Framo and Inter-generational Family Therapy

In the words of marriage & family therapy theoretician, James L. Framo, his theory aims to build “a conceptual bridge between the personal and the social” (1992, p. 111). Framo, along with other theoreticians of the time, such as Murray Bowen, Carl Whitaker, and Ivan Boszormenyi-Nagy, were interested in not only the internal intrapsychic processes occurring within individuals, but also the social spaces between individuals as well. According to Framo, “it is just as important to know what goes on inside people as what goes on between them” (1996, p. 12). This type of thinking deviated from the typical views and practices within clinical psychology prevalent in the 1960’s and 1970’s, and represented a paradigm shift.

Although Framo (1979) attributes the field’s vast understanding of the individual intrapsychic world to Freud, he also points out that Freud’s inability to acknowledge the significance of outside social factors has had broad implications for both psychological theory and practice. According to Framo, social factors cannot afford to be overlooked, especially those relating to the family. According to his theory, the family is the singular most important force that influences an individual’s life and behavior (Framo, 1979). He asserts that “the family shapes the fiber of people’s beings in a way no other social force can begin to realize” (1979, p. 988). He places special emphasis on the importance and role of one’s family-of-origin.

Framo believes that many problems in an individual’s life can be traced to one’s family-of-origin. According to Framo, “parents live through and repeat with children and spouses the conflicts derived from their families of origin. Problems in a family tend to be repeated from one generation to the next” (1996, p. 3). For Framo, it is important to not only address relevant problems, but to take these intergenerational problems back to their very roots. Being familiar with one’s family history can greatly help an individual make sense of current family dynamics and issues. This thinking forms the basis for Framo’s unique intergenerational approach to family therapy.

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Key Concepts

Object Relations Theory

James Framo built upon the work of Murray Bowen, the first marriage and family therapy theorist to emphasize the importance of intergenerational forces, by adding Fairbairn’s theory of object relations to Bowen’s model (as cited in Searight, 1997). Fairbairn’s (1952) object relations theory actually contributes much insight to the intergenerational family therapy approach. According to Fairbairn, establishing meaningful, close relations with others is the key motivating force in a person’s life. He claims that humans are essentially driven in life to obtain satisfying object relations. Pleasure is derived from this object-seeking, but aggression arises from frustration over not obtaining sought after objects (Framo, 1992).

According to Fairbairn’s object relations theory, if children interpret their parents’ behavior as rejecting or withholding, or if they perceive their parents as having deserted them, they will be unable to give up the external figure or object, nor change it in their outer reality. In turn, they will handle their frustration by internalizing the need-hated object (the parent) into their intrapsychic world where they can attempt to control the object. Framo explains that the internal object becomes an introject, “a psychological representative of an external object” (1992, p. 112), and is repressed. During this process, the actual emotional relationship between self and parent is internalized. Framo (1982) asserts that these introjects become “sub-identities” (p. 26), and play a role in personality formation. Good objects become positive memories and ideal objects. Whereas, bad objects contribute to intrapsychic conflict.

Inner objects, or introjects, acquired as a child, serve as role models for future close relationships. According to Framo:

Life situations in outer reality are not only unconsciously interpreted in the light of the inner-object world, resulting in distorted expectations of other people, but active, unconscious attempts are made to force and change close relationships into fitting the internal role models (1982, p. 26).

This phenomenon frequently leads to all sorts of relationship difficulties, particularly marital troubles. As will be discussed shortly, having clients’ parents participate in intergenerational therapy is highly beneficial because their presence, along with therapeutic guidance can help expose an adult child’s internal objects and loosen their strong influence.

Couples Therapy & Couples Group Therapy

Framo encourages many of his individual clients to partake in couples therapy or couples group therapy. Framo believes in treating partners together rather than separately and considers couples therapy to be more beneficial than individual therapy. Once clients have had several sessions of couples therapy, he often has them consider an underutilized form of therapy known as couples group therapy.

Couples group therapy is comprised of a small group of people, usually three couples, who are similar in age and life experience. In these two hour sessions, headed by a male and female co-therapy team, each couple is focused on separately and encouraged to explore their parataxic and transference distortions. This type of therapy is unique in that distortions are

transferred onto one’s mate, as opposed to a therapist like in typical psychodynamic therapy. Other couples observe this process and provide feedback to one another.

In order to avoid frightening his clients away, Framo waits till he has established a relationship with a couple before he mentions the idea of intergenerational family therapy. People can at times be quite resistant to the notion of this particular type of therapy. Framo has noticed that, “these resistances are diminished and more easily managed in the couples group context” (1992, p. 18). Participating in couples group therapy has proven helpful in preparing clients for intergenerational family therapy. In fact, most of Framo’s family-of-origin family therapy sessions originate from couples group therapy (Framo, 1992).

Intergenerational Family Therapy

Framo’s intergenerational family therapy is unique in that it includes the family-of-origin in the therapeutic process. The involvement of the family-of-origin is critical because old family ways can be re-experienced and re-lived during the therapy session. With the help of a competent family therapist a family can learn to “break up old, repetitious relationship patterns” (Hoffman, 1981, p. 250). Framo bases his intergenerational, family-of-origin approach on the belief that it is better to have a client speak directly, face-to-face to a family member, as opposed to simply speaking to a therapist about that person.

Goals of Therapy

The ultimate goal of Framo’s intergenerational family therapy is to help a family improve their relations with one another. Other pertinent therapeutic goals include reducing the family’s general anxiety level (especially in the beginning stages of therapy) and assisting family members in negotiating the type of relationships they want with one another. Helping clients to realize what they can and cannot give one another is of particular importance and can have lasting positive effects upon family members. Framo claims that the overarching metamessage of each therapy session is the acknowledgement that the session and issues directly pertain to the client, not oneself as the therapist (as cited in Hoffman, 1981).

Structure & Process

Each intergenerational family therapy session is uniquely different. However, certain elements remain constant. A client’s family-of-origin is always invited. According to Framo, it is best for as many family members to attend as possible because this will increase the “therapeutic leverage” (1996, p. 12) of the therapist. Sessions are actually canceled if certain members are missing or fail to show up for the session. Furthermore, a client’s spouse is typically not invited because Framo feels that the emphasis needs to remain on issues pertaining directly to a client’s family-of-origin, not marriage. In general, each session is comprised of two, two hour sessions separated by a break. Sessions are always captured on video or recorded so that extended family members who were not physically present can still feel involved in the family therapy process, and so that members who did attend have the opportunity to gain new insight into the session. Spouses are welcome to view or listen to these recordings as well.

Interventions &Techniques

Interventions are carefully planned and implemented with this type of therapy. Framo uses a variety of therapeutic techniques which will now be described. In general, Framo prefers to call his intergenerational family therapy sessions “family conferences” (1992, p. 89). This more informal labeling helps take some of the pressure off of the therapy session itself. Furthermore, rather than using the term therapist, he prefers to use the term facilitator. This is largely due to Framo’s belief that the therapist in these sessions should not be interested in diagnosing clients and their families. Instead, he or she is primarilly facilitating family discussion and problem solving. As a facilitator, it is extremely important that a therapist doesn’t side with any particular family member. He or she must show loyalty not only to the client, but to each family member as well. Learning to balance the needs of each member present is essential.

It is important that the therapist keep material flowing. Circular questioning, providing support, summarizing, and encouraging active engagement are techniques frequently utilized to achieve this important task (Framo, 1992). A therapist sheds new light and perspective on topics of debate by reframing issues. This technique can help adult children get past their anger and actually help them learn to experience compassion for their parents. When the therapist intentionally reacts to parents as people, it becomes easier for the adult children to do so as well (Framo, 1992). Helping clients view their family members, especially their parents, as real people, is a cornerstone of this type of therapy. Forgiveness and understanding are highly stressed.

In intergenerational family therapy, much resistance stems from family members’ fear of change and the uncertainty change brings with it. Framo believes that intergenerational therapy allows for change because it creates an environment which “legitimizes disloyalty” (1992, p. 123) to the family-of-origin. During these sessions, when a family member behaves differently than expected, the resultant dissonance caused by this occurrence, creates an opportunity for change. When a parent behaves differently, the event has the potential to reduce the attachment a child has to a bad internal object, and can actually allow for the object’s release (Framo, 1992).

Effectiveness

Long-held, systemic family rules are not only revealed in the therapy session, but they are halted by the therapist. With the help of appropriate, carefully timed interventions on behalf of the therapist, these family rules can be changed. In Framo’s clinical experience, slight shifts to the family-of-origin system in small increments, can cause long-term changes in familial relations (Framo, 1992). These potential changes can occur on any of three levels- the individual, marital, or family-of-origin level.

Framo’s intergenerational therapy is not ideally suited for quick fix changes. Rather, changes following a session tend to be subtle and occur over time (framo, 1992). However, it is believed that the effectiveness of this therapeutic approach can be increased with supplementary individual and couples therapy. In his clinical work, Framo found that follow up sessions can prove especially beneficial in the long term.

As mentioned earlier, Framo is not able to accurately determine which clients will benefit the most or the least from his intergenerational, family-of-origin therapy. In reality, numerous factors are involved in determining the effectiveness of this type of therapy. For instance, family variables, individual variables, therapist variables, or any combination of the aforementioned three, can greatly influence the results of this type of work.

Application to Specific Populations

Framo’s intergenerational therapy approach can be applied to a broad segment of the population. Everyone has a family-of-origin and almost everyone experiences intergenerational conflict to some extent. Although it is not entirely clear which individuals and families actually benefit the greatest or least from this type of therapy, it has been clinically observed that self-referred clients and families, who specifically request these sessions, seem to obtain the most benefit (Framo, 1992).

Framo’s therapeutic approach remains promising in its application to diverse and multicultural populations. Not only is Framo keenly aware of family cultural nuances, but he is aware of ethnic cultural differences as well. He claims, “If you do not know the ways and style of a particular ethnic kind of family, you can interpret normal behavior for that culture as pathology” (1982, p. 277). He stresses the importance of treating family processes as opposed to individual symptoms which are too easily pathologized. Furthermore, from a developmental standpoint, his theory is geared towards benefitting and enhancing the family lives of people of all ages and generations.

Clinical Experience & Research

In terms of clinical practice, strong theoretical guidelines for intergenerational therapy do not exist (Framo, 1992). Furthermore, there is no one right way to conduct family-of-origin therapy or even family therapy in general. According to Framo (1996), therapists must first develop a style of therapy that personally works for them and then build a theory based on their clinical experience. Framo believes that the key to becoming a family therapist is to be familiar with one’s own family. Participating in family therapy oneself is the best way to gain valuable family knowledge and experience working with family systems (Framo, 1979).

Currently, there is a lack of solid outcome data pertaining specifically to the evaluation of family-of-origin therapy. The creation of systematic research methods addressing clinical problems is much needed. It is important that clinical theories be operationally stated and that testable hypothesis be routinely given. Framo (1992) points out some interesting topics for future research study. They include the following: analyzing the short and long term effects of intergenerational family therapy on individuals, couples, and extended families; comparing outcome studies between intergenerational family therapy and other family therapy orientations; studying the effects intergenerational family therapy sessions have on the young children of participating members; and determining at what point in couples therapy family-of-origin sessions will be of most value to clients.

Conclusion

Intergenerational family therapy can be considered the “ultimate brief therapy” (Framo, 1992, p. 131). In today’s world of managed healthcare, this therapeutic approach has the potential to be of particular interest to insurance companies due to its immediate, action-oriented nature. As a theory and clinical practice, intergenerational family therapy has much applied value. Furthermore, family-of-origin therapy is able to reach extended family members who normally might not seek out mental health services. With this in mind, family-of-origin therapists can encounter and have an effect on a portion of the population that they normally wouldn’t encounter in individual therapy sessions.

By blending object relations theory with family therapy, Framo’s family-of-origin therapy works by clarifying faulty memories, emphasizing in-person interaction over speculation, and getting to the heart of family issues by addressing intergenerational family legacies linking the past and present (Framo, 1992). Although his intergenerational family therapy is frequently met with resistance, his approach has much to offer individuals, couples, and families alike.