ProblemSolving vs. Empowering Processes

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Problem-Solving vs. Empowering Processes

• Engagement
• Problem identification assessment
• Goal setting Planning
• Implementation
• Evaluation
• Termination

• Forming partnerships
• Articulating situations, defining directions,
  identifying strengths, assessing resources
• Framing solutions
• Activating resources, creating alliances,
  expanding opportunities
• Recognizing success
• Integrating gains

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Processes involved with Traditional Models of
Therapy
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ENGAGEMENT

• Social Meeting / Introduction
• Family Focus on clients perspective
• Child Interview Familiarize with roles,
  tasks, expectations
• Child Therapy Establish trust and safety

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ASSESSMENT

• Social Ask questions to explore interests
• Family Assess needs in partnership
• Child Interview Assess developmental level
• Child Therapy Evaluate symptoms

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PLANNING/GOAL-SETTING

• Social Find common ground for interaction
• Family Reframe needs/ Engage family in
  strategies
• Child Interview Define course of action/
  Adjust style
• Child Therapy Develop treatment plan

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TREATMENT / ACTION

• Social Doing things together /
  Conversation
• Family Take action steps/Evaluate impact on
  system
• Child Interview Ask questions/ Gather and
  give information
• Child Therapy Interventions using
  therapeutic techniques

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TERMINATION

• Social Goodbye and planning
• Family Review progress, Evaluation
  planning
• Child Interview Thank them for work/
  Anticipate next steps
• Child Therapy Review/Anticipate future/
  Educate / Goodbye

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Solution-Focused Therapy

• Grew out of strategic family therapy
• Brief therapy model
• Focus is to help family find new solution to
  problems
• Strengths and possibilities create
  self-fulfilling prophecies and can lead to change
• Small changes are all thats necessary because
  they lead to larger changes
• Uses miracle questions and exceptions
  questions

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EXERCISE Revisiting the Smith FamilyDiscuss
how a Solution Focused Approach and a Traditional
Problem-Solving Approach would be used
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Traditional Theories in Child Family Practice
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Family-Centered PracticeConceptual Framework

• Ecological perspective
• Competence-centered perspective
• Developmental perspective
• Permanency planning orientation

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An integrated child and family model

• Work with children always includes some sort of
  work with their parents when they are living and
  available (Webb).
• Parent Counseling/Guidance
• Parent Child Sessions
• Sibling Sessions
• Entire Family Sessions
• Effective treatment should be designed for
  whatever problems are recognized and should
  involve family members in ways that will
  ameliorate those problems (Straughan, from
  Webb).

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Principles of Family Systems Theory/Therapy

• Family symptoms may be passed through many
  generations.
• If the identified client changes, another member
  of the family may become maladjusted as he/she
  absorbs the family stress.
• Effective therapy requires a realignment of the
  way all members relate to one another.

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Principles (cont.)

• Families have unique bonds, rules, communication
  networks, and myths.
• People act differently in their family systems
  than in other environments.
• Families seek homeostasis.
• Family members can drive each other crazy.
  Some members, the identified client, develop
  symptoms in order to reduce the stress in the
  family.

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3 Common Assumptions of Family Practitioners

• The family system is critical to working with an
  individual client.
• Observed behavior is considered as a presenting
  problem, which is symbolic of deeper structures
  and patterns of behaviors.
• Effective family treatment depends on
  interdisciplinary orientation.

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Application of Family-centered perspective

• Family is central unit of attention
• Preservation of family ties
• Ultimately, no family members well-being can be
  subjugated (put at risk) to support the overall
  family goals
• Neighborhood/community-based services

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Application of Family-centered perspective

• Partnerships between professional and informal
  helpers
• Extended family involvement
• Advocacy and social action
• Strength focus (child and family strengths)
• Parents as resources
• Self-help groups

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A Framework for Beginning Family Work

• Focusing on the family
• Assessing needs in partnership
• Reframing needs positively
• First encounters

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Family Therapy(2 broad perspectives)

• Body of knowledge
• Personality Dynamics
• Origin of theories
• Psychology
• Overriding goal
• Increase autonomy of individuals in the family

• Body of knowledge
• Social Systems
• Origin of theories
• Sociology
• Overriding goal
• Facilitate smooth functioning of the family unit

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Family Therapy Models

• Behavioral
• Adlerian
• Bowenian
• Structural (Minuchin)
• Solution Focused
• Systemic
• Externalization of Blame

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Behavioral assessment issues

• What aspects of problem are due to specific
  behaviors of individuals?
• What specific behaviors need to be changed?
• What factors maintain dysfunctional behaviors or
  prevent functional behaviors?
• What resources in client environment are
  available for changing behavior?
• What intervention is most likely to have positive
  effect on target behaviors?

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Behavioral - Gathering information

• Multiple sources of info needed
• Parental accounts of child behavior may be
  inaccurate
• Many variable produce a behavior
• Info gathered through check lists, inventories,
  surveys and schedules
• Description of behaviors
• Functional analysis of behaviors
• Identify relationship between behavior and its
  reinforcers

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Adlerian Family Education

• Socially oriented perspective
• Based on premise that behavior is purposeful
• If family can ID causes or goals of misbehavior
  and reaction to it, intervention can be
  identified.
• Goals of childs misbehavior are usually
• Attention-getting
• Power struggle
• Revenge
• Displays of inadequacy
• Uses parent education (Systematic Training for
  Effective Parenting)

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Adlerian Gathering information

• Ask family to recount day from initially getting
  up.
• Childs behavior, what went wrong, and parents
  feelings are discussed.
• Childs nonverbal answers are often key to
  assessing goals of misbehavior.
• Family roles and position are relevant.
• Goals is to ID social factors that contribute to
  behavior
• Much attention to family consultation (and
  training)

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Bowenian Family Systems

• Assessment process covers two dimensions
• Study of intergenerational family (4-6
  generations)
• Current family emotional system (Eco-map)
• Family history
• Organizes facts
• Clarifies distortions
• Demystifies mysteries
• Ids major events
• Ids issues and themes that continue to be
  addressed by the current generation

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Bowenian - Gathering information

• Genograms
• Look at themes, patterns, impact of world events,
  identification among family members, transmission
  of expectations, etc.
• Eco-maps
• Paper and pencil assessment process
• Social distance, importance, and flow of positive
  and negative energy with external systems are
  identified and coded.
• Strengths and stresses of various relationships
  allow therapist to ID strengths, supports,
  concerns, and begin discussion with clients.
• Concepts of enmeshment, disengagement, and
  triangulation are important.

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Structured Family Therapy

• The importance of Family Context
• The significance of Dyads or Triads
• Family Structure
• Psychopathology as Serving a Family Function in
  Families
• Circular Sequences of Interaction
• Family Life Cycle
• Multigenerational Patterns
• Views of the Individual

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Structured - The Importance of Family Context

• People are products of their social context
• Any attempts to understand them must include an
  appreciation of their families
• Changes in family context create powerful changes
  in people and their problems

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Structured (cont.)- The Significance of Dyads or
Triads

• There is an interlocking of pathology its
  important to understand how they reinforce each
  other
• Use of metaphors in order to understand the
  interactions among groups of people

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Structured (cont.) Family Structure

• Families can be understood best when you
  understand their level of boundaries with various
  subsystems within them, particularly between
  generations
• Note the boundaries within the executive system
  (nuclear family) and look at the family hierarchy
  whos in charge? Whos supposed to be in charge?

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Psychopathology as Serving a Family Function

• The family dyad is stressed, therefore a 3rd
  person is sought out as a distraction to diffuse
  the stress (triangulation)
• One members problems serves as a function for
  the family (this is their role within the family)
• The role allows the family to avoid threatening
  changes

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Circular Sequences of Interaction (circular
implies ongoing)

• Circular causal sequences of behavior
• Circular interactions, as opposed to linear
  (which is simply cause effect)
• ex The child is withdrawn and shy because his
  father is overprotective. The father is
  overprotective because the child is so withdrawn
  and shy.

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Systemic Family Therapy

• Infrequent intense sessions
• Behaviors developed over time are a result of
  familys adaptation
• Meaning of behavior is important
• Therapist is neutral/ tests hypotheses
• Uses circular questions
• Family identifies own solutions

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Externalization of Blame

• Addresses oppression of families
• Assumes with a positive approach families can
  expand times where problem does not dominate them
• Empowers by externalizing problem
• Create new family stories with a different
  relation-ship to the problem

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Family Life Cycle

• Families encounter difficulties when negotiating
  transitions to the next stage of the family
  developmental process
• The emotional system of the family is comprised
  of 3 to 4 generations
• Sees significant family ceremonies as family
  rites of passage everyone comes to terms with
  the transition
• Events such as divorce, retirement geographical
  uprooting impacts the life cycle

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Theoretical Premises

• Looks at families in relation to their
  developmental phase
• Views symptoms dysfunctions in relation to
  normal functioning over time
• - in order to understand the emotional problems
  that people develop as they move together in life
• - the family should be viewed as the more than
  the sum of its parts

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Multigenerational Patterns

• The idea that families evolve over generations
• Longitudinal look at the familys patterns of
  syndromes, traumas, and crises over the decades

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Stages of the Family Life Cycle

• 1. Young Adulthood separating from the family
  of origin without cutting off or fleeing
  reactively to a substitute emotional cornerstone
• 2. Joining of Families through Marriage
• - establishing of marital system
• - realignment of relationships among family
  friends to include spouse

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Stages of the Family Life Cycle

• 3. Families with Young Children
• - marital relationship must accommodate for
  child(ren)
• - childrearing, financing and household tasks
• - realignment of relationships among family to
  include parenting and grandparenting
• 4. Families with Adolescents
• - role shifting in order to allow youth to move
  in and out of the family system
• - refocus on mid-life marital and career issues
• - beginning shifts towards joint caring of
  elderly parents

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Stages of the Family Life Cycle

• 5. Launching Children and Moving On
• - renegotiation of marital system as a dyad
• - development of adult to adult relationships
  between grown children and their parents
• - realignment of relationships to include
  in-laws and grandchildren
• - dealing with disabilities and of parents
  (grandparents)

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Stages of the Family Life Cycle

• 6. Families in Later Life
• - maintaining own and/or couple functioning
  interest, despite physical decline
• - exploration of new familial and social roles
• - support for more central role of middle
  generation
• - system widening to accommodate the wisdom
  experience of the elderly
• - dealing with loss of spouse, siblings, and
  other peers and preparation for own death
• - life review and integration

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EXERCISEApplying Family Life Cycle principles
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Interventions Using the Family Life Cycle

• With children
• Intensity of the parents preoccupation with a
  child stems from (1) historic or current
  relationship with his or her mother and father OR
  (2) relative weakness of spousal, sibling, or
  peer relationships currently and/or historically
• Intervention
• Shift focus away from the individual and move
  towards systemic considerations

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Interventions Using the Family Life Cycle (cont.)

• With adolescents
• Serves as catalyst for reactivating emotional
  issues and sets triangles into motion
• Brings to surface unresolved conflicts between
  parents grandparents or between parents
  themselves
• Stress transmitted both up and down the
  generations

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Interventions Using the Family Life Cycle (cont.)

• Intervention
• Understanding of the adolescent developmental
  tasks
• Reframe the familys conception of time
• Work with the subsystems parents, adolescents,
  siblings, other relatives
• Therapists use of self

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Role-playing Exercise