization and Its Discontent (1930). In contrast, Adler reinforced the old
concept of man as a social being, a view almost lost in the current tendency to regard
man primarily from a biological point of view. The second opposing force which Adler
encountered was even more formidable than that of Freud's psychoanalysis. It was the
traditional causal istic-mechanistic orientation of science which adhered to a scientific
model developed in the ;eventeenth century. Adler was 50 years ahead of his time. Both
the domination of Freudian influence and the scientific orientation of his time deprived
Adler of the recognition which he deserved during his lifetime. A certain pessimism
about the recognition which he and his followers would ever achieve was evident in
Alfred Adler's introduction to my book, The Fundamentals of Adlerian Psychology
(1950). Had both influences--the psychoanalytic and the traditional scientific
orientation--persisted, Adlerians would not have been able to gain the influence they
now enjoy. On the other hand, there were strong trends which Adler, knowingly or not,
followed and supported. The recognition of the social nature of man had been almost
entirely forgotten in American psychiatry; it was Alfred Adler who revived concern for
the social makeup of man, a concept which had been emphasized by Nietzsche and
other European thinkers. Man's freedom to decide for himself was an old religious
axiom rejected by causal istic-mechanistic science. The emerging 15 philosophy of
Existentialism supported Adler's concept of man as it was in turn greatly strengthened
by Adlerian influence. Man was one ag~ip r~cogn~zed_~ a dec~sio -makon&-
Q!gani~and the concept of free will lost its customary disgrace. The scientific
revolution of the twentieth century started with Planck's Quantum Theory; and the
endeavors of the theoretical physicists supplemented, if they did not dispose of many of
the cherished assumptions of classical physics. Just as the importance of subjectivity
became respectable through Russerl's phenomenology, so Kant's recognition of man's
limited ability to perceive reality as it is was presented more simply. and therefore more
effectively in AQ1~L..s c~;;;-~{~an' s inevitably tendentious or biased apperception
w~ich Jimjt§ 0 _preve~ts th~ QQ~ive evaluatign of reality and of observable "facts."
Although the principle most characteristic of Adler's psychology, t co ni ion that all
behavior has a ,urpose, did not originate with him, teleology nevertheless became the
most aharacteristic and significan.t=.Jlspec.t of -the_AdLerian approach_ to the
understanding of human behavior. The Freudians have become known as
"psychoanalysts," the Existential therapists called themselves "Onto-analysts," and
Adlerians will probably come to be known in the future as "Teleo-analysts." Lookin for
the _purpose of man's behjlvio On tead 0 °t ~es is ~till limited to relatively few of us in
the social and behavioral sciences. Interestingly enough, biologists like the Neo-
Vitalists began to recognize the physiological processes as serving a purpose, the
survival of the individual (Benedickt, 1933). The American pragmatists like Pierce,

152
William James, and MacDougall were clearly teleoanalytically oriented, albeit to a
large degree on the strength of biological assumptions. For them the significance of
behavior lay in its consequences. We can observe only the consequences of behavior
and all efforts to find its causes are mere speculation. Consequently, we will find as
many different convictions and assumptions as to the causes of behavior as there are
different schools of thought and different concepts of the nature of man, Although all of
our dealings with people, professional or personal, are based on a definite concept of
man, we have in fact no scientific tools to evaluate the many personality theories extant.
Furthermore, most of us are not even aware of which concept of man we have accepted
for ourselves. It was the advent of experimental psychology, of pseudo-scientific
psychoanalysis, and of biologically-oriented behaviorism that pushed aside the
significant findings of the American pragmatists. It seems that Adlerians have taken up
where the pragmatists left off. Adler's emphasis on man's ability to set his own goals
aroused the scorn of those scientists who insisted that free will is a myth which belongs
to religion and not to science and psychology. They wanted to rely on observable and
objective facts, and their insistence was--and often still is--an obstacle to the 16
recognition of the Adlerian approach as truly scientific. Replacing the so-called "facts"
with a growing emphasis on the observer's subjectivity has now become as respectable
in physics as Adler's insistence on guessing became recognized as a valid form of
scientific investigation in psychology. All evidence of the corrective and therapeutic
results obtained through methods Adler had designed would not have been sufficient to
overcome the low esteem in which he and his followers were held for a long time, were
it not for the current scientific revolution. Another so-called "weakness" of Adler's
psychology is now becoming its greatest asset. Reality was believed to be complex,
nearly incomprehensible. With the re-discovery of the Law of Parsimony, the simpler
the explanation of observable facts, the greater the probability that it is correct, Adlerian
"simplicity," which actually only appears as such in theory, not in practice, has been
given status in the new scientific atmosphere that deals more with probabilities than
with "facts" and "causes." Adler considered the holistic approach as fundamental to his
psychology. For this reason, he named it "Individual Psychology." Usually
misunderstood, the term, the wholeness and indivisibility cannot be divided in different
parts as Freud and the experimental psychologists attempted to do. They studies a
segment of phenomena in the hope of understanding an individual. The holistic
principle was not original with Adler. Gestalt psychologists recognized that the whole is
more than the sum of all its parts and used their approach not for therapy, but for
perception and learning. During Adler's time in Vienna, holistic trends were beginning
to make inroads in medicine. Martius (1899) was the first to recognize the total
constitution of the individual, and Bauer (1935) suggested that the constitution
encompasses not one or even several organs of the patient, but the entire personality. In
this milieu Adler devised his holistic approach to the understanding of a person.
Initially by the scientific community, Individual Psychology was no match for the term
"Holism" which Smuts (1926) promulgated at that time. The holistic concept gained
public acclaim and became fashionable. Many psychologists and sociologists have
failed to understand the proper usage of the term for they are too deeply steeped into the

153
traditional scientific approach of Reductionism to give up the study of partial
phenomena for the search for the whole. Here Adler's unique contribution was evident
in his development of a technique study applicable to the understanding of an
individual. For many years, all that was known to the professional community about
Adler was his concept of the inferiority complex and his "will to power." Both concepts
characterize only one phase of Adler's development and by no means compare in
importance with his discovery of methods of perceiving the entire being within a short
time, perhaps even instantaneously. The perception of the whole person is possible if
one reeognizes the life style adopted by each individual. A unique 17 pattern
characterizes each personality. The holistic approach leads to the perception of a
pattern. The movement of each individual in his pres~nt field of action provides a basis
for an holistic understanding of the individual. In his movements, he expresses his past
experiences, his present attitudes, and his ideas of the future. Ambivalence is
impossible because the individual cannot proceed in more than one direction at one
time. What appears as ambivalence is self-deception or a pretense for escaping the
responsibility for the individual's actions. Using Adler's method, the observer can
surmise his motivations without ever talking to the individual; simply by following the
individual's movements and from these deducting the "private logic" underlying his
movements. The life style is established during the formative years when the child tries
to comprehend life, develop approaches and fictitious goals which seem to provide him
with a place in life. His movements within the family indicate the way he can be
significant and have a place. Adler's methods of understanding the family constellation
is one of his major contributions. In the traditional explanation of the child's personality
through the exploration of his relationship to his mother, without the total family
constellation perspective, the observer only views the child with a "tunnel vision,"
seeing only the major relationship and not his total field of movement. Consequently,
the children exert a greater influence on each other more than do the parents. Seeing the
siblings exert a crucial influence in the personality development of each family member
by deciding among themselves the role each intends to play, the parents only reinforce
the children's decision. More important was Adler's discovery of the significance of
early recollections. The individual recollects those childhood incidents which are
compatible with his concept of himself and life. The early recollections are so reliable
as a projective test (Mosak, 1958) that they can be used to ascertain whether or not the
patient has changed his life style through therapy and if so, in which way. Freud's book,
Psychopathology of EveryLife (1915) written during the time of his close collaboration
with Adler, revealed the strong influence of Adler. Freud accepted Adler's concern for
goals in maintaining some semblance of accepting social goals in his concept of the
"secondary gain" of the neurosis. Yet, in the same book, he discarded early
recollections as having no significance because the "childhood reminiscences" are
"concealing memories" or "screen memories," hiding the really important events which
were repressed. As a consequence, only recently are early recollections more widely
used, although it takes a training in perceiving patterns to make full use of the
information provided by early recollections. Adler revolutionized the technique of
psychotherapy and counseling. The full impact of his innovations will only be felt when

154
a larger segment of our professional community will be 18 acquainted with and trained
in our methods. The best way to spread this information is demonstrating the technique
for students and larger professional groups. One cannot perceive the implication of our
approach by reading or hearing about it; only through observation of actual counseling
or therapeutic sessions does the significance of Adler's genius become visible. In recent
times Adler received credit for having been the first ego psychologist. More significant
was his exclusive dealing with cognitive processes. He found that emotions are not the
driving force as is generally assumed among professionals and laymen alike. They are
created by the individual to fortify his decisions, the direction in which he choses to
move. Consequently, the therapist has to recognize the patient's ideas and concepts, in
order to help him to change them, if they are mistaken. The technique of confrontation
is singular for Adler's approach. We help the patient to see his goals so that he can find
better alternatives. This is only possible when we deal with intentions and convictions;
emotions could be in no way effected by a disclosure. In this sense, psychotherapy
becomes a learning process and the change is equivalent to a conversion. One of the
most controversial aspects of Adler's therapeutic approach is the assumption that the
therapist can decide whether the patient is right or wrong in his assumptions and beliefs.
Indeed, we show him his basic mistakes~ On what ground can we do so? It is true that
values differ from person to person, from community to community, culture to culture.
Who is in a position to say which values are correct and which faulty? Some assume
that each society has the right to determine which behavior pattern is correct and which
is not. Adler provided a yardstick by which mistaken approaches of groups and of
societies can be recognized. He made a contribution to social and behavioral sciences
by the formulation of an "ironclad logic of social living." It is the first formulation of a
universal social law after Marx had attempt~d to formulate one which turned out not to
be universally acceptable. Adler's concept, if understood, applied, and practiced may
provide the yardstick for improvement to the individual as well as to groups and
nations. It is particularly fitting for our present cultural struggle, prompted by the
development of democracy and its concomitant equality for all. The logic of human
relationships_ re uires that they cannot be harmonious and stable unle.ss_each--
individual is cons idered as equal and-r-ecog-nizes -his.-ow.n equa lity with his
fellowmen~ All patterns of behavior and intentions, which either degrade the other
fellow or oneself, are anti-social and bound to create friction rather than harmony and
agreement. We are culture-bound to find a way to treat each other ad equals and to
believe in our own worth as an equal partner, regardless of what each one may be,
regardless of virtues or deficiencies. The basic positive value which Adler emphasized
is social interest (1964). It is a poor translation of the German 19
Gemeinschaftsgefuehl, a feeling of belonging, of being a part (Ansbacher, 1968). As
social creatures, we are born with the capacity and the desire to feel belonging. Adler
recognized that the restrictions of social interest are due to an inferiority feeling, a
mistaken evaluation of oneself as being inadequate. In this way, Adler provided--
probably so far exclusively--a basis for determining what is normal (Shoben, 1957).
The question of normalcy is very much discussed today, but seldom do we hear a
satisfactory explanation of what it is. One either assumes the average to be normal;

155
whatever the majority of people think and do is then considered to be normal. Or, one
considers normalcy as the absence of pathology, which is a viscious circle because how
can one be sure of knowing what is pathological if one does not know what is normal?
The concept of social interest provides a valid answer. Only where a person feels
belonging, is he willing to participate and to contribute, without concern for himself and
his status, genuinely concerned with the welfare of the group to which he belongs. Only
then can he act and behave in a "normal" way. This social interest is not static. If one
feels adequate, one enlarges the degree and extent of one's social interest; it becomes
restricted when one feels deficient and inadequate. This is, then, the basis for our
therapeutic efforts; to help the individual overcome his doubts in himself, to develop a
greater social interest. Adler showed the way toward a solution of our pressing social
problems: the development of social interest in all, not only through counseling and
therapy, but through education; through stimulation of a new way of thinking;
developing the kind of human beings who can establish democracy on the basis of
respect for all; through a fellow feeling with all mankind. The concept of social interest
is truly a "Challenge to Mankind" (Adler, 1964). This was Adler's gift to our era.
References
 Adler, A. Social interest: A challenge to mankind. New York: Capricorn Books,
1964.
 Ansbacher, H. L. The concept of social interest. Journal of Individual Psychology,
1968, 24, 131-149.
 Bauer, J. Constitution and disease. New York: Grune and Stratton, 1935.
 Benedickt, M. Das biomechanische (neo-vitalische) denken in der medizin und in
der biologie. Jena: Gustav Fischer, 1933.
 Dreikurs, R. Fundamentals of Adlerian psychology. Chicago: Alfred Adler Institute,
1950. Freud, S. Civilization and its discontents. London: Hogarth, 1930. Freud, S.
Psychopathology of everyday life (1915). New York: Mentor Books, 1951. 20 Martius,
F. Pathogenese Innerer Krankheiten. Vienna: F. Deuticke, 1899. Mosak, H. H. Early
recollections as a projective technique. Journal of Projective Techniques, 1958, 22, 302-
311. Shoben, E. J., Jr. Toward a concept of normal personality. American Psychologist,
1957. !~. 183-189. Smuts, J. C. Holism and evolution. New York: Macmillian. 1926.

156
Listofcognitivebiases
From Wikipedia, the free encyclopedia
Cognitive biases can be organized into four categories: biases that arise from too much information, not
enough meaning, the need to act quickly, and the limits of memory.[1]
Cognitive biases are tendencies to think in certain ways that can lead to systematic deviations from
a standard of rationality or good judgment, and are often studied in psychology and behavioral
economics.
Although the reality of these biases is confirmed by replicable research, there are often
controversies about how to classify these biases or how to explain them.[2]
Some are effects of
information-processing rules (i.e., mental shortcuts), called heuristics, that the brain uses to
produce decisions or judgments. Such effects are called cognitive biases.[3][4]
Biases have a variety of
forms and appear as cognitive ("cold") bias, such as mental noise,[5]
or motivational ("hot") bias, such
as when beliefs are distorted by wishful thinking. Both effects can be present at the same time.[6][7]
There are also controversies over some of these biases as to whether they count as useless
or irrational, or whether they result in useful attitudes or behavior. For example, when getting to
know others, people tend to ask leading questions which seem biased towards confirming their
assumptions about the person. However, this kind of confirmation bias has also been argued to be
an example of social skill: a way to establish a connection with the other person.[8]
Although this research overwhelmingly involves human subjects, some findings that demonstrate
bias have been found in non-human animals as well. For example, hyperbolic discounting has been
observed in rats, pigeons, and monkeys.[9]

157
Contents
[hide]
 1Decision-making, belief, and behavioral biases
 2Social biases
 3Memory errors and biases
 4Common theoretical causes of some cognitive biases
 5Individual differences in decision making biases
 6Debiasing
 7See also
 8Notes
 9References
Decision-making, belief, and behavioral biases[edit]
Many of these biases affect belief formation, business and economic decisions, and human behavior
in general. They arise as a replicable result to a specific condition. When confronted with a specific
situation, the deviation from what is normally expected can be characterized by:
Name Description
Ambiguity effect
The tendency to avoid options for which missing information makes the
probability seem "unknown".[10]
Anchoring or focalism
The tendency to rely too heavily, or "anchor", on one trait or piece of
information when making decisions (usually the first piece of information
acquired on that subject)[11][12]
Anthropocentric thinking
The tendency to use human analogies as a basis for reasoning about other,
less familiar, biological phenomena.[13]
Anthropomorphism or
personification
The tendency to characterize animals, objects, and abstract concepts as
possessing human-like traits, emotions, and intentions.[14]
Attentional bias The tendency of our perception to be affected by our recurring thoughts.[15]
Automation bias
The tendency to depend excessively on automated systems which can lead
to erroneous automated information overriding correct decisions.[16]

158
Availability heuristic
The tendency to overestimate the likelihood of events with greater
"availability" in memory, which can be influenced by how recent the
memories are or how unusual or emotionally charged they may be.[17]
Availability cascade
A self-reinforcing process in which a collective belief gains more and more
plausibility through its increasing repetition in public discourse (or "repeat
something long enough and it will become true").[18]
Backfire effect
The reaction to disconfirming evidence by strengthening one's previous
beliefs.[19]
cf. Continued influence effect.
Bandwagon effect
The tendency to do (or believe) things because many other people do (or
believe) the same. Related to groupthink and herd behavior.[20]
Base rate fallacy or Base rate
neglect
The tendency to ignore base rate information (generic, general
information) and focus on specific information (information only
pertaining to a certain case).[21]
Belief bias
An effect where someone's evaluation of the logical strength of an
argument is biased by the believability of the conclusion.[22]
Ben Franklin effect
A person who has performed a favor for someone is more likely to do
another favor for that person than they would be if they had received a
favor from that person.
Berkson's paradox
The tendency to misinterpret statistical experiments involving conditional
probabilities.
Bias blind spot
The tendency to see oneself as less biased than other people, or to be able
to identify more cognitive biases in others than in oneself.[23]
Cheerleader effect
The tendency for people to appear more attractive in a group than in
isolation.[24]

159
Choice-supportive bias
The tendency to remember one's choices as better than they actually
were.[25]
Clustering illusion
The tendency to overestimate the importance of small runs, streaks, or
clusters in large samples of random data (that is, seeing phantom
patterns).[12]
Confirmation bias
The tendency to search for, interpret, focus on and remember information
in a way that confirms one's preconceptions.[26]
Congruence bias
The tendency to test hypotheses exclusively through direct testing, instead
of testing possible alternative hypotheses.[12]
Conjunction fallacy
The tendency to assume that specific conditions are more probable than
general ones.[27]
Conservatism (belief revision)
The tendency to revise one's belief insufficiently when presented with new
evidence.[5][28][29]
Continued influence effect
The tendency to believe previously learned misinformation even after it
has been corrected. Misinformation can still influence inferences one
generates after a correction has occurred.[30]
cf. Backfire effect
Contrast effect
The enhancement or reduction of a certain stimulus' perception when
compared with a recently observed, contrasting object.[31]
Courtesy bias
The tendency to give an opinion that is more socially correct than one's
true opinion, so as to avoid offending anyone.[32]
Curse of knowledge
When better-informed people find it extremely difficult to think about
problems from the perspective of lesser-informed people.[33]
Declinism The belief that a society or institution is tending towards decline.
Particularly, it is the predisposition to view the past favourably (rosy

160
retrospection) and future negatively.[34]
Decoy effect
Preferences for either option A or B change in favor of option B when
option C is presented, which is similar to option B but in no way better.
Denomination effect
The tendency to spend more money when it is denominated in small
amounts (e.g., coins) rather than large amounts (e.g., bills).[35]
Disposition effect
The tendency to sell an asset that has accumulated in value and resist
selling an asset that has declined in value.
Distinction bias
The tendency to view two options as more dissimilar when evaluating
them simultaneously than when evaluating them separately.[36]
Dunning–Kruger effect
The tendency for unskilled individuals to overestimate their own ability
and the tendency for experts to underestimate their own ability.[37]
Duration neglect The neglect of the duration of an episode in determining its value
Empathy gap
The tendency to underestimate the influence or strength of feelings, in
either oneself or others.
Endowment effect
The tendency for people to demand much more to give up an object than
they would be willing to pay to acquire it.[38]
Exaggerated expectation
Based on the estimates,[clarification needed]
real-world evidence turns out to be less
extreme than our expectations (conditionally inverse of the conservatism
bias).[unreliable source?][5][39]
Experimenter's or expectation
bias
The tendency for experimenters to believe, certify, and publish data that
agree with their expectations for the outcome of an experiment, and to
disbelieve, discard, or downgrade the corresponding weightings for data
that appear to conflict with those expectations.[40]

161
Focusing effect The tendency to place too much importance on one aspect of an event.[41]
Forer effect or Barnum effect
The observation that individuals will give high accuracy ratings to
descriptions of their personality that supposedly are tailored specifically
for them, but are in fact vague and general enough to apply to a wide range
of people. This effect can provide a partial explanation for the widespread
acceptance of some beliefs and practices, such as astrology, fortune telling,
graphology, and some types of personality tests.
Framing effect
Drawing different conclusions from the same information, depending on
how that information is presented
Frequency illusion
The illusion in which a word, a name, or other thing that has recently come
to one's attention suddenly seems to appear with improbable frequency
shortly afterwards (not to be confused with the recency illusionor selection
bias).[42]
This illusion may explain some examples of the Baader-Meinhof
phenomenon[43]
, when someone repeatedly notices a newly learned word or
phrase shortly after learning it.
Functional fixedness Limits a person to using an object only in the way it is traditionally used.
Gambler's fallacy
The tendency to think that future probabilities are altered by past events,
when in reality they are unchanged. The fallacy arises from an erroneous
conceptualization of the law of large numbers. For example, "I've flipped
heads with this coin five times consecutively, so the chance of tails coming
out on the sixth flip is much greater than heads."
Hard–easy effect
Based on a specific level of task difficulty, the confidence in judgments is
too conservative and not extreme enough[5][44][45][46]
Hindsight bias
Sometimes called the "I-knew-it-all-along" effect, the tendency to see past
events as being predictable[47]
at the time those events happened.
Hostile attribution bias
The "hostile attribution bias" is the tendency to interpret others' behaviors
as having hostile intent, even when the behavior is ambiguous or benign.

162
Hot-hand fallacy
The "hot-hand fallacy" (also known as the "hot hand phenomenon" or "hot
hand") is the fallacious belief that a person who has experienced success
with a random event has a greater chance of further success in additional
attempts.
Hyperbolic discounting
Discounting is the tendency for people to have a stronger preference for
more immediate payoffs relative to later payoffs. Hyperbolic discounting
leads to choices that are inconsistent over time – people make choices
today that their future selves would prefer not to have made, despite using
the same reasoning.[48]
Also known as current moment bias, present-bias,
and related to Dynamic inconsistency.
Identifiable victim effect
The tendency to respond more strongly to a single identified person at risk
than to a large group of people at risk.[49]
IKEA effect
The tendency for people to place a disproportionately high value on objects
that they partially assembled themselves, such as furniture from IKEA,
regardless of the quality of the end result.
Illusion of control
The tendency to overestimate one's degree of influence over other external
events.[50]
Illusion of validity
Belief that our judgments are accurate, especially when available
information is consistent or inter-correlated.[51]
Illusory correlation Inaccurately perceiving a relationship between two unrelated events.[52][53]
Illusory truth effect
A tendency to believe that a statement is true if it is easier to process, or if
it has been stated multiple times, regardless of its actual veracity. These are
specific cases of truthiness.
Impact bias
The tendency to overestimate the length or the intensity of the impact of
future feeling states.[54]

163
Information bias The tendency to seek information even when it cannot affect action.[55]
Insensitivity to sample size The tendency to under-expect variation in small samples.
Irrational escalation
The phenomenon where people justify increased investment in a decision,
based on the cumulative prior investment, despite new evidence suggesting
that the decision was probably wrong. Also known as the sunk cost fallacy.
Law of the instrument
An over-reliance on a familiar tool or methods, ignoring or under-valuing
alternative approaches. "If all you have is a hammer, everything looks like
a nail."
Less-is-better effect
The tendency to prefer a smaller set to a larger set judged separately, but
not jointly.
Look-elsewhere effect
An apparently statistically significant observation may have actually arisen
by chance because of the size of the parameter space to be searched.
Loss aversion
The disutility of giving up an object is greater than the utility associated
with acquiring it.[56]
(see also Sunk cost effects and endowment effect).
Mere exposure effect
The tendency to express undue liking for things merely because of
familiarity with them.[57]
Money illusion
The tendency to concentrate on the nominal value (face value) of money
rather than its value in terms of purchasing power.[58]
Moral credential effect
The tendency of a track record of non-prejudice to increase subsequent
prejudice.
Negativity bias or Negativity
effect
Psychological phenomenon by which humans have a greater recall of
unpleasant memories compared with positive memories.[59][60]
(see also
actor-observer bias, group attribution error, positivity effect, and negativity

164
effect).[61]
Neglect of probability
The tendency to completely disregard probability when making a decision
under uncertainty.[62]
Normalcy bias
The refusal to plan for, or react to, a disaster which has never happened
before.
Not invented here
Aversion to contact with or use of products, research, standards, or
knowledge developed outside a group. Related to IKEA effect.
Observer-expectancy effect
When a researcher expects a given result and therefore unconsciously
manipulates an experiment or misinterprets data in order to find it (see
also subject-expectancy effect).
Omission bias
The tendency to judge harmful actions as worse, or less moral, than
equally harmful omissions (inactions).[63]
Optimism bias
The tendency to be over-optimistic, overestimating favorable and pleasing
outcomes (see also wishful thinking, valence effect, positive outcome
bias).[64][65]
Ostrich effect Ignoring an obvious (negative) situation.
Outcome bias
The tendency to judge a decision by its eventual outcome instead of based
on the quality of the decision at the time it was made.
Overconfidence effect
Excessive confidence in one's own answers to questions. For example, for
certain types of questions, answers that people rate as "99% certain" turn
out to be wrong 40% of the time.[5][66][67][68]
Pareidolia
A vague and random stimulus (often an image or sound) is perceived as
significant, e.g., seeing images of animals or faces in clouds, the man in
the moon, and hearing non-existent hidden messages on records played in

165
reverse.
Pessimism bias
The tendency for some people, especially those suffering from depression,
to overestimate the likelihood of negative things happening to them.
Planning fallacy The tendency to underestimate task-completion times.[54]
Post-purchase rationalization
The tendency to persuade oneself through rational argument that a
purchase was good value.
Pro-innovation bias
The tendency to have an excessive optimism towards an invention or
innovation's usefulness throughout society, while often failing to identify
its limitations and weaknesses.
Projection bias
The tendency to overestimate how much our future selves share one's
current preferences, thoughts and values, thus leading to sub-optimal
choices.[69][70][60]
Pseudocertainty effect
The tendency to make risk-averse choices if the expected outcome is
positive, but make risk-seeking choices to avoid negative outcomes.[71]
Reactance
The urge to do the opposite of what someone wants you to do out of a need
to resist a perceived attempt to constrain your freedom of choice (see
also Reverse psychology).
Reactive devaluation
Devaluing proposals only because they purportedly originated with an
adversary.
Recency illusion
The illusion that a word or language usage is a recent innovation when it is
in fact long-established (see also frequency illusion).
Regressive bias
A certain state of mind wherein high values and high likelihoods are
overestimated while low values and low likelihoods are
underestimated.[5][72][73][unreliable source?]

166
Restraint bias
The tendency to overestimate one's ability to show restraint in the face of
temptation.
Rhyme as reason effect
Rhyming statements are perceived as more truthful. A famous example
being used in the O.J Simpson trial with the defense's use of the phrase "If
the gloves don't fit, then you must acquit."
Risk compensation / Peltzman
effect
The tendency to take greater risks when perceived safety increases.
Selective perception The tendency for expectations to affect perception.
Semmelweis reflex The tendency to reject new evidence that contradicts a paradigm.[29]
Sexual overperception bias /
sexual underperception bias
The tendency to over-/underestimate sexual interest of another person in
oneself.
Social comparison bias
The tendency, when making decisions, to favour potential candidates who
don't compete with one's own particular strengths.[74]
Social desirability bias
The tendency to over-report socially desirable characteristics or behaviours
in oneself and under-report socially undesirable characteristics or
behaviours.[75]
Status quo bias
The tendency to like things to stay relatively the same (see also loss
aversion, endowment effect, and system justification).[76][77]
Stereotyping
Expecting a member of a group to have certain characteristics without
having actual information about that individual.
Subadditivity effect
The tendency to judge probability of the whole to be less than the
probabilities of the parts.[78]

167
Subjective validation
Perception that something is true if a subject's belief demands it to be true.
Also assigns perceived connections between coincidences.
Surrogation
Losing sight of the strategic construct that a measure is intended to
represent, and subsequently acting as though the measure is the construct
of interest.
Survivorship bias
Concentrating on the people or things that "survived" some process and
inadvertently overlooking those that didn't because of their lack of
visibility.
Time-saving bias
Underestimations of the time that could be saved (or lost) when increasing
(or decreasing) from a relatively low speed and overestimations of the time
that could be saved (or lost) when increasing (or decreasing) from a
relatively high speed.
Third-person effect
Belief that mass communicated media messages have a greater effect on
others than on themselves.
Triviality / Parkinson's Law of
The tendency to give disproportionate weight to trivial issues. Also known
as bikeshedding, this bias explains why an organization may avoid
specialized or complex subjects, such as the design of a nuclear reactor,
and instead focus on something easy to grasp or rewarding to the average
participant, such as the design of an adjacent bike shed.[79]
Unit bias
The tendency to want to finish a given unit of a task or an item. Strong
effects on the consumption of food in particular.[80]
Weber–Fechner law Difficulty in comparing small differences in large quantities.
Well travelled road effect
Underestimation of the duration taken to traverse oft-traveled routes and
overestimation of the duration taken to traverse less familiar routes.
"Women are wonderful" effect
A tendency to associate more positive attributes with women than with

168
men.
Zero-risk bias
Preference for reducing a small risk to zero over a greater reduction in a
larger risk.
Zero-sum bias
A bias whereby a situation is incorrectly perceived to be like a zero-sum
game (i.e., one person gains at the expense of another).
Social biases[edit]
Most of these biases are labeled as attributional biases.
Name Description
Actor-observer
bias
The tendency for explanations of other individuals' behaviors to overemphasize the
influence of their personality and underemphasize the influence of their situation (see
also Fundamental attribution error), and for explanations of one's own behaviors to do the
opposite (that is, to overemphasize the influence of our situation and underemphasize the
influence of our own personality).
Authority bias
The tendency to attribute greater accuracy to the opinion of an authority figure (unrelated
to its content) and be more influenced by that opinion.[81]
Defensive
attribution
hypothesis
Attributing more blame to a harm-doer as the outcome becomes more severe or as personal
or situational similarity to the victim increases.
Egocentric bias
Occurs when people claim more responsibility for themselves for the results of a joint
action than an outside observer would credit them with.
Extrinsic
incentives bias
An exception to the fundamental attribution error, when people view others as having
(situational) extrinsic motivations and (dispositional) intrinsic motivations for oneself
False consensus
effect
The tendency for people to overestimate the degree to which others agree with them.[82]

169
Forer effect (aka
Barnum effect)
The tendency to give high accuracy ratings to descriptions of their personality that
supposedly are tailored specifically for them, but are in fact vague and general enough to
apply to a wide range of people. For example, horoscopes.
Fundamental
attribution error
The tendency for people to over-emphasize personality-based explanations for behaviors
observed in others while under-emphasizing the role and power of situational influences on
the same behavior[60]
(see also actor-observer bias, group attribution error, positivity effect,
and negativity effect).[61]
Group attribution
error
The biased belief that the characteristics of an individual group member are reflective of
the group as a whole or the tendency to assume that group decision outcomes reflect the
preferences of group members, even when information is available that clearly suggests
otherwise.
Halo effect
The tendency for a person's positive or negative traits to "spill over" from one personality
area to another in others' perceptions of them (see also physical attractiveness
stereotype).[83]
Illusion of
asymmetric
insight
People perceive their knowledge of their peers to surpass their peers' knowledge of them.[84]
Illusion of
external agency
When people view self-generated preferences as instead being caused by insightful,
effective and benevolent agents
Illusion of
transparency
People overestimate others' ability to know them, and they also overestimate their ability to
know others.
Illusory
superiority
Overestimating one's desirable qualities, and underestimating undesirable qualities, relative
to other people. (Also known as "Lake Wobegon effect", "better-than-average effect", or
"superiority bias".)[85]
Ingroup bias
The tendency for people to give preferential treatment to others they perceive to be
members of their own groups.

170
Just-world
hypothesis
The tendency for people to want to believe that the world is fundamentally just, causing
them to rationalize an otherwise inexplicable injustice as deserved by the victim(s).
Moral luck
The tendency for people to ascribe greater or lesser moral standing based on the outcome
of an event.
Naïve cynicism Expecting more egocentric bias in others than in oneself.
Naïve realism
The belief that we see reality as it really is – objectively and without bias; that the facts are
plain for all to see; that rational people will agree with us; and that those who don't are
either uninformed, lazy, irrational, or biased.
Outgroup
homogeneity
bias
Individuals see members of their own group as being relatively more varied than members
of other groups.[86]
Self-serving bias
The tendency to claim more responsibility for successes than failures. It may also manifest
itself as a tendency for people to evaluate ambiguous information in a way beneficial to
their interests (see also group-serving bias).[87]
Shared
information bias
Known as the tendency for group members to spend more time and energy discussing
information that all members are already familiar with (i.e., shared information), and less
time and energy discussing information that only some members are aware of (i.e.,
unshared information).[88]
Sociability bias
of language
The disproportionally higher representation of words related to social interactions, in
comparison to words related to physical or mental aspects of behavior, in most languages.
This bias attributed to nature of language as a tool facilitating human interactions. When
verbal descriptors of human behavior are used as a source of information, sociability bias
of such descriptors emerges in factor-analytic studies as a factor related to pro-social
behavior (for example, of Extraversion factor in the Big Five personality traits [60]
System
justification
The tendency to defend and bolster the status quo. Existing social, economic, and political
arrangements tend to be preferred, and alternatives disparaged, sometimes even at the
expense of individual and collective self-interest. (See also status quo bias.)

171
Trait ascription
bias
The tendency for people to view themselves as relatively variable in terms of personality,
behavior, and mood while viewing others as much more predictable.
Ultimate
attribution error
Similar to the fundamental attribution error, in this error a person is likely to make an
internal attribution to an entire group instead of the individuals within the group.
Worse-than-
average effect
A tendency to believe ourselves to be worse than others at tasks which are difficult.[89]
Memory errors and biases[edit]
Main article: List of memory biases
In psychology and cognitive science, a memory bias is a cognitive bias that either enhances or
impairs the recall of a memory (either the chances that the memory will be recalled at all, or the
amount of time it takes for it to be recalled, or both), or that alters the content of a reported memory.
There are many types of memory bias, including:
Name Description
Bizarreness effect Bizarre material is better remembered than common material.
Choice-supportive
bias
In a self-justifying manner retroactively ascribing one's choices to be more informed
than they were when they were made.
Change bias
After an investment of effort in producing change, remembering one's past performance
as more difficult than it actually was[90][unreliable source?]
Childhood amnesia The retention of few memories from before the age of four.
Conservatism or
Regressive bias
Tendency to remember high values and high likelihoods/probabilities/frequencies as
lower than they actually were and low ones as higher than they actually were. Based on
the evidence, memories are not extreme enough[72][73]
Consistency bias
Incorrectly remembering one's past attitudes and behaviour as resembling present

172
attitudes and behaviour.[91]
Context effect
That cognition and memory are dependent on context, such that out-of-context
memories are more difficult to retrieve than in-context memories (e.g., recall time and
accuracy for a work-related memory will be lower at home, and vice versa)
Cross-race effect
The tendency for people of one race to have difficulty identifying members of a race
other than their own.
Cryptomnesia
A form of misattribution where a memory is mistaken for imagination, because there is
no subjective experience of it being a memory.[90]
Egocentric bias
Recalling the past in a self-serving manner, e.g., remembering one's exam grades as
being better than they were, or remembering a caught fish as bigger than it really was.
Fading affect bias
A bias in which the emotion associated with unpleasant memories fades more quickly
than the emotion associated with positive events.[92]
False memory A form of misattribution where imagination is mistaken for a memory.
Generation
effect (Self-
generation effect)
That self-generated information is remembered best. For instance, people are better able
to recall memories of statements that they have generated than similar statements
generated by others.
Google effect
The tendency to forget information that can be found readily online by using Internet
search engines.
Hindsight bias
The inclination to see past events as being more predictable than they actually were;
also called the "I-knew-it-all-along" effect.
Humor effect
That humorous items are more easily remembered than non-humorous ones, which
might be explained by the distinctiveness of humor, the increased cognitive processing
time to understand the humor, or the emotional arousal caused by the humor.[93]

173
Illusion of truth
effect
That people are more likely to identify as true statements those they have previously
heard (even if they cannot consciously remember having heard them), regardless of the
actual validity of the statement. In other words, a person is more likely to believe a
familiar statement than an unfamiliar one.
Illusory correlation Inaccurately remembering a relationship between two events.[5][53]
Lag effect
The phenomenon whereby learning is greater when studying is spread out over time, as
opposed to studying the same amount of time in a single session. See also spacing
effect.
Leveling and
sharpening
Memory distortions introduced by the loss of details in a recollection over time, often
concurrent with sharpening or selective recollection of certain details that take on
exaggerated significance in relation to the details or aspects of the experience lost
through leveling. Both biases may be reinforced over time, and by repeated recollection
or re-telling of a memory.[94]
Levels-of-
processing effect
That different methods of encoding information into memory have different levels of
effectiveness.[95]
List-length effect
A smaller percentage of items are remembered in a longer list, but as the length of the
list increases, the absolute number of items remembered increases as well. For example,
consider a list of 30 items ("L30") and a list of 100 items ("L100"). An individual may
remember 15 items from L30, or 50%, whereas the individual may remember 40 items
from L100, or 40%. Although the percent of L30 items remembered (50%) is greater
than the percent of L100 (40%), more L100 items (40) are remembered than L30 items
(15). [96][further explanation needed]
Misinformation
effect
Memory becoming less accurate because of interference from post-event information.[97]
Modality effect
That memory recall is higher for the last items of a list when the list items were received
via speech than when they were received through writing.

174
Mood-congruent memory
bias
The improved recall of information congruent with one's current mood.
Next-in-line effect
That a person in a group has diminished recall for the words of others who spoke
immediately before himself, if they take turns speaking.[98]
Part-list cueing effect
That being shown some items from a list and later retrieving one item causes it
to become harder to retrieve the other items.[99]
Peak-end rule
That people seem to perceive not the sum of an experience but the average of
how it was at its peak (e.g., pleasant or unpleasant) and how it ended.
Persistence The unwanted recurrence of memories of a traumatic event.[citation needed]
Picture superiority effect
The notion that concepts that are learned by viewing pictures are more easily and
frequently recalled than are concepts that are learned by viewing their written
word form counterparts.[100][101][102][103][104][105]
Positivity effect
(Socioemotional selectivity
theory)
That older adults favor positive over negative information in their memories.
Primacy effect, recency
effect & serial position
effect
That items near the end of a sequence are the easiest to recall, followed by the
items at the beginning of a sequence; items in the middle are the least likely to
be remembered.[106]
Processing difficulty effect
That information that takes longer to read and is thought about more (processed
with more difficulty) is more easily remembered.[107]
Reminiscence bump
The recalling of more personal events from adolescence and early adulthood
than personal events from other lifetime periods[108]
Rosy retrospection The remembering of the past as having been better than it really was.

175
Self-relevance effect
That memories relating to the self are better recalled than similar information
relating to others.
Source confusion
Confusing episodic memories with other information, creating distorted
memories.[109]
Spacing effect
That information is better recalled if exposure to it is repeated over a long span
of time rather than a short one.
Spotlight effect
The tendency to overestimate the amount that other people notice your
appearance or behavior.
Stereotypical bias
Memory distorted towards stereotypes (e.g., racial or gender), e.g., "black-
sounding" names being misremembered as names of criminals.[90][unreliable source?]
Suffix effect
Diminishment of the recency effect because a sound item is appended to the list
that the subject is notrequired to recall.[110][111]
Suggestibility
A form of misattribution where ideas suggested by a questioner are mistaken for
memory.
Telescoping effect
The tendency to displace recent events backward in time and remote events
forward in time, so that recent events appear more remote, and remote events,
more recent.
Testing effect
The fact that you more easily remember information you have read by rewriting
it instead of rereading it.[112]
Tip of the
tongue phenomenon
When a subject is able to recall parts of an item, or related information, but is
frustratingly unable to recall the whole item. This is thought to be an instance of
"blocking" where multiple similar memories are being recalled and interfere
with each other.[90]

176
Travis Syndrome
Overestimating the significance of the present.[113]
It is related to the
enlightenment Idea of Progress and chronological snobbery with possibly
an appeal to novelty logical fallacy being part of the bias.
Verbatim effect
That the "gist" of what someone has said is better remembered than the verbatim
wording.[114]
This is because memories are representations, not exact copies.
Von Restorff effect That an item that sticks out is more likely to be remembered than other items[115]
Zeigarnik effect
That uncompleted or interrupted tasks are remembered better than completed
ones.

177
Lessons and Forms from Shaolin Kung Fu
I have always found a parallel between psychotherapy and martial arts.
Each is a form of combat; a means to winning in battle when no other recourse is possible. Each requires
a life-long commitment to practice, of continual improvement of one’s focus, grace, and precision. To
excel, one must develop their Qi, an inner grounding and centeredness essential to the source of one’s
power and resolve.
A few years ago I wrote a manuscript on the lessons of Choom Sim Gum, an extremely old system of
hand and cold weapon combat. The excerpt below is on its core fighting principles and attitude. Like most
martial arts, I find that its tenets offer a striking perspective on therapy and its philosophy and practice.

178
- from Instructions by Si Tai Gung Hayashi (Grandmaster Lim)
Choong Sim Gum, or “Loyalty to the Way of the Sword”, is an archaic form of martial arts originating in
the pre-historic settlements of the areas stretching from Mongolia down through the present day Korean
peninsula. Originated by women, its rudiments are the foundation for Shaolin Kung Fu and the early
Chinese systems of combat which pre-date and are mother to all other fighting styles originating from the
Orient, including Karate, Tae Kwon Do, Hapkido, Aikido, Judo and Jiu-Jitsu. Having evolved from the
use of the sword, Choong Sim Gum it is unrivaled in its ability to focus one’s awareness of battle and the
imminent possibility of death. As such, it is deliberate, fluid and exceedingly brutal.
Core Principles

179
1. Purpose of combat: The only goal and ambition of combat is to win and, thereby, to survive. No
other interest exists, making the mind-set one of singular determination and ruthless finality.
2. Direction of combat: Combat has only one direction, an ever present imperative to press
forward. To retreat is to encourage the opponent to further their attack, thereby increasing the level of
risk and the likelihood of death. One should always attack the attacker; a simple but highly effective
strategy that unbalances the opponent, provides for a better defense, and controls the direction and
flow of combat. Attacking should be ruthless, without mercy and should continue until the opponent
is fully incapacitated or dead.
3. Combat space: The Choong Sim Gum fighting arena is extremely close and should be confined
to a three (3) foot circumference around the body. One must never step outside this area and control
all action within it. Combat is, typically, within 1-6 inches of the opponent.
4. Closing space: Stepping up and into the opponent immediately shortens the fighting distance to
within inches, reducing the effectiveness of their attack while bringing them into range of one’s
elbows and knees, exceedingly powerful weapons in close-distance combat. Similarly, “baiting” or
encouraging the opponent to attack immediately brings them within range, closing the distance of
combat.
5. Pressing the Attack: To advance, one steps into the opponent with the lead leg between or to
the immediate side of their legs, shuffle-stepping the rear foot forward. Derived from the sword form
this manner of stepping up into the opponent’s space (“pushing” or “crowding” the opponent) retains
a powerful stance while commanding the direction of fighting and the distance within which combat
occurs.
6. Striking: Hand, arm and elbow strikes originate from the fingertips and wrists and not from the
shoulder, as in some sports or martial arts. The strike continues toward the target until the entire arm
is fully extended (“reaching”), turning the torso, waist and hips. This maximizing the distance of the
strike while minimizing one’s own vulnerability by positioning the torso sideways or perpendicular to
the opponent. Kicks are, typically, low, to below the below the waist
7. Power striking: Choong Sim Gum employs a very subtle yet extremely advanced technique that
increases the power of a strike by accelerating its force along an angle. This magnifies the effect of
the force through the motion of the strike upon impact. Detailed in the Long Chun section of the
Notes, this highly effective maneuver adds extraordinary energy and power into each strike and
compliments soft as well as hard forms of the art.
8. Double-striking: A similarly advanced, highly effective technique is double-striking. Strikes, such
as with the elbow or iron palm, are “echoed” by a sharp push, a strike-push sequence that brings the
blow, and one’s weight, into the opponent’s body or limb.
9. Progressive striking (combinations): Combining strikes in a progressive, sequential manner
maximizes the effectiveness of the counter-attack. Optimally, by striking in succession one may move
from a point furthest away, such as a limb, and continue toward the body (thorax) before stepping
through and past. Combinations may also pivot around the axis of the opponent’s body.
10. Timing when to strike: When practicable, attack the opponent as they are breathing in and
inhaling. Avoid attacking when the opponent is exhaling, as this is when their Qi is strongest. When
inhaling, the body is caught in a necessary function and its guard is down. Similarly, attacking should

180
be done before the opponent has prepared for battle or when their focus has been interrupted. Simple
measures, such as screaming or spitting/puffing air in the face, can distract the opponent, interrupting
their concentration, timing and Qi.
11. Defending against strikes: Choong Sim Gum does not employ traditional “blocking” measures, as
found in most other martial arts. Rather, the principle method of defense is an aggressive counter-
attack of the combatant’s limb. One strikes as a return defense, but does not block. By attacking the
strike, the power of the blow is neutralized as injury is imparted to the opponent. Another means of
“defending” against attack is a simple side-step or redirection of the strike. Timing is critical to
effectively step toward and to the side of a strike by the hand or foot. The closer one moves toward
the opponent’s body (thorax) the more likely they are to neutralize attack.
12. Combat readiness: When squaring off with an opponent, the locus of one’s focus should be an
imaginary point on the upper sternum (“second button from top”). This ensures a full peripheral view
of the opponent’s breathing, arms, legs and general movement.
13. Combat stance: The principle fighting stance of Choong Sim Gum is Long Chun (Long
Chuan/Long Cheung). It protects the vital areas from attack while controlling the center-line along
which personal combat occurs. In doing so, it forces the opponent to strike from the outside thereby
telegraphing their intent and slowing the speed of their attack.
The principle preparedness stance (ready stance) is Yi Ma Shi, which squares off the torso and legs
thereby allowing for a quick, flexible response to the opponent’s attack. Form practice customarily
begins in the Yi Ma Shi with the hands held in Long Chun, left hand held in the lead position: The
body is squared, with the shoulders, torso and feet facing forward a wide, shoulder-width apart. Knees
are slightly bent, with the left-hand braced out in front of the chest, elbow bent, fingers in knife-hand
or loosely splayed and the palm turned upward, facing the sky. The shoulders are at a slight angle, not
squared off. The right-hand is held horizontally across the lower chest or diaphragm, palm down, with
finger-tips touching just at the left-elbow (in chamber). The chamber hand should not be held under
the elbow as the opponent can readily trap it under the lead hand. Keeping the thumb tight to the hand
prevents injury. When accompanied by a left-foot Chaou Tae (knee and toes turned outward, foot
braced flat out at knee height) the stance cannot be breached from the front. Senior students do NOT
employ the Long Chun stance when attacked; rather, they stand with arms to their sides and step into
the opponent, parry or absorb the opponent’s strike before countering. A passive stance “baits” the
opponent into telegraphing their attack.
14. The Center-line: The center-line is the zone around which battle occurs and must be dominated at
all cost. Protecting one’s center-line, while attacking the opponent’s, is fundamental to survival and is
a cornerstone of Choong Sim Gum.
Note: The “center-line” is defined by an imaginary line bisecting the body and drawn from the
center of the top of the head straight down through the navel. It covers the immediate area to the right
and left of this line, housing the body’s vital organs, including the head, neck, torso and groin. One’s
hands always remain at and return to the center of the chest or center line. The center-line is protected
by the fighting stance one adopts as well as by the turning of the torso and shoulders (side-ways)
while striking an opponent. In Choong Sim Gum, the twisting of the torso allows the limbs to
effectively transfer power and reach their maximum extension.

181
15. Facing multiple opponents: When attacked by more than one opponent, the counter-attack
should begin with the combatant furthest away. Keep moving, in turn, to the next farthest opponent.
This helps ensure that one is moving in to attack and away from being attacked. It throws off the
opponents’ planning and timing, thereby reducing the effectiveness of their attacks.
16. Avoiding potentially lethal risks: High kicks, arching kicks, spin kicks, jump kicks, stepping back
or turning one’s back to the opponent to kick provide dangerous openings that can readily be
exploited. One should avoid roundhouse or outward arching strikes, kicks higher than the waist and,
as a general rule, never turn their back to the opponent under any circumstance.
17. The role of key groups of techniques: a) Long Chun forms are highly effective for combat
within arm’s reach of the opponent, both as a means of closing distance as well for thwarting the
opponent’s attack; b) Chul Soo Moo Chuan forms are a distinctly higher generation of techniques
intended for very close combat, “pressing” the body to within inches (1-5) of the opponent. This
closeness to the opponent renders one’s strikes more effective (harder and more accurate) and allows
striking to alternate from side-to-side in such a way as to keep the opponent upright despite being
repeatedly struck.
18. Combat practice: Form practice and sparring are traditional methods for refining technique,
coordination, and reaction time. The dangerousness of the Choong Sim Gum techniques, however,
makes sparring an impractical method for practice. Instead, the principle training tool is a large
wooden tree trunk or post bearing metal bars and padded areas for striking. Similar to the Muk Yan
Jong and Makiwara, the Choong Sim Gum Wooden Post is an excellent tool for improving one’s
coordination and for habituating the body to particular sequences of action. It trains the hands, body
and legs to work within the center-line and acclimates one to close proximity fighting. It also
conditions the body to striking, hardening the bones from within.
Note: Bones harden through the slow process of calcification of micro-fractures, caused by
either sudden trauma or prolonged stress. This is the underlying mechanism of Choong Sim Gum
Iron Body training, which relies on repeatedly subjecting the body and limbs to impact vibrations
through striking. Although the conditioning process should be slow, requiring low impact striking
over several years, it can be accelerated in the arms through the use of the Attun or wooden
truncheon. When a heavy baton is continually used against the Wooden Post, the vibration slowly
hardens the bones while avoiding damage to nerves and muscles.
Center-line Zone

182
19. Forms: Forms (Katas) are prearranged sequences of combat that serve as the fundamental method
for teaching the traditions and lessons of a martial art. They refine stance and technique and teach
coordination, the foundation of skill and the root of the power referred to as Qi (Chi). Form practice
hones body memory, making reaction to attack automatic, fast, and disciplined. Forms aide combat
preparedness and should be practiced bare-handed as well as with a weapon in hand, such as the
Attun, Katana (wooden) or Bo. The lower and deeper the stance, the stronger the strikes and the
greater the strength of one’s Qi.
20. Invisible Hands: A subtle, yet powerful technique of Choong Sim Gum is keeping the hands
invisible until the distance is closed for attack. It takes great patience and practice to learn to strike in
such a coordinated manner; the striking hand moves to its target as if pulled to the strike and not
pushed from the elbow or shoulder. The hand moves, then snaps into the strike at the very last
minute: smoothly, move the hand within striking range then snap the wrist, opening or closing the
hand for the attack; the shoulder should NOT move and the body does not telegraph the strike until it
has reached its target. The correct sequence is hand, then elbow, then shoulder. This is also true when
striking with a Bahk Sow or elbow strike.

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