the Initial Phone Call
|
 (1.) overview of presenting problem
(2.) arrange for family to come for consultation (3.) schedule time/place/who will be there (4.) send out reminder call |
Goals of the 1st Interview |
To build an alliance with the family and develop a hypothesis about what's maintaining the presenting problem. It's important to think about things family is already doing or have done in past that support them moving forward in their lives. It is important to establish rapport and rather than information. It is important to ask them about how they feel about being in therapy. |
genogram |
A schematic diagram of family system that uses squares for representing males, circles for females, horizontal lines for marriages, and vertical lines for children. It is useful for both visualizing relationships and visualizing conflicts within the family. |
Two kinds of family information that are particularly important are: |
(1.) solutions that don't work and (2.) transitions in the life cycle. |
Successful therapy focuses on the clients' ___ not ___. |
strengths, weaknesses |
What is the process of the family vs. the content from the family? |
The first term defines how members of family or group relate. The second term is what they talk about. |
Bowenians start by (1.)___. Structural therapists start by (2.)___. |
 (1.) asking process or circular questions
(2) inviting them to discuss their problems |
treatment contract |
an explicit agreement between the client(s) and the therapist that specifies the terms of therapy, including the frequency and length of sessions, who attends the sessions, and fees. |
| How long does it take for a therapist to recommend a course of treatment? |
It takes 1 to 3 sessions, during which the the therapist bonds with the family, seeks to understand their situation, and determines the feasibility of working with them. |
First Session Checklist: C-L-A-P-I-P-H-O-N-E |
Make CONTACT with each of the family members by acknowledging them/ their point of view, establish LEADERSHIP by controlling the session's structure and pace, develop a working ALLIANCE with the family by balancing warmth and professionalism, compliment clients on POSITIVE actions/family strengths, INVITE questions, focus on specific PROBLEMS and attempted solutions, develop a HYPOTHESIS about unhelpful interactions about presenting problem, don't OVERLOOK possible involvement of family members/friends/helpers who aren't present, NEGOTIATE treatment contract that acknowledges family's goals and specifies the therapist's framework for structuring treatment, and maintain EMPATHY w/ individuals and respect for family's way of doing things |
What is accomplished in the Early Phase of Treatment? |
This phase is devoted to refining the initial hypothesis about what's maintaining problem and beginning to work on resolving it, challenge actions/assumptions, and push for change. It important to have therapeutic alliance. |
| therapeutic alliance |
listening to and acknowledging the client's point of view |
Therapists have to be willing to ___ their clients toward ___ |
push, change |
| linearity |
the notion that one event is cause and other is effect |
| circularity |
events are thought to be related to series of interacting loops |
It is important to challenge ___ thinking to help clients take ___ for what they can ___ |
linear, responsibility, control |
It is important to take the focus off of ___ individuals and broaden the problem to an ____ one- to see the problem as ___ and ___. |
blaming, interactional, shared, comaintained |
A useful formula for explaining circular thinking: |
The more you do X, the more he does Y, and the more you do Y, the more she does X. (For X and Y, try substituting "nag" and "withdraw," or "control" and "rebel.") |
Don't tell the client ___ ___ ___ ___, because it takes the focus off of the ___ and puts the focus on ___ |
what he should do, client, you |
People aren't likely to change their assumptions unless they feel they've been ___ ___ ___. |
heard and understood |
Avoid homework assignments that ___ ___. Save those things for ___ ___. |
generate conflict, therapy sessions |
| formulation |
a therapeutic hypothesis about what is responsible for creating and maintaining a client's presenting problems |
Early Phase Checklist: I-F-F-A-C-E-S |
IDENTIFY major conflicts and bring them into consulting room, develop a hypothesis and refine it into a FORMULATION, Keep FOCUS on primary problems/interpersonal conditions supporting them without neglecting to support constructive interactions, ASSIGN homework that addresses problems and underlying structure/dynamics perpetuating them, CHALLENGE family members to see their own roles in problems that trouble them, ENCOURAGE change, both during session and between sessions at home, and make use of SUPERVISION to test validity of formulations and effectiveness of interventions. |
What is accomplished in the Middle Phase of Treatment? |
This phase is devoted to helping family members express themselves and achieve mutual understanding, unless the therapy is meant to be brief and problem-focused. Then, this phase is pared down considerably. |
During the middle phase of therapy the therapist takes a (more or less) active role in the sessions. |
Less |
During the middle phase of therapy, therapists should interrupt the family dialogue only when.. |
the anxiety escalates and/ or the conversation becomes destructive. |
In the middle phase, clients are encouraged to focus on... |
seeing their own part in unproductive interactions. |
Four attitudes are important in maintaining an effective therapeutic alliance: |
calmness, curiosity, empathy, and respect |
Middle Phase Checklist: I-F-A-S-B-E |
Use INTENSITY to challenge family, ingenuity to get around resistance, and empathy to get underneath defenses; FOSTER individual responsibility/mutual understanding; AVOID being so directive that family don't learn to rely on and improve their own ways of relating to each other; Make SURE that efforts to improve relationships are having a positive effect on presenting complaint; when meeting w/ subgroups don't lose sight of whole BIG family picture, and don't neglect any individuals or relationships, especially those difficult ones that are so tempting to avoid; and take time to EVALUATE whether or not you are are plateauing or making progress. |
| For brief therapists, termination comes when... |
the presenting problem is resolved. |
| For psychoanalytic therapists, termination comes... |
after years of long-term learning. |
| boundaries |
emotional barriers that protect and enhance the integrity of individuals, subsystems, and families. |
| family life cycle |
stages in family life-- from separating from parents through getting married, having children, retiring, and so on-- that generally require modifications in the family's structure. |
| managed care |
a system in which third party companies manage insurance costs by regulating the terms of treatment. ___ companies select providers, set fees, and control who receives treatment and to what degree. |
| structure |
recurrent patterns of interaction that define and stabilize the shape of a relationship |
| subsystems |
smaller units in families determined by generation, sex, or function. |
