MCFT 5000 Systemic Care Skills Notes.pdf

Doing Family Therapy Summarize the main points from the reading below Organize the above information into a chart Chapter 4 First Session Goals Build rapport Decide how you need to be Create new/deeper conversations Assess the problem and the family Change the emotional climate in the room Offer a...

Doing Family Therapy Summarize the main points from the reading below Organize the above information into a chart Chapter 4 First Session Goals Build rapport Decide how you need to be Create new/deeper conversations Assess the problem and the family Change the emotional climate in the room Offer a new view of the problem and a preliminary treatment plan Assign homework Build Rapport • Importance of Rapport: • Building rapport is crucial in family therapy as it creates a sense of safety and trust, enabling clients to engage in the therapeutic process. • Rapport is necessary for clients to open up, share their feelings, and work collaboratively with the therapist. • Techniques for Building Rapport: • Show courtesy by addressing everyone by name, making eye contact, and listening actively without interruptions. • Match body posture, tone, language, and perceptual systems to connect with clients on their level. • Be mindful of your dress to appear professional and make clients feel comfortable. • Be sensitive to cultural differences and show respect for the uniqueness of each family's values and beliefs. • Actively listen to clients, inviting them to explain more and acknowledging their emotions. • Clarify and set expectations, both at the macrolevel (overall goals and approach) and microlevel (how the therapy process unfolds), to ensure alignment between therapist and clients. • Listening and Feedback: • Actively listening to clients is a powerful means of building rapport, making them feel heard and understood. • Feedback provided during the therapy process can reinforce the therapist's competence and demonstrate understanding. • Customizing Approach: • Understanding past therapy experiences of clients can help tailor the therapist's approach, avoiding repeating negative experiences and building trust. • Clarifying expectations at both broad and speci c levels is essential to ensure clients know what to expect from therapy. Decide how you need to be • Tailoring Your Approach: It's essential to assess the emotional state of each family member and tailor your therapeutic approach accordingly. One-size- ts-all methods may not be effective, so you should adapt your style to match the emotional needs of each individual. • Transference Cues: Pay attention to how family members describe their past and present relationships. These descriptions offer insights into their emotional sensitivities and wounds. By avoiding actions that trigger these sensitivities and providing what they need most, you can create a safe therapeutic environment. • Parallel Process: Understand the concept of parallel process, which involves examining the emotional reactions and responses in the moment during therapy sessions. If a family member makes statements like, "He never listened to me," or "She doesn't understand how I feel," consider whether your own actions or words may have triggered these comments. Adjust your responses accordingly to maintain a positive therapeutic relationship. Addressing Patterns: If you notice recurring patterns in the family's interactions or comments, it's fi important to address them directly. Ask open-ended questions to explore these patterns and their fi • impact on the therapeutic process. This proactive approach helps identify potential issues in the clinical relationship and offers opportunities for correction and emotional healing. Example A family therapy session involves a family consisting of a father (Allen), a mother (Terry), and their son (Daniel). During the session, Allen expresses his anger and remains silent for much of the time. Terry, on the other hand, appears anxious. The therapist notices these emotional states and tailors their approach accordingly. - For Allen, who is angry and silent, the therapist acknowledges his anger and assures him that it's okay to feel that way. This approach aims to help Allen feel understood and accepted rather than pushing against his anger. - In Terry's case, the therapist recognizes her anxiety and attempts to reduce tension. The therapist may use humor or relaxation techniques to help Terry relax and feel more comfortable during the session. Create New / Deeper Conversations Main Points Description Examples Create New/Deeper - Instead of routine - Ask Allen to express worried feelings Conversations: assessment questions, engage about a break-in incident involving in meaningful dialogue. Daniel, creating a deeper conversation. Assessment and Treatment - Suggest Allen says something positive Simultaneously: to Daniel during a session. - Assess Allen's willingness to follow advice and its impact on family dynamics. Focusing on Basics: Tracking the Process: - Identify who in the family - Terry is worried about Brian, and has a speci c problem and Daniel is upset about school, laying the what it entails. groundwork for further exploration. - Monitor family interactions - Observe how Allen and Terry handle to uncover underlying issues. Daniel's behavior, noting differing parenting styles and addressing areas fi of disagreement. Going Where They Are Not: - Ask challenging questions Inquire if differing parenting styles are that might be uncomfortable affecting Allen and Terry's relationship but are essential for therapy. as a couple. Creating an Experience: - Actively involve the family - Help the family envision a different in the therapy process and future and counter their belief that challenge existing narratives. things will remain the same. Demonstrating Honesty and - Maintain honesty and Leadership: leadership throughout the session. - Ensure silences are not misinterpreted, fostering a sense of safety and trust within the family. - Emphasize safety during therapeutic silences. Additional Information: - Start treatment during the rst session by engaging in therapeutic conversations. - Simultaneously assess family dynamics and intervention effectiveness. - Address dysfunctional patterns and missing elements. - Encourage discussion of challenging topics. - Present therapy as an active process with the therapist providing leadership. - Maintain honesty and safety throughout the process. Assess the Problem and the Family • Deeper conversations serve as the starting point for treatment and assessment. • Family therapy involves shifting between information gathering and helping the family reach its goals. fi • The initial stage focuses on understanding the problem and developing a treatment plan. What keeps this family from solving these problems on their own? • The therapist's goal is to help families not only solve immediate issues but also learn to address problems independently • Assessment involves identifying individual and family learning problems and issues about learning, where emotions override skills. • Skills and emotional triggers are evaluated to uncover the source of dif culties. How well can the family members communicate with one another? • Effective communication is essential for problem-solving. • The therapist assesses the family's overall communication skills and styles. • Encourages individuals to regulate their emotions, avoid power struggles, and engage in productive conversations. What is the family’s emotional range? • Assessing the family's emotional range and expression is important. • Limited emotional ranges can lead to misinterpretations and misunderstandings. • The therapist observes emotional patterns within the family and helps expand emotional ranges. Are there cracks in the family structure? Using Bowen’s theory What is the family’s theory about the cause of their Assess family type problems? What are the individuals’ stuckpoints and mental health issues that keep family members from being fi “adult”? - Assess indivudal coping styles and obstacles that may get in the way of moving forward as a family - Mental health issues What are the family’s strengths? THe therapist should identify and articulate the family’s strengths, draw out stories of resiliency, and commend them for seeking help. - Observation and listening - Avoid becoming absorbed in the family’s content. - Maintain a frame for viewing their dynamics. - Provide leadership Scenario - assessing family’s emotional range Therapist: (Observing a family during a session) "I've noticed that when we discuss sensitive topics like your son's behavior, there's often a lot of anger and frustration in the room. Allen, you tend to express your frustration with raised voice, while Terry, you often get teary-eyed. Can you both tell me how you feel in these moments, and how do you typically respond to each other's emotions?" Allen: "I get so frustrated because I feel like Daniel's behavior is out of control, and it's hard for me not to yell." Terry: "When he raises his voice, it scares me, and I just start crying because I don't know what to do." Therapist: "Thank you for sharing that. It's important to understand these emotional reactions. Allen, it seems like you mainly express frustration and anger. Terry, you mentioned feeling scared and sad. Let's explore if there are other emotions beneath these reactions and if there are healthier ways to express them. Also, how does Daniel respond to these emotional moments?" In this scenario, the therapist observes the family's emotional expressions during discussions, encourages them to share their feelings, and begins to assess their emotional range. This assessment will help identify patterns and opportunities for expanding their emotional repertoire for more effective communication and problem-solving. Scenario - assessing individuals’ coping style In this scenario, Terry faces challenges in controlling her emotions, while Allen has dif culty dealing with con icts. These individual struggles not only affect their parenting and problem-solving skills but also contribute to the emotional atmosphere within the couple and the family. Furthermore, these issues may extend beyond their family life and potentially impact their relationships outside of the family, including fi fl their interactions at work or with others. Different types of family structures - Bowen’s Theory Healthy Family Structure: • Parents (P) on top with clear power and control. • Children (C) on the bottom with less power. • Solid line between adults and children, indicating a clear boundary. • Solid line between parents, showing a solid adult relationship. • Solid lines between children, indicating they can get along and support each other. Less Healthy Variations Problems Dissension between parents • Hierarchy is broken, and the child may feel entitled. • Other parent may seek solace or support Solutions • Parents should reconnect, and work as a team. • The child should return to a child role. elsewhere. Parent-Child Surrogate • Relationship • Vertical line between parents, indicating child should return to a child disengagement. role. One child aligned with a parent as a surrogate. • Hierarchy is broken, and the child may feel entitled. • Parents should reconnect, and Other parent may seek solace or support elsewhere. One-Down parent • • One parent alone and in Empower the one-down parent, charge, the other parent promote teamwork and a good with the children. adult relationship. Disempowered parent feels like a child. • Children treat the disempowered parent as a peer. • Possible ringleading by the disempowered parent against the other. Child-Run Family • No parent on top, a child • Bump the child down (usually a teen) • emotionally or physically incapacitated parents or running the family. involve authorities for entitled May be due to incapacitated parents or severe dysfunction. • • Provide support for Child sets the emotional tone, parents feel helpless, and the child feels entitled. behavior. List of Questions to ask Youself and the Clients Question Rationale Even though their styles may be different, Are they presenting a united front, and if do both parents agree on rules and not, where and what are the effects, and expectations for the children? Are there why? areas they dis- agree about? How do they handle them? Do they describe themselves as being Not only are they able to work together as polarized with one tend- ing to be more a team, but they are also aware of lenient because the other is so strict and whether or not they can do that, showing vice versa? self-awareness about the larger dynamic between them. Do the parents say they have no time for What is the quality of everyday life? Is each other, are child- or work-centered, or their couple relationship important seem disengaged from each other in the enough to make it a priority? If not, why room? Are they motivated and able to not? make time to do things together as a couple? How do the parents feel the children are Sometimes parents are overreacting to getting along with each other? How do the what may be more normal sibling rivalry. children feel they are getting along with At other times, the siblings are honestly each other? Are the children kind to each struggling with each other and feel they other, or do they bicker or jockey for have no support from the parents or parent attention? parent. How well the siblings interact not only lets you know if one child is feeling more neglected or one child is more favored, but also is a barometer of the overall state of the parents and the family . Do one parent and the children gang up The structural problem, where one parent against the other par- ent? is unempowered and sides with the children against the other parent. Is there one child who is driving the Is one child entitled, or are the parents session process, and the parents seem struggling to manage their everyday lives. unable to contain her? Common Family Presentation What is the Family’s Theory About the Cause of Their Problems? Family Presentation Characteristics Parent Expectations Goals for Therapy What Not to Do "Fix-My-Child" - Identi ed child struggling - Expect individual child - Help parents see their role - Do only Parents therapy in the issue, engage them individual therapy with the child Enmeshed vs. Disengaged Parents - Family impacted - Expect the child to be - Change parents' - One overly involved parent - Enmeshed: Help with - Improve the parental " xed" uninvolved parent perspective, empower them relationship, create unity - Replicate family polarization in therapy - One distant and aloof - Disengaged: Encourage - Change roles, promote - Side with one Overwhelmed Single - Chaotic, little structure - Expect assessment, - Empower the parent, skill - Take over and Transitional Family - Disciplinarian leaves - Expect to rein in entitled - Develop limit-setting skills, - Replace the parent Parent less strictness structure, rule enforcement child - Oldest child becomes - Reactive, "us versus the world" building, reduce chaos facilitate grief parent rescue the parent missing parent's role - Help entitled child nd a entitled Crisis Family support and boundaries healthier role - Expect help with current crisis - Build trust, proactive problem-solving - Create dependency, replicate reactive role Referred/No- Problem Family - Mandated therapy, resistant - Believe no problem, oppose therapy - Clarify your role, explore concerns, nd goals - Enforce the referring agency's stance Changing the Emotional Climate Therapists should aim to intentionally change the emotional climate within the therapy room to create new experiences for family members and alter their perspectives and moods. • Therapeutic Performance: Viewing therapy as a performance allows therapists to be deliberate and proactive in shaping the impression they make and the emotional climate in the room. • Noting and Responding to Transference Cues: Therapists should pay attention to transference fi fi fi fi cues to avoid triggering old wounds and replicate dysfunctional patterns in family dynamics. • Tapping into Softer Emotions through Content: Therapists can change the emotional climate by uncovering and addressing softer emotions like worry, fear, and sadness that often lie beneath the surface, replacing harder emotions like anger and frustration. • Tapping into Softer Emotions through Nonverbal Cues: Nonverbal cues, such as body language and gestures, can also help therapists access and address softer emotions in family members. • Using Voice and Gestures: Deliberately modulating voice tone and body language can help therapists convey empathy and match the emotional tone in the room. • Educational Speeches: Therapists can provide informative speeches to help families see their problems in a new light, offering explanations and insights that reduce anxiety and offer hope. • Enactments: Staging speci c conversations between family members on important topics can break old patterns, unlock new emotions, and gauge their ability to try something new. • Family Sculpture: An experiential event like a family sculpture can be used to represent the family's dynamics and ideal states, fostering emotional exploration and expression. • Interpretation and Insight: Therapists can provide insight into family members' behavior by connecting it to their past experiences or patterns, helping them gain a new perspective. Offer a New View of the Problem and a Preliminary Treatment Plan The therapist is preparing to conclude the therapy session by offering a new perspective on the problem and presenting a preliminary treatment plan to the family. This involves summarizing the key points discussed during the session and suggesting a course of action based on the information gathered and observations made. Examples of summary statements and treatment plan suggestions are provided in the text: Concern/Issue Summary Statement Preliminary Treatment Plan Child's Bedtime - Parents' concern about - Suggest implementing a structured Issue daughter's sleep dif culties. bedtime routine. - Include calming activities like reading books. - Collaboratively create the routine in the fi fi next session. Child's Schoolwork Struggles - Parents' worry about child's - Recommend discussing the issue with the schoolwork. teacher and involving the school - Child's dif culty paying psychologist for testing. - Offer assistance in communicating with attention and understanding the teacher. Family Con icts the teacher or psychologist. - Emphasize the importance of stopping - Family's ability to express feelings but quick escalation of arguments. - Propose an agreement not to argue for the arguments. week. - Encourage writing down concerns for discussion in the next session. Child's Separation Anxiety - Child's anxiety about school due - Plan to play and talk with the child in the to the mother's illnes next session. - Identi cation of separation - Arrange a meeting with both parents to anxiety. develop anxiety-reduction strategies. Examples of Summary Statements: - “So you are both worried about your daughter having trouble fall- ing asleep at night. Because of your changing work schedules, it also sounds as if you both are handling bedtimes differently. One of the things that are helpful for children your daughter’s age is to have a set bedtime routine. The structure of it and the inclusion of winding-down activities, like reading books, can help her relax. I’d like you to both think about a bedtime routine that you think you both could manage and we can map it out together next week. How does that sound?” - You all did a great job describing how you feel and, though a lot of the problems seem to be between dad and Jake, it affects you all. We can use our sessions to work on these problems, but I’m most worried about how quickly the arguments between you two esca- late. The rst step is stopping these arguments. What I’d like you to do is agree not to argue this week, and when things come up that bother you, write them down and we’ll talk about them here next week. Are you both willing to do fi fl fi fi that?” Assign Homework • Homework as an Integral Part of Therapy: Homework is a crucial component of family therapy sessions and goes beyond the stereotype of therapy just being a weekly conversation. It involves active steps to initiate change. • Accelerating Treatment Process: Homework accelerates the treatment process by allowing clients to practice new skills and behaviors outside the therapist's of ce. It maintains the momentum created during the session. • Testing Family's Motivation: Homework serves as a test of the family's motivation and willingness to implement changes at home. It helps therapists gauge the family's commitment to the therapeutic process. • Identifying What Works and What Doesn't: Homework assignments help therapists identify what strategies or interventions are effective and where the change process may break down. This feedback informs subsequent sessions. • Clarity and Achievability: Homework assignments should be clear, concrete, and achievable. Especially in the rst session, they should not be overly complex. Assignments may involve tasks such as discussions, observations, or tracking speci c behaviors or emotions. • Warm-Up Exercises: Homework assignments can serve as warm-up exercises to help clients fi fi fi become proactive, assess their readiness for change, and step outside their usual comfort zones. Chapter 3 The Basic Seven Determine what is the problem / separate means and ends Think adult Look for what’s missing, go where they’re not Block the dysfunctional patterns Track the process Create an experience, apply the brake Be honest Determine what is the problem / seaparte means and ends Main Points Description Clear Problem De nition - Clients should articulate their problems precisely to make them solvable. Identifying the Problem - The person who perceives a problem is responsible for solving it. - Therapists should not take sides or enforce the existence of a problem but Enforcer facilitate conversations. Uncovering the Problem - Explore deeper concerns motivating behavior and identify the true source Under the Problem of the problem. Separating Means and - Therapy is a means to an end, not an end itself; focus on overarching Ends goals rather than arguments over means. Linking Problems and - Show how individual problems are interconnected, creating dysfunctional Patterns patterns within the family. Collapsing Separate - Recognize that seemingly separate problems may share a common Problems underlying issue, allowing for simultaneous resolution. Developing a Therapeutic - Use clear problem identi cation and means-ends separation to de ne Contract therapy focus and guide treatment planning. fi Avoiding the Role of fi fi Owner Monitoring Progress - Return to problem clarity and means-ends separation when feeling overwhelmed or when clients struggle with the plan. Think Adult In this section, the author discusses the importance of assessing the psychological health of family members by comparing their behaviors and skills against healthy standards, particularly Murray Bowen's concept of self-differentiation and the adult stance. The adult stance is characterized by emotional calmness, self-observation and adaptability in relationships, viewing others with compassion, not reacting to others' negative emotions, making assertive choices, focusing on personal responsibility, and being thoughtful in decision-making and problem-solving. The author emphasizes the value of evaluating clients based on their adherence to this adult model to identify problems and challenges in their coping styles and emotional behaviors. Application of "Thinking Adult" in Family Example Situation Therapy 1. Con ict-Averse A parent who avoids con ict The therapist helps the parent address their Parent and accommodates their fear of con ict and become more assertive in family members. family interactions to improve family dynamics. 2. Perfectionistic A teenager who is self-critical The therapist assists the teen in recognizing Teen and perfectionistic. that perfectionism is the core issue and helps reduce anxiety related to striving for perfection. 3. Emotionally A couple that frequently The therapist guides the couple to understand Reactive Couple engages in emotional that managing their emotions is the primary arguments and struggles to challenge. By learning to control emotions, they regulate their emotions. can enhance con ict resolution and relationship progress. Look for what’s missing, go where they’re not Main Points Details Think Like Sherlock - Family therapists should observe what is missing in therapy sessions. fl fl fl fl Holmes Microlevel Awareness - Look for missing behaviors, emotions, and unspoken topics during sessions. Uncover Absent - Solutions to family problems often lie in unaddressed emotions and stories. Emotions and Stories Challenging Clients - Therapists should challenge clients to explore missing elements, ask tough questions, and guide conversations to uncomfortable places. Stirring the Pot - By moving families away from their comfort zones, therapists create opportunities for deeper conversations and change. Training Your - Therapists can enhance their ability to spot what's missing by actively Perception listening and anticipating what should be present. Being a Change Agent - Therapists serve as change agents and guides, helping families address what they've been avoiding or missing. Staying Focused - In challenging sessions, therapists can refocus by looking for what's missing in the room or revisiting identi ed gaps in family dynamics. Block the dysfunctional pattern Description Dysfunctional Dysfunctional patterns within a family are the central focus of family therapy Patterns are Central and complement what is not seen. Allow Patterns to During the initial session, therapists provide space for families to tell their stories Unfold and observe the dysfunctional patterns as they emerge. Identify and Block After recognizing the pattern, therapists block it by interrupting the dysfunctional the Pattern pattern, encouraging the family to interact differently. No Need for Perfect Therapists don't need a perfect replacement pattern; the goal is to create Replacement disruption that prompts the family to engage differently. Encourage Change By consistently blocking the dysfunctional pattern, therapists motivate the family through Blocking to explore new ways of relating, fostering an opportunity for change. Facilitate Self- With the therapist's guidance over time, family members can learn to recognize Recognition the dysfunctional pattern themselves. fi Main Points Develop Pattern Therapists can improve their ability to identify patterns by observing therapy Awareness sessions, movies, or real-life family gatherings. Track the process Main Points Details Importance of Tracking the - Avoid getting lost in content details. Process - Detect and work with patterns. - Guide and shape the unfolding therapy process. Content and Process - Content and process run alongside each other. Relationship - Observing the interplay between words, emotions, and intent. Tracking Methods - Use questions and statements to track the process. - Shift clients' focus from meaningless content to meaningful, honest content. Resistance and Challenges - Initial resistance from clients when pointing out mismatches. - Stick with the process to promote self-awareness and change. Staying in Lockstep with the - Ensure agreement and alignment with the family.| Family - Correct process deviations promptly. Addressing Out-of-Step - Repair missteps in interactions and relationships Moments - Tackle problems and misunderstandings as they occur. Bene ts of Tracking - Therapy stays on course, and clients learn to confront problems effectively. - Avoid falling into stale patterns of behavior. Courage and Persistence - Turn up the corners of content to uncover underlying issues. - Confront dif cult questions and resist the urge to defer them. Conclusion - Stay with the process, move forward, and openly address what you see. Create an experience, apply the brake • Identifying the Problem: • Clients often present with speci c issues or behaviors, but it's important to dig deeper to fi fi fi identify the underlying problems. Asking questions and exploring emotions can reveal hidden issues. For example, a child's • behavioral problems might be connected to unresolved grief. Crafting Experiences: • • Therapy is experiential, where emotions are stirred, experienced, and sometimes changed. • Actively creating therapeutic experiences, such as exploring grief or using art in therapy, can help clients connect with their emotions and provide opportunities for healing and change. Balancing Experience and Explanation: • • Experience is like the gas pedal, driving emotional engagement and change. • Explanation is the brake, providing context and understanding. • Balancing the two is essential; too much experience can be overwhelming, while too much explanation may sti e emotional expression. Modulating Anxiety: • • Therapy involves modulating anxiety levels for both the therapist and the family. • The goal is to navigate the tightrope of anxiety, using experience as the walking challenge and explanation as the balancing pole. Explanation can help manage anxiety when needed, but it should not overshadow the • therapeutic experience. Be Honest Honesty as Central: • • Honesty is the foundational element that runs through all seven skills of family therapy. • It is crucial for maintaining the right direction, leadership, problem de nition, process tracking, pattern recognition, and exploration of what's missing. Admitting Uncertainty: • • Honesty includes admitting when things have gone off course, when you're unsure of the situation, or when you've made a mistake. • Openly acknowledging confusion and the need to regroup keeps you responsible and authentic. Leadership and Authenticity: • • Leadership in family therapy isn't about having all the answers; it's about guiding the fi fl process and patterns. fi • Being honest and authentic in your interactions encourages the same from the family members. • Value of Integrity: • Honesty aligns with values, principles, and philosophies that emphasize integrity and matching words, actions, and emotions. • Encouraging honesty in the therapeutic setting is a fundamental aspect of therapy. • Guidelines for Practitioners: • The reading emphasizes that family therapists should not feel pressured to have all the answers but should instead collaborate with the family to explore and address issues. • The seven skills are tools to maintain therapeutic progress and personal integrity in the eld of family therapy.