What s the Main Issue Here?

Transcription

1 What s the Main Issue Here? Assessing Families with a Multimodal/Multi-Method Perspective W. Bryce Hagedorn, PhD, LMHC, NCC, MAC What is an Assessment? A method to measure characteristics of people, programs, or objects Evaluates typical performances, behaviors or qualities A process involving the use of to bring the issue into focus One instrument is not a substitute for a thorough psycho-social assessment The / approach Why use an Assessment? Assessment IS an intervention Helps family members see what is occurring within the family system Encourages new behaviors just by asking about nonproductive and outdated behavioral patterns Suggests hope and Amplifies strengths and accomplishments MHS

2 Why Use an Assessment? Helps move families out of linear thinking He s acting out is because he has ADHD If you had her life, you would act that way too If you had her for your wife, you d need a drink to help you make it through a day It all comes down to the finances he always has to save every penny! Best practices Helps therapists understand & respond appropriately to client families Methods of Assessment Formal Methods Questionnaires/Instruments More than 1,000 assessment instruments Some therapists are reluctant to use these because they and/or feel that it removes them from Commonly measure: Family members attitudes, values, roles, selfperceptions, and satisfactions with family relationships Formal Assessments Family Therapy Instruments Family-of-Origin Scale Personal Authority in Family System Questionnaire Family Adaptability & Cohesion Evaluation Scale III Family Inventory of Life Events & Changes Family Environment Scale Family Assessment Device Family Strengths Scale Family Coping Strategies Scale Self-Report Family Inventory MHS

3 Formal Assessments Marital Therapy Instruments Locke-Wallace Marital Adjustment Test PREPARE/ENRICH Bienvenu Marital Communication Inventory Dyadic Adjustment Scale Marital Coping Questionnaire Primary Communication Inventory Marital Satisfaction Inventory Marital Instability Inventory Dyadic Trust Scale Marital Problem-Solving Scale Couple Rating Scale Methods of Assessment.. Informal Methods Observational Measures Objective outsider measures family functioning Couples Creativity Assessment Tasks Family Assessment Form Diagnostic Interviews Genograms Direct observation Other Structured Interviews (The Clinical Family Assessment Interview) Assessment Helps Assessment helps to describe the BIGGER picture and helps parents see the acting out behavior within the context of the family system When Sara gets whiny and gets mom and dad s attention, Billy acts out Who does what etc. MHS

4 Outcomes of the Assessment Process Can I get paid? Marriage & family therapy field has been by the medical model of DSM V codes not attributable to mental disorders Global Assessment of Relational Functioning Scale ( ) Analogous to GAF Indicates the overall functioning of family on a continuum from competent to dysfunctional The World According to GARF Relational unit functioning satisfactorily from self-report of participants and from perspectives of observers. Functioning of relational unit is somewhat unsatisfactory. Over a period of time, many but not all difficulties are resolved without complaints. Relational unit has occasional times of satisfying and competent functioning together, but clearly dysfunctional, unsatisfying relationships tend to predominate. Relational unit is obviously and seriously dysfunctional; forms and time periods of satisfactory relating are rare. Relational unit has become too dysfunctional to retain continuity of contact and attachment. Clinical Family Assessment Either one long session or over the course of Involves the family Major goals of the Assessment Interview To understand the unhealthy dynamics in the family system To confront pathological behaviors within the system To engender insight related to self- and other s interactions To promote healthy, systems-oriented change MHS

5 Clinical Family Assessment Overall Goal: Help the pathologically acting child, adolescent, and/or parent (the IP) understand the Suggests things really need to change Your behaviors MUST improve for this family to continue to function Help the family to recognize the and how to use the system to help the healing process Clinical Family Assessment Objectives of the Assessment Interview (including IP) Orient family members to the assessment process Jointly identify IP s Gather data regarding IP s behaviors Secure family members commitment to IP s improvement Respond to family s post-interview needs Phase One Identification Goal: to help family in the assessment & treatment processes Age of participants Would anyone be placed in jeopardy for participating? Younger children More vulnerable persons (MR, DD, etc.) Abusive parent toward spouse/partner and/or children MHS

6 Phase Two Introduction Goal: to Counselor briefly welcomes family, introduces self, & outlines the session(s) Frame and acknowledge the importance of the family s role as Discuss confidentiality Establish meeting rules Respond to voiced concerns Phase Three Strengths Assessment Goal: family members will Describe healthy ways the family (or IP) is Identify ways the family (or IP) can get needs met w/o acting out Identify and encourage continued ways in which the family (or IP) is acting positively Establish trust and rapport Intent is not to presenting concerns Want to reinforce the power of the family system and Phase Four Behavior History Goal: to determine the - All family members are included View behaviors within the family Identify and encourage repeat of such positive behaviors Age of children Hx of negative behaviors Psychosocial Hx and impact of negative behaviors on each element of this Hx MHS

7 Phase Five Reestablishing Goal: ensure that Teach IP s family for help Communicate and reestablish family members commitment to one another Use Phase Six Conclusion Goal: help family gain a sense of closure Recap the session s Discuss any further thoughts or concerns Discuss and plan for Some Skills to Use Throughout Questioning Ask clients to describe someone or something (e.g., the negative behavior) in 1 to 5 words e.g., What three words would you use to describe your mother? Questioning Intent is to learn client s perceptions of others e.g., Barney what three words do you believe your mother would use to describe you? Then, ask mother if this is accurate and what she would say differently Great insight producer! MHS