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    Copyright:

    © All Rights Reserved
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    28 views30 pages

    Handbook of Clinical Family Therapy Chpt4

    Uploaded by

    Karem Ramos Muñoz
    terapia familia estrategica

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 30
    CHAPTER 4 Brief Strategic Family Therapy for Adolescents with Behavior Problems rte al Maja, Visors Me nd José Seapoceni: Behavioral problems in adolescence interfere with youths ability to master nor- mal developmental sile and to function effectively in their environment, Dit- ruptive behaviors, including dence of authority, violation of personal and prop erty rights of others, and substance use area great concer to parents, schoo! staf, and society asa whole. Many individual, familial and socal factors have beenim- plicated as eritical variables inthe evolution and treatment of adolescent behav tor problems However, no single factor has received as much attention asthe fam iy Clinical theory and research have helped to dently specific family interactional patterns that are inked to adolescent behavior problems, and to develop family based intervention strategies that specifically target thes patterns (Marin & Marin, 1991; McGoldrick, 1988; Spapocenik, Seopetta, & King, 1978). This chapter presents Brief Strategic Family Therapy (BSFT), an empirically supported intervention designed to target behavioral problems and drug abuse by ‘working with the Famiy, We present the basic principles and goals of BSFT and provide a description of specie clinical interventions Firs, deiitons of behav foral problems anda brie overview of BSFT are provided. Second, we preset a specific approach othe assessment of dysfunctional family interactions. Third, we ing This, adolescents referred to treatment are often viewed by the family as the tole cause of al of the family problems. Tha is they ae the family’s “dentied pasent”| ‘Alttough the identified patient is usually the target of family negativity, the ‘dented patient may aio receive considerable support ftom one ot more family ‘membirs. One parent, for example, may support or nurture inappropiate behav Jor falling to provide needed sanctions or consequences, irrespective ofthe level of negativity. dentife patents are easy to identify because they ae often the cen- terpzees of family discussions. That is, family interactions tend to revolve around ‘he identified patient. The more that family members blame and centralize he adolesent, the more difficult will be to change the family repetitive, mal- sudaptire interactions Conflict Resolution ‘While solving differences of epinion i always challenging itis much more chat Jenging when done in the context of a history of highly conflictve relationships Disagreements are natural and all families experience them, A family cen ap- proach and atemp to manage conflicts (ie, disagreements) in five ways: denial avoidance, difusion,confict emergence without resolution, and conflict emer {gence with resolution. Fors family to function wel it must se the full ange of stylesinsolving conflicts Different styles may work well at different times Forex ample,» couple that fuly discusses and negotiates co resolution every difference ‘of opinion would not have ime to do anything ese. Hence, priorities ned to be «established to determine which conflicts deserve fullattention and negotistion and which shouldbe set aside for a more appropiate or convenient time, Similarly, iffusion of «confit ata time when the parties are not in & good frame of mind ‘can pave the way for more constructive discussions when tempers have cooled Furthermore, itcan preven a total breakdown of communications. Timely diff sion thus faiitates ater sucessful negotiations. eal, a well-functioning family uses all conBict management styles, accord- ing to the needs ofthe stustion. Emergence of the conflict witha subsequent res ‘lution is eneraly considered to be the bes solution in areas of conflict that are of significant importance tc the familys functioning. Separate accounts and opin ions regarding « particular confct are clealy expressed and confronted. Then, ‘he family sable to negotiste a solution that i acceptable (oa family members involved. Conflicts go unresolved however, when farnily members are stuck in a conflict resolution style that does not permit bringing to resolution crucial die ences of opinion. Clinical Formulation Assessment refers othe process of conducting a systematic review of family inte: actions to identity specific qualities inthe patterns of interaction ofeach Fi That is assessment identifies the strengths and weaknesses of family interactions Incontrast, ctinialfrmalauon refers tothe proceso integrating the information ‘obtained through assessment into molar processes that characterize the family’s interactions (Sapocznik & Kurtnes, 1985). In individual psychodiagnosticscin- {cal formulation explains the presenting symptom in relationship tothe individuals psychodynamic. Similarly, clinial formulation in BSFT explains the presenting symptom in relationship to the fails characteristic patterns of interaction, In BSFT, the same family domains (described eae) are assessed in every ease sand serve asthe primary bate forall clinical formulations. Thus every fail will resent with unique configurations and patteras of iteration The therapist uses ‘the domains noted previoudy to derive systemic diagnosis of the family and 0 ‘design interventions that systematically addres these pattens of interaction. In this sense, every family is hendled in a unique and specialized manner However, {he same strategies for assessing family interactions, making clinical formulations, and implementing teatment plans are applied in every case. For example i [BSFT, the therapist’ clinical formulation will abways inchadean articulation ofthe ‘way im which disturbances in family interactions (Le, structure, resonance) give ‘se 10. 0F maintain problem behaviors Treatment Goals: Restructuring “The main goal in BSFT iso help the family change the maladaptive interactional patterns that ae identified during the diagnostic process. The therapist pans how fhe ore wll intervene to hep the family move from its presen way of interac. ing. and the undesirable symptoms it produces, to.a more adaptive and success ful way of interacting that wil eliminate these symptoms. By joining the fails, the therapist is able to work 25am insider. In this oe, the therapist sale Lo en courage the family to behave sit usally does. This permits the therapist to dic gnose the Family and to develop a focused treatment plan thet wil facia the ‘stablishment of new skills in the fami. "The interventions used to help families move from their maladaptive patterns ofinteratons to healthier patterns are called restractring The four restrctr= ing techniques described here will gve the beginning therapist the basic tools needed ( carry out the work of helping the family change is patterns Working inthe Present: Process versus Content One ofthe hallmarks of BSFT isa sustained focus on family relationships in the hereand-now. As noted eal, in the section on enactments, the therapist is ex plicily concerned with tempting to engage family members in ative dicwsions in treatment, ather than relying on thei reports about what has happened in the past In BSFT, the present focus is almost exclusively about family interactions, thats, proces focus. This presenJprocess focus becomes the primary mechanism through which the therapist diagnoses and restructures family interactions. In fact, it isthe therapist's ability to focus on process rather than content that isthe (ssence of BSFT. Therefore, the therapist needs to focus on what is happening here {and nom. rather than geting tapped inthe content (reasons the ferly provide) ‘of what happened thee and then. A process focus enable the therapist to wen {iy and restructure repetitive, maladaptive patterns of family interaction that are ioctl linked to the adolescent’ problem behaviors ‘The BSFT therapist understands the process ofa family system by attending to ‘behaviors that are involved ina interaction. It the how of what people do, and the what happens in an interaction. Process describes the flow of actions and re- {ctons between family members. The repetitive ations and reactions between and among family members become the focus of planned interventions in BSFT Gontent easier and more obvious to observe, Most therapists have some ex- erence eliciting content from family members. Training programs provide in- formation and experiences that help therapies learn techniques fr helping ind ‘idols share information about their current experience and personal histor, Contents what people are actually saying when they are interacting. Content Felers tothe specific or concrete facts used in the communication. Content i odes the reasons families give fora particular interaction. Families wil try to en- Elf the therapist wit historical descriptions that ae rich in content. Despite all the efforts of Families to trap the therapist in ornate conten, ii eral as Dre (Protons a Che ad Adolescent viously noted, that the thempist maintains focus on the here-and-aow and on the pattems ofthe interactions that arse Reframing Reframning isthe formulation ofa diferent perspective of frame of reality than ‘he one within which the family has been operating. The therapist presets this ‘ew frame tothe family ina manner that sels it othe family The tow frame then used to faciitate change. Iis important to note that in BSFT the goa! of re framing isnot to change individual cognition. Rather, the goa iso isrpt rigid, ‘maladaptive family interaction patterns and create a new context in whieh moe adaptive fay interactions can occur, Reframing ie typically used to Ssrupt nop, ative affect, based on negate perceptions, by oflering postive alternatives othe family. This sit from negative affect to positive affect create a window of op ‘ortunities that the therapit must open to make new iterations happen For example, families with a drug-abusing adolescent often enter treatment de- scribing the identied patient as disobedient, rebellious, and disrespect, Fan ily members are usually angry and rejecting f the identified patent, blaming the adolescent for al ofthe pain in te family. There ate no signs of warmth orcas ing for her or him a8 an incividual. Reframing in these circumstances i oval rite for reducing negativity and idntied patienthood in these families Exe ‘anding the family’s view ofthe adolescent from the simple perspective that this 55a misbehaving, o even esl child—to one that also considers him or her as 2 ‘ulnerable child who isin pain can profoundly influence family interactions Such an expansion in focus isnot easy to attain, because families are invested inthe jurtent frame, For example to perceive thei child a not merely problematic bat also suffering, can induce a sense of guilt in parents, and may lead them to reset ‘defensively to such a reframe. Therapists must use convincing seframes that ae timed tothe familys readiness. For example, ia parent doesnot “buy” the child {im pain the therapist might modify the reframe to suggest that "lds not sels {hat you [the parent) are s hurt by your child”—the reframe here is fom anger {othe hurt and pan ofthe purent Reframing i a very safe intervention; that iit does not equize challenging tnd doesnot have to include directives; st such, we encourage therapist o wee betty: Reframing isan intervention that usually does not cause the therapist any loss of rapport. For that reason, the therapist should feel fee tose fe pars ‘iculacty in the most exposie of situations. An experienced therapist is says ‘quipped with some standard reframes that he or she can access in various situs {ions anger as psn or loss (underlying the anger, highly conflitve relationships {8 close or passionae, crises as opportunities (0 pl the family closer, tobe, ome a stronger person), fecing overwhelmed asa signal that one must echarge ‘one's batteries, impulsiveness s spontaneity, and insensitivity a telling itasit (Mitrani, Seapocanik, & Robinson Batista, 2000), Reframing interventions are also important in helping the therapist to over ‘ome therapeutic impasses. Every family exhibits some reluctance to change, Ths ‘eluctance may occur during any phase of treatment and often signBes return ‘o the Fait status quo. One way this retum is often noted is through a retuen to i qd high ves of confit asthe family fils to experience new ways of relating with ‘ne another. Therapists should be prepared fo thece minfaures in arryng out the tsks of treatment, and should continue to refcame family members ina pos- {sve ight to keep them focused on the change process. Working with Boundaries and Alliances Family members most form alliances to carry out important functonsin the fam- ity For example a strong parental alliance esenil to maintain effective behav jor control and nurturance of children. Much ofthe work in BSFT voles help- ing family members esteblich adaptive alliances that meet the needs of the farily| ands mdridual members This often involves disrupting harmful alin ‘An alince basically denotes the existence of a subsystem, which has bound- ries round it, To change the nature ofan alliance the therapist shifts the bound- ‘aesthat connect some family members, and those that Keep others apart. This is alld siting Boundaries For example, in the case of an overivolved mother ‘auger subsystem, the therapist may ask the father to engage ina fun task with the dhughter in order to strengthen the daughter-father liane. As the daughter develps a relationship with her father, her overelanee in mom weakens. “The parenting subsystem s central in nearly all BSFT interventions. Building a stron leadership subsyrtom with clear boundaries and the porto carry outlead- ership functions is eitical fo the ife ofthe family. Membership inthe parental fubsjstem is exible, and can include two parents (married oF separated) or 2 tingle parent and grandparent or oder sibling if authority is delegated. In work ing with behavior problem adolescents itis important that the therapist recognize that members ofthe parental subeystem have complex relationships that involve ‘more than parenting Functions Issues fom other aspects ofthe relationship of fepinterere with effective parenting. Although these other issues (suchas mati tal ccaict) can be addressed in treatment, BSFT is not intended to resolve all of the poblems encountered bythe marital couple. Because ofthe strategies and the probkm.-focused nature of BSFT, the therapist tis to resolve ony those aspects Sf thi difficulties with each odher that are interfering with ther ability to ap- roach their problems with their youth. In the example above, once father devel- {ps a interest in daughter, the therapist can take advantage of the common i terest between dad and mom to initiate parenting conversations. In this way the ‘mos sesitive marital couple issues are side stepped to focus trateskcally on par- entng fuetions Beandary shilting als involve the lear demarcation ofthe perimeter around 4asutsjstem. There are times, for example, when children interfere with iterac- ‘ions between parents. In tis example, boundaries between the generations are | weakand need to be more clearly marked. The therapist can make it understood hat parents have aright toa certain amount of privacy to achieve a clearer de- tmaeation of limits between the generations. In the same wa, the sibling subsys- {ery asthe right toa certain amount of privacy, and is often necessary to mark. the boundaries or limits of how mach parents should intrude i sibling if, or in {he interactions among siblings Shiting alliances may also bea very useful strategy for addressing problems that arise in therapy sessions and that interfere with the therapist's success in ad-

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