Family Crises and Intervention - Final Exam PDF

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2/2 TuesdayStability of Family Organization - Morphostasis: maintenance of/resistance to change in family interaction patterns (homeostasis, feedback mechanisms to constrain change) - Some stability is necessary for the family to carry out its functions in meeting members’ needs - Rigidity leads to ...

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2/2 Tuesday Stability of Family Organization - Morphostasis: maintenance of/resistance to change in family interaction patterns (homeostasis, feedback mechanisms to constrain change) - Some stability is necessary for the family to carry out its functions in meeting members’ needs - Rigidity leads to failure to adapt to transitions/changes and exacerbate the stress that is experienced - Morphogenesis: family’s tendency to change its organization/ patters in order to adapt to life stressors o First-order change (temporary change to adapt to a stressor) o Second-order change (lasting reorganization to family system; more fundamental) Stressor vs. Crisis - Stress: Minor; everyday part of life; change causes stress, and can then turn into a crisis if you cannot manage it - Crisis: can have significant, lasting damaged if not dealt with correctly History of Crisis Intervention - Began during WWII o Coconut Grove Nightclub Fire ▪ Used community care takers; no need for a license! - Wellesly Project – Gerald Caplan o Originally focused on sudden bereavement and trauma surrounding birth during post-WWII Baby Boom (infant death, premature babies, etc.) o Early intervention (focusing right during the start of the crisis) - Suicide Prevention movement in the 1960s o Used non-professional volunteers Contributions - Psychoanalytic Theory o Ego Strength (identify needs, find resources) - Existential Theory o Crisis as danger and opportunity (happier, hopeful spin_ - Humanistic o Carl Rogers o Person-centered o Positive Regard - Cognitive Behavioral Theory - Family Systems o Awareness of system maintenance/resistance to change Effective Helpers - What makes someone a good helper - What characteristics are helpful/harmful Burnout - Causes o Emotional tax of clients’ transference/resentment o Limited Resources o Bureaucracy (Paperwork)

o Intense emotional arousal o Equating effectiveness with client success o Secondary/vicarious trauma

2/4 Thursday ABC-X Model of Family Crisis A – Provoking or stressor event; sufficient enough to cause change in a family - Family Stress Theory o Not all stress is negative, but when a family’s response is not effective, symptoms can arise - Can be normal developmental transitions - Systemic, interconnectedness of families = even if a stressor affects one family member, it will affect the system. - Family Life Chart on ELMS - Assessing Stressor o Boss (2002) uses the following classifications to assess the stressor (A of the ABC-X Model) ▪ Source – origin of stressor (internal vs. external) ▪ Type • Ambiguous vs. clear • Volitional vs non-volitional ▪ Duration – how long has family been facing stressor ▪ Density – how many stressors are occurring at once, or in a row B – Family’s resources/strengths - Resources o Community, family, and individual levels - Coping o Resources vs. behaviors - Does family use resources available? - Family flexibility C – Meaning/definition attached to event - Family’s interpretation of meaning and capacity to manage o Meaning largely contributes to behavioral response X – Degree of stress of crisis - The ABC’s determine the degree of stress Kanel – ABC Model of Crisis Intervention A – Developing Rapport - Attending behavior o Active listening (verbal & nonverbal behavior) o Cultural differences in how nonverbal behavior is experienced (not stereotyped) - Questioning o Open-ended vs. closed-ended (How are you? / What’s today’s date?) o Explore levels of meaning attached to behavior ▪ branches of tree cognitions or downward arrow - Paraphrasing - Summarizing (clarifying thoughts vs. emotions) - Avoid giving advice/interpreting B – Identifying the Problem - Identify precipitating event

o Recent upsetting event(s) – meaning to person/a.k.a. cognitive key (e.g. loss of control, self-esteem, nurturance danger to well-being or ability to achieve goals) o Pile-up of stressors - Checks for suicidal, homicidal, substance abuse, other antisocial behavior risks - Provide therapeutic interaction with client o Validation and supportive statements o Education o Empowerment (encourage actions to take back power) o Reframing C – Coping - Identify client’s past and present attempts at coping (and degree of effectiveness) - Encourage flexibility and trying new approaches o experimental approach – try out methods, evaluate, revise as needed; counteract yes, but… responses, and I’ve tried everything responses - Present alternative coping approaches (support groups, therapy, social service agencies, medical & legal & financial referrals, bibliotherapy & videos, exercise, recreation, building support network) - Monitor, keep in touch, follow up Resources - Material resources - Personal resources (Ego strength) - Social resources

2/9 Tuesday Ethical Principles and Issues - Dual relationships (therapeutic help in two different settings) - Informed consent (important to help the office legally; important so they know all the details of the study/therapy) - Confidentiality o Issues with parents and children, secret keeping in couple and family therapy, release of information regarding participants in family therapy o Child abuse reporting act (in some states); Maryland’s regulations o Elder abuse reporting act (in some states) - Importance of professional continuing education (required by licensing boards in major professions in most states) - Practicing within the scope of one’s professional expertise o Use of paraprofessionals – advantages but raises expertise issue o Having appropriate training to make an adequate assessment/diagnosis and provide interventions o Knowing when to make referrals - Countertransference (and dealing with clients’ transference reactions) o Therapist/counselor self-awareness is crucial Burnout and Secondary PTSD - Definitions o Physical and emotional exhaustions ▪ Negative self-concept ▪ Negative attitude toward work ▪ Loss of concern for clients o Symptoms ▪ Psychosomatic (e.g. fatigue, headaches) ▪ Cognitive (e.g. negative self-concept, hopelessness) ▪ Behavioral (e.g. withdrawal, aggressive behavior) ▪ Emotional (e.g. Depression) - Those at risk for burnout o Professional helpers o Family caregivers - Secondary PTSD (compassion fatigue) o Research shows it is not related to helper’s prior trauma o Important for people who provide intervention to be aware of own symptoms, engage in preventive strategies (including self-care) Stress as a Function of Culture, Race, and Sexual Orientation - Adaptation among Immigrant Families o As of 2006 census, 12.5% of U.S. population are immigrants with documentation (largest groups: 53.5% from Latin America, 26.8% from Asia, 13.3% from Europe); overall, very diverse immigrants, so no typical characteristics o Types of migrants: ▪ Economic migrants – came seeking better jobs and pay ▪ Family migrants – came to join family members in U.S.

Involuntary migrants – came to escape political violence or environmental devastation in country of origin o Earlier laws facilitated immigration for family reasons (e.g. for family reunification, for a family facing dire circumstances in country of origin to migrate as refugees) o Beginning ………. Acculturation o Stress when values, beliefs, rules, roles, strategies that they have used to function successfully in home culture differ from those that are normative in the host culture such as U.S. o Acculturation: process of adjusting to a new culture and assimilating, involving changes in identity, values, behaviors, attitudes, interactions, relationships ▪ Cultural identity involves: • Who you spend your time with (e.g. interacting with people who share your culture of origin versus those from the host culture) • The language you speak in school, at work, at home, in social relationships • The food you eat, music you listen to, media you read/watch • Where you shop • Traditions, holidays, etc. you observe o Degree of acculturation is extent to which family members take on those aspects of the host culture; can be bicultural (research indicates those who develop biculturalism adapt better and are more satisfied) o Often generational gaps in acculturation develop in immigrant families, with children acculturating more and faster than their parents; a potential source of family conflict, as well as disruption of the power hierarchy in a family when parents depend of children for language translation Common Stressors and Barriers o Stressors: ▪ Societal level (immigration policies, discrimination) ▪ Family conflict level (generational, marital regarding role changes) ▪ Individual level (e.g. depression, isolation) ▪

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2/11 Thursday Systems-Oriented Models of Couple and Family Therapy The following are three prominent examples of approaches to couple and family therapy, which are widely practiced. For each model, basic concepts are described, and then representative methods are presented that are used to assess a family and intervene to help them with their problems. The three models represent a variety of approaches, in terms of how family problems and their causes are conceptualized, and how clinicians attempt to help families overcome them. In class we will examine how each model can be helpful in preventing or treating sources of family stress. There are other models that are practiced in the field and that can be helpful as well. Structural Family Therapy: Concepts - Family’s ability to cope with internal and external stressors depends on its structural organization and flexibility o Subsystems ▪ Boundaries (rigid, clear/permeable, diffuse) (continuum from disengagement to enmeshment) (also boundary around family -- extent of openness to outside influences and support) ▪ Hierarchy ▪ Coalitions, triangle o Flexibility, adaptability of structure and rules ▪ Ability to adapt over time as needs of members and demands from external stressors change - Assumes family is competent and capable of solving their own problems. - Symptoms are a product of a faulty structural system. o Communication processes ▪ Constructive exchanges of information needed to solve problems and meet members’ needs ▪ Collaborative problem-solving o Cultural variations in family structure ▪ Therapist works with family culture. Does that work for you, not What is the ideal? Structural Family Therapy: Assessment - Assessment o Observe how members arrange themselves, interaction patterns (subsystems, boundaries, triangles) o Listen for how family describes members’ roles o Create enactments in sessions to elicit family patterns Structural Family Therapy: Interventions - Interventions o Re-arrange family in therapy room o Direct members to interact in different ways during sessions (e.g., instruct parent(s) in taking charge of child misbehavior during session; block one parent from including child in talk about parents’ relationship) o Therapist forms temporary alliance with a member to empower him/her when he/she has low power

o Assign homework tasks that create new interaction patterns (e.g., sibling activities, couple date nights) Solution-focused Family Therapy: Concepts - All individuals, couples, and families face problems in their lives and need to have effective ways to solve them, but they often get stuck in repeatedly attempting the same ineffective solutions - Their narrow perspective blocks them from identifying and trying alternative solutions that can work better - Therapy focuses on the future, not the ineffective past, focuses on existing family strengths, and is optimistic - The family members (not the therapist) are the experts on their lives and what they need; they are naturally resilient and are the ones who can identify new solutions once they stop focusing in a negative way on problems - There is no one correct or normal way to live; what is normal for a family is the absence of the problem that they have defined Solution-focused Family Therapy: Assessment & Interventions - Assessment/Intervention o Listen to the family’s description of their problem briefly, but shift the focus to the solutions that they have attempted – what has worked at least partly or not worked, what solutions they keep trying, and what types of solutions they have not attempted o Ask the miracle question to identify how they want their circumstances to be different/better; get them to define the improved conditions in observable behavioral terms o The family, not the therapist decide what their goals are – what they want to change. Those goals are the only focus of the therapy, and when they are reached, therapy is finished. o Use scaling to get the family to identify manageable steps along the way to reaching their goal. If where you are now is 0 and reaching your goal of X is 10 on a 0-10 scale, what would it take to get to a 1? o Compliment the family on all efforts they make toward change Narrative Family Therapy: Concepts - Families and the individuals within them develop narratives or stories about their lives, based on dominant narratives existing in the culture within which they live (e.g., people’s value depends on how successful they are in their careers and financially), messages passed down through the generations in their family (e.g., women are responsible for taking care of men in our family), and their own personal experiences (e.g., I’m not a good student). - The narratives include roles that family members play (e.g., gender role stereotypes about what females and males are capable of), the ways that the world will affect them (e.g., we can’t trust anyone but our family), what causes problems (e.g., if there is a problem, someone must be to blame for it, and you need to identify who that it an blame/punish them for it), and likely outcomes in their lives (e.g., things just don’t turn out well for us – we never get any breaks in life). - A family’s narratives constrain the options that they see in their lives (limits what they notice in situations and how they think they can respond to issues in life);

families who seek therapy commonly have negative, pessimistic, hopeless, helpless themes in their narratives. - A central goal of therapy is to help families create new narratives that open up more possibilities in life for them. Narrative Family Therapy: Assessment & Interventions - Assessment o Invite family to tell their story (narrative) of their family life and experiences o Therapist adopts a not knowing approach – the family teaches him/her about their experiences; therapist listens for themes in the family’s narrative (including how they define their presenting problem(s) and think about their causes, controllability, etc.) o Look for unique outcomes or exceptions within the narrative (in which the general theme did not fit (e.g., when the children did not argue, but rather got along with each other) o Explore cultural and family-of-origin factors that have contributed to the narrative - Intervention o Collaborate with the family in externalizing the presenting problem (something the family can unite to fight against; no longer considered an innate characteristic of a member) (e.g., conflict pessimism depression) o Ask relative influence questions (e.g., How did the two of you overcome the conflict during your vacation trip so it had little influence on your relationship?) o Replace problem-saturated narrative with a narrative in which the family overcomes the problem (focus on language regarding control of the problem; use unique outcomes information to devise ways to make the story come out better) o Develop a network of support for the new narrative (e.g., extended family, friends who support a more harmonious family) o Rituals

2/16 Tuesday Cognitive-Behavioral Family Therapy C.B.T. - Emotion (Cognitive) o What we feel affects what we think and do - Thought o What we think affects how we act and feel - Behavior o What we do affects how we think and feel Types of Behavior Affecting Family Interaction - Excess of negative acts & deficits in positive acts; negative reciprocity and escalation; demand-withdrawal; mutual avoidance - Deficits in expressive and listening skills used in communication (e.g. lack of specificity, defensive responses) - Deficits in problem-solving skills - Deficits in behavior change skills (e.g. reliance on aversive control) Learning Principles (applied to family interaction) - Classical conditioning (of emotional responses) - Reinforcement o Positive reinforcement o Negative reinforcement o Punishment o Reinforcement rules - Observational learning (modeling) - Cognitive factors in learning (e.g. expectancies, self-efficacy) Problematic Family Patterns - Inter-parental conflict with poor communication - Parent-child or parent-adolescent conflict with poor communication - Parental focus on negative characteristics of the child/adolescent; failure to notice and reinforce positive behavior - Inadequate problem-solving skills - Cumulative family stressors - Shared family beliefs in helplessness and hopelessness in the face of stressful life experiences - Negative attribution about other family members’ actions Cognitive-Behavioral Family Therapy: Behavioral Interventions - Decreasing exchanges of negative behavior between parents and children, and increasing of exchanges of positive behavior: o Behavioral contracts (with a focus on increasing positive behavior) o Communication skill training (including parents communicating clearly to child about rules) o Problem-solving training o Scheduling pleasant activities together o Allowing adolescents to increase independent behavior o Parent’s consistent reinforcement of the adolescent’s positive behaviors; use of warmth and social support

o Parents’ consistent use of non-aggressive discipline techniques (e.g. withdrawal of privileges) o Parents allowing adolescents to participate somewhat in family decision-making o Clear boundary between parents and children (e.g. parents do not burden adolescents with adult problems; keep adolescents out of the middle of parental conflicts) Guidelines for Good Communication - Take turns being the person who expresses ideas and emotions, and being the person who is listening to the other person’s ideas and emotions. A person will listen better to you if you listen well to him or her - When you are listening to the other person, try to understand what he or she is experiencing - When you are listening to the other person expressing his or her thoughts and emotions, do not give advice, do not defend yourself, and do not criticize the other person. Only try to understand his or her perspective - After the other person stops speaking, let him or her know that you listened well and that you understand. Communicate your understanding by summarizing what he or she said. For example, I heard you say that you feel sad that we have spent little time together. - When you are expressing you own thoughts and emotions to the other person, use clear and specific messages. Do not say that you are right and the other person is wrong. Speak about your own feelings, and do not blame or threaten the other person. - Whenever possible, let the other person know that you respect his or her ideas, even if the two of you disagree. - Be aware that people often believe nonverbal messages more than verbal messages. Your posture, gestures, facial expressions, and voice tone influence the message that the other person gets from you. Guidelines for Problem-Solving - Clearly and specifically state what the problem is (in terms of observable behavior) o Break large, complex problems into several smaller ones o Make sure all parties agree on the definition of the problem - Brainstorm possible solutions (don’t evaluate now) - Discuss pros and cons of each possible solution - Decide on a solution (or combination of solutions) that all parties agree on - Decide on a trial period to implement the solution - Evaluate the solution’s degree of success, and try another one if necessary Cognitive Factors in Relationships - Selective attention (perception) - Attributions - Expectancies - Assumptions - Standards Cognitive-Behavioral Family Therapy: Cognitive Interventions - Identification of negative attributions family members make about each other’s motives, personality, etc.

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