EP05 Workshop 24 - Family Assessment: Seven Steps Model - Salvador Minuchin, MD

Description:

This workshop will be a presentation of segments of one or two family therapy sessions describing how this model gives invaluable information to guide the practitioner in the development of therapy.

Educational Objectives:

1. Given a family therapy session, describe an assessment style.
2. To describe a map that can be used in the beginning of the therapy process. 

*Sessions may be edited for content and to preserve confidentiality*

Outline:

Introduction and Therapy Approach

• Minuchin introduces session structure: two tapes from 1972 and a recent session from England

• Outlines his four-step therapy map: engage the identified patient, explore childhood, examine systemic change

• Describes the family featured: a woman in her 40s with depression and suicidal behavior

• Addresses common assumptions about blended families—loyalty, proximity, and boundaries

Initial Family Interaction and Therapist's Role

• Highlights mother’s suicidal behavior and ongoing conflict between father and son

• Stresses avoiding assumptions and allowing natural family expression

• Notes technical need for a wireless mic for audience engagement

• Emphasizes restraint and avoiding premature intervention

Observations and Diagnostic Assessments

• Observes mother’s voicelessness and father’s concern for the son

• Highlights diagnostic elements: the son’s social skills, the mother’s emotional state

• Describes working with chronically ill children—importance of challenge and engagement

• Encourages therapist curiosity and an exploratory mindset

Exploring Family Dynamics and Conflict

• Notes father-son conflict is less threatening than the mother perceives

• Emphasizes unpacking loyalty and conflict within the family system

• Recommends letting conflict unfold before intervening

• Stresses the therapist’s role in facilitating insight and change

Addressing Emotional Responses and Therapeutic Techniques

• Shares personal emotional responses to working with the family

• Discusses using nonverbal cues and metaphor to communicate

• Advocates restructuring family hierarchy to elevate the father's role

• Encourages therapist honesty, self-correction, and ongoing exploration

Second Session and Exploring the Past

• Second session focuses on family history and roots of the mother’s fear

• Highlights importance of the son witnessing his parents' stories

• Identifies husband's nurturing potential as key to change

• Calls for therapists to use emotional responses skillfully

Challenges and Adjustments in Therapy

• Addresses working with violent, fearful family dynamics

• Balances emotional involvement with professional detachment

• Stresses the importance of therapist authority and experience

• Urges flexibility and tailoring approach to family needs

Conclusion and Future Sessions

• Concludes by identifying next therapeutic steps and continued exploration

• Reaffirms curiosity and therapist's role in enabling change

• Stresses family trust as crucial to progress

• Encourages audience to remain observant and questioning

Husband's Lack of Affect and Emotional Involvement

• Question raised about husband’s lack of visible emotion

• Response: focus was on the woman’s past, not the husband's affect

• Suggestion to ask sons how they felt about hearing their mother’s story

• Clarification: therapist chose not to focus on the husband in that moment

Dr. Minuchin's Approach and Impact

• Audience member expresses renewed idealism due to Minuchin’s approach

• Minuchin compares his ongoing processing to Jesuit or Talmudic thinking

• Emphasizes therapist survival, innovation, and self-protection

• Notes intentional detachment from the male figures to focus on the woman

Therapist's Role and Emotional Process

• Question on link between witnessing domestic violence and self-harm

• Acknowledges distorted worldview and woman’s erratic but intelligent presentation

• Family is aware of her self-harm; stresses involving children in healing

Emotional Expression in Therapy

• Asked if he’s ever cried in session—he hasn’t, though others have

• Cautions against the need to always have the “better idea”

• Explains difference between therapist and teacher roles; self-observation is key

Family Dynamics and Therapeutic Techniques

• Asked about father's view of son and mother—focus on behavior over content

• Powerful moment described: father and son physically standing, showing threat

• Created scenario for mother to criticize husband to increase emotional intensity

Therapist's Decision-Making and Session Dynamics

• Chose to position husband above son to enhance wife’s competence

• Focused on woman’s present interaction rather than childhood

• Values being useful over being right; aims to create conditions for change

• Actively intervenes to raise emotional engagement in session

Therapist's Use of Self-Disclosure and Emotional Responses

• Asked about therapist transparency—Minuchin shares often to build rapport

• Declined to revisit husband’s childhood to focus on creating positive emotion

• Uses self-disclosure to foster authenticity and impact

Therapist's Approach to Individual and Family Therapy

• Shifted from individual to family work due to greater ease with family dynamics

• Encourages reading his books; focus on process over content

• Highlights importance of generating positive emotional states in therapy

Therapist's Handling of Emotional Reactions and Countertransference

• Asked how he manages emotional reactions—becomes “invisible” to protect himself

• Woman’s suicidal ideation discussed—goal is creating a healing, secure context

Therapist's Use of Self-Disclosure and Emotional Responses (continued)

• Uses self-disclosure routinely; values authenticity

• Stresses composure and autonomy while remaining emotionally engaged

Therapist's Approach to Limited Sessions and Sibling Rivalry

• In brief therapy, does as much as possible and creates a forward map

• Reviews four therapy stages: challenge the problem story, reveal family’s role, offer alternatives

Engaging Reluctant Family Members in Therapy

• Asked how to work with only one willing sibling—start there and build hope

• Plan: engage parents first, then draw in reluctant siblings

• Emphasizes building a context that invites family participation and change