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A psychotherapy that involves family members in addition to the identified patient, and/or explicitly attends to the interactions among family members (Pinsof and Wyne 1995).
the better. . Communication is a natural ability. 4. 3. Communication can break down. Communication is a good thing. Communication will solve all our problems. 8. 6.1. Meanings are in words. 7. Telling is communicating. Communication is a verbal process. The more communication. 2. 5.
` The diagnostic family interview is an invaluable tool to assist the psychiatrist in the development of diagnostic and therapeutic goals. .
regardless of the nature of the presenting problem. or it can occur when therapeutic efforts of any type are partially or totally ineffective. .` The diagnostic interview can take place as the initial contact with the family. it can be part of the comprehensive assessment of a symptomatic child or adult.
` The goals of clinicians vary and may include: Identifying family and individual variables that may play the decisive role in shaping the behavior of a problematic family member. .
structure. and development according to the family life cycle. and Conducting an initial family treatment session. . when the necessity of such course has been recognized by the family or by the referral source.Assessing the adequacy of family functioning.
. matching the names with family members. and inviting them to make themselves comfortable. asking the family to introduce themselves by name. The family is put at ease by engaging in mutual introductions.The clinician acts as a host to the family according to the prevailing customs.
and chairs for young children. . preferably in a conversational living room arrangement.3. and with play material.The family should be provided with adequate seating. table.
` Zilbach (1986) recommends that the clinician crouch down to establish eye ± to ± eye contact with young children and be alert to the possibility that some young children may be afraid of handshakes or physical touching. .
` A few minutes may be spent in small talk. . inquiring.
The clinician asks the family to describe the problem that has prompted the clinical contact. The initial inquiry may be directed to the father. . in recognition of the often tenuous motivation of many fathers to attend the therapeutic setting. or to the mother. as the person who may be most knowledgeable about the family life and problems.
The therapist should observe carefully the family¶s relatively unconstrained nonverbal behavior.The therapist should then inquire about the views of different family members on problematic areas in the family. .
. boundary formation. including the level of differentiation. and boundary flexibility of different family subsystems and family members.The exploration of family structure through observation of family interactions provides the clinician with valuable clues.
and x siblings subsystems . The common family subsystems include the: x marital ± parental x parent ± child.The clinician is particularly interested in the functional adequacy of different family subsystems.
. would provide additional subsystems of grandparent ± parent and grandparent ± grandchild. very common in certain ethnic and socioeconomic groups.` Grandparental involvement.
toddlers. include the little ones´ can readily communicate the clinician¶s goal. x Simple statements such as ³I¶d like to meet you all. who are an important source of diagnostic data about the family. these include young children. .` For the initial session. all members of the household and significant others should be invited. and infants.
. The diagnostics interview preferably should be scheduled for 90 minutes to allow a systematic evaluation of the family in an unhurried fashion.` ` The clinician should avoid any lengthy phone discussion to justify the participation of all family members because a prolonged explanation based on general assumptions may make the therapist appear as if he or she lacks confidence.
. patterns of control.` The assessment of family structure should include the determination of the characteristics constellations of family conflicts. including the brittleness of family defenses. expression of feelings. clarity of parental authority and generational boundaries. and family rigidity.
. as well as their expressive ± integrative function. addressing the expression of affect and provision of comfort. geared toward enhanced adaptation and problem resolution.` The assessment of family functioning should include the exploration of instrumental ± adaptive functions of the family.
The diagnostic family interview can be extended into interviews with family subgroups, such as parents or children, or with one child for exploration of other important information that may not be readily shared in a conjoint session.
x Establish structure in the interview to counter the common tendency of dysfunctional families toward chaos, a high level of blame, and silencing of the members. x Maintain objectivity, avoid side taking or premature closure of topics, and elicit the views of all family members. x Address the transactional patterns that are clearly burdensome to many family members and therefore more amenable to change (Gordon and Davidson 1981).
x Understand role of different family members within the family unit. x Uncover the explicit and implicit rules that govern family interaction. x Determine the family¶s problem ± solving behavior. x Understand the nature of boundaries, splits, alliances, and coalition formations in the family.
.x Assess the level of concordance between the developmental and chronological stages of the family. x Help the families transcend the repetitive. and trivial problems and recognize the underlying patterns and main issues. immediate. x Assess the concordance between the value system of the family and the surrounding community.
.` A significant goal of the family diagnostic interview is to help the family recognize and acknowledge its strengths as a family and the assets of family members. particularly the index patient.
it is best to delay the therapeutic recommendation until the closing conference. .` When the diagnostic family interview is part of an overall comprehensive evaluation.
the transactional patterns in the family system. and the referral information. the family diagnostic interview should be closed by highlighting the points of convergence among the problems of the index patient.` Under other circumstances. . the information gathered from the different family members.
` An experienced family therapist attempts to highlight the family¶s assets. knowing well that the family is aware of its conflictual interactions and relationships but barely cognizant of those assets that are the key to therapeutic success. .
.` An inexperienced family therapist tends to focus on family problems to reveal his or her observational acumen. this may inadvertently make the family feel severely disturbed and discouraged.
.` Significant experiences in the past may influence family orientation and mythology and directly or indirectly relate to the family problems.
significant financial losses. or other events that were traumatic for the family.` Such information includes the early death or suicide of a grandparent when a parent was very young. .
.` The gradual unfolding of historical information in the family session is an important aspect of the family interview and generally reveals the affectively charged and dynamically significant past experiences of the family.
` ` The contracting phase is an important step prior to initiating formal family therapy. . It refers to agreed ± on issues and goals for treatment between the therapist and the family.
` ` Later on. . the goals can be expanded to include the disagreement between the parents. Many treatment failures are due to inadequate contracting between the family and the therapist. such as in their views on child rearing or on other issues.
. the Department of Human Services or the court system). or between the family and referral sources (e.g..` The problems of contracting include covert disagreement between the therapist and the family. within the family.
` What to look for? x Projective identification x Unresolved grief x Clarity of ego boundaries and capacity for intimacy/separateness .
currently influence present relationships. x Gaining change occurs through family members gaining conscious insight into previously unconscious processes generating problems in family relationships. conflicts.` What to think about? x Internal processes within individual family members shape family interactions. defenses and relationships from the past. x Family member¶s motivations. .
. x Clarifying communications. x Encouraging family members to speak from the ³I´ position.` What to do? x Opening emotional expression in the family relationships.
cutoff relationships. such as doubling and role reversal.x Interpretation of unconscious conflicts to resolve projective processes. and difficulties in modulating closeness and distance in the family relationships. x Psychodynamic techniques. .
x Therapeutic rituals to facilitate developmental transitions and grief over losses. . x Family genograms.
` What to look for? x Contrasting the particular family structure with that ³normal´ to the culture and developmental stage in terms of: .
x x x x x x x x Organization (structure) Rules (sequences of action) Roles that shape the family members¶ actions Boundaries Hierarchy of power Alliances Coalitions Verbal and nonverbal behavioral sequences .
.` What to think about? Presenting problem results from a family structure out of alignment with the culture and the developmental stage of the family.
` What to do? x Actively shift the family structure x IN session enactments x Out ± of ± session homework assignments .
where. what. and how people are involved in trying to solve the problem . when.` What to look for? x Here ± and ± now context of the problem x Who.
.` What to think about? x ³The solution becomes the problem´ x Difficult life ± cycle transitions give birth to clinical problems when people persist in old coping strategies but relational and communication processes need to change to meet new life contexts.
` What to do? x Psychoeducation x Direct behavioral assignments to adopt new problem ± solving strategies x Defiance ± based. paradoxical interventions .
` What to look for? x Family member difficulties in recognizing deviant behavior x Lack of clearly ± defined family rules x Problems in emotional communication among family members. usually a paucity of expression of positive feelings coupled with an excess of negative expressions .
x Relational conflict due to a paucity of relational skills x Relational conflict due to interpretive errors based on family assumptions or cognitive distortions .
given the practical and emotional restraints experienced. x Family members need to learn cognitive and behavioral principles of learning.` What to think about? x Each member of the family is assumed to be doing his or her best to cope with the behavioral contingencies perceived at that point in time. .
x Family members need to gain skills needed: x To reinforce desired behaviors. x To learn skills for communicating clearly and effectively. x To modify faulty assumptions and interpretations about other family member¶s actions. x To eliminate reinforcement of undesired behaviors. .
x Conduct skill training in empathic listening expressing positive feelings and speaking negative communications respectfully.` What to do? x Conduct psychoeducation about the presenting problem. .
x Conduct training in a problem ± solving and conflict ± resolution skills. . x Teach operant conditioning strategies for behavior shaping with children.
feelings and behaviors that generate symptoms. .x Teach principles for contingency contracting to replace coercive and blaming behaviors with contracts specifying what each family member agrees to perform. x Teach family members to utilize behavioral observation and thought diaries in out ± of session assignments to track patterns of thoughts.
stories and beliefs. x Listen for first ± person narratives from the family members¶ lived ± experiences that imbue with meaning such abstractions as ³love´. .` What to look for? x Listen for exact usage of language expresses as metaphors. ³trust´ and other important language of relationships.
. or unique outcomes. when problems might have occurred but surprisingly did not.x Note exceptions. x Note what is happening at times when problems are absent.
x Narratives of identity.` What to think of? x The limits of a person¶s language constitute the limits of his or her experiential world. or stories. are the basic units of human experience. x A canon of personal narratives shapes the meaning each family attributes to his or her experience. x Narratives. strongly influence family interactions. . about which one is as a family member.
and/or expand their stories in conversation. tell.x Family conflicts emerge: x When lack of narrative skills makes their experiences unintelligible to others. x When the available narratives preclude ways of relating other than conflictual ones. . x When family members become positioned relationally such that they cannot hear. x When specific words or expressions hold very different meanings for different family members due to the personal narratives with which they are associated.
narratives of family life that open better possibilities for solving problems that the current narratives that have dominated the family dialogue. x Ask questions that elicit forgotten. or unnoticed.` What to do? x Focus on creating a dialogue in which important personal narratives can be safely expressed. heard. . and reflected upon by family members.
.x Engage family members in an inquiry of: x What is happening in family interactions when problems are being solved successfully and symptoms are not occurring? x Skills. practical knowledge. competencies and resources of the family that can be brought to bear upon the problem.
5 Session 6 Termination Rebuilding family connectedness Use of art tasks .Family Demographics & History Family Therapy Process Intake Interview Case Conceptualization & Treatment planning Session 1 Building Working Alliances Combining strategic FPT with art Free drawing task Family mural art task Session 2 .
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