Accommodation in Couple and Family Therapy
Name of Concept
Accommodation broadly refers to the spontaneous way a system instinctively adapts to coordinate functioning (Nichols 2017). Accommodation has two distinct definitions within the field of marriage and family therapy. The first is defined through a structural lens and describes the techniques a therapist uses to make self-adjustments in order to successfully join with and understand a system’s functioning (Minuchin 1974). The purpose of accommodation in this context is to join with the system to create change.
The second application of accommodation describes the way family members change or adapt their behavior to decrease another family member’s emotional distress often reinforcing an individual’s maladaptive behavior (Calvocoressi et al. 1995). Within the family system, accommodation maintains maladaptive functioning and/or behaviors often through subliminal patterns of interaction. Family accommodations (FA) often maintain or increase maladaptive symptoms (Lebowitz et al. 2012).
Theoretical Context for Concept
Mapping the origins of accommodation is difficult due to the expansive nature of the term. The first time the concept was theorized was by Howard Giles to describe the phenomenon of changing the way one speaks depending on the person being spoken to (Swann et al. 2004). Although Giles’ accommodation theory is not a common reference of family therapy theory, its designation of the term to define the subconscious way humans adapt to one another serves as a foundation for how accommodation is conceptualized by psychologists and family therapists.
The construct of accommodation was first identified and defined by developmental psychologist, Jean Piaget. Piaget (1932) defined accommodation to describe a child’s ability to adapt their internal schemas to the changing world. Piaget’s accommodation similarly describes a type of inherent adaptation. However, Piaget’s theory focuses on the individual context as opposed to a systemic context. Thus, Piaget’s definition of accommodation is useful to understand one origin of the construct albeit an individualistic definition. Other theorists defined the construct within a relational context providing a more useful construct within family therapy.
Conversely, Minuchin developed a conceptualization of accommodation originating in his model of Structural Family Therapy. His perspective of accommodation progressed the term to encompass patterns of interaction. Minuchin advanced accommodation from merely linguistic, as suggested by Gilesor internal to interpersonal, as suggested by Piaget (1932) (Swann et al. 2004). Minuchin’s explanation of accommodation describes the way a system develops patterned transactions, or mutually influences ways in which members impact and monitor one other’s behavior (Minuchin 1974). With a systemic perspective, Minuchin applied the concept of accommodation to the therapeutic relationship, thus creating the technique of joining and accommodating.
Accommodation in family therapy refers to two specific concepts: (1) the therapist adjusting to a system’s style while functioning to successfully join and (2) the adapting of a family system by creating mutually influencing patterns to support one another’s functioning. Both applications of accommodation include adjusting behavior, whether intentional or involuntary. The distinction between the ways accommodation is conceptualized is critical to understanding its value to family and couple therapy.
In the therapeutic relationship, accommodation is a necessary step in approaching the alliance. In structural therapy (Minuchin 1974), joining and accommodating complement one another and, when used deliberately, can progress and expedite treatment. Minuchin (1974) describes this process of accommodation as a therapist’s adaptation to the family system through maintenance, tracking, and mimesis. Maintenance refers to the accommodation technique of deliberately supporting a family structure to create change; tracking describes the therapist’s accommodating technique of following the content and process of the system by asking clarifying questions, actively listening, and remaining interested in the system’s communication; and mimesis refers to human operations that are implicit and spontaneous such as a therapist adopting the language and style of a system (Minuchin 1974). Each of these accommodating techniques directly applies to family therapy.
In Cognitive Behavioral Therapy (CBT), the construct of accommodation is defined as a maintenance factor of child anxiety symptoms. Accommodation is the process by which family members reinforce avoidance behaviors of the anxious child resulting in the increase or maintenance of the child’s anxiety symptoms (Black 2017; Lebowitz et al. 2012). Within the CBT framework, accommodation is defined as maladaptive process as opposed to a therapeutic adaptive process, interaction that maintains and/or amplifies symptoms and family dysfunction.
Family accommodation (FA) appears differently across anxiety disorders and Obsessive-Compulsive Disorder (OCD), although it generally originates from a parent’s natural empathy toward their children’s distress. In children with social anxiety, separation anxiety, or other anxiety disorders, FA can take the form of a parent speaking for their child, allowing their child to stay home from school, or sleeping in their child’s bed. Accommodation becomes a problem when it maintains or amplifies a maladaptive symptom of a disorder. This usually means a parent is colluding with their child to avoid situations and/or objects that provoke anxiety. For children with OCD, parents accommodate by helping their child avoid triggering situations, participate in rituals, and provide reassurance, thus maintaining the avoidance behavior (Lebowitz et al. 2012).
Overall, accommodation describes a general pattern of sequences that influences the entire system, either the therapeutic system (as defined by Minchin) or the family system (as defined by Lebowitz et al. 2012). Accommodation is natural, inevitable, and typically occurs without much thought. Thus, family therapy aims to bring awareness to accommodation as both a therapeutic technique and a method of acknowledging maladaptive family patterns.
Application of Concept in Couple and Family Therapy
Accommodation refers to two different clinical applications: joining the family and identifying a specific maladaptive behavior pattern within a family dynamic. In the first application, refers to the joining process in family therapy, the family therapist adapts or mirrors the communication style and structure of a family. For structural therapists (Minuchin 1974), accommodation is mandatory and intentional. For those practicing a different, systemic model, noticing the way a therapist accommodates to the family system can facilitate joining and bring awareness to the process of building an alliance with each member of a family. Using the structural model, a therapist can join with a family or couple by accommodating, rather than challenging them (Minuchin 1974).
Family accommodation (FA) is also highly relevant to couple and family therapy, as it serves to conceptualize patterns of family behavior that maintain the identified patient’s presenting problem. FA can constrain systems either in times of change, such as when a family struggles to adapt to new circumstances, or when a parent colludes with a child’s symptoms of anxiety, OCD, or other diagnoses (Minuchin 1974; Lebowitz et al. 2012). FA exacerbates symptoms of some disorders and contradicts the empirically supported method of treatment for anxiety disorders such as exposure therapy (Merlo et al. 2009). Therefore, a family therapist can use their knowledge of accommodating behaviors to reduce symptom severity by interrupting the constraining pattern of FA. Family therapists can interrupt maladaptive patterns by teaching a family to recognize FA, demonstrating ways in which they can decrease FA such as with exposure techniques, and guiding them to manage symptoms without accommodating behaviors (Merlo et al. 2009).
A therapist works with Chris, the 13-year-old identified patient (IP) with a history of trauma, his new guardians, his biological father, Todd, and Todd’s partner, Joanna. Before the work began, the therapist accommodated through maintenance by validating Todd’s cause for concern and empathizing with Chris’s presenting problem of anger. In addition, the therapist immediately began to take note of the way the new family creates their patterns of interaction. In their third session, the therapist tracks a pattern where Joanna interrupts Todd when he is asked a direct question about Chris. Chris responds by scoffing at Joanna. In tracking this interaction, the therapist can begin to accommodate to the system and notice how the system functions. The therapist continues to accommodate when she notices how the family uses humor to manage discomfort. After Chris’s scoff towards Joanna, Todd makes a joke about the tension in the room, while Joanna and Chris join him in laughter. When the therapist notices this addition of humor, the therapist adapts through mimesis by spontaneously mirroring their style of humor and joins in the laughter.
An example of the second definition of accommodation is when a family member reinforces or maintains maladaptive symptoms within an individual or the family. For example, a therapist meets with Luisa, a 10-year-old identified patient (IP) experiencing OCD symptoms such as checking her locked doors and rereading homework assignments to a point where she feels out of control. The therapist works with Luisa and her family to understand how she may avoid experiencing distress by engaging in her specific rituals such as checking and rereading. After the therapist discusses this with the family, he notices how Luisa’s mother, Sue, seems unsure in their session. The therapist decides to meet with the parental subsystem separately and reflects his observation to Sue and her husband, John. John begins to nod his head in agreement with the therapist and says, “I think Sue has a hard time when she sees Luisa do her rituals so she helps her [Luisa] so they get done faster.” The therapist watches Sue as John says this and notices a tear roll down Sue’s cheek. John turns to her and says, “Sue, I can imagine it must be really difficult to see your daughter in such distress.” As Sue wipes tears and John rubs a hand on her back, Sue admits that she wants to reduce Luisa’s stress. Sue then goes on to acknowledge how her assistance in Luisa’s rituals reinforces her symptoms, finally seeing how Sue’s actions present as accommodation. Together, John and Sue agree to attempt new actions that reduce accommodation in their system.
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