family therapy terms


I’m taking a couples assessment class this summer, and right now I’m reading about a tension between family therapy models that Sciarra and Simon (in Handbook of Multicultural Assessment) call either idiographic or nomothetic.

Nomothetic models say that families have problems because they get out of whack in ways that families do. That is, each nomothetic model has its own list of ways that families can get out of whack and a therapist using that model is to keep a sharp lookout for those things. Structural therapists look for dysfunctional boundaries, for example. Strategic therapists look for incongruous hierarchies. Bowenians look for emotional reactivity. Emotionally-focused therapists look for maladaptive attachment styles. Each nomothetic model says that the therapist needs to assess for these underlying problems, treat them, and therapy should be successful.

Idiographic models call nomothetic models “cultural imperialism.” That means nomothetic therapists are just teaching (or tricking) their clients into thinking, feeling, and acting like them. Nomothetic therapists are forcing their culture on their clients. Calling someone a cultural imperialist is about as close to an accusation of pure evil as a post-modernist will make. Further, idiographic models say that culture (any culture) is oppressive of individuals, and that this oppression is the only reason families seek therapy. The ideographic therapist’s job (Sciarra & Simon list language-systems, solution-focused, and narrative therapies as idiographic) is to have a conversation with families about the ways they are being oppressed by their culture.

There are a couple of funny things going on here, but to understand it, first you need to know that nomothetic models are mostly “old-school” models that emerged in the 1950s and 60s, while ideographic models are newer, postmodern, all the rage, and emerged as a consequence of this nomothetic/ideographic conversation. In the 1980s, postmodern family therapists started saying that family therapy was arrogant and hierarchical and created the idiographic schools.

The first funny thing is that the old-school, nomothetic family therapy models emerged in much the same way, as a reaction to the arrogant and hierarchical field of psychiatry. The founders of family therapy said to psychiatry, “Human problems exist in the context of families. Your pathologizing medical model is not appropriate here.” Now the ideographic models are saying to the nomothetic founders, “Human problems exist in the context of cultures. Your pathologizing medical model is not appropriate here.”

Who is right? Well, that depends on your epistemology. So far, the nomothetic models have more experimental evidence to support them, and they are undeniably effective. To be fair, they have had more time to collect evidence, so in time things may go either way. And to be extra-fair, real post-modern idiographs can reject experimental evidence on philosophical grounds; experiments are so modern, so medical-model. What value system produced your research questions, anyway? That’s funny thing number two.

Funny thing number three is that, as Ken Wilber says, everyone may be right. Perhaps problems happen at every level of complexity, from our bodies to our minds to our families to our larger social systems, and nomothetic models just specialize in the family level, while idiographic models specialize in cultures. It’s a neat idea, possibly too neat, and difficult to tease out. I’ve written a little about it here.

The fourth funny thing is that the idiographic models, while broadening the scope of consideration in some ways, put the focus back on the individual in therapy. They say that culture is intrinsically dehumanizing, and that dehumanization is what an idiographic therapist talks about, but the other parties in the process are not part of the conversation. If I’m a narrative therapist and you send your depressed son to me, we will talk a lot about that depression. We will externalize it, maybe give it a name like “Mr. Funky,” talk about how Mr. Funky speaks with the voice of oppressive culture, talk about times when your son was able to overcome Mr. Funky’s influence and work on ways of increasing that ability. In the end, if I’m a good therapist, we have probably helped your son, but we’ve also focused on how your son thinks, feels, and behaves, where a nomothetic therapist would have been focusing on the whole family–how do they interact? Do the parents get along? How might this symptom of depression make sense in your son’s immediate system of relationships? Who all has a stake in this behavior and can we get them in the room too? And so on. There is a way that by ostensibly moving the location of pathology out of the family to the larger culture, ideographic models have brought the clinical focus back to individuals, which may seem like regression to the founders of family therapy.

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Normalization is one of the primary techniques of a family therapist. Most family therapists do not put much stock in traditional ideas of “mental illness,” preferring instead to believe that the behaviors that their clients complain about are understandable reactions to tough circumstances. Normalizing is just pointing that out. People come in thinking they (or their kids) are crazy, broken, or bad, and once the therapist understands the situation, they can say something like, “Wow, you two are under a lot of stress! It’s no wonder you’ve been fighting lately. That’s a lot to carry around,” or “Actually, the latest research shows that adolescents need at least nine hours of sleep at night. I don’t think Johnny’s behavior is out of the ordinary…”

Normalization isn’t always verbal, either. It can be expressed by the therapist’s demeanor while hearing about the problem–no shock, no worry, just calm understanding–and in their easy willingness to talk openly and frankly about it. This part isn’t always easy, of course. It takes a lot of self-examination and your own therapeutic work to find your own triggers and ameliorate them.

The idea in normalization is both to educate clients about the situations they find themselves in and to take the pressure to change off of them. Often the stress that they create by ruminating on, arguing about, and trying to fix something that isn’t really the problem has become their main problem. Whether or not it has become their main problem, it isn’t helping.