Basic Stages and Skills of Marriage and Family Therapy

Stages of therapy I. Early Stage II. Middle Stage III. Termination The first interview Initiate engagement and assessment II. Middle Stage Engagement Assessment Intervention Change and resistance III. Termination

The First Interview Goals for the initial phone call This is your first contact with the client Overview of problem Arrange for family to come in for consultation The more people, the better Be empathetic Validate their struggle “It sounds like you are having a really difficult time in your marriage” Communicate a sense of competency Ex. Is this something you can help us with?

2 important objectives for first interview I. Initiate engagement Did you have hard time finding the office? Were my instructions clear? Etc. Provide the format: “The main purpose of this meeting is to give you an opportunity to meet me and to let me meet you. I understand that a lot has been occurring in your family that has been upsetting for all of you. What I would like to do in this meeting is to hear everyone’s point of view about what’s going on. Finally, at the end of our meeting, I would like to share with you my perceptions, give you my recommendations, and allow time for you to ask me questions.”

First interview cont’d. II. Initiate Assessment Gather necessary information Chronological? Vs. thematic? Formulate hypothesis about what is causing/maintaining the problem Different than in individual therapy No diagnosis No particular family member is singled out

During Assessment: Don’t forget that every case is unique Listen carefully to the family’s account of the problem and ask detailed questions Try to move families from linear (It’s Ahmet) and medical model thinking (He has ADHD) to an interactional perspective Be sensitive to gender inequalities, cultural issues, and ethical issues Be careful for land mines like: “What should we do?, what’s wrong with Johnny?”

Develop observation skills More interactions to pay attention to: Where do people sit in relationship to one another? Who speaks for the family as well as for other family members? How does the spokesperson introduce the family’s problems? How do other family members react to the spokesperson’s presentation? Does anyone object or agree? Who supports whom most frequently during the discussion? Which relationship are the most conflicted? What patterns are common to the family’s disagreements? Who gets involved in these arguments? Who stays out of them? At which point is the therapist invited into the disagreements? Who consistently elicits the therapist’s support?

1st and 2nd meeting Establishing goals and clarify an intervention plan Q: How will we know when you are done? Q: I would like each of you to tell me what you would like to get out of our meetings. Goals can be intrapersonal or interpersonal

Early phase of treatment Deeper Engagement Creating rapport/joining/therapeutic alliance Validation Refine therapist’s hypothesis Begin work with family to resolve problems Assign homework Challenge family members to see their own roles in their presenting problems

Adopting systemic lenses Underline the differences in each person’s presentations of the problem. Shift focus from individual blame to interpersonal dynamics Keep in mind the stage of the life cycle (temporal context)

Acknowledge and be aware of interpersonal and temporal context Ex: “Mr. Martin, you and Cindy (14 yrs old) certainly see things in different ways. Has this always been the case and, if not, when did it begin?” “Cindy, the differences between you and your mother are clear but I was wondering if you have differences of opinion with other family members?”

Challenge unhelpful interactions “The more you do X, the more he does Y, and the more you do Y, the more she does X” (nag/withdraw) Point out what is not working Th: “When you ignore your wife’s complaints, she feels hurt and angry. You may have trouble accepting the anger, but she doesn’t feel supported” C: “What should I do?”

Middle phase of treatment Therapist adopts a less active role Encourage family to rely on their own resources Encourage family members to talk amongst themselves Use intensity Intervention: Could be theory specific Focus on change

Termination Goals are met Early drop out When family/couple has resolved presenting problems When family/couple feels they can manage their lives without professional help Having closure It’s useful to review what was learned with the family at this stage Early drop out

Termination Goals are not met Referral