1. Basic Stages and Skills of Marriage and Family Therapy

3. 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

4. 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?

5. 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.”

6. 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

7. 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?”

8. 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?

9. 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

10. 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

11. 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)

12. 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?”

13. 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?”

14. 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

15. 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

16. Termination
Goals are not met
Referral