ESSENTIAL TOOLS IN FAMILY THERAPY

Transcription

1 ESSENTIAL TOOLS IN FAMILY THERAPY Barry J. Goldman-Hall, LCSW December 4, 2017 Santa Clara County Department of Behavioral Services Training

2 Introduction & Brief Overview Brief Overview of Training (tools in your tool box) Summary of Presenter s Experience Select Survey of Participants Professional role Most pressing challenge in family work Most rewarding experience working with families

3 Joining/Engaging Families Getting Invited to Stay Developing a collaborative partnership with our families Families/Parents as Partners Intentional joining/hierarchical precedence Respecting cultural, gender, and family hierarchies Assessing the distribution of power in a system (who is charge?) Functional Family Therapy: Matching Stage (engagement & motivation) Structural Family Therapy: Joining Strategic Family Therapy: Initial Phase

4 Joining/Engaging Families (continued) Developing a relationship/buy-in from all invested in the family s challenges Consequences of ignoring/not engaging oppositional, unmotivated, resistant members with power, will lead to failure Fishman s concept of the homeostatic maintainer. SCIP s alignment process (i.e. Active process of focused subjectivity ).

5 Joining/Engaging Families (continued) Assessing the family s, compelling reason/leverage, to work with us. Distinguish from client motivation Can be external or internal Case example, the P Family. (toxic divorce, triangulation), Another 3 of you s in our life?

6 Joining/Engaging Families (continued) Hearing the family s story, before they will consider yours Consumer s experience of accurate empathy (NOT agreement or disagreement) Hearing family narrative, theory(ies), explanation (s) for difficulties. Typically does not include new solutions. Dr. Scott Miller: Clients experience of therapist s genuineness. #1 factor (by far) in client s experience of effectiveness of intervention.

7 Joining/Engaging Families (continued) Making it safe to look someplace else Quintessential skill of good therapists QUESTIONS, FEEDBACK, CLARIFICATON?

8 Family Assessment/Diagnosis: Developing a Systemic Hypothesis Brief overview of the language of family systems work Patterns of Interaction: Process vs Structure Boundaries between individuals & subsystems (diffuse-clear-rigid) Characteristics of relationships (enmeshed-functional-disengaged) Hierarchy (distribution of power in system; consider gender & culture) Homeostasis (Eastfield example: You better get back in there! ) Triangles (collusion, coalition) Dyads (alliance, conflict)

9 Family Assessment/Diagnosis: Developing a Systemic Hypothesis (continued) Harry Aponte s Ecological Approach, to Family Diagnosis Primary goal of understanding is to solve a problem The forces that create the problem are all active in the current behavior and transactions Each intervention, as well as the entire course of treatment, flows from a progressive series of diagnostic hypotheses Need for a strong systemic hypothesis to contextualize family functioning

10 Family Assessment/Diagnosis: Developing a Systemic Hypothesis (continued) General characteristics of struggling families (with case examples) Disengaged, chaotic families Explosive, enmeshed families (too hot to handle) Pseudo-functioning/depressed families (families w/secrets, It s just a phase. ) QUESTIONS, FEEDBACK, CLARIFICATON?

11 Family Interventions Who do you see and in what groupings? Can entire family tolerate/problem-solve together? Family Therapy, most often doesn t include whole family. Have to see the dance first (examples). Subsystem work (parent/child system, sibling system, etc.)

12 Family Interventions Benefits of working with subsystems Reduce emotional intensity Align with disempowered subsystems (unbalancing)

13 Family Interventions Expanding the system Adds complexity and new perspectives Creates positive alliances, allies, support, etc. Going fishing. Using genogram to identify family resources.

14 Family Interventions Building intensity/creating focus (SFT) From honey to vinegar (case example) Consequences of not changing (last card in your deck)

15 Family Interventions Family Interventions Reframing (Wizard of Oz clip) An integral part of most models of practice QUESTIONS, FEEDBACK, CLARIFICATON?

16 Case Consultations The P Family, where do you start? The C Family, enactment example (includes handout). Cases from participants

17 Summary, Closing remarks, Q&A, Evaluation, Post-Test THANK YOU!