Basic Techniques of Family Therapy

1. Basic Techniques of Family Therapy Aida Mahmud Psychology 660 2.3.10

2. The First Interview Goals: Build an alliance with the family Come up with a hypothesis to the problem Gather information and create a report

3. First Session Agenda: Introduce yourself Ask parents to introduce their children Orient family to the room Point out the caller’s initial report and ask each member’s opinion Create an alliance with the members by ensuring each member will get an opportunity to be heard Ask the members how they felt about coming to therapy Become familiarized with each members accomplishments and interests. Emphasize on family goals and strength's to motivate for future appointments. Some therapists like to get a family genogram while others like to focus at the problem at hand and believe that history will rise through out the sessions. Have members come up with solutions and if they have tried some “the solution could be a part of the problem.” Some conflicts may arise due to fact that the members don’t adapt to different life cycles. Ultimately we want family members to relate to each other which can be accomplished by: Asking process or circular questions Structural therapy Some therapists like to get a family genogram while others like to focus at the problem at hand and believe that history will rise through out the sessions. Have members come up with solutions and if they have tried some “the solution could be a part of the problem.” Some conflicts may arise due to fact that the members don’t adapt to different life cycles. Ultimately we want family members to relate to each other which can be accomplished by: Asking process or circular questions Structural therapy

4. Early phase of treatment Identify major conflicts and bring them into the consulting room. Develop a hypothesis and have the family formulating it through process and structure, family rules, triangles, and boundaries. Focus on primary problem and interpersonal relations supporting it, while not loosing sight of the constructive interaction Assign homework and give the reasoning behind it. Challenge family members to see their roles in the problem and push for CHANGE in and out of the sessions. Use a supervisor if validity is needed for the formulation of the therapy. Push for change if one wants to see positive results Effective family therapy addresses interpersonal conflict. Michael White suggested the problem saturated stores Phil Guerin suggested that families stop blaming each other and start looking at themselves Virginia Goldner suggested that violent men take responsibility for their behaviorPush for change if one wants to see positive results Effective family therapy addresses interpersonal conflict. Michael White suggested the problem saturated stores Phil Guerin suggested that families stop blaming each other and start looking at themselves Virginia Goldner suggested that violent men take responsibility for their behavior

5. Discussion: Do you think taking a thorough history of the family is necessary during the early phases of treatment? How does background exploration contribute to a direct/indirect style of therapy?

6. The Middle Phase of Treatment Use intensity to challenge family members, ingenuity to get around resistance, and empathy to get underneath defensiveness Avoid directiveness in order for the family not to loose the sense of relating to one another. Foster individual responsibility and mutual understanding Make sure improvement in relationships is related to the problem at hand. Don’t loose focus of the who family as a whole in subgroups as well as not loosing focus of individuals in a family. Family members learn to deal constructively with one another while the therapist is more of a silent player at this stage. To decrease the anxiety, the patients cold direct their conversation to the therapist or learn to talk to one another in a less defensive form. Family members learn to deal constructively with one another while the therapist is more of a silent player at this stage. To decrease the anxiety, the patients cold direct their conversation to the therapist or learn to talk to one another in a less defensive form.

7. Termination Has the presenting problem improved? Is the family satisfied with their achievement or would they like to continue with therapy? Does the family understand what was going on and know how to avoid similar situations in the future? Do minor setbacks mean that therapy was a waste of time? Has the family’s relationship improved outside of the context as well as within the family? Termination occurs when the family is satisfied with the result and that they have a solution to their problem that made them come in the first place. sign of termination is when the family has nothing else to talk about besides having small talks during therapy. It is good to find out what each member has learned in therapy as well as what they are doing to bring about CHANGE in their lives. Follow up by the therapist after termination is a good idea. Termination occurs when the family is satisfied with the result and that they have a solution to their problem that made them come in the first place. sign of termination is when the family has nothing else to talk about besides having small talks during therapy. It is good to find out what each member has learned in therapy as well as what they are doing to bring about CHANGE in their lives. Follow up by the therapist after termination is a good idea.

8. Create alliance by showing: Calmness: shows confidence and portrays that any unsolvable problem is solvable. Curiosity: implies that you don’t have the answer to every question Empathy: gives them the impression that you know what they are going through. Respect: treating clients as equals and not patronizing them. Being honest to them. Types of children: Inhibited: fear of family disapproval, will sit quietly and afraid to play. Aggressive: will attack toys and play aggressively Anxious: flit around the room, unable to choose one thing. Enmeshed: introduces him/her self into the parent’s problems.

9. Family Assessment Bowenians: three generational genogram Psychoanalysts: through personal histories Behaviorists: a variety of questionnaires and checklist Solution focused and narrative therapists: formal evaluation. When there is a problem, some families just deal with it and have a preconceived solution of getting by rather than coming up with a solution. Each member should have opportunity to express their feelings, viewpoint and perspective When there is a problem, some families just deal with it and have a preconceived solution of getting by rather than coming up with a solutionWhen there is a problem, some families just deal with it and have a preconceived solution of getting by rather than coming up with a solution

10. Family Assessment Its not the problem that’s the problem; it’s the family’s inability to solve it Family therapist needs to move families from linear and medical model thinking to an interactional perspective. Movement from intrapsychic to interpersonal Explore the scope of the presenting problem, looking for alternative possibilities Explore the strengths as well as deficits of the identified patient Explore how other people respond to the identified patient and his or her symptoms.

11. Family Assessment Therapists need to show curiosity about that particular family to show that they care. Therapist needs to explore the family’s attempts to deal with the problem. There needs to be a shift from linear to circular thinking to expand the focus from individual to patterns of interaction, as well as moving away from cause and effect explanations. Circular thinking suggest that problems are sustained by an ongoing series of actions and reactions. Circular thinking suggest that problems are sustained by an ongoing series of actions and reactions.

12. Understanding the Referral Route It is important to know who referred the patients and whether or not they are seeing someone else, or whether they are a part of another treatment Identifying the Systemic Context A therapist needs to get a better understanding of the systemic context that is involved with a family or a problem in order to better guide the sessions and help out the family resolve their differences. The context may include the class mates, friends, co-workers,… since being in the process of several treatments could cause more problems or if they have seen other therapists in the past. since being in the process of several treatments could cause more problems or if they have seen other therapists in the past.

13. Stage of the Life Cycle Always consider life cycle while formulating a case since there is a reason why the family has chosen that particular time in their life to seek therapy. There are always some major changes in a family’s life that could be the reason why some of the members are having a harder time adjusting. There are always some major changes in a family’s life that could be the reason why some of the members are having a harder time adjusting.

14. Family Structure As a therapist, it is always important to understand the family structure and what the subsystems are as well as the nature of the boundaries that is created among them. Enmeshed family: parents always interfere in conflict among siblings that they never get to negotiate themselves Disengaged families: parents don’t get involved to an extent where they can’t even show sympathy and support the children’s feelings.

15. Communication “It’s unlikely that conflicts will get solved before people start to listen to each other” “Family members who learn to listen to each other with understanding often discover that they don’t need to change each other”

16. Drug and Alcohol Abuse Substance abuse is common with those who are depressed or anxious which is associated with violence, abuse and accidents. It’s critical to find out if there are any substance abuse, which can shift the nature of the therapy.

17. Domestic Violence and child Abuse The process of questioning if there is a suspicion of abuse could begin with the family present, but it is wise to meet with each member individually in order for them to feel free to talk openly. Therapist could jeopardize the alliance that he/she has been making with the client, but at times, therapy needs to take second place next to safety. As a therapist, if there is a case of abuse, they have to report it, but the therapist needs to make sure of that factAs a therapist, if there is a case of abuse, they have to report it, but the therapist needs to make sure of that fact

18. Domestic Violence and Child Abuse Some signs of abuse could be sleep disturbance, encopresis, enuresis, abdominal pain, exaggerated startle response, appetite disturbance, sudden unexplained changes in behavior, overly sexualized behavior, regressive e behavior, suicidal thoughts or running away. If a case is suspicious, it is better to notify the supervisors or refer to a therapist who is experienced in cases of child abuse.

19. Extramarital Involvements Affairs are a crisis where it can destroy a marriage. Couples normally go to third parties to deal with issues which can make therapy less effective.

20. Gender Issues One should look at: “do the gender roles established in a couple seem to work for them or do unresolved differences, conflict, or confusion appear to be sources of stress? How does each partner experience the fairness of give and take in the relationship? Men typically value independence and try to avoid anything that will take that independence from them. Family dynamics influences gender socialization. Gender differences underline relationship problems. “unrecognized gender inequalities contribute to family problems in a variety of ways” “unrecognized gender inequalities contribute to family problems in a variety of ways”

21. Cultural Factors In therapy, the subculture of each client/patient needs to be experienced in order for the therapist to create a cultural sensitivity “it’s more important to be respectful of differences and curious about other ways of doing things than to attempt to become an expert on ethnicity.” if necessary, the therapist should attempt to make connections after working hours to get a better feeling of that family’s origin. It is always a good idea for the therapist to ask the client to teach him/her about their culture since it gives the patient a sense care coming from the therapist. It may be difficult for the practitioner to learn to respect diversity and developing sensitivity to some of the issues faced by members of other cultures. if necessary, the therapist should attempt to make connections after working hours to get a better feeling of that family’s origin. It is always a good idea for the therapist to ask the client to teach him/her about their culture since it gives the patient a sense care coming from the therapist. It may be difficult for the practitioner to learn to respect diversity and developing sensitivity to some of the issues faced by members of other cultures.

22. The Ethical Dimension Therapy is for the client’s benefit and not for the therapist to work on unsolved issues Clients are entitled to confidentiality (can’t tell parents, spouse, …) Avoid dual relationship Need to provide the best possible treatment, and if they are unable to do so, they must refer the patient to another therapist. Therapist (psychologist) should provide services in their area of expertise and based on their education and training. Psychologists need to take drastic measures when personal problems interfere with professional duties. There are a set of ethical codes and rules that each therapist MUST abide by. EXThere are a set of ethical codes and rules that each therapist MUST abide by. EX

23. The Ethical Dimension Need to be trained in age, gender, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, socioeconomic status and many other areas to provide appropriate treatment and if not, they need to refer the client to those familiar in those areas. “marriage and family therapists assist persons in obtaining other therapeutic services if a marriage and family therapist is unable or unwilling, for appropriate reasons to see a person who has requested professional help. “marriage and family therapist do not abandon or neglect clients in treatment without making reasonable arrangements for the continuation of such treatment.”

24. Similar Ethical Codes in Social Work No dual relationship with current or past clients should not solicit private info from client unless its necessary for their services Should not disclose information unless such disclosure is authorized Should terminate services when are no longer needed.

25. Flags for Unethical Practice Specialness- special case Attraction- not necessary sexual but could be impressed with status Alterations in the therapeutic frame- longer sessions Violating clinical norms- not reporting special cases or referring Professional isolation- not consulting professional colleagues When a therapist is stuck in a therapy session, it is important for them consider the contributions of individual psychopathology, psychodynamics. When a therapist is stuck in a therapy session, it is important for them consider the contributions of individual psychopathology, psychodynamics.

26. Family therapy with specific presenting problems

27. Marital Violence A prevailing paradigm is to separate the couple and assign the offender to anger management or intervention programs while providing the partner with battered women’s treatment. Michael Johnson: 1.) patriarchal terrorism which is part of a pattern in which violence is used to exercise control over the partner which escalades over time. 2.) common couple violence is when violence erupts as a response to a particular conflict, and is more likely to be mutual and infrequent where the trends do not escalade. allows the therapist to ask the woman if she has kept anything a secret on the level of the violence In these cases, couples therapy is dangerous, while seeing them together allows you to see their interaction. allows the therapist to ask the woman if she has kept anything a secret on the level of the violence In these cases, couples therapy is dangerous, while seeing them together allows you to see their interaction.

28. Marital Violence These types of couples in therapy are stuck between love and hate, blaming and feeling ashamed, wanting to escape and remaining obsessed with each other. Need to inquire about drinking and drug use. “therapeutic safety zone”= zero tolerance for violence Therapist needs to make them think, ask for specific and concrete details. The therapeutic task is to hold the man accountable for his violence, while also trying to understand him in complex and sympathetic terms. Taking time out is an employed strategy Both sides need to learn to speak up and listen to each other Need to explore dialogues for communication, yet the couple tend to be emotionally reactive therefore they need to take turns to talk to the therapist.Need to explore dialogues for communication, yet the couple tend to be emotionally reactive therefore they need to take turns to talk to the therapist.

29. Sexual Abuse of Children Goals: ensure that the abuse doesn’t recur reduce the long-term effects of the trauma. establish a support system to break through the isolation that facilitates abuse and inhibits disclosure Treatments Child protective approach- undermine the integrity of the family Family system approach- fails to protect the child Assessment of sexual abuse is often complicated by conflicting stories Assessment of sexual abuse is often complicated by conflicting stories

30. Things To Do Priority should be given to restricting unsupervised access to children for the offender. a careful assessment that uncovers other possible incidents of abuse or patterns of inappropriate sexual expression. create a safe forum to explore his/her complex and ambivalent feelings about what happened. A combination of individual and conjoint sessions helps to make a safe to talk environment It is important to let the child decide when and how much they want to open. They need to recover a sense of control over their lives. Family sessions should be geared toward increasing support for the victimized child, which may entail strengthening the parental unit. The child may feel guilty about getting an adult in trouble. Family sessions should be geared toward increasing support for the victimized child, which may entail strengthening the parental unit. The child may feel guilty about getting an adult in trouble.

31. Discussion: ultimately in a case of child sexual abuse, the family is responsible for the child. Do you believe this is the best way to handle the situation (allow the abusive parents decide what is good for their child)?

32. Working with Managed Care Remember to work WITH case managers, not against them.

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