Chapter 7 - The Process of Family Therapy

Question 1

FOUR Common Factors in Therapy

Answer 1

• EXTRATHERAPEUTIC factors
• Therapy RELATIONSHIP factors
• EXPECTANCY, HOPE, AND PLACEBO
• MODEL AND TECHNIQUE

Question 2

FOUR Stressors for the Therapist

Answer 2

• DEPRESSION
• LESS TIME WITH FAMILY
• UNREALISTIC EXPECTATIONS OF ONE”S FAMILY
• PSYCHOLOGICAL DISTANCING from FAMILY due to professional status.

Question 3

Enhancers

Answer 3

• Increased ability to solve one’s family problems

• Acceptance of greater ability and desire to
communicate effectively

• Synergy between personal and professional life

Question 4

Common Problems of Being a Family
Therapist:

Overemphasis On:

Answer 4

• DETAILS
• PROCESS versus CONTENT
• REDIRECTION
• Making people HAPPY
• VERBAL expression
• Coming to an EARLY or too EASY resolution

•Dealing with one member of the family (i.e.,
SCAPEGOAT)

Question 5

Common Problems of Being a Family. .
Therapist:

10 Underemphasis Areas

Answer 5

• Establishing STRUCTURE
• Battle for STRUCTURE
• Professional DISCLOSURE statement
• INFORMED CONSENT BROCHURE
• SHOWING CARE & CONCERN
• Therapeutic PRESENCE
• SOLER: SQUARE, XXXX, LEANING, EYE CONTACT, RXXXX
• ENGAGING FAMILY MEMBERS
• BATTLE FOR INITIATIVE
• Attending to NONVERBAL family dynamics

Question 6

Pre-Session Planning and Tasks

Answer 6

• Obtain INFORMATION
• Establish ATMOSPHERE
• Evaluate INTAKE
• Form a PRELIM DIAGNOSIS of what is happening with the family

Question 7

Initial Session Themes:

Answer 7

• JOIN the family: Establishing rapport
• INQUIRE about members’ perceptions of the family
• OBSERVE family patterns/assess
• FAMILY DANCE
• SUBSYSTEMS
• TRIANGULATION
• EMESHMENT
• DISTANCING
• ASSESS NEED
• ENGENDER HOPE FOR CHANGE
• Make RETURN APPT
• RECORD impressions

Question 8

Middle Phase of Treatment

Answer 8

• Involve PERIPHERAL family members
• Seek to CONNECT family members
• Establish CONTRACTS and promote QUID PRO QUO
• EMPHASIZE THE CHANGE within the FAMILY system

• REINFORCE family members for trying new
behaviors

• Stay ACTIVE as a therapist
• Link family with appropriate OUTSIDE systems
• Focus on PROCESS
• Interject HUMOR when appropriate
• Look for EVIDENCE of CHANGE in the family

Question 9

Termination

Answer 9

• ORIENTATION
• SUMMARIZATION
• Discussion of LONG-TERM GOALS
• FOLLOW UP and RELAPSE

Question 10

Extratherapeutic factors (40%).

Answer 10

Anything about clients and their environment that leads to CHANGE

EXAMPLES: In a family this might be their moving to a new neighborhood, the death of someone who was abusive, a change in routine or in jobs, or the birth of a child.

Question 11

Therapy relationship factors (30%).

Answer 11

includes the relationship of the client’s family with the therapist and the therapist’s relationship with the family.

Relationships matter, and factors that help families and therapists bond include displaying empathy, warmth, and concern and adopting the language of the family.

Question 12

Expectancy, hope, and placebo factors (15%).

Answer 12

“When clients expect therapy to be helpful, it tends to be helpful” (Reiter, 2014, p. 17).

Client expectations are a common factor contributing to client change (Heafner, Kang, Ki, & Tambling, 2016). Therapists can promote family clients expectations by assuring them that therapy is useful and that they can make positive changes.

Question 13

Model and technique factors (15%).

Answer 13

the unique approaches that therapists use to help families change.

All of the approaches included in this book are effective in helping families make changes.

The particular model that a therapist uses is a guide that directs him or her in assisting the family in making positive changes.

Question 14

professional self-disclosure statement

Answer 14

Clients have both a right and a need to know about fees and payment schedules, theoretical frameworks and treatment approaches, rules about appointments, how and when they are allowed to contact the therapist, rules about confidentiality, and the therapist’s educational background and training

Gladding, Samuel T.. Family Therapy (p. 160). Pearson Education. Kindle Edition.

Question 15

informed consent brochure

Answer 15

This includes all the information in a self-disclosure statement,

1. the techniques and theories used by the family therapist,
2. the risks of therapy, and the limits of confidentiality (McCurdy & Murray, 2003).
3. family signs off that they understand the policies and procedures of therapy and consent to participate. They are given a copy of what they signed as a reminder.

Gladding, Samuel T.. Family Therapy (p. 160). Pearson Education. Kindle Edition.

Question 16

S

O

L

E

R

Answer 16

S = facing the client SQUARELY

O = OPEN POSTURE that is nondefensive, such as avoiding crossing one’s arms or legs

L = LEAN FORWARD forward in the direction of the client’s family, to show interest.

E = EYE CONTACT

R = RELAXATION.

Gladding, Samuel T.. Family Therapy (p. 162). Pearson Education. Kindle Edition.

Question 17

battle for initiative

Answer 17

This battle centers on the family becoming motivated to make changes. A family that does not see any benefit in altering its behaviors is likely to either drop out of therapy or simply go through the motions.

Gladding, Samuel T.. Family Therapy (p. 162). Pearson Education. Kindle Edition.

Question 18

Three pre-session questions:

Answer 18

What happened?” (in order to form an initial diagnosis). •

Why did it happen?” (in order to formulate a clinical explanation of household dynamics)

What can be done about it and how?” (in order to devise a clinical treatment plan)

Question 19

A frame

Answer 19

Bateson (1955)—is a

perception that organizes one’s interactions so that “at any given time certain events are more likely to occur and certain interpretations of what is going on are more likely to be made”

Gladding, Samuel T.. Family Therapy (p. 166). Pearson Education. Kindle Edition.

Question 20

subsystems

Answer 20

Almost all families have thaat is, members who because of age or function are logically grouped together, such as parents or siblings.

Question 21

triangulation

Answer 21

focused on as a way of relieving tension between two other family members. It is crucial for therapists to recognize and work through subsystems so that families can relate in a more open and healthy manner.

Gladding, Samuel T.. Family Therapy (p. 167). Pearson Education. Kindle Edition.

Question 22

enmeshmen

Answer 22

overinvolvement physically and/or psychologically

Question 23

distancing

Answer 23

isolated separateness, physically and/or psychologically occurs.

Gladding, Samuel T.. Family Therapy (p. 167). Pearson Education. Kindle Edition.

Question 24

resistance to treatment

Answer 24

“members attempting to control sessions, absent or silent members, refusal of family members to talk to each other in sessions, hostility, and failure to do homework” (Olkin, 1993, p. 33).

Other forms of resistance include being late to sessions, denying reality, rationalizing, insisting that one family member is the problem, and challenging the therapist’s competence.

If treatment is to be successful, family therapists have to understand the nature of resistance and overcome it without alienating family members.

Gladding, Samuel T.. Family Therapy (p. 168). Pearson Education. Kindle Edition.

Question 25

paradox

Answer 25

strategy in which therapists give families permission to do what they were going to do anyway

y
This type of directive allows a family to be more flexible in its responses and deal with matters in an open manner.

Gladding, Samuel T.. Family Therapy (p. 169). Pearson Education. Kindle Edition.

Question 26

circular questioning

Answer 26

In this procedure, the detached family member is asked to give his or her impressions about the different interactions of other family members.

The therapist might ask, “How does your father act when that happens? How does your mother respond?”

The process, in itself, elicits involvement and helps the family recognize the uniqueness of the individuals within it. Circular questioning “can and does trigger therapeutic change”

Gladding, Samuel T.. Family Therapy (p. 171). Pearson Education. Kindle Edition.