fcp - final

8/8/2019 FCP - Final

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Prepared by: Alecs Smith



` 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).



1. Meanings are in words.

2. Communication is a verbal process.

3. Telling is communicating.

4. Communication will solve all our problems.5. Communication is a good thing.

6. The more communication, the better.

7. Communication can break down.

8. Communication is a natural ability.



` The diagnostic family interview is an invaluable

tool to assist the psychiatrist in the development of

diagnostic and therapeutic goals.



` The diagnostic interview can take place as the

initial contact with the family, regardless of the

nature of the presenting problem; it can be part of

the comprehensive assessment of a symptomaticchild or adult; or it can occur when therapeutic

efforts of any type are partially or totally

ineffective.



` The goals of clinicians vary and may include:

I dentifying family and individual variables t hat may

play t he decisive role in shaping t he behavior of a problematic family member.



Assessing t he adequacy of family functioning,

structure, and development according to t he family life

cycle; and

Conducting an initial family treatment session, w hen

t he necessity of suc h course has been recognized by

t he family or by t he referral source.



The clinician acts as a host to t he family according to

t he prevailing customs.

The family is put at ease by engaging in mutual

introductions, asking t he family to introduce

t hemselves by name, matc hing t he names wit h

family members, and inviting t hem to make

t hemselves comfortable.



3.The family should be provided wit h adequate seating,

preferably in a conversational living room

arrangement, and wit h play material, table, and c hairs

for young c hildren.



` Z ilbac h (1986) recommends t hat t he clinician crouc h

down to establish eye ± to ± eye contact wit h young

c hildren and be alert to t he possibility t hat some young

c hildren may be afraid of handshakes or physical

touc hing.



` A few minutes may be spent in small talk, inquiring.



The clinician asks t he family to describe t he problem

t hat has prompted t he clinical contact.

The initial inquiry may be directed to t he fat her, in

recognition of t he often tenuous motivation of many

fat hers to attend t he t herapeutic setting, or to t he

mot her, as t he person w ho may be most

knowledgeable about t he family life and problems.



The t herapist should t hen inquire about t he views of

different family members on problematic areas in t he

family.

The t herapist should observe carefully t he family¶s

relatively unconstrained nonverbal behavior.



The exploration of family structure t hroug h observation

of family interactions provides t he clinician wit h

valuable clues, including t he level of differentiation,

boundary formation, and boundary flexibility of different

family subsystems and family members.



The clinician is particularly interested in t he functional

adequacy of different family subsystems. The common

family subsystems include t he:

x marital ± parental

x parent ± c hild; and

x siblings subsystems



` Grandparental involvement, very common in certain

et hnic and socioeconomic groups, would provide

additional subsystems of grandparent ± parent and

grandparent ± grandc hild.



` For the initial session, all members of the

household and significant others should be

invited; these include young children, toddlers,

and infants, who are an important source of diagnostic data about the family.

x Simple statements such as ³I¶d like to meet you all,

include the little ones´ can readily communicate the

clinician¶s goal.



` 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.` The diagnostics interview preferably should be

scheduled for 90 minutes to allow a systematic

evaluation of the family in an unhurried fashion.



` The assessment of family structure should include the

determination of the characteristics constellations of

family conflicts, patterns of contr ol, clarity of

parental authority and generational boundaries,

expression of feelings, and family rigidity, includingthe brittleness of family defenses.



` The assessment of family functioning should include the

exploration of instrumental ± adaptive functions of the

family, geared toward enhanced adaptation and problem

resolution, as well as their expressive ± integrative

function, addressing the expression of affect andprovision of comfort.



` 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 prematureclosure of topics, and elicit the views of all family

members.

x Address the transactional patterns that are clearly

burdensome to many family members and thereforemore 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 Assess the concordance between the value system

of the family and the surrounding community.

x Help the families transcend the repetitive, immediate,

and trivial problems and recognize the underlying

patterns and main issues.



` A significant goal of t he family diagnostic interview

is to help the family recognize and

acknowledge its strengths as a family and the

assets of family members, particularly t h

e index patient.



` When the diagnostic family interview is part of an

overall comprehensive evaluation, it is best to

delay the therapeutic recommendation until the

closing conference.



` Under other circumstances, the family diagnostic

interview should be closed by highlighting the

points of convergence among the problems of

the index patient, the information gathered fromthe different family members, the transactional

patterns in the family system, and the referral

inf ormation.



` 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 assetsthat 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 anddiscouraged.



` Significant experiences in the past may influence

family orientation and mythology and directly or

indirectly relate to the family problems.



` Such information includes the early death or

suicide of a grandparent when a parent was very

young, significant financial losses, or other eventsthat were traumatic for the family.



` The gradual unfolding of historical information in

the family session is an important aspect of the

family interview and generally reveals theaffectively charged and dynamically significant

past experiences of the family.



` The contracting phase is an important step prior to

initiating formal family therapy.

` I t refers to agreed ± on issues and goals for

treatment between t h

e t h

erapist and t h

e family.



` Later on, the goals can be expanded to include

the disagreement between the parents, such as in

their views on child rearing or on other issues.

`

Many treatment failures are due to inadequatecontracting between the family and the therapist.



` The problems of contracting include covert

disagreement between the therapist and the

family, within the family, or between the family and

referral sources (e.g., the Department of Human

Services or the court system).



` What to look for?

x Projective identification

x Unresolved grief

x

Clarity of ego boundaries and capacity for intimacy/separateness



` What to think about?

x Internal processes within individual family members

shape family interactions.

x Family member¶s motivations, conflicts, defenses

and relationships from the past, currently influence

present relationships.

x Gaining change occurs through family members

gaining conscious insight into previously

unconscious processes generating problems infamily relationships.



` What to do?

x Opening emotional expression in the family

relationships.

x Clarifying communications.

x Encouraging family members to speak from the ³I´

position.



x Interpretation of unconscious conflicts to resolve

projective processes, cutoff relationships, and

difficulties in modulating closeness and distance in

the family relationships.

x Psychodynamic techniques, such as doubling androle reversal.



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 Organization (structure)

x Rules (sequences of action)

x Roles that shape the family members¶ actions

x Boundaries

x Hierarchy of power

x Alliances

x Coalitions

x Verbal and nonverbal behavioral sequences




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



` What to look for?

x Here ± and ± now context of the problem

x Who, what, when, where, and how people are

involved in trying to solve the problem




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



x Relational conflict due to a paucity of relational skills

x Relational conflict due to interpretive errors based on

family assumptions or cognitive distortions




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, given

the practical and emotional restraints experienced.

x Family members need to learn cognitive and

behavioral principles of learning.



x Family members need to gain skills needed:

x To reinforce desired behaviors;

x To eliminate reinforcement of undesired behaviors;

x To modify faulty assumptions and interpretations about other family member¶s actions;

x To learn skills for communicating clearly and effectively.



` What to do?

x Conduct psychoeducation about the presenting

problem.

x Conduct skill training in empathic listening

expressing positive feelings and speaking negative

communications respectfully.



x Conduct training in a problem ± solving and conflict ±

resolution skills.

x Teach operant conditioning strategies for behavior

shaping with children.



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, feelings

and behaviors that generate symptoms.



` What to look for?

x Listen for exact usage of language expresses as

metaphors, stories and beliefs.

x Listen for first ± person narratives from the family

members¶ lived ± experiences that imbue with

meaning such abstractions as ³love´, ³trust´ and

other important language of relationships.



x Note exceptions, or unique outcomes, when

problems might have occurred but surprisingly did

not.

x Note what is happening at times when problems are

absent.



` What to think of?

x The limits of a person¶s language constitute the limits

of his or her experiential world.

x Narratives, 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 of identity, about which one is as a family

member, strongly influence family interactions.



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 specific words or expressions hold very different

meanings for different family members due to the personal

narratives with which they are associated;

x When family members become positioned relationally such

that they cannot hear, tell, and/or expand their stories in

conversation.



` 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 Ask questions that elicit forgotten, or unnoticed,

narratives of family life that open better possibilities

for solving problems that the current narratives that

have dominated the family dialogue.



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.



Family Demographics & History

Case Conceptualization &

Treatment planning

Family Therapy Process

Intake Interview

Session 1 Session 6Session 2 - 5

Building Working

Alliances

Free drawing task

Combining strategic

FPT with art

Family mural art

task

Use of art

tasks

Rebuilding family

connectedness

Termination

fcp - final

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