Shifting Lenses: Approaches to a Family Conflict through Structural Family Therapy, Emotional Systems Therapy, Solution-Focused Therapy and Narrative Family Therapy

By Adam J. Pearson

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Introduction: Possible Versions of a Life

According to White and Epston (2004), two of the founding voices that spoke narrative therapy into being, it is crucial for clinicians to recognize that “the person is not the problem; the problem is the problem” and that every time we ask a question, “we are generating a possible version of a life” (p. 88-90). Indeed, as solution-focused therapy points out, carefully-worded questions have the power to reframe problems and understandings to loosen people out of states of psychosocial ‘stuckness’ and release them into the clear air of a way of living with more ‘degrees of freedom,’ to borrow a term from formal logic (Simon & Nelson, 2012). However, the questions we pose, and therefore, the “versions of a life” that we open up for the families with whom we work, emerge from the key concepts and understandings that are nested within the theoretical lenses we use to examine the family’s experience (White & Epston, 2004).

In order to illustrate the different gemstones of therapeutic understanding that can be mined out of analyzing family therapeutic situations through different conceptual lenses, this paper will begin by outlining the situation of a family in crisis and then proceed to explore the family’s understandings through a series of theory-grounded analyses. A structural lens will be used to peer into the family’s inner workings; an emotional systems perspective will be applied to explore the subtle currents of emotion within the ocean of familial interiority; a solution-focused approach will be considered to explore the prototypical relationships family members can embody; and last but not least, a narrative interpretation will tease out the metaphors, worker responses, and personal connections that can bring a therapeutic interaction to life.

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The Cast of Characters: A Description of the Cash Family in Crisis

The curtain opens on the therapy room of a hospital social worker who, as a reason for the referral, has been tasked to coordinate a discharge plan for a recently paraplegic teenage girl named Vespyr after her three-week hospitalization. In the course of her discussion with the family, however, she finds that the presenting problem seems to be not only how to plan the discharge, but also how to facilitate communication and communal agreement on a single discharge solution among family members with strongly-held and potentially opposing views.

In this scenario, loosely based on the film Captain Fantastic, Vespyr is a 16 year old, English-speaker who lives with her father, Ben (46 years old), a widower of one year, and five siblings in a rural home outside of the city. A dramatic fall during a mountain-climbing incident left both of Vespyr’s legs paralyzed, while the rest of her body remained unaffected. The hospital worker met with Vespyr, her twin sister Keilyr (16 years old), her father, Ben, and her grandfather, Jack (78), to discuss Vespyr’s living arrangements after she is discharged.

In the session that follows, the third meeting between the social worker and the family, the individual members’ values, beliefs, and sticking points begin to reveal themselves. Ben is an anti-capitalist, anti-institutionalist man who values a view of his family as a “tribe” for whom a meaningful life is a life lived together and marked by physical activities in Nature. He believes that the optimal situation for Vespyr would involve her returning to live in their rural home. Although Ben is firm on this point, he also concedes that some adaptations may be needed to facilitate Vespyr’s new wheelchair-bound life, such as the installation of ramps in the home or the use of an adapted bow to allow her to still engage in her beloved pastime of archery.

Jack, in contrast, is a wealthy city-dweller who tends towards caution and believes that the ideal environment for Vespyr in the wake of her new physical challenges is the city; he would like Vespyr to live with him and benefit from urban organizations, adaptive resources, and his vast finances, which can buy her everything she may need. Jack and Ben have had a history of conflict, strained communication, and residual conflict over the death of Jack’s daughter and Ben’s wife, Leslie, whose death by suicide Jack blamed on Ben. Both family members enter the session thinking there is no need to be there as each of them already knows what is “best.”

Vespyr herself feels torn between these two strong patriarchal figures. On the one hand, she feels tremendous love for her father, desires to stay close to her family “tribe,” and feels a fondness for their immersive Nature-oriented way of living. On the other hand, she would also prefer to stay close to her friends at her school in the city, appreciates her grandfather’s willingness to help and be involved, and has some concerns over her new physical limitations. While she is sympathetic with her grandfather’s suggestions and has felt like she has grown closer to her grandfather as a result of his frequent visits during her time in the hospital, in the previous sessions, she has tended to espouse values and views more similar to those of Ben.

In contrast, Vespyr’s twin sister Keilyr feels less closely aligned with their father’s views. While Keilyr cares about her sister and wants to stay close to her, she also does not want Vespyr to endanger herself by potentially not getting the support she needs if she chooses to remain at Ben’s. Indeed, Keilyr seems able to appraise the situation in a neutral manner that allows her to question the problematic aspects of living exclusively at either Ben’s or Jack’s home. After Vespyr expresses wishing that she could have the “best of both worlds,” Keilyr proposes a compromise that would allow Vespyr to live with both Ben and Jack. She suggests that Vespyr could stay with Jack on weekdays and with Ben both on the weekends and during the summer when the area surrounding Ben’s poses fewer risks due to wintertime conditions.

In the course of the worker’s sessions with the family, she observes that Ben and Jack seem to have become more willing to compromise after they have seen how much Vespyr values and loves both of them. Indeed, both admit to the social worker that they believe that Keilyr’s balanced solution begins to seem more plausible. It seems to the worker that Ben and Jack have demonstrated a greater willingness to hear one another out and both Jack and Ben describe having moved from a 10 to a 9, in Ben’s case, and a 9 to a 7, in Jack’s case, in their solution-focused rating of how open they are to making a compromise together. The worker suspects that Vespyr’s ambivalence and Keilyr’s concerns seem to have increased the tension between the twins. By the end of the session, it seems that the family has reached a potential solution, which involves Vespyr living at her grandfather’s residence during the school year and spending weekends and summer holidays with her family in their rural home.

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Systemic Challenges in the Cash Family: A Structural Analysis

To begin to explore the ways in which this worker might begin to interpret this family’s situation, we can peer through the lens of structural family therapy and see how the concepts of subsystems, boundaries, and rules play out within the Cash “family context” (Thomlison, 2016).

First, as the structural perspective suggests, the Cash family is not simply a collection of individuals, but also composed of several subsystems. According to Minuchin, subsystems, are relationships of two or more people that are defined along the lines of gender, generation, or functions, such as parenting, within the overarching family (Nichols, 2014). A first such subsystem in this situation is the executive or parenting subsystem, that is, the group of individuals who make decisions about where and how to raise the young people within the family (Nichols 2014). In this case, Ben is a prime figure within the parenting subsystem. In the past, his wife Leslie was as well, indeed, Ben and Leslie formed a spouse subsystem that was shattered with Leslie’s passing. Moreover, as a result of her death, she is no longer actively present within the family. Although she is now physically absent from the parenting subsystem, , she still continues to exert a ‘presence’ within it in the form of the tension that has emerged based on Jack blaming Ben for her death. Indeed, after Leslie’s death destabilized the parenting subsystem, her father, Jack, entered this same subsystem by beginning to assume a more active influence over decisions about the Cash children’s lives.

The challenge that the conflict between Jack and Ben poses in relation to the presenting problem is that it has compounded their pre-existing disagreements over their differing values and resulted in a disharmonious and disengaged parenting subsystem in which they are not communicating cooperatively (Nichols, 2014).  Instead, they have learned  to disagree adopt an uncooperative default stance in which they each assume that they alone know what is best for Vespyr. In the past two sessions, the worker has begun to work at helping Jack and Ben to begin to see that they have some values in common—such as wanting the best for Vespyr, loving her, and having had some positive memories together in the past—as a way of attempting to help them become a little more open to listening to one another and entertaining each’s other’s ideas. In effect, this approach has represented a structural intervention made within the parenting subsystem with the goal of facilitating intrasubsystemic communication in order to move Jack and Ben towards developing a mutually agreed upon discharge plan for Vespyr’s living situation.

A second subsystem within the family is the child or sibling subsystem represented by Vespyr and Keilyr. This subsystem, which was once very close-knit and deeply enmeshed, to use Minuchin’s term for a relationship of high-closeness at the expense of independence (Nichols, 2014). However, some tension, and consequent intrasubsystemic disengagement, has emerged between the two twins as a result of their disagreement over whether Vespyr should live with Ben, as Vespyr initially argued, or live with Jack, as Keilyr initially suggested. Since the parenting subsystem was initially divided between two figures with strong views who were each arguing against one another rather than working together, the disengagement within that subsystem has reverberated out to affect the closeness within the sibling subsystem.

Indeed, Vespyr previously took Ben’s side while Keilyr supported Jack’s point of view. By this third session, however, the worker has managed to make an intervention within the sibling subsystem, once again building on their strong bond, love for one another, and common wish for Vespyr to be both safe and empowered, to facilitate greater cooperation and communication within it. Indeed, by building on Vespyr’s wish for “the best of both worlds” and Keilyr’s suggestion of a scheduled joint living situation divided between both Ben and Jack’s homes, the worker has managed to rebuild some of their former closeness while moving them towards a solution.

A second structural issue that has impacted the presenting problem and the task of solving it has been the issue of boundaries. For Minuchin, boundaries are invisible boundaries that regulate people’s interactions (Nichols, 2014). Boundaries can exist both within and between subsystems and be either rigid, that is, restrictive and allowing minimal contact with outside subsystems, or diffusely unrestrictive and open, potentially resulting in enmeshment (Nichols, 2014). With Ben and Jack, we find a clear case of a rigid boundary. Previously, both Jack and Ben used their rigid boundary to not only remain emotionally distant from one another, but also physically distant in order to avoid conflict which would upset Leslie or the children. This was, in effect, a mutually-beneficial coping strategy, which while impeding communication, facilitated harmonious emotional regulation. However, when Jack entered the parental subsystem after Leslie’s death, the once helpful rigid boundary between the two became a hindrance since the primary function of a parenting subsystem is to make executive decisions about what will happen in the care of the children, and an uncommunicative system cut off by its own rigid boundaries cannot easily make such decisions.

The boundaries situation between Keilyr and Vespyr as a sibling subsystem is slightly different. Theirs is a case in which initially diffuse boundaries have become a little more tense and rigid as a result of their arguments over what to do about Vespyr’s discharge. In addition, boundaries between members of the sibling subsystem and members of the parenting subsystem add additional complexity. Ben and Vespyr are more enmeshed and have more diffuse boundaries between them than Ben and Keilyr, since Keilyr is more open to siding with Jack and disagreeing with Ben. Similarly, Vespyr’s diffuse boundaries with her father result in more rigid boundaries against Jack, while Jack’s more diffuse boundaries with Keilyr help pull her a little further away from her father. To improve communication, boundaries between Jack and Ben must become less rigid and enable them to talk in a more open and solution-directed manner.

A final structural consideration with a significant bearing on the presenting problem is the issue of rules within this family. For Minuchin, rules are spoken or unspoken constraints on what subjects can be discussed and what actions are and are not permitted within families (Nichols, 2014). Rules are significant because they demarcate boundaries; firm rules result in more rigid boundaries while less stringent rules result in more diffuse boundaries. Numerous rules could be cited in this example, but the one that most stands out is the unspoken rule against talking about Leslie’s death or expressing their feelings of grieving around her passing. Because of this rule, Jack and Ben have not been able to work through their issues around Jack’s blame of Ben for Leslie’s death, a prime bone of contention which has rigidified their boundaries and closed them off to cooperatively communicating with one another. Although not as relevant to the presenting problem, the rule has also resulted in the children subsystem being more distant from openly communicating with Ben because they feel their feelings are not always permitted to be spoken about. One possible direction for a structural intervention around rules might be for the worker to attempt to guide the family towards discussing whether this rule is working for them or whether they might like to experiment with the possibility of shifting it. Developing a new rule about communicating emotions could facilitate moving on from the past and improve the communication flow both within and between the family’s subsystems.

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The Dynamics of Emotion in the Cash Family: An Emotional Systems Analysis

Just as Minuchin’s approach shines the beam of social worker attention on the supra-individual subsystemic structures within the family in order to find points that help and hinder the resolution of their presenting problems, Bowen’s emotional systems approach helps illuminate the impact of feelings within the family. Three of Bowen’s concepts in particular hold valuable keys to unlocking the complexities within the Cash family context, namely, emotional triangles, emotional cutoff, and differentiation of self.

First, for Bowen, emotional triangles emerge when tension or anxiety between two family members results in a third party being brought in to reduce the tension (Nichols, 2014). In the background of the family’s current situation lies the previous emotional triangle in which Leslie found herself pulled into the conflict between Jack and Ben’s opposed values and beliefs about how their children should be parented. With Leslie’s passing, that triangle was dissolved.

As a result, the emotional tension between Jack and Ben escalated once more, this time, not only ramping up their historical conflict with one another, but also impacting their disagreements over where Vespyr should live after her discharge. As a result, two new triangles have emerged. The first involves Vespyr, who feels torn between the two members of her new multigenerational parenting subsystem composed of her father and her grandfather. Although initially siding with her father, her grandfather’s evident caring and closer role in her life during his visits to her during her hospital stay have pushed her even more towards the center of this triangle. The result is ambivalence; she literally sees value on both sides.

A second triangle has emerged between Ben, Jack, and Keilyr, who has stepped in between the two out of a wish to facilitate some of the communication she saw lacking between them and articulate an attempt at a solution that would please both of them by including both of their households in Vespyr’s discharge plan. By joining with Keilyr, the worker has attempted to build on this mediating role she has already started playing and de-triangulate her relationship with her father and grandfather by helping the whole family become more open to compromise. Like the falling of a series of dominoes, as communication and openness to hearing one another out emerges between Jack and Ben, tension and anxiety decreases between them, which places Vespyr less in the center of their conflicts, and loosens up the Vespyr-Jack-Ben triangle as well. Triangles cannot exist except with dyadic tension; as the tension dissolves, so does the triangle.

Correlatively, Bowen’s notion of emotional cutoff describes a situation in which two family members manage anxiety in their relationship by avoiding intimacy with one another or insulating themselves with the presence of third-parties (Nichols, 2014). The most prominent example of an emotional cutoff in the microcosm of the Cash family described in the solution we are considering here exists between Ben and Jack. As previously mentioned, due to their conflicting views and values, Ben and Jack sought to decrease anxiety for their family members by avoiding one another both physically and emotionally, or mutually introducing an emotional cutoff between the two of them.

In contrast, both Vespyr and Keilyr feel that they can share their love and be close with both Jack and Ben separately, although doing so with the two of them present is often difficult. If they attempt to show closeness with Ben in the presence of Jack, Jack may feel slighted while seeming to align with Jack can result in a reaction from Ben. This is the inevitable result of the rigid boundaries and the emotional cutoff between Ben and Jack within their parenting subsystem—to link structural thinking to emotional systems thinking for a moment.

When two people emotionally cutoff, it forces other family members to either take sides or be perceived as doing so even when they would prefer not to. Keilyr’s attempt to find a compromise Jack and Ben could both agree to could also be seen as an attempt to begin to loosen up their emotional cutoff from one another. Indeed, the social worker also attempts to intervene in a similar direction by pointing out their common values, the positive shared memories they have had in the past, and their mutual love for Vespyr. The emotional effect of such an intervention, when successful, is to begin to increase warmth, rapport, or emotional closeness, and thereby, erode the rigidity of an emotional cutoff. In this family’s case, this intervention seems to have been successful, for Ben and Jack are well on their way to agreeing to a version of Keilyr’s solution.

A final emotional systems concept with a bearing on the presenting problem in this family’s life situation is the notion of differentiation of self. In a classic text on the subject, Bowen (1976) explains that differentiation of self describes how free a family member feels to think, feel, and act in a way that is free from reaction to and susceptibility to the emotions and views of others.  People with strong differentiation of self both feel free and act free in this way; in contrast, people with poorly differentiated selves tend to either manifest as ‘chameleons’ who constantly adjust what they think, say, and do to please others or as bullies who push others to agree with them and conform to their will out of an inability to tolerant differences seen as threats (Bowen, 1976). Indeed, and very interestingly relevant to the Cash family’s situation, what Bowen calls an extreme rebel is a poorly differentiated person who pretends to be a differentiated self by routinely opposing the positions of others (Bowen 1976).

Differentiation of self plays into the conflict over planning Vespyr’s release in interestingly complex ways. Ben seems to present, in some respects, as an extreme rebel who develops his self-definition by routinely opposing not only dominant discourses within society around the value of capitalism and institutions, but also by routinely clashing with Jack as a perceived representative of these discourses, and therefore a threat to Ben’s self-identity. In another respect, Bowen might also suggest that Ben, while seeming to have a strongly differentiated self prima facie, could also be interpreted as poorly differentiated in his relentless attempts to impose his own views and ways on his children and refusing to tolerate disagreement (Nichols, 2014). These intra-self dynamics within Ben impact his relationship with Jack, which increases conflict and decreases collaboration towards a mutually agreed upon discharge plan.

In contrast to Ben, however, Keilyr represents a figure with a very strong differentiation of self. She is able to listen to what Ben and Jack present without being excessively drawn into either of their points of view, surrendering her own agency as an independent thinker, or allowing herself from being easily won over by either of them. Indeed, it is precisely Keilyr’s strong differentiation of self that enables her to formulate the compromise that the worker can build upon to move the family towards a solution to their presenting problem.

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Prototypical Client-Worker Relationships: A Solution-Focused Analysis

A third thunderbolt that casts theoretical illumination into the murkiness of complexity within the Cash family strikes with the power of a third therapeutic approach: solution-focused therapy and its notions of the prototypical relationships of the visitor, complainant, and customer.

First, for the solution-focused perspective, a visitor is someone who is not in the market for therapy, but is present at the insistence of a third party—like a hospital social worker, for example—since they have no complaint and no wish for therapy (Nichols, 2014). The closest representative to this prototypical model within this case scenario is Ben. Ben’s very anti-institutional philosophy sets him up to be a visitor from the beginning; not only is he opposed to what he perceives to be ‘big pharma’s’ capitalist profiteering through the hospital system, but he already believes he knows what is best for Vespyr. Therefore, there is no need for a meeting at all, since he already believes that he has the solution and therefore there is no problem. If there is no problem, then there is no need for a problem-solving session. This is the archetypal attitude of the visitor, namely: there is nothing wrong, and therefore we, as a family, do not need to be here. An effective intervention with a visitor like Ben would involve asking a question like “what’s the minimum that needs to happen to get you and Jack on the same page enough to satisfy the hospital and get you all out of this office?” This is an approach this worker could attempt.

Second, while the visitor denies the problem, the complainant blames it on somebody else (Simon & Nelson, 2012). From the solution-focused perspective, a complainant is someone who has a clear complaint, which conveniently excludes them from the problem, and places the blame squarely on someone else’s shoulders (Nichols, 2014). While Jack may be more customer-like than Ben, he can also be interpreted as a complainant. As far as he is concerned, if Ben were not so irrational, radically revolutionary in his views, neglectful in his parenting, and pathological in his role in his daughter’s death, they would not be here and Vespyr would be safely and exclusively living with him. The worker joins with Jack by helping him to see exceptions in Ben’s behaviour; that there were times when he made responsible decisions for the children, that there was useful information that he taught them, and that they did in fact have some happy memories together in the past. Ideally, what a worker would like to do with Jack is to help him to come to an awareness of how perhaps he may have had at least some small part to contribute to the lack of communication with Ben and how he could, as a result, both enlist Ben’s help and be part of a solution in his own right.

The final prototypical client-worker relationship in this scenario is the customer, a role arguably best exemplified by Keilyr. From the solution-focused perspective, the customer is the ideal client; not only do they acknowledge a problem, but they are ready to take action on it, establish clear goals, and make changes (Nichols, 2014). All of these qualities describe Keilyr perfectly. On the one hand, she sees that there is a problem; if they are not careful in their choice of a living situation for Vespyr, she could face serious risks. Keilyr also notes that Ben and Jack’s lack of communication is a problem because they both are partially right; the solutions that each of them are arguing for exclusively could each carry pieces of a more comprehensive solution that would satisfy them both. To work with a customer like Keilyr, the worker uses her compromise to establish the foundations of a solution that would get both Jack and Ben invested in implementing it because it addresses both of their concerns while also incorporating both of their valid points. In a family that contains visitors and complainants, customers can represent a fulcrum of change, such as to bring about the “best of both worlds” for which Vespyr yearns.

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Metaphors, Worker Emotions, and Connecting Similarities: A Narrative Analysis

Beyond the structures, emotions, and strengths within families, narrative therapy reveals another dimension: the realm of a story, which can be elucidated in this worker-family interaction in three distinct aspects, (1) metaphors, (2) worker emotions, and (3) connecting similarities.

First, as has already been suggested, for White and Epston (2004), the problem is not the family, but an issue that can be externalized—or treated as separate from—the family members and is shaped by the family’s stories about the problem. Empowering stories externalize the problem and help guide the family towards a solution while problem-saturated stories limit the family’s ability to cope and block off their options (Nichols, 2014). One way of arriving at a more empowering story and externalizing a problem at the same time is the use of metaphor, or a striking image that offers a figurative way to conceptualize both a problem and a way to a solution (White and Epston, 2004). In this case, the metaphor of home—envisioned perhaps as a comforting fire-warmed cabin that we happily allow to embrace us after being chilled by freezing winter air, or the warmth of a soft covers—may hold a key to a more empowering story.

What does “home” look like for you, Vespyr? The worker might ask, as she begins the phase of deconstruction or breaking down a problem-saturated story by reframing its terms (Nichols, 2014). Does “home” stop where the walls of your father’s house stop? Or can “home” also be found at Grandpa Jack’s? Is “home” more a space between people, the space of the relationships with the family members you love, than a particular physical location? Can “home” be big enough to embrace two physical houses? Questions like these can help reauthor or rebuild a more empowering story (Nichols, 2014). Now, the problem is not one another. Instead, it is figuring out what “home” means for Vespyr and how we can find a notion of “home” that is big enough to include both Ben’s house and Jack’s house in the comforting warmth of its hearth. Perhaps Keilyr’s suggestion of a shared living arrangement is a way of finding this “home” and bringing Vespyr safely back to it, even if she is in Ben’s house part of the time and in Jack’s in another part of the time. When “home” is divorced from “house,” its form can change.

Similarly, as seen through the radically different lens of the narrative approach, worker emotion is not irrelevant; indeed, it represents a potential ingredient in a recipe for change with the power to nourish the family and the worker alike (Nichols, 2014). What worker emotions could constructively be relayed to the family in a way that would have positive clinical effects? Our narrative-focused worker might inform the family that when she sees how passionately they are advocating for their ideas, she feels admiration for the fact that they must really love and care about each other. If they did not love Vespyr as much as they do, they would not argue as strongly for where she should live as they each see it. Indeed, the worker might even note that their love for one another is heartwarming; its warmth is contagious. The worker might also join with the family in recognizing that she can feel their frustration; after all, being hospitalized is stressful and trying to find a discharge plan that everyone can embrace and invest in is a challenge even for the best therapist.

Finally, she might note that she feels hopeful, hopeful that with all of the strengths present in this family, with all of the pieces of a solution that they have contributed, and with all of their intelligent ideas and worthy points to take into consideration, there is indeed hope for finding a solution for Vespyr’s discharge plan. Indeed, the worker might also feel grateful, grateful to Keilyr for seeing a bridge where others may not have seen one.

Finally, a strategy of the narrative approach for finding solutions through re-storying problems from people to externalized issues is the notion of finding connecting similarities in other instances or experiences that link to the presenting problem (Nichols, 2014). This worker might note that her brother was once hospitalized and that their family was once tasked with figuring out where he would stay after he was diagnosed with a severe illness that would require tube-feeding and close medical monitoring after his discharge. She might note that although her family also found it difficult to decide on a solution, and argued just as passionately over what form it would take, they still ended up finding one that worked. And if there was hope for her hotheaded family, then there just might be hope for the Cash family too.

Many Views of Rome: A Conclusion on the Equifinality of Theoretical Lenses

When a worker looks through the lenses of structural therapy, emotional systems work, solution-focused therapy, and the narrative approach, different views emerge. Depending on the lenses, relational structures, patterns of emotional regulation, exceptions and strengths, or ways of storying an issue can come to the forefront, but just as we can look at Rome in many ways and still see the same city where ‘all roads lead,’ so can these equally valuable lenses of family therapy end up converging on an equifinal result – solutions that work and changes that matter.

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References

Bowen, M. (1976). Theory in the practice of psychotherapy. Family therapy: Theory and
practice
, 4, 2-90.

Nichols, M.P. (2014). The essentials of family therapy. 6th edition. Boston: Pearson.

Simon, J. K., & Nelson, T. S. (2012). Solution-focused Brief Practice with Long-term Clients in
Mental Health Services:” I Am More Than My Label.”
New York: Routledge.

Thomlison, B. (2016). Family assessment handbook: An introductory practice guide to family   assessment: Pacific Grove, California: Cengage Learning.

White, M., & Epston, D. (2004). Externalizing the problem. Relating experience: Stories from health and social care, pp. 88-93. New York: Routledge.

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