Therapeutic Approach

Family Systems Therapy

Core Idea:

Family Systems Therapy views the individual as part of an interconnected emotional unit. Rather than treating issues in isolation, it explores how symptoms are embedded in—and sustained by—patterns within the family system. Change in one member inevitably affects the entire system.
 

Key Components of the Family System

1. The Family System as a Whole

Each family operates as an emotional ecosystem with:

  • Structure: Power dynamics and hierarchy within the family.
  • Roles: Recurring positions members adopt (e.g., hero, scapegoat, caretaker).
  • Rules & Norms: Often unspoken expectations about behavior, emotion, and communication.
  • Homeostasis: The family’s drive to maintain emotional stability, even if it means sustaining dysfunction.

2. Family Roles

Family members often unconsciously take on roles, especially in stressful or dysfunctional systems:

  • Caretaker – Keeps the peace, absorbs others’ emotions.
  • Scapegoat – Blamed for family problems; often carries collective distress.
  • Hero – High achiever who distracts from deeper issues but may carry internal pressure.
  • Lost Child – Withdrawn and emotionally overlooked.
  • Mascot – Uses humor or distraction to deflect tension. These roles can shift or be challenged as the system evolves.

3. Patterns of Interaction

Families develop habitual ways of relating:

  • Pursuer–Distancer: One member seeks closeness, the other withdraws.
  • Triangulation: A third person is pulled into a conflict between two others to relieve tension.
  • Scapegoating: One person (often a child) is blamed to deflect from systemic issues.
  • Coalitions: Subgroups form (e.g., parent–child alliance) that can destabilize balance.

4. Boundaries

Boundaries regulate closeness and autonomy within the family:

  • Enmeshed (Diffuse): Over-involved, lacking individual space.
  • Disengaged (Rigid): Emotionally distant, limited connection.
  • Clear (Healthy): Flexible balance between individuality and connection.

5. Intergenerational Transmission

Families often pass down trauma, roles, and patterns unconsciously.
Genograms (multi-generational family maps) help identify:

  • Repeating patterns (e.g., estrangement, addiction, emotional cutoff)
  • Cultural or historical influences
  • Unresolved grief or relational wounds

6. Differentiation of Self

This concept, from Bowenian theory, reflects a person’s ability to:

  • Maintain their identity and thinking under emotional pressure.
  • Stay connected to others without being emotionally fused or reactive. Low differentiation = high reactivity and enmeshment.
    High differentiation = clarity, emotional regulation, and relational balance.

7. Emotional Triangles

When two family members are in conflict, they may involve a third (often a child) to diffuse tension. While this reduces anxiety short-term, it often entrenches dysfunction.
Therapy aims to “de-triangle” and restore direct communication.

8. Family Life Cycle & Developmental Stages

Families move through predictable stages (e.g., coupling, parenting, launching children, aging).
Challenges can arise when families:

  • Resist natural transitions
  • Regress to earlier dynamics under stress
    Therapy identifies and supports healthy adaptation at each stage.

9. Therapeutic Tools & Techniques

  • Genograms to explore history and inherited patterns.
  • Reframing to shift perspectives on roles and problems.
  • Circular questioning to reveal interactional loops.
  • Structural interventions (e.g., adjusting boundaries, role-play, family sculpting) to shift entrenched patterns.

10. Communication Styles

Dysfunctional families often rely on:

  • Indirect or passive-aggressive communication
  • Emotional invalidation
  • Role-based speech (e.g., a child acting like a parent) Therapists work to foster direct, respectful, emotionally honest communication that supports connection and growth.

11. Goals of Family Systems Therapy

  • Improve communication and emotional safety.
  • Identify and shift rigid or harmful family roles and dynamics.
  • Heal intergenerational trauma.
  • Restore balance and strengthen the emotional functioning of both the family and its individual members.

Cognitive Behavioral Therapy (CBT)

Core Idea:

CBT is based on the principle that thoughts, emotions, and behaviors are deeply interconnected. Unhelpful thoughts can lead to emotional distress and self-defeating behaviors — but by identifying and changing these thought patterns, people can improve how they feel and act.

 

Key Concepts & Principles:

  • Cognitive Distortions: Automatic, often irrational thought patterns (e.g., catastrophizing, mind reading) that fuel anxiety, depression, and low self-esteem.
  • Thought Records: Tools for tracking, analyzing, and reframing distorted thinking.
  • Behavioral Experiments: Actively testing beliefs by trying new behaviors and observing outcomes.
  • Behavioral Reinforcement: Recognizing how avoidance or compulsions maintain symptoms — and using action to break these cycles.
  • Skill-Building: CBT teaches practical strategies for managing distress, solving problems, and improving communication.
  • Present-Focused: Emphasizes current thought and behavior patterns more than past experiences.

Common Cognitive Distortions:

  • All-or-Nothing Thinking: Viewing things in extremes (“I’m either a success or a failure.”)
  • Catastrophizing: Expecting the worst-case scenario.
  • Overgeneralizing: Believing one setback means everything will go wrong.
  • Mind Reading: Assuming others think negatively about you.
  • Personalization: Taking undue responsibility for events outside your control.

How CBT Works:

  1. Identify Problematic Thoughts: Notice patterns that drive emotional distress.
  2. Challenge & Reframe: Evaluate the accuracy of these thoughts and consider healthier alternatives.
  3. Modify Behavior: Test new behaviors that disrupt unhelpful cycles (e.g., confronting fears, scheduling activities).
  4. Practice & Apply: CBT emphasizes homework and real-life application to reinforce skills and insights.

Techniques Used in CBT:

  • Cognitive restructuring (challenging irrational beliefs)
  • Behavioral activation (increasing engagement in positive, meaningful activities)
  • Exposure therapy (gradual confrontation of feared situations)
  • Relaxation and stress management (e.g., breathing techniques)
  • Problem-solving and assertiveness training
  • Homework assignments to promote consistency between sessions

Common Issues CBT Helps With:

  • Anxiety (e.g., GAD, panic, phobias, OCD)
  • Depression
  • PTSD
  • Eating disorders
  • Insomnia
  • Substance use
  • Chronic pain or health anxiety
  • Stress and burnout

Style of Therapy:

  • Structured and Time-Limited: Typically 6–20 sessions, depending on the issue.
  • Collaborative: Therapist and client work together as a team.
  • Goal-Oriented: Sessions are focused and practical.
  • Empowering: Clients learn to become their own therapists, using CBT tools long after treatment ends

Acceptance and Commitment Therapy (ACT)

Core Idea:

ACT is about learning to accept what’s out of your control while committing to actions that enrich your life. Instead of trying to eliminate painful thoughts or feelings, ACT helps people make space for them and move forward in alignment with their deepest values.

Key Concepts

  • Cognitive Defusion
    Learning to “unhook” from unhelpful thoughts — seeing them as stories your mind tells you, not absolute truths.
  • Acceptance
    Making space for difficult emotions without trying to resist, suppress, or fix them.
  • Present-Moment Awareness
    Cultivating mindfulness — being here, now, with openness and curiosity.
  • Self-as-Context
    Recognizing that you are not your thoughts or feelings — you are the observer of your experience.
  • Values Clarification
    Identifying what truly matters to you and using that as your compass.
  • Committed Action
    Taking purposeful steps, even in the face of discomfort, to live a meaningful life.

Goals of ACT

  • Increase psychological flexibility — the ability to stay open, centered, and committed to values-driven action
  • Reduce avoidance and emotional suppression
  • Help people live fully rather than struggle to feel “better”
  • Support meaningful change, even when inner pain remains present

Common Techniques

  • Mindfulness and grounding exercises
  • Defusion practices (e.g., “Name the story” or “Thank your mind”)
  • Metaphors like Passengers on the Bus or Leaves on a Stream
  • Values mapping and life direction tools
  • Real-life behavioral commitments and habit-building

Used For

  • Anxiety, depression, and trauma
  • OCD and eating disorders
  • Chronic pain and illness
  • Substance use and addiction
  • Burnout, grief, and life transitions
  • Anyone stuck in avoidance, perfectionism, or inner struggle

Therapeutic Style

  • Compassionate, experiential, and deeply human
  • Emphasizes living well with discomfort — not erasing it
  • Collaborative, creative, and tailored to individual values
  • Focused on helping clients build resilience, not just relief

Key Quote:

“The goal isn’t to feel better. It’s to get better at feeling.”
— ACT philosophy

Dialectical Behavior Therapy (DBT)

Core Idea:

DBT is a structured, skills-based therapy designed for people who experience intense emotions, unstable relationships, and impulsive or self-destructive behaviors. At its core is the concept of dialectics — holding two seemingly opposing truths, such as: “I’m doing the best I can,” and “I need to change.”
This balance between acceptance and change is the heart of DBT.

Key Concepts

  • Dialectics: Learning to navigate opposing truths without getting stuck in all-or-nothing thinking.
  • Validation: Emotions and experiences are acknowledged as real, even if change is needed.
  • Skills Training: DBT focuses on four key skill areas:
  1. Mindfulness

Being fully present, aware, and nonjudgmental — a foundation for all other skills.

  1. Distress Tolerance

How to survive emotional crises without making things worse (e.g., using TIPP, self-soothing, or distraction skills).

  1. Emotion Regulation

Learning to identify, understand, and manage overwhelming emotions in healthier ways.

  1. Interpersonal Effectiveness

Assertive communication, boundary-setting, and navigating conflict while preserving relationships and self-respect.

Goals of DBT

  • Reduce self-harm, suicidal ideation, and impulsive behaviors
  • Improve emotional regulation and relationship functioning
  • Build acceptance alongside active behavioral change
  • Empower clients with tools for long-term resilience

What DBT Is Used For

  • Borderline Personality Disorder (BPD)
  • Chronic suicidality or self-injury
  • PTSD and trauma
  • Eating disorders (e.g., bulimia, binge eating)
  • Substance use and addiction
  • Mood disorders with emotional dysregulation

Structure of DBT

DBT is intensive and typically includes:

  1. Individual Therapy – Weekly one-on-one sessions focused on motivation and applying skills.
  2. Skills Training Group – A classroom-style group to learn and practice DBT skills.
  3. Phone Coaching – Real-time support between sessions for applying skills during crises.
  4. Therapist Consultation Team – A support group for DBT providers to stay sharp, ethical, and effective.

Examples of DBT Skills

  • TIPP: Fast-acting distress tolerance tools (e.g., splash cold water, intense exercise)
  • DEAR MAN: Script for assertive communication
  • Wise Mind: Integrating logic and emotion in decision-making
  • Radical Acceptance: Letting go of what we can’t control to reduce suffering

Therapeutic Style

  • Highly structured and goal-oriented
  • Validating and nonjudgmental, yet accountability-focused
  • Collaborative — therapist and client are partners in change
  • Often longer-term and intensive, depending on the severity of issues

Trauma Informed Therapy

Trauma-informed therapy is an approach to therapy that recognizes and responds to the impact of trauma on an individual’s life, particularly in how it shapes their emotions, thoughts, behaviors, and relationships. Rather than focusing solely on the trauma itself, this therapeutic approach emphasizes creating a safe, supportive, and validating environment where the client feels empowered to heal at their own pace.

Key principles of trauma-informed therapy include:

  1. Safety: Ensuring that the therapeutic space feels physically, emotionally, and psychologically safe. This includes respecting the client’s boundaries and making sure they feel in control of their healing process.
  2. Trustworthiness: Building a reliable and transparent relationship where the client can trust the therapist. This means being consistent, clear, and dependable in all aspects of therapy.
  3. Choice: Giving clients autonomy by involving them in the decision-making process. This could include offering choices about what topics to explore, what techniques to use, and when to move forward in the therapeutic process.
  4. Collaboration: Working with the client as a partner in the healing process, recognizing that they are the expert on their own experiences. The therapist listens actively, supports, and helps guide the healing rather than imposing solutions.
  5. Empowerment: Focusing on the client’s strengths and resilience, helping them feel empowered to take control of their healing and reclaim a sense of agency in their lives.
  6. Cultural, historical, and gender considerations: Acknowledging that trauma can manifest differently across cultures, genders, and personal histories, and being sensitive to these differences during therapy. This principle ensures that therapy is personalized and inclusive.

Trauma-informed therapy also integrates an understanding of how trauma affects brain development and emotional regulation, often using approaches like Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and EMDR (Eye Movement Desensitization and Reprocessing), depending on the individual's needs.

Ultimately, trauma-informed therapy helps clients process past traumas in a compassionate and empowering way, allowing them to rebuild their sense of self and cultivate healthier coping mechanisms.