family therapy concepts process and practice phần 10 doc

PROFESSIONAL RESOURCES 561 • during the interview stage of the exercise, intervening as little as possible, and using the freeze/unfreeze device to do so. Ex 2. Brief for the Family Four people take on the roles of the family, as for exercise 1. Try to complete the process of getting into role in 20 minutes. Use the skeleton roles below to get in role. In this exercise, assume that you are attending your second session. In the fi rst session, the therapist (and team) asked about the presenting problem, the pattern of interaction around it, the beliefs underpinning it and explored possible predisposing factors by constructing a genogram with you. At the end of the fi rst session, the therapist (and team) offered a three-column formulation of the presenting problem (Mary’s headaches and low mood) and exceptions to it. Your family accepted the formulation and agreed to a treatment contract for four further sessions to resolve the presenting problems. When getting into role, discuss what your impressions of the last session were, your memories of your relationship with the therapist and the explanation of the problems that emerged from the session. Then discuss what you will say has occurred between the fi rst and second sessions. Imagine if you really were this family what would have gone on during this intersession interval. In the role-play part of the exercise, the therapist will invite the family to participate in certain tasks within the session, such as discussing how to resolve the presenting problems. As a family, try to cooperate with the task, but also try to follow these role prescriptions. If you are role-playing the mother, June, start off by working coopera- tively with your husband but gradually move towards siding with your daughter, when she expresses feelings of loss and sadness at leaving her home town and country to come and live here in this town, or when your partner seems unreasonable or unsympathetic to your position. You feel lonely and overwhelmed in this new town and country. You are distraught by your daughter’s condition. You miss the way your partner used to be when you lived back home. If you are role-playing the father, Martin, start off by working coopera- tively with your wife but gradually move towards siding with your son, when he says things about just getting on with life or when your partner seems unreasonable or unsympathetic. You are exhausted from working long hours and trying to get established in your new job. Things at work are very demanding, but you know you can do the job well, and in time the pressure at work will subside. When you come home you are disap- pointed that your wife is not more supportive. You also wish she would sort out Mary’s problems instead of making them worse, by being so sub- tly critical of the move to this country. 562 RESEARCH AND RESOURCES If you are role-playing the daughter, Mary, and your mother and father get into a heated and potentially confl ictual conversation in the session about planning what to do to help you, complain of pain, or depression or talk about stuff that is of interest to yourself and your mother but not your father. Interrupt them if you wish. Don’t wait to be asked to take a turn. Just get in there, and say how things are for you. You really don’t want to be in this country. You really miss all your friends. Your father is never home because of his very demanding job. Your mother is the only one who understands what it’s like for you. Your father does not understand how hard it is for you or for your mother in this awful country. If you are role-playing the son, Frank, if your mother and father get into a heated conversation in the session about planning what to do, complain about your sister and talk about stuff that is of interest to yourself and your father but not your mother. Above all, you want to get his approval as the golden boy of the family. You have done your best to fi t into your new school, make new friends, and get into sports here in this new town. You want your father to say good things about you for all this. For all of you role-playing this family, try to hold onto these extreme positions in the family interview at least for a while, but be a bit respon- sive to the therapist’s interventions, because you trust the therapist who will in the long-term help you all adjust to your new living situation and help Mary with the headaches and sadness. As for exercise 1: • pretend that the team sitting behind the therapist is invisible • pretend you are working with the same therapist throughout the session (so there is no need to reintroduce yourselves if a new team member takes the therapist role) • pretend that time is frozen if the therapist says ‘freeze’ and that it has started again if the therapist says ‘unfreeze’ • ignore urges to discuss the value of the exercise or to disrupt it by giggling. Ex 2. Brief for the Team In this exercise, assume that you are conducting the second session with this family. In the fi rst session you asked about the presenting problem, the pattern of interaction around it, the beliefs underpinning it and explored possible predisposing factors by constructing a genogram. At the end of the fi rst session you offered a three-column formulation of the presenting problem (Mary’s headaches and low mood) and exceptions to it. The family accepted the formulation and agreed to a treatment contract for four further sessions to resolve the presenting problems. PROFESSIONAL RESOURCES 563 Convene a pre-session meeting for 20 minutes to plan how to reconnect with the family; facilitate an enactment; and invite the clients when they get stuck to introduce more appropriate boundaries into their family. To reconnect with the family, open the session by checking out how each member is right now, what they remember most vividly from the last session, and how the week has been. Use this checking-in process, to reintroduce the three-column problem formulation and formulation of exceptional circumstances where the problem is expected to occur but does not. Plan to follow the guidelines for enactments given in Chapter 9 in the section on Changing Behaviour Patterns within Sessions (see p. 277–279). Introduce the enactment by inviting the parents to work with each other to reach agreement on what to do today, tomorrow and the next day about the problem (Mary’s headaches and low mood). Ask the parents to invite the children to listen but not interrupt unless invited to do so. Invite the parents to proceed with this enactment without you intervening until they get stuck. If they try to involve you, say you just want to watch them solving the problem so you can better understand how it is that they become stuck. They may get stuck because the mother and father cannot jointly solve problems and plan without the son or daughter intervening and siding with one parent or the other. When it is clear that they are truly stuck, acknowledge this by asking them is this where they usually get stuck. Then invite the parents to jointly reach an agreement on how to proceed. Ask them to do this in a way that takes account of the youngsters’ views but which is not dictated by the youngsters’ views. If the parents go off track or if a child intervenes, stop them, and insist that the parents work together to reach a joint agreement on how to proceed. About 25 minutes into the session ask the family to ‘freeze’. Use the guidelines in Chapter 9 in the section on Invitations to Complete Tasks (see p. 290–291) to make a plan of how to invite the family complete these two tasks: • The father, Martin and the Daughter, Mary, are invited to spend two 20-minute periods together during the week doing an activity of the daughter’s choosing (because Mary needs her father’s support at this diffi cult time or some other such reason). • The couple, June and Martin, are invited to spend one evening together during the week doing something relaxing that they both enjoyed (because the couple need to spend more time together if they are to become a more effective team for helping to solve Mary’s problem or some other such reason). Ask the family to unfreeze, deliver the tasks and invite the family to attend a third session. 564 RESEARCH AND RESOURCES As for exercise 1: • plan to conduct a 40-minute session • plan for a few people on the team to have a turn at taking the role of the therapist to complete specifi c pre-planned parts of the exercise • the family will pretend that the team sitting behind the therapist is invisible • the family will pretend that they are working with the same therapist throughout the session (so there is no need to reintroduce yourselves each time a new team member takes the therapist role) • the family will pretend that time is frozen if the therapist says ‘freeze’ and that it has started again if the therapist says ‘unfreeze’ • ignore urges to discuss the value of the exercise or to disrupt it by giggling. Ex 2. Debriefi ng Routine As with exercise 1, when the 40-minute role-play family interview is completed, use the same debriefi ng routine as was described for exercise 1. This involves: • inviting the class not to take a break since this will cause the family to de-role • inviting each family member to state how they feel now about their relationships with other family members, the therapist and the team • asking family members to specify which aspects of the session made them feel good, hopeful, cooperative with the therapist, and attached to family members • asking them to specify what made them feel bad, hopeless, resistant to the therapist and alienated from family members • asking the family to postpone de-roling until the experiences of the family have been described • inviting the therapy team and family members to pinpoint what they have learned from these accounts of the family’s therapy experiences. The sorts of lessons may include the following: • enactment can be very stressful but it does highlight the family’s stick- ing point that is preventing them from solving their problem • if a breakthrough occurs in enactment, it can be liberating • inviting families to complete tasks can have a variety of immediate effects. As with exercise 1, ask the therapists who did the interviewing to self- rate the degree to which they believe they achieved what they set out to PROFESSIONAL RESOURCES 565 achieve in the interview on a 10-point scale from 1 ϭ didn’t achieve this goal, to 10 ϭ achieved this goal well, for the following items: • reconnected with the family, checked out how each member was, what they remember from the last session, and how the week had been • Invited the parents to reach agreement on what to do today, tomorrow and the next day about the problem with the children listening but not interrupting unless invited to do so • let the family go at this until they got stuck • resisted becoming sucked into the family system when the parents tried to involve you, by saying you wanted to watch them solving the problem so you can better understand how it is that they become stuck • when the parents went off track or a child intervened, stopped them, and insisted that the parents work together to reach a joint agreement on how to proceed • invited the family to complete two tasks and attend the next session. As with exercise 1, if the self-ratings are unfair, invite other members of the group to remember aspects of the session which showed that the session tasks (listed above) were achieved and to offer fairer ratings. If you video the session, then you can ask members of the class as homework to review the tape to fi nd evidence of having achieved session goals and show these to the class next week. Exercise 3 – Addressing Ambivalence and Presenting Multiple Perspectives Ex 3. Setting up the Exercise Required reading for this exercise is Chapters 4 and 9. To conduct this exercise it is best if the class have completed exercises 1 and 2. In exercise 1, three-column formulations of the presenting problem (Mary’s headaches and low mood) and exceptions to it were constructed and a treatment contract was established. In exercise 2, an enactment was conducted in which the therapist facilitated family problem solving and set intergenerational boundaries between the parents and the children. If exercise 3 is attempted without the class having done exercise 1, the supervisor/trainer must brief the family and the team more extensively by providing them with three-column formulations of the problem and exception. Follow the same general procedures for this setting up this exercise as for exercises 1 and 2. This includes: • 20 minutes for preparation, 40 minutes for role-playing, and 40 minutes for debriefi ng • inviting the family and team to prepare in separate areas or rooms 566 RESEARCH AND RESOURCES • suggesting that a number of team members take turns at conducting therapy • explaining the freeze/unfreeze device as outlined for exercise 1 • avoiding getting sidetracked into discussing the value of the exercise • during the planning phase of the exercise, checking in with the family and the team periodically to make sure they are completing the process of getting into role and planning the interview correctly • during the interview stage of the exercise, intervening as little as possible, and using the freeze/unfreeze device to do so Ex 3. Brief for the Family Four people take on the roles of the family, as for exercise 1 and 2. Try to complete the process of getting into role in 20 minutes. Use the skeleton roles below to get in role. In this exercise, assume that you are attending your third session. In the fi rst session, the therapist (and team) asked about the presenting problem, the pattern of interaction around it, the beliefs underpinning it and explored possible predisposing factors by constructing a genogram with you. At the end of the fi rst session the therapist (and team) offered a three-column formulation of the presenting problem (Mary’s headaches and low mood) and exceptions to it. Your family accepted the formulation and agreed to a treatment contract for four further sessions to resolve the presenting problems. In the second session you engaged in an enactment in which the parents June and Martin tried to develop a plan to deal with Mary’s headaches and sadness and found that they often became stuck when the children intervened in their attempts at problem solving. At the end of the second session, the father, Martin and the daughter, Mary agreed to spend two 20-minute periods together during the week doing an activity of Mary’s choosing. Also the mother, June, and the Father, Martin, agreed to spend one evening together without the children, doing something relaxing that both enjoyed. Despite agreeing to do these tasks and knowing that the therapist would review progress with them at the start of session 3, life continued as usual in your family. June, the mother, was scared to spend time relaxing with Martin in case it ended in a row as usual. Martin, the father was swamped at work and didn’t want the hassle of possible confl ict with June or Mary and so didn’t get around to doing the tasks. Mary, the daughter, was feeling helpless and down and so did not prompt her father to do the task. Frank, the son was uninvolved in this but saw it all happening quite clearly. When getting into role, discuss what your impressions of the last session, your memories of your relationship with the therapist and the PROFESSIONAL RESOURCES 567 explanation of the problems that emerged from the session. Then discuss what you will say has occurred between the second and third sessions. Imagine if you really were this family what would have gone on in con- siderable detail during this intersession interval and discuss it among yourselves. Be prepared to let the therapist know that you did not do the tasks and to discuss the diffi culties you may have had completing the tasks between sessions. As for exercise 1: • pretend that the team sitting behind the therapist is invisible • pretend you are working with the same therapist throughout the session (so there is no need to reintroduce yourselves if a new team member takes the therapist role) • pretend that time is frozen if the therapist says ‘freeze’ and that it has started again if the therapist says ‘unfreeze’ • ignore urges to discuss the value of the exercise or to disrupt it by giggling. Ex 3. Brief for the Team In this exercise assume that you are conducting the third session with this family. In the fi rst session you asked about the presenting problem, the pattern of interaction around it, the beliefs underpinning it and explored possible predisposing factors by constructing a genogram. At the end of the fi rst session you offered a three-column formulation of the presenting problem (Mary’s headaches and low mood) and exceptions to it. The family accepted the formulation and agreed to a treatment contract for four further sessions to resolve the presenting problems. In the second session you facilitated an enactment in which the parents, June and Martin, tried jointly to decide how to address Mary’s headaches and sadness. They tended to get stuck from time to time and the children would interrupt them, so you helped them establish a boundary between themselves and the children. At the end of the session you invited them to do two tasks and made it clear that you would review progress with the tasks in session 3. The tasks were: • the father, Martin, and the daughter, Mary, were invited to spend two 20-minute periods together during the week doing an activity of the daughters’ choosing. • the couple, June and Martin, were invited to spend one evening together during the week doing something relaxing that they both enjoyed. The family have come back for session 3 and will tell you that they have not completed their tasks. 568 RESEARCH AND RESOURCES Convene a pre-session meeting for 20 minutes to plan how to reconnect with the family; review the obstacles they faced in trying to carry out the tasks; address their ambivalence about completing tasks and working to solve the presenting problems; and present multiple perspectives on the dilemma they face. To reconnect with the family, open the session by checking out how each member is right now, what they remember about the tasks they were invited to do between the last session and this session, and briefl y to say how the week has been. Use this checking-in process to lead into explor- ing their ambivalence about changing their situation. To address ambivalence, use the techniques in Chapter 9 in the section on Addressing Ambivalence (see p. 291–293). About 25 minutes into the session, ask the family to ‘freeze’ and then work together as a team to write out a split message taking into account the multiple perspectives of various family members. Use the techniques described in Chapter 9 on Presenting Multiple Perspectives (see p. 295–297) to do this. Then ask the family to ‘unfreeze’ and deliver the split message to them. Conclude by inviting them to come for a fourth session. As for exercise 1: • plan to conduct a 40-minute session • plan for a few people on the team to have a turn at taking the role of the therapist to complete specifi c pre-planned parts of the exercise • the family will pretend that the team sitting behind the therapist is invisible • the family will pretend that they are working with the same therapist throughout the session (so there is no need to reintroduce yourselves each time a new team member takes the therapist role) • the family will pretend that time is frozen if the therapist says ‘freeze’ and that it has started again if the therapist says ‘unfreeze’ • ignore urges to discuss the value of the exercise or to disrupt it by giggling. Ex 3. Debriefi ng Routine As with exercises 1 and 2, when the 40-minute role-play family interview is completed use the same debriefi ng routine as was described for exercise 1. This involves: • inviting the class not to take a break since this will cause the family to de-role • inviting each family member to state how they feel now about their relationships with other family members, the therapist and the team PROFESSIONAL RESOURCES 569 • asking family members to specify which aspects of the session made them feel good, hopeful, cooperative with the therapist and attached to family members. • asking them to specify what made them feel bad, hopeless, resistant to the therapist and alienated from family members • asking the family to postpone de-roling until the experiences of the family have been described • inviting the therapy team and family members to pinpoint what they have learned from these accounts of the family’s therapy experiences. The sorts of lessons may include the following: • when ambivalence is addressed in the session it can lead to some family members feeling understood if it fi ts with individual family members’ experiences • when a multiple perspective intervention is offered to the family it can be liberating if it fi ts with family members’ experiences. As with exercises 1 and 2, ask the therapists who did the interviewing to self-rate the degree to which they believe they achieved what they set out to achieve in the interview on a 10-point scale from 1 ϭ didn’t achieve this goal, to 10 ϭ achieved this goal well for the following items: • checked out how each member was, what they remembered about the tasks they were invited to do, and asked them how the week had been • addressed ambivalence, using the techniques in Chapter 9 • developed and presented a split message taking multiple perspectives into account using the techniques described in Chapter 9 • concluded by inviting the family to a fourth session. As with exercises 1 and 2, if the self-ratings are unfair, invite other members of the group to remember aspects of the session which showed that the session tasks (listed above) were achieved and to offer fairer ratings. If you video the session, then you can ask members of the class as homework to review the tape to fi nd evidence of having achieved session goals and show these to the class next week. Exercise 4 – Externalising Problems and Building on Exceptions Ex 4. Setting up the Exercise Required reading for this exercise is Chapters 4 (especially the sections on solution-focused Therapy (see p. 132–135) and Narrative Therapy (see p. 135–8)) and 9 (especially the section on Externalising Problems and Building on Exceptions (see p. 297–299)). To conduct this exercise it is best if the class have 570 RESEARCH AND RESOURCES completed exercise 1, and it is good if they have completes exercises 2 and 3, but not essential. In exercise 1, three-column formulations of the presenting problem (Mary’s headaches and low mood) and exceptions to it were constructed and a treatment contract was established. If exercise 4 is attempted without the class having done exercise 1, the supervisor/trainer must brief the family and the team more extensively by providing them with three-column formulations of the problem and exception. Follow the same general procedures for setting up this exercise as for exercises 1 to 3. This includes: • 20 minutes for preparation, 40 minutes for role-playing and 40 minutes for debriefi ng • inviting the family and team to prepared in separate areas or rooms • suggesting that a number of team members take turns at conducting therapy • explaining the freeze/unfreeze device as outlined for exercise 1 • avoiding getting sidetracked into discussing the value of the exercise • during the planning phase of the exercise, checking in with the family and the team periodically to make sure they are completing the process of getting into role and planning the interview correctly • during the interview stage of the exercise, intervening as little as possible, and using the freeze/unfreeze device to do so. Ex 4. Brief for the Family Four people take on the roles of the family, as for exercise 1 and 2. Try to complete the process of getting into role in 20 minutes. Use the skeleton roles below to get in role. In this exercise, assume that you are attending your fourth session. In the fi rst session, the therapist (and team) asked about the presenting problem, the pattern of interaction around it, the beliefs underpinning it and explored possible predisposing factors by constructing a genogram with you. At the end of the fi rst session the therapist (and team) offered a three-column formulation of the presenting problem (Mary’s headaches and low mood) and exceptions to it. Your family accepted the formulation and agreed to a treatment contract for four further sessions to resolve the presenting problems. In the second session you engaged in an enactment in which the parents, June and Martin, tried to develop a plan to deal with Mary’s headaches and sadness and found that they often became stuck when the children intervened in their attempts at problem solving. At the end of the second session, the father, Martin and the daughter, Mary agreed to spend two 20-minute periods together during the week doing an activity of Mary’s choosing. Also the mother, June, and the father, Martin, agreed to spend one evening together without the children, doing something relaxing that both enjoyed. In the third session, the reasons why your family did not do the tasks set in the second session were explored in detail. At the end of the session, [...]... 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Consulting and Clinical Psychology, 55, 396–403 Dale, P (1986) Dangerous Families: Assessment and Treatment of Child Abuse London: Tavistock Dallos, R (1991) Family Belief Systems, Therapy and Change Milton Keynes: Open University Press Dallos, R (1997) Interacting Stories: Narratives, Family Beliefs and Therapy London: Karnac Dallos, R & Aldridge, D (1985) Handing it on: Family constructs, symptoms and choice . the therapist and alienated from family members • asking the family to postpone de-roling until the experiences of the family have been described • inviting the therapy team and family members. the experiences of the family have been described • inviting the therapy team and family members to pinpoint what they have learned from these accounts of the family s therapy experiences. The. Externalizing Problems and Building on Exceptions and the ideas of Solution-focused Therapy and Narrative Therapy presented in Chapter 4: PROFESSIONAL RESOURCES 573 • Review progress and look for any

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