1. Pre-Internship
November 9, 2009

2. Today’s Outline…
Guidelines presentation – Ashley, Jacqueline, & Emily (1:00-1:30)
Change & interaction (1:30-2:10)
Break (2:10-2:20)
Multisystemic assessment (2:20-2:40)
Interpretation & understanding (2:40-3:00)
Triads – Group 2 (3:00-3:50)

3. Self in the System: Change & Interaction

4. Problem of Change
What is your theory of change? How do you think changes occur in therapy?
Client-directed or therapist-directed?
Individuals or family systems?
1st order or 2nd order? Which do you focus on?
Manipulation or collaboration?
Behavior or insight?
What are the implications of your theory of change? Based on what you think about change, how will your therapy look?

5. Interaction
Lasting change = spiraling process of altered interactions (interpersonal) and enriched understanding (personal)
Shifting focus between the interpersonal (the system) and the personal (the self)
What do you think is more important in family therapy, questioning or observation?
Spontaneous interaction vs. enactments directed by the therapist

6. Interaction
Mobilizing family interactions reveals impediments to relational functioning
Interactional – interruptions, arguments
Psychological – fear of intimacy, unwillingness to compromise
Problems in interaction
The self
The dyad
Triangles
Principle of minimal intervention

7. Break
2:10-2:20

8. Multisystemic Assessment

9. Assessment
Diagnosis – static conditions that fall into discrete categories; more appropriate for medical diseases than for psychological problems
Evaluation – suggests process that starts & ends before treatment
Provisional assessment – looking at both internal & external sources of stress; being tentative with your determinations

10. Brief Intervention Simple problem-maintaining sequences
MRI-Brief therapy
Defiant families – give them bad advice
Compliant families – give them good advice
Families stuck in transition
Family life cycle transitions

11. The Larger Context
Why?
Families are prone to blame themselves for pressures they cannot escape.
We measure events against our own values and experience.

12. Ecological Model of Assessment (Bronfenbrenner, 1979; Bronfenbrenner & Morris, 1997)
Macrosystem
Exosystem
Mesosystem
Microsystem
Individual

13. Ecological Model
Individual – psychological issues, psychopathology, development
Microsystem – dyadic relationships in nuclear family
Mesosystem – relationships in extended family
Exosystem – other environments in which family members exist
Macrosystem – societal & governmental influences

14. Small Group Discussion
Discuss possible internal/external stressors existing at each system level for families in your stage of the life cycle.
Group 1 – Launching/young adulthood
Group 2 – Newly married
Group 3 – Families with young children
Group 4 – Families with adolescents
Group 5 – Families in mid-life
Group 6 – Families in later life

15. Interpretation & Understanding

16. Insight: How to Reach the “Ah-hah” Moment
As you have observed therapy this semester, what have been some of the most effective ways that you have seen therapists use to bring about insight and understanding in their clients?

17. Interpretation
Pointing out something of which family members are unaware – especially suppressed emotion, unsuspected motivation, and patterns of reciprocal influence – in a manner that has implications for responsible, self-initiated change
Should move people to deeper experience, with acceptance of self and others given equal weight to understanding
Correct interpretation – discloses something new; novel & striking

18. Interpretation vs. Conjecture
Conjecture – forming hypotheses about a family in the therapist’s own mind; should always be tentative
Interpretation – what a therapist tells a client about unsuspected motivations & unrecognized patterns of interaction
Essential interpretation in family therapy – reciprocity
Content of interpretations
Unsuspected motivations
Enduring rigid patterns of relating to others

19. Delivering Interpretations
General rule – interpret in whatever order and in whatever way seems most likely to further treatment
Time for interpretations – when interactions get stuck and the reasons are close to awareness
Effective interpretations are delivered tentatively – don’t want to be in a parent role

20. How Do You Know Your Interpretation Was Effective?
Followed by fresh material due to diminishing anxiety & guilt
Recognition with surprise
Return of forgotten memories
Dreams
Fantasies
Strong feelings
Relaxation of defenses
Causes a disturbance
Interrupts the taken-for-granted appearance of things

21. Confronting Clients
In your observations, have you seen therapists confront clients? How did the client respond? Did it seem helpful to the process of therapy?
General rules
Use confrontation sparingly
Wait until family members are committed to therapy
Wait until self-defeating patterns are clearly evident
Subject is personal responsibility but the context can be possibility instead of failure

22. Triads: Group 2

23. Next Week Guidelines presentation – Tara, Sybil, & Kelsey
Quiz #2 – Multigenerational theory/therapy
Triad #3 due
All observation summaries due
Reading – Nichols, 8