DEVELOPING A SHARED DIRECTION
Treatment plans should be based on assessment data for the family. Each treatment plan should be individualized and should fit the unique characteristics of the family and interactive culture.
Most treatment plans involve some combination of the elements. First, goals are developed from assessment data to fit each unique situation. Second, the family and larger network are considered as potential participants. Third, interventions that fit the family's development level and the clinician's skill level are chosen either spontaneously or deliberately.
DEVELOPING GOALS
The treatment plan should address the family's goals and hypothesis generated during the assessment process. A good treatment plan requires the therapist to analyze the hypothesis to:
(a) Prioritize areas of change
4 criteria must be considered
1. Which problem is of most immediate importance to the family?
2. Which problem has the greatest negative consequence if not handled immediately?
3. Which problem can be corrected most easily considering the resources and constraints?
4. Which problem require handling before other problems can be solved?
(b) Making goals concrete and specific
Suggestions to help family members describe changes(goals) is more observable terms:
1. Ask each family member to describe how he or she would like things to be different.
2. Ask family members to describe changes in positive rather than negative terms.
3. Ask family members to be specific about what they want changed.
Developing Goals From Family Strengths
Emphasizing strengths helps alter the family's self-image and gives family members hope that their goals can be attained.
In establishing goals based on strengths, the therapist and family work in partnership. Instead of selecting goals for the family, the therapist listens to what the family would like changes and encourages them to express what they would like to be different. The therapist should respond to the family's concern around these basic needs before dealing with higher order needs such as parent-child relationship. The therapist must also interpret the family's definition of the problem in a different way to give it new meaning. This new interpretation helps the family get in touch with their own strength.
Building on Existing Strengths
The following interview strategies are helpful in identifying strengths:
1. Emphasize positive statements reported by family members.
2. Encourage family members to share their story about themselves.
3. Note family interactions that reflect strength and competence.
4. Emphasize times that family members enjoy together.
5. Reframe problems or negative statements in a more positive way.
6. Emphasize the things that families do well.
Eliciting family strengths helps the clinician understand how families cope with problems as well as how they promote growth and development.
These principles to maximize the effectiveness of any family therapy model that the clinician might prefer. This foundation is build on the following assumptions:
a. There are several potentially effective ways to begin treatment;
b. families have resources and strengths to resolve problems;
c. families often are aware of alternative ways to alter a problem: and
d. solution to the problem if they suggest.
INVOLVING FAMILY MEMBERS
Therapists should request the family's help in solving the problems.
In presenting a rationale for involving all family members, Garfield suggests:
* When a family member begins to describe his problem, the therapist should listen sympathetically. He should also pay attention to the interactional aspects of the problem. The therapist may take note of issue and return to it later including the other family members in the evaluation. If the person describes the problem in personal term, the therapist may inquire if anyone i the house is aware of this problem and how they have responded to it. This reframes the problem in interactional terms, and allows the therapist to find out who else lives i the house and how they may involved in the problem.
Whatever the request for the help, all family member who are related to the problem should be asked to attend the initial session.
Overcoming Initial Resistances
Family members may often resistant to attend therapy sessions, especially if they fell blame or responsibility for the problem.
The beginning therapist must understand the protective nature of these responses and deal with them in a supportive manner. the real issue here seems to be who is responsible for bringing reluctant family members to therapy and how this might be accomplished.
Family member's reluctance to attend therapy often reflects the systemic nature of the problem.
Beginning family therapists and students should consult with their supervisors to assess the motivational level of the family members who make initial contacts. The practitioner must pay attention to the individual's feelings and address each area of discomfort with a plan such that the proposed conjoint session could avoid the client's worst fears.
A therapeutic strategies for communication with the reluctant family member should be discussed. The therapist must decide what to do in the event that not all members of the family make their scheduled appointments. When the entire attends the initial sessions, he therapist can better anticipate the effect of individual changes on the whole system.
Connecting With Family Members
If family therapists are to be effective in this context, they must connect with the family. Connecting is both an attitude and a skill. To connect with the family, the therapist must convey acceptance of family members and respect for their way seeing and doing things.
The therapist can join with family members in the following ways:
1. Greet each member of the family by name.
2. Make friendly contact with each member.
3. Respect the family hierarchy.
4. Acknowledge each member's experience, position, and actions.
Boszormenyi-Nagy developed the strategy of multidirected partiality. His goals was to address the challenge of connecting with each member of the family. He systematically interacted with each family member to understand each position and to communicate that understanding each member to ratify or clarity. He was able to gain a clear picture of what each member thought about the presenting problem and what issues might become obstacles to change. The skill of connecting with each member of the system becomes trademark of the evolving family therapist.
INVOLVING THE NETWORK
The purpose of this is to assist the therapist in identifying sources of support and resources for the family. Sources of support vary along a continuum beginning with the family unit and moving outward to social organization.
Sources of support might include:
(a) nuclear or immediate family
(b) relatives
(c) informal network members
(d) social organization
(e) educational organizations and agencies
(f) professional services
(g) policymaking groups and individuals
People who can be supportive to the family have many characteristics:
(a) they are good at understanding other's needs;
(b) they provide unconditional support;
(c) they provide a variety of helping activities; and
(d) their support is a reciprocal process that benefits both the helper and the family members.
Interview Strategies
Strategies that the therapist can employ to identify sources of support and resources in the family are as follows:
1. Ask th family what they have done to resolve the problem.
2. brainstorm a list of persons from human service who are in regular contact with the family.
3. Identify neighbors or friends who can meet needs that cannot met by the family.
4. Ask th family if there's anything that would stop them from asking a resource person for help.
Natural supports are people who are resourceful and empathetic to the family. Professional support personnel should not replace natural support; rather, they should strengthen these relationship.
In spite of the benefits of informal supports, the practitioner should also be aware that there are several legitimate barriers to their use:
(a) Family members may not have the skills to develop relationships with others.
(b) Family members may be reluctant to ask for help when there are racial or ethnic differences.
(c) Family members may be unwilling to approach others whom they don't know.
(d) Family members may prefer to rely on themselves and not depend on others.
(e) Family members may be closed and reluctant to let others know their business.
Developing a Collaboration Team
There are several ways to start a collaboration team:
First: The therapist must develop good relationships with larger systems such as schools, hospital, and social service agencies.
Second: The therapist should provide feedback to referral sourced (school councilors, social workers, etc.) about current cases when clients have given their permissions.
Third: Therapists should asks other professionals (collaborators) for their suggestions and ideas about cases.
Fourth: Therapists should seek out professionals to form an interagency team that can deal with problems that come to the attention of various organizations.
In many settings, the family is assigned to a case manager or a team. While therapist may treat the family, the case manager determines the nature of the treatment. The therapist here may not have access to all family members nor have control over the welfare of the child. The essential issue here is how the therapist works with the team.
Guidelines for the Collaboration Team Interview
Harry Aponte(1976a) initiated the development of Collaboration Team Interview from ecostructural model and has been described more recently by O'Callaghan(1988) and Boyd-Franklin(1989). Brown and Vaccaro have evolved a set of guidelines for the collaboration team based on these models.
The most important consideration for the therapist in conducting collaboration team interview is to remain neutral.
GUIDELINES FOR CONDUCTING A FAMILY-SCHOOL COLLABORATION MEETING
1. Establish a positive climate for change.
2. Report the purpose of the meeting.
3. Have each participant tell how he or she sees the problem.
4. Discuss the strengths of the child.
5. Let participants tell what results they hope to see.
6. Decide how this can be accomplished.
7. Decide if other people need to be involved in the intervention.
8. Discuss obstacles to the intervention.
9. Decide how the participants will know if the intervention has been successful.
10. Decide if a follow-up meeting needs to be scheduled.
A. Try to understand the family-problem and how the team-member perceives it.
B. Make frequent use of the word "we" in developing a collaboration relationship with team member.
C. Examine attempted solutions on the part of team members.
D. Work with individuals within their prescribed votes.
The increased emphasis on family preservations and home-based services has led to therapeutic practices characterized by collaboration between families and community organizations. Thus, the therapist must assist families to become aware of resources and support. It is critical that the family be empowered to take action on their own behalf; The therapist cannot simply act for the family.
Obstacles to Collaboration
Based from Amatea and Sherrard, for preparing collaboration, beginning practitioner is well advised to anticipate as many potential problems as possible.
Following list of obstacles to collaboration in school settings.
1. Educators and therapists are engaged in different systems and traditions, which other makes communication and team work problematic.
2. Therapists can often become triangulated in the pattern of blaming and counter blaming between adults at home and school.
3. Many therapists are unfamiliar with school context and learning/schooling issues.
4. The engagement of school personnel in addition to family members in the resolution of a child's problem requires a redefinition of traditional notions of family confidentiality and parameters as to what information is to be shared and with whom.
5. Insurance reimbursement is not organized to find collaborative team efforts between family therapists and school personnel.
When these obstacles are overcome, the collaboration process may become an intervention that effects change on it's own.
CHOOSING INTERVENTIONS
After the therapeutic gaol has been establish, a therapeutic intervention must be chosen; that is after one or more problem behaviors have been selected, therapists must decide what they are going to do with the family to bring about the stated goals. They must determine a logical rationale for using a particular intervention. The critical question about choosing an intervention ism "what intervention, by whom, is most effective for the family, with what specific problem, and under which set of circumstances?".
The therapeutic experiences must meet the family's goal and not simply reflect the therapist's own theoretical biases. Psychosomatic problems have been treated most effectively with the structural approach (Aponte and Van Deusen, 1981) and there is little or no evidence of symptom substitution.
In providing guidelines for determining an appropriate intervention, we do not intent to imply that only one particular approach can work with a particular type of problem.
Two studies reported that, when the family was more disorganized, a direct approach was more effective. Anderson, Reiss, and Hogarty(1986) have had success with a psychoeducational family approach to managing schizophrenic behavior in which education i combined with the development of a cooperative relationship with the family to provide on going cane to a family member.
A minimum requirement in deciding on the intervention is that the therapist must make a thorough analysis of the context in which the problem occurs; that is the therapist must have asked, and gotten answer to the following questions before determining an appropriate intervention:
1. What is the problem and how often does it occur or how intense is it?
2. What are the consequences of the problem behavior to the family and other in the environment (e.g., teachers, friends, and neighbors)?
3. What resources to promote change does the family have in their environment?
4. What effects would a change in the problem behavior have on the family and others?
Bardinas, Evelyn
Rencio, Jomalou
Mondelo, Katrina
Capucao, Ryan
De Guzman, Joel
(b) Family members may be reluctant to ask for help when there are racial or ethnic differences.
(c) Family members may be unwilling to approach others whom they don't know.
(d) Family members may prefer to rely on themselves and not depend on others.
(e) Family members may be closed and reluctant to let others know their business.
Developing a Collaboration Team
There are several ways to start a collaboration team:
First: The therapist must develop good relationships with larger systems such as schools, hospital, and social service agencies.
Second: The therapist should provide feedback to referral sourced (school councilors, social workers, etc.) about current cases when clients have given their permissions.
Third: Therapists should asks other professionals (collaborators) for their suggestions and ideas about cases.
Fourth: Therapists should seek out professionals to form an interagency team that can deal with problems that come to the attention of various organizations.
In many settings, the family is assigned to a case manager or a team. While therapist may treat the family, the case manager determines the nature of the treatment. The therapist here may not have access to all family members nor have control over the welfare of the child. The essential issue here is how the therapist works with the team.
Guidelines for the Collaboration Team Interview
Harry Aponte(1976a) initiated the development of Collaboration Team Interview from ecostructural model and has been described more recently by O'Callaghan(1988) and Boyd-Franklin(1989). Brown and Vaccaro have evolved a set of guidelines for the collaboration team based on these models.
The most important consideration for the therapist in conducting collaboration team interview is to remain neutral.
GUIDELINES FOR CONDUCTING A FAMILY-SCHOOL COLLABORATION MEETING
1. Establish a positive climate for change.
2. Report the purpose of the meeting.
3. Have each participant tell how he or she sees the problem.
4. Discuss the strengths of the child.
5. Let participants tell what results they hope to see.
6. Decide how this can be accomplished.
7. Decide if other people need to be involved in the intervention.
8. Discuss obstacles to the intervention.
9. Decide how the participants will know if the intervention has been successful.
10. Decide if a follow-up meeting needs to be scheduled.
A. Try to understand the family-problem and how the team-member perceives it.
B. Make frequent use of the word "we" in developing a collaboration relationship with team member.
C. Examine attempted solutions on the part of team members.
D. Work with individuals within their prescribed votes.
The increased emphasis on family preservations and home-based services has led to therapeutic practices characterized by collaboration between families and community organizations. Thus, the therapist must assist families to become aware of resources and support. It is critical that the family be empowered to take action on their own behalf; The therapist cannot simply act for the family.
Obstacles to Collaboration
Based from Amatea and Sherrard, for preparing collaboration, beginning practitioner is well advised to anticipate as many potential problems as possible.
Following list of obstacles to collaboration in school settings.
1. Educators and therapists are engaged in different systems and traditions, which other makes communication and team work problematic.
2. Therapists can often become triangulated in the pattern of blaming and counter blaming between adults at home and school.
3. Many therapists are unfamiliar with school context and learning/schooling issues.
4. The engagement of school personnel in addition to family members in the resolution of a child's problem requires a redefinition of traditional notions of family confidentiality and parameters as to what information is to be shared and with whom.
5. Insurance reimbursement is not organized to find collaborative team efforts between family therapists and school personnel.
When these obstacles are overcome, the collaboration process may become an intervention that effects change on it's own.
CHOOSING INTERVENTIONS
After the therapeutic gaol has been establish, a therapeutic intervention must be chosen; that is after one or more problem behaviors have been selected, therapists must decide what they are going to do with the family to bring about the stated goals. They must determine a logical rationale for using a particular intervention. The critical question about choosing an intervention ism "what intervention, by whom, is most effective for the family, with what specific problem, and under which set of circumstances?".
The therapeutic experiences must meet the family's goal and not simply reflect the therapist's own theoretical biases. Psychosomatic problems have been treated most effectively with the structural approach (Aponte and Van Deusen, 1981) and there is little or no evidence of symptom substitution.
In providing guidelines for determining an appropriate intervention, we do not intent to imply that only one particular approach can work with a particular type of problem.
Two studies reported that, when the family was more disorganized, a direct approach was more effective. Anderson, Reiss, and Hogarty(1986) have had success with a psychoeducational family approach to managing schizophrenic behavior in which education i combined with the development of a cooperative relationship with the family to provide on going cane to a family member.
A minimum requirement in deciding on the intervention is that the therapist must make a thorough analysis of the context in which the problem occurs; that is the therapist must have asked, and gotten answer to the following questions before determining an appropriate intervention:
1. What is the problem and how often does it occur or how intense is it?
2. What are the consequences of the problem behavior to the family and other in the environment (e.g., teachers, friends, and neighbors)?
3. What resources to promote change does the family have in their environment?
4. What effects would a change in the problem behavior have on the family and others?
Bardinas, Evelyn
Rencio, Jomalou
Mondelo, Katrina
Capucao, Ryan
De Guzman, Joel
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