لایب سان

Author(s): Suzanne Midori Hanna (Editor)

Publisher: Routledge, Year: 2018

ISBN: 9781351051453,1351051458

Contents List of Figures, Tables, and Boxes xv List of Cases xvii Preface xviii Acknowledgments xxi List of Abbreviations xxii PART I How to Think Systemically 1 1 Family Therapy: The Interpersonal View 3 Prologue 4 What Is Family Therapy? 5 The Interpersonal View: Family Process, Cybernetics, and Social Ecology 6 How Did It Begin? From Freud to Minuchin 9 Why Are There So Many Models? 13 Overview of First-Generation Family Therapy 14 Structural Family Therapy 15 Organization 15 Power 16 Interactional Sequences 16 Hypotheses 16 Strategic Family Therapy 16 Systemic Meaning of Symptoms 17 Hierarchy 17 Hypotheses 17 Mental Research Institute (MRI) Model 18 Communication and Behavior 18 Anxiety 19 Hypotheses 19 Behavioral Family Therapy 19 Sequences and Reinforcements 20 Coercion Theory 20 Hypotheses 20 Psychodynamic Family Therapy 20 Past Is in the Present 21 Subjective Experience 21 Object Relations 22 Attachment 22 Hypotheses 23 CONTENTSviii Bowenian Family Therapy 23 Natural Systems 24 Eight Interlocking Concepts 24 Hypotheses 25 Contextual Family Therapy 25 Relational Ethics 26 Ledger System 26 Hypotheses 27 Experiential Family Therapy 27 The Satir Method 28 Carl Whitaker 28 Human Growth and Development 29 Hypotheses 29 So, Where Do I Start? Toward Integration 30 Organization 31 Problem-Solving 31 Emotional Climate 31 First Steps 31 Summary 32 2 The Postmodern Era and Integration 36 Constructivism and Social Construction 38 Impact of Diversity 39 Major Mental Illness and the Recovery Movement 40 Second Generation: 1970–2000 41 Solution-Focused Family Therapy 41 Narrative Family Therapy 44 Applications 49 Emotionally Focused Couple Therapy 50 Cognitive-Behavioral Couple Therapy 51 Multidimensional Family Therapy 54 Multisystemic Therapy 55 Multifamily Groups for Schizophrenia 57 MFGs and Sandy Hook 60 Applications 62 Third-Generation Emphasis on Special Populations: 2000–Present 65 Oppositional Defiant Children and Adolescents 65 Depressed and Suicidal Youth 67 Military Personnel 68 Trauma Survivors 69 Importance of Screening 70 Trauma-Sensitive Family Therapy 71 Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) Families 73 Summary 75 3 Integration of Theory: Common Themes 79 Gender 82 Gender Politics and Family Therapy 83 Empowerment for Men 83 CONTENTS ix Empowerment for Women 84 Gender Balance 86 How to Focus on Gender 86 Race and Culture 88 Black Families 89 Just Therapy: The Therapy of Social Justice 90 Belonging 91 Sacredness 91 Justice 91 Simplicity 91 Liberation 92 Mrs. Obutu: An Immigrant’s Dilemma 92 How to Focus on Race and Culture 93 Intergenerational Relationships 95 Development in Adulthood 95 Symptoms in Context 96 How to Focus on Intergenerational Relationships 98 Transitions and Development 100 Normative Changes 101 Adolescence 102 Midlife 102 Later Life 102 Divorce or Remarriage 105 Nonnormative Changes 106 Military Service 106 Out-of-Home Placements 107 How to Focus on Transitions and Development 107 Family Structure 108 Parent Engagement 109 How to Focus on Family Structure 110 Individual Experience 113 Attachment 115 Fairness and Entitlement 115 Belonging and Identity 116 Personal Authority and Interdependence 116 Self-Esteem and Self-Acceptance 116 How to Focus on Individual Experience 117 Cup of Coffee Intervention 117 Tracking Personal Growth 117 Awareness Wheel 118 Reframing Anger 121 Summary 121 4 Integration of Practice: Common Factors 123 Client Attributes and Extratherapeutic Factors, 40% 125 Honor the Client’s Worldview 125 Reframe Resistance 126 Stages of Change 127 Motivational Interviewing 129 CONTENTSx Guiding Style 130 Ambivalence 130 Exploring Values 130 Change Talk 131 Affi rmation 131 Summarizing 131 The Therapeutic Relationship: Joining, 30% 131 Develop an Alliance 134 Highlight Family Strengths 135 Acknowledge Effort, Caring, and Intent 136 Gift Giving 136 Instilling Hope, 15% 137 Use Positive Language 137 Discover Successes 138 Emphasize Small Steps of Change 138 Explore Possibilities 139 Therapist Attributes and Approaches, 15% 140 Feedback Informed Therapy (FIT) 141 The Self of the Therapist: Attributes of Good Clinicians 142 Centered and Self-Reflective 143 Flexible 144 Therapeutic Strategy 148 Yes, But . . . 148 One Down 149 Discussion of Harvey 152 Tips for Self-Development 152 Summary 153 PART II Systemic Thinking in Action 157 5 Starting Off on the Right Foot: Referral and Intake 159 Task 1: Assess the Referral Process 161 The Politics of Referrals: Who Defines the Problem? 162 Stigma 164 Self-Referrals 164 Couple Referrals 165 Family Referrals 166 Professional Referrals 166 Mandated Referrals 168 Task 2: Describe the Problem in Relational Terms 169 Intakes: From Problem to Process 169 What Is the Problem? 170 Who Should Be Included? 173 Who Has Tried to Help? 175 Hypotheses: Use the Common Themes 176 Joining 178 Referral and Intake 179 Client Motivation 180 Family and Others 180 CONTENTS xi Hypotheses: Common Themes 180 Initial Treatment Contract 180 Discussion 181 Questions That Beginning Clinicians Often Ask 181 1. How Should I Handle the Issue of Substance Use if I Suspect It Is a Part of the Problem? 181 The Importance of an Individualized Approach 182 The CAGE 183 Trauma Screening 183 2. How Should I Deal with a Suicide Threat? 184 Explore Individual Experience 184 Explore Relational Resources 184 Safety Planning 185 3. What Should I Do If I Discover Family Violence? 186 Assess Lethality 186 Deconstruct Rage 187 4. How Should I Handle Family Secrets? Privacy vs. Secrecy 188 Summary 190 6 From Problem Definition to Treatment Plan 192 Task 3: Organize Treatment 195 Clarify the Role of the Therapist 195 Describe the Therapeutic Process 197 Task 4: Assess Individual Functioning 199 Talk the DSM Talk 199 Walk the MFT Walk 200 Task 5: Assess Relational Functioning 201 Track Interactional Sequences: The “Microscope” of Family Therapy 202 What’s in a Couple Sequence? 203 Discussion 205 Expand the System 206 Relational Hypotheses: Use Common Themes 209 Discussion and Application 211 Sample Summary for Denise 212 Task 6: Develop Shared Goals 213 Assess Level of Crisis 213 Explore Hidden Agendas 214 Set Family Goals: Where Are They Going? 215 Prioritize 216 Make Goals Concrete and Specific 216 Discussion 218 Multisystemic Goals 219 Task 7: Plan Interventions: How Will You Help Them Get There? 219 Developmentally Appropriate Practice 220 What Would You Like to Have Happen? 221 Discussion 223 Problem History 224 Compare Family Therapy Models 226 CONTENTSxii Treatment Plans 229 The Language of Managed Care 229 Recovery Models and Person-Centered Care 229 Summary 232 7 Relational Assessments as Interventions: Exploring Client Experience 234 Assessments as Intervention 235 Interactional Patterns: Content and Process 236 Temporal Patterns: Past, Present, Future 237 Genograms 238 Types of Genograms 238 Constructing Genograms 239 Circular Questioning: In Relationship to What? 243 Tracking Interactional Sequences: Facts vs. Assumptions 245 Just the Facts 246 Assumptions and Interpretations 247 Tracking Longitudinal Sequences: Narratives About Changes Over Time 247 Advantages of Timelines 249 Deconstruction: People and Experiences 251 Developing a Rationale for the Timeline 251 Creating a Sense of Movement 252 Summarizing Details 252 First Session: Intake and Initial Interview 253 Defi ning the Problem 253 Tracking Interactional Sequences 253 Precipitating Events 254 Goals 254 Contract 255 Data-Gathering Phase (Genogram) 255 Second Session: Tracking Longitudinal Sequences 256 Timeline 256 Marking and Discussing Time Periods 256 Comparing Life Stages 257 Using, Identifying, and Emphasizing Family Strengths 257 Third Session: A Return to the Presenting Problem 257 Cultural Issues and Family Values 257 Family Interaction and Structure 257 Transforming Assessment to Intervention Through Reframing 257 Hypotheses 259 Gender, Race, Culture 259 Intergenerational 259 Transitions 260 Family Structure 260 Individual Experience 260 Interventions 260 Discussion 261 The Process of Change 264 Summary 264 CONTENTS xiii 8 Biopsychosocial Interventions in the Real World 266 Managing In-Session Process 267 Focusing 268 Increasing Intensity 269 Marking Boundaries 270 Unbalancing 271 Making the Covert Overt 272 Reconstructing Belief Systems 273 Identifying Current Belief Systems 273 Reframing the Meaning of Symptoms 274 Stressing Complementarity 275 Using Metaphors 276 Experimenting with New Behaviors 279 Generating Alternative Solutions 279 Resolving Conflict 280 Coaching Communication 281 Modeling 281 Instruction 282 Practice 283 Feedback 283 Assigning Tasks 284 Developing Rituals 285 Introducing Paradox 287 Discovering Hidden Emotions 288 Validating Attachment Patterns 289 Introducing Attachment Needs 289 Promoting Acceptance of Attachment Needs 289 Inviting Responsiveness to Attachment Needs 290 Enacting Attachment Dialogs 290 Balancing the Nervous System 291 Stress Physiology 292 Survival First 293 Trauma Therapy: Restoring the Basics 294 Social Engagement 294 Orienting 294 Anchoring Safety in the Body 295 Grounding and Resourcing 296 Restoring Defensive Movements 297 Summary 298 9 Advanced Strategies 300 Interventions for Children 301 Behavior Management 302 Parent Training 302 Emotional First Aid for Children 305 Games for Symptoms 305 Art Interventions 307 Understanding Expressive Communication 308 Developmentally Appropriate Practice 310 CONTENTSxiv Accessing Relationships Through the Creative Process 310 Activities for Traumatic Injuries 312 Trauma Healing 314 Military Trauma 314 Childhood Abuse 317 Resources for Trauma Healing 319 Unresolved Grief and Loss 321 Operational Mourning 321 Reclaiming Relationships 322 Memorials 323 Health-Care Interventions 324 Guidelines for Chronic Illnesses 325 End-of-Life Care 326 Network Therapy: Who Is the Client? 328 The Teacher 329 The Probation Officer 331 The Multidisciplinary Team 332 Summary 333 Epilogue 335 Appendices 339 Appendix A: Sandy Hook 341 A.1 Timeline: Peter, Nancy, Ryan, Adam 341 A.2 Sandy Hook Emails 343 A.3 Sandy Hook Government Report Excerpts 345 Appendix B: Online Resources 350 Appendix C: Post-Traumatic Stress Disorder Checklist – Civilian Version (PCL-C) 352 Appendix D: Adverse Childhood Experience (ACE) Questionnaire 354 Appendix E: Ethics At-Risk Test for Marriage and Family Therapists (MFTs) 356 Appendix F: Questions to Assess Violence 358 Appendix G: A Family Suicide Watch 360 Appendix H: Sample Treatment Plans 362 Appendix I: Teacher Consultation 369 I.1 Teacher Consultation: Functional Analysis 369 I.2 Behavior Management Plan 370 Appendix J: Emotional First Aid for Children 372 Appendix K: Daddy and Granddaddy: A Teen’s Resolution of Family Suicides 374 Appendix L: Films of Interest to Students of Family Therapy 382 Appendix M: Structural Family Therapy Mapping 387 Glossary 388 References 397 Subject Index 410

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