The purpose of One-Person Family Therapy (OPFT) is to accomplish BSFT's goals (i.e., reduction of drug abuse and improved
function-ing of the whole family) while workfunction-ing primarily with one person in therapy. By working with only one family member in most thera-py sessions, OPFT enhances BSFT's strategic qualities. A corol-lary of the assumption that families are interactive systems that is critical to the development of OPFT is the Principle of
Complementarity. It states that if a system is to maintain itself and its typical patterns of behavior, the behavior of each member must coordinate with, be maintained by, and be contingent upon the behavior of each and every one of the family members. Thus, if the behavior of one person in a family changes, then the other family members also have to change their behavior.
What follows is a brief discussion of the four major steps in OPFT: 1) the diagnostic interview, 2) choosing the IP, 3) join-ing, and 4) restructuring. These steps in OPFT will be explained by presenting the case of David S., a 16-year-old Hispanic who took methaqualone hydrochloride (Quaaludes) at least weekly and smoked marijuana daily. He had run away from home, and the Juvenile Court referred him for therapy. A fuller discussion of OPFT can be found in Szapocznik et al. (1984, in preparation-a).
Diagnostic Interview
In the case of David, the first step was an interview and diagnos-tic session with his entire family. Such an interview, although not absolutely essential, makes it easier to understand the family structure (patterns of interaction). The initial interview
revealed that the family identified David as the principal
repository of blame for the family's unhappiness, i.e., as the IP.
The assessment of family interactions indicated that the mother
overprotected David. The father, on the other hand, labeled his son as hopeless, denigrating him for his failures. In our work with Hispanic adolescent drug abusers, this pattern of an overly protective mother and a punitive father is common. In addition, David's mother and father continually bickered throughout the assessment session, but consistently diffused the conflicts existing between them by focusing on David's "problems." Thus, several dysfunctional structures were revealed in this initial interview.
How to Choose the OP
The second step in the OPFT procedure is choosing the One Person (OP) for therapy. A number of factors should be considered, including: 1) rigidity of the IPhood (i.e., the degree to which all the family's problems are blamed only on the IP), 2) central-ity in family interactions, 3) power in the family, and 4) avail-ability in both a psychological and practical way.
In this case, the identified patient--David--was selected as the OP, for several reasons. The first was the rigidity of the
IPhood. David's family was very unwilling to accept the possibil-ity that anything could be wrong with the family other than David.
A second reason for choosing David was his centrality. By virtue of his being the IP, most arguments within the family centered around him. Finally, David was eminently available because of a court mandate.
Joining
Establishing a therapeutic alliance. As already described, in BSFT the initial task of the therapist is to join the family system. In OPFT, because the entire family generally is not available during most therapy sessions, the therapist enters the family, as well as directs change, through the OP. To accomplish this, a strong therapeutic alliance is established with the OP.
The OPFT therapist continues to track the family's characteristic patterns of interaction through the OP's perceptions.
For example, when David presented himself for the first session, he was dressed in a black jacket and gave the impression of a tough, "streetwise" adolescent who took pride in flaunting his drug experiences. Although initially cautious and cool, later he began to enthusiastically recount experiences he had when he ran away from home. This situation provided the opportunity for the therapist to begin the joining process. The therapist listened intently and allowed David to savor his bold adventure. David was allowed to experience the opposite of his initial self-blame and negativism about what he had done. By listening attentively, the therapist shared a critical experience with the patient and estab-lished a therapeutic alliance that provided a foundation on which to begin to assess the family structure.
Enactment analogue. In structural family therapy with the entire family present, a necessary component of joining is to encourage enactment of the typical family interaction patterns in the pres-ence of the therapist. This aids in both entering the family system and making the experiential diagnosis. In OPFT, however, because just one person is present, only an enactment analogue is possible--a representation of the family's characteristic inter-actional patterns in lieu of direct observation.
In OPFT, when the OP is asked to represent her/his family, what the OP usually represents is the behavior of others rather than the self. The therapist assumes from the Principle of Complemen-tarity that for the system to maintain itself, the OP must behave in a fashion that complements the reported behavior of others, i.e., the OP has introjected the kinds of behaviors that comple-ment the behavior of others in the family. Because the OP tends to perceive the other family members' behaviors but not her/his own, in the enactment analogue the OP is requested to represent the other family members' behaviors. A full picture of the family's structure (patterns of interaction) emerges when the family's behaviors as represented by the OP and the behaviors the therapist has assumed the OP has introjected are brought together.
When the therapist inquired about David's perception of the prob-lem in the family, David responded by complaining that he felt humiliated by his family. His relationship with an older girl-friend provided the therapist with some content to use in further assessing the family interactional patterns, revealing that David's place in the family structure had him in two conflicting roles: his mother's innocent baby ("My poor little one, that terrible woman is misleading you") and his father's no-good bum
("You are no son of mine to go with a woman like that!"). The enactment analogue, then, provided the therapist with an experi-ential diagnosis used to plan the restructuring described below.
Restructuring
Restructuring refers to the actual interventions that are designed to change family interaction patterns. In OPFT, the therapist directs changes in dysfunctional interaction patterns by bringing about changes in the OP's behaviors that have complemented and, therefore, maintained the dysfunctional interactions.
OPFT explicitly creates change at both the intrapersonal (affec-tive and cogni(affec-tive) and interpersonal levels. In OPFT, the thera-pist facilitates intraoersonal changes in the OP that can effect changes in those OP behaviors that maintain dysfunctional family interactions. (Because of the strategic orientation of HSFT, no other intrapersonal changes are sought by the OPFT therapist.) The therapist then facilitates or directs the OP to change these behaviors. When the OP complies, the interaction patterns are eventually forced to change as one "cog in the systemic wheel"
behaves differently, as the Principle of Complementarity states.
Intrapersonal restructuring. In David's case, the therapist began to restructure David's introjection of the family's interaction patterns by tracking (i.e., following and making use of) David's
reports of his parents' behavior toward him, that of alternately babying and denigrating him. The therapist moved from the
reported interaction pattern to David's internalized complementary behavior.
David's habitual response to his parents was to allow himself to be dragged to the behavioral extremes that his parents expected of him in his role of IP. During intrapersonal restructuring, David achieved an understanding of his conflicting role behavior and de-sired to reach a middle ground more suitable to his stage in life, i.e., neither child nor adult, but adolescent. He desired to feel and behave, as well as to be treated, according to his age. Thus, the only intrapersonal changes sought were those required to restructure the corresponding interpersonal interactions.
Interfacing intrapersonal and interpersonal restructuring. Before beginning interpersonal restructuring, the OP must understand how she/he contributes to the family's interactional patterns. In David's case, the therapist asked David to imagine himself in the family context while the interaction is going on. Thus, David was asked to observe, along with the therapist, an imagined family interaction. As David observed the imagined family interaction, he was taught by the therapist how he contributed to the inter-action and how his being labeled an IP was the result of quietly and passively accepting that role and label.
Interpersonal restructuring. Once the OP clearly understands the complementary roles in the family, and has given up her/his desire to play these roles, the OP has an investment in changing the family's dysfunctional patterns; thus, the OP and the therapist now have common goals, and they become therapeutic allies facing the remainder of the family. The final step in the therapy is to carry out the actual interpersonal restructuring with the aid of the OP, and frequently through the OP.
The therapist, for example, might coach David to stand up to his father when his father begins to denigrate him. The way in which system change takes place is that when David changes his behavior, in effect, he has interrupted the sequential flow of family inter-actions that cast him into the IP role. This is a clear example of how OPFT differs from many other psychotherapies. It does not stop at creating awareness. Instead it uses awareness as a tool for redirecting the interpersonal behavior of the OP and thereby bringing about system change.
The therapist must take care that the manner in which a son is taught to stand up to his father tracks (follows and makes use of) the family's structure as much as possible in order to minimize the direct challenge to his father. In addition, in OPFT, the therapist must rely heavily on the OP's ability to change her/his
own behavior and to maintain the change in the face of strong fam-ily pressure. Hence, the OPFT therapist must carefully plan and rehearse the OP's new behavior. It is particularly important to role-play various outcomes that could ensue from the OP's change.
Once the new role is mastered in therapy, following the
performance-based strategy described above, homework based on the new role can be assigned. The tasks involve the OP's changing her/his complementary role behavior in the family.
Ideally, when the OP changes, the family accommodates itself to the change, thereby supporting the new behavior. Generally, however, the first response to the OP's changed behavior is more likely to be family pressure to return to its habitual interaction patterns. The resulting confrontation will generally produce a family crisis. This point is an ideal moment for the therapist to request and obtain a conjoint family therapy session. During these conjoint sessions, the therapist can verify the enactment analogue and support the changes the OP is instigating.
In addition, a conjoint session or two provides an opportunity--albeit a limited one--for the therapist to intervene directly in family interaction patterns in which the OP is not complementary (e.g., in the case of David, the therapist could intervene in the marital relationship directly during a conjoint session).
However, in one or two family sessions, it is not likely that major structural changes in these other family dysfunctional patterns can be achieved. Therefore, only those aspects of these
"other" dysfunctional interactions that affect the OP are stra-tegically targeted for change.