Interview with Patricia Pitta, Ph.D., ABPP: An overview of Dr. Pitta’s book titled, Solving Modern Family Dilemmas: An Assimilative Therapy Model

Interviewed by AAFCP Co-Editor, Martha Ruiz-Shank, Psy.D.

MR: Dr. Pitta, you wrote: Solving Modern Family Dilemmas an Assimilative Therapy Model, can you tell me about the book and what the focus is?

PP: “The book is meant to help people learn how to think in an integrative manner. The book is broken up into two parts. First, the theoretical piece, the first chapter deals with what is integration. The second chapter is about context. The third chapter is about theories and concepts included in the Assimilative Family Therapy. The fourth, discusses the tools used in Assimilative Family Therapy and how it helps heal.

The second part is the exciting part of the book; it brings the four chapters to life with application to cases through the life cycle. The focus of the book is the modern family and I present grandparents parenting grandchildren and in the adolescent chapter and I offer an example of a military family dealing with adolescents acting out after deployment. Another chapter looks at a lesbian coming out to her family. In the couples’ chapter, I used the two worlds of struggles for working parents in trying to approximate intimacy and love in relationship. In the last chapter, I reviewed the struggles of the middle age caretakers caring for their elderly parents as well as themselves.

What is special about the book is that every session is accompanied by a session summary that describes how the home theory (Bowen Family Therapy) is utilized in formulating the therapy session and how other interventions and concepts are integrated with home theory. The therapy tools that are utilized are presented for each session. The session summaries helps readers understand how to think integratively .

At the end of each chapter is a treatment guide that discusses the goals of session, interventions and the outcomes. It makes it easy for the reader to understand and internalize how to be an integrationist from a family therapy perspective and utilize the AFT model in their practice.”

“What the book enables someone to do is to create their own assimilative model!”

MR: What is Assimilative Family Therapy Model?

PP: “Assimilative Family Therapy Model is where you have a home theory and you integrate concepts and interventions of other theories. I use Bowen Family Systems as my home theory and I use Psychodynamic, Cognitive Behavioral Therapy, Communications and other systems concepts.”

MR: Dr. Pitta, what is the difference between eclectic and integrationist?

PP: “An eclectic will go to a buffet and pick a tomato, potato, piece of meat, and maybe fruit and they may eat this and that. An integrationist will go a buffet and pick ingredients and smoosh them up and come up with a different dish. When they integrate the ingredients they come up with a different model. “ This example was presented by Norcross and Goldfried (l992).

MR: Can you explain what other theories you integrate with the Home Theory?

PP: “I integrate Psychodynamic Theory. I look at drive theory and how it affects one’s behaviors and I identify defenses: repetition compulsion, denial, doing and undoing, repression and distortion and how clients use these defenses to deal with the challenges and issues but only to be faced remaining stuck in their stance. I also look at Object Relations: splitting, projection, introjection and projective identification and how it influences how one looks at others and themselves in relation to the how they interact with the world. The use of Psychodynamic Play Therapy play symbols are helpful in affording children the ability to work through difficult feelings and thoughts allowing them the freedom to think, feel and act differently. In Behavioral, Cognitive and Cognitive Behavioral Therapy I look at concepts such as: cognitive relabeling, assertiveness training, relaxation therapy, role-play and modeling and behavioral parent training to offer clients the opportunity to change perceptions and behaviors to enable cognitive and behavior change. I integrate Communication Theory based on the work of Gottman and Associates. I integrate speaker-listener techniques which help clients learn how to communicate more effectively and enhance relationships and interactions. Leveling techniques are utilized to enable clients to edit what they say and to learn to think before they speak in order to learn to negotiate and communicate in a more effective manner. One of the important points of Gottman’s theory is that the ratio of negativity to positivity is that it predicts whether hurts and conflicts can be resolved and I incorporate the Sound House Theory. The components in the Sound House Theory are enhancing and building love maps, letting your partner influence you, emotional attunement.

In other systems interventions, I adopted reparenting the parents; you can do it in Couples Therapy or Individual Therapy. The therapist helps a person repair wounds from the past.

When you integrate a Cognitive Behavioral or Psychodynamic or Communications intervention with the home theory you make the intervention a lot more powerful than either of the separate parts standing on their own.”

MR: I know you mentioned Context is an important piece of Assimilative Family Therapy Model. Can you explain further?

PP: “Context is an envelope that contains client and therapist experiences, beliefs, attitudes prophecies, and descriptive characteristics. It is a foundation in how a client uses dilemmas and life history. Each individual is a product of his background and environments. How we perceive and interact with the world is largely influenced by his or her context.

I identified non-contextual variables a therapist needs to look at when evaluating and working with a client. These are, age, ethnicity, culture and racial background, sex gender, sexual orientation and marital status, socioeconomic level, resilience, attachment and emotional regulation, optimism, life state/life cycle, last is religion, spiritual affiliation, and belief.
Life experiences and context set a stage for who you are, how you think or how you affiliate, who you trust and messages you carry within. A therapist context can ___ the therapeutic environment or can promote growth.

Before the first session, a client gets a contextual and resistance questionnaire. In the contextual questionnaire, the client answers the question before going to session. The therapist can obtain a contextual diagram to have a good idea of who is coming in. Therapists are more empathetic and understanding of clients by understanding their context.”

MR: Dr. Pitta, you talk about resistance, what is resistance?

PP: “It is the level of the patient’s opposition to perceived efforts on the part of the therapist to control the client’s free behaviors. Levels of resistance are not permanent, they change. What I have done is created a resistance questionnaire that I give to the clients before they come in. It asks questions like; do you like to be told what to do when solving dilemmas? There are 10 questions and from that the therapist will get an idea if they will resistance or compliance.”

MR: You have identified contextual variables throughout the life cycle. Can you explain?

PP: “I have identified children/teens and look at trust, teens and power. A child has no other option than to trust their parents and as children get older they begin to questions their parents. Teens, I look at peers. Power, parents are very powerful and they have to share the power with their teens. I also look at a lesbian coming out to her family and look at heterosexism and micro aggression. In couples, I look at intimacy, search for the self in each other, trust and power. Parenting parents and caretaking spouses, I look at the state of family caregiver, the help of the caregiver, dealing with elderly and physically decline, manipulations, frustration and abuse, state of family function or dysfunction.”

MR: Can you talk about common factors and role in this model of treatment?

PP: “Common factors are viewed as a consistent thread underlying effective treatment. They are building blocks upon what theory is based. Building blocks are building a positive therapeutic alliance, enabling the client to view therapists as someone who knows how to help, the client committing and being motivated to work in therapy, and clients having hope, realistic expectation that can be helped and healed. Common factors go back to 1936.
Common factors in Assimilative Family Therapy, the therapist armed with the knowledge of multiple theories and ability to integrate according to the needs of the clients and presenting symptoms will enable client to make positive changes to help heal their dilemmas.”

MR: What is a genogram? How do you use it?

PP: “Genogram is done in the first session. It is a map of all the relationship that exist, the masked anxiety, triangles, fusion, differentiation, cutoffs. It tells the therapist what relationship aspects the client has. It allows the therapist to see patters, and see how patterns have been going on through generations. It helps normalize what the clients are currently experience and it gives the client a choice to change or to keep repeating the pattern.”

MR: Case conceptualization is a very important strategy in developing a successful and effective treatment. Can you explain how you use this concept in Assimilative Family Therapy?

PP: “Case conceptualization is like a lens of a camera. The lens offers a framework and blueprint on how to engage and work with clients and families. It offers a means to understand how a family and an individual develop and maintains problems. It is a way of summarizing diverse clinical information about a client and the family that identifies the client’s patter of interaction. It helps identify genesis of symptoms and the purposes served in the systems.

I created a case conceptualization questionnaire because it is hard for therapist to understand. The questionnaire will help therapists create their own case conceptualizations based on their theoretical background and understanding of context and common factors.”