Process of Family Therapy Flashcards
4 curative elements of therapy
- extratherapeutic factors (anything about clients and their environment that leads to change, like moving somewhere)
- therapy relationship (empathy, warmth, concern, adopting language of the family)
- expectancy, hope, placebo (assurance that therapy is useful and encouragement that the clients can make positive changes)
- model and technique (guide that directs, framework)
enhancers
increased ability to solve one’s own family problems, acceptance of one’s own contributions to family dysfunction, deeper appreciation of one’s own family, greater ability/desire to communicate effectively
common overemphases with new practitioners
- overemphasis on content over process
- overemphasis on making everyone happy
- overemphasis on verbal expression
- overemphasis on coming to an early/too easy resolution
- overemphasis on 1 family member (scapegoat)
redirection
therapist asks couple or family to attend to the process of their relationship rather than the content of it
common underemphases with new practitioners
- underemphasis on establishing structure
- underemphasis on showing care/concern
- underemphasis on engaging members in the process
- underemphasis on letting the family work out its own problems
- underemphasis on attending to nonverbal family dynamics
SOLER
S-Squarely facing the family (literally and metaphorically)
O-Open posture, non-defensive
L-Lean forward in direction of family to show interest
E-Eye contact (sometimes culturally, avoiding staring)
R-Relaxation, therapist must choose to remain relaxed
battle for initiative
Families must be motivated to make change. Ask:
How would it be if you were able to live in peace?
What do you really want from your family?
Case conceptualization: 3 Pre-session questions to ponder
- What happened? (form initial diagnosis)
- Why did it happen? (formulate clinical explanation of household dynamics)
- What can be done about it, and how? (devise clinical treatment plan)
joining
establishing a sense of trust between the therapist and all members of the family
frame
perception/opinion 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
family dance
the ways in which individuals in the family interact with one another (outward appearance, cognitive functioning, repetitive & nonproductive sequences, basic feeling state, roles that reinforce resistances, prevalent family defenses, subsystems, triangulation, etc.
subsystem
members who because of age or function are logically grouped together (such as parents, siblings)
triangulation
relieving tension between two family members by putting a 3rd member in where it should not be
enmeshment
overinvolvement physically or emotionally
distancing
isolated separateness
resistance
opposing treatment, usually through passive-agressive tendencies like attempting to control sessions, absent/silent members, refusal to talk with one another in session, hostility toward therapist, failure to do homework, lateness, denying reality, rationalizing, insisting on identifying one member as the problem, challenging the therapist’s competence
boundaries
therapist’s responsibility to set good boundaries and teach families to be good clients, rules for therapy (like being on time, no name calling, etc.)
reframing
the art of attributing different meaning to behavior so the behavior will be seen differently by the family
paradox
a form of treatment in which therapists give families permission to do what they were going to do anyway
homework
- helps families behave and feel differently
- intensifies relationship between therapist and family
- gives therapist opportunity to see how members relate to one another
clinical notes
should include impressions of both content and process from session
- can be studied over time to see patterns
- gives opportunity to be reflective and objective, resisting seductive lure to become a family member
- probe in specific ways by reminding families what was previously dealt with
getting the uninvolved member to participate
- ask him/her to be the “reporter” who summarizes the work done at the end of a session or gives feedback on interactions
- circular questioning
- use the power of the family as a group, invoking verbal and even physical pushing from them
circular questioning
procedure whereby the detached member is asked to give impressions about different interactions between family members
quid pro quo
contract to foster “payoffs” in relationships, where rewards are given for desired behavior
termination
- orientation (bringing it up before it happens)
- summarization (reviewing what has happened)
- discussion of long-term goals (focusing on future behaviors)
- follow-up and relapse prevention (informing families that family therapy is a never-ending process, open-ended)
*3-session termination process: setting the termination date, a next-to-the-last session, and final farewell session
(members share written wishes for each other, celebration of new family, funeral for old family’s dysfunctions)
Phases of treatment
1-inital session/s: joining, recognizing power in the family dynamics, setting boundaries, noticing coalitions, roles, rules, and patterns of communication (can be done in having the family describe a typical day for them), engender hope for positive change
2-middle phase: raising awareness of process issues, reorienting (changing what they’re doing)
3-termination: mutual agreement and a set plan for termination are best, follow-up appointment several months out can be scheduled as a check-up
reorienting (changing behavior)
perceptions, beliefs, values, and goals
structure and organization of the family
skills and social behavior of the family through teaching
changes in power balancing
