1. Family Interventions/Approaches to Treatment Lorraine M. Torres-Sena, Ph.D. New Mexico VA Healthcare System

2. Functional Family Therapy (Alexander and Parsons, 1982) Family-based Approach *Initially developed for treating juvenile delinquency *Integrates behavioral, systems and cognitive intervention strategies

3. Functional Family Therapy (FFT) Three Phases – dynamic and overlapping *Engagement/Motivation *Behavior Change *Generalization

4. Engagement/Motivation (Early Phase) Goals of Phase *Develop Therapeutic Alliance *Reduce Negative Communication *Minimize Hopelessness *Refocus Solution Attempts *Reduce Dropout *Increase Motivation for Change

5. Engagement/Motivation (Early Phase) Risks and Protective Factors *Risks *Negativity and Blaming *Hopelessness *Lack of Motivation *Protective *Credibility *Alliance *Treatment Availability

6. Engagement/Motivation (Early Phase) Assessment Focus *Behavioral *Presenting Problem *Risk and Protective Factors *Relational *Contextual *Risk and Protective Factors

7. Early Phase Treatment Adherence Give Rationale for Family Treatment (Session 1) Inquires About Treatment Expectations (Session 1)

8. Early Phase Treatment Adherence Reducing/Managing Hostility (All Sessions) *Interrupts *Divert Hostile Interactions Using starting and stopping reframes *Process Comments *Shifting the Focus

9. Early Phase Treatment Adherence Positive Expectation for Treatment *Statements about Hope *Normalizing *Goal Identification

10. Early Phase Treatment Adherence Relational Definition of the Problems *Relationship Focus *Interrelates thoughts, feelings and behaviors between family members *De-emphasize Individual Focus

11. Early Phase Treatment Adherence Identify Functions of Behavior *Identify Repeated Patterns or Themes *Explore Sequence of Behaviors *Functions of Each *Distance *Midpointing *Contact Review and Assign Homework

12. Behavior Change (Middle Phase) Goals *Individualized Plan *Relational Skills *Communication *Parenting *Problem-Solving

13. Behavior Change (Middle Phase) Risks *Poor Parenting *Negative/Blaming Communication Protective *Positive Parenting *Supportive Communication Context *Parental Pathology *Development Level

14. Behavior Change (Middle Phase) Assessment Focus *Quality of Relational Skills *Compliance with Behavior Change *Relational Problem Sequence

15. Communication Listening Skills *Level 1 – Repeating *Level 2 – Rewording *Level 3 – Paraphrasing *Level 4 – Reflection of Feeling

16. Communication cont… Assertiveness Training *Passive versus Aggressive *Assertive Formula *Anger Management

17. Communication DOs of Communication *Brief Statements (10 words or less) *Use I Statements *Direct and Specific Statements *Active Listening *No Interruptions *Paraphrase What Heard *Stay on One Topic *Focus on Here and Now

18. Communication cont… DONTs of Communication *Long Lectures *Blaming *Vague Statements *Poor Listening *Interrupting *Put-downs *Yelling, screaming, etc… *Sarcasm *Mind reading *Laundry Listing

19. Parenting ABCs of Understanding Behavior *Antecedents *Behaviors *Consequences Reinforcements *Using Positive Reinforcements *Withdrawal of Positive Reinforcements *Punishment *Stability and Consistency Effective Communication

20. Problem-Solving Gather Information Identify the Problem Brainstorming Pros and Cons Decide on Acceptable Solution Decide on an Alternative Implement Plan Evaluate Plan

21. Trauma Themes (Resick, 1988) Safety Trust Power/Competence Esteem Intimacy

22. Middle Phase Treatment Adherence Review Homework Outcome Clarify Behavior Changes Provide Rationale for Intervention Educate Family on Behavioral Strategies Practice Behavioral Strategy and Provide Feedback Assign Homework Based on Behavioral Strategy and Interpersonal Functions

23. Generalization (Late Phase) Goals *Maintain/Generalize Change *Relapse Prevention *Community Support *Resources to Maintain Change

24. Generalization (Late Phase) Risks *Poor Relationships – School/Community *Low Social Support Protective *Positive Relationships – School/Community

25. Generalization (Late Phase) Assessment Focus *Multi-systemic Community Resources Needed *Maintenance of Change

26. Late Phase Treatment Adherence Discuss Behavioral Changes Made Identify Similar Family Situations to Test the Generalization of New Skills Relapse Prevention Strategies with Emphases on Predicting Problems Identify Community Resources and External Supports Review/Reinforce Treatment Gains Identify Further Growth Areas

27. Behavioral Couples Therapy Engagement *Develop Positive Expectations -Partner Involvement Crucial -Partner Willing -Clear Rationale -Ready for Challenges *Develop Culture of Partner Involvement -Conjoint Interview for 1 st appt

28. Behavioral Couples Therapy Conjoint Therapy Not Recommended when: *Serious Domestic Violence *Spouse Not in Relationship *Malignant Aggression/Distress *Strong Preference to not have Partner

29. Behavioral Couples Therapy Goals of Treatment *Couple Learn Skills to Cope Differently with Symptoms *Couple Learn Skills to Cope Together *Couple Develop Skills to Improve their Relationship

30. Behavioral Couples Therapy Couple-Related Functional Analysis *Couple Behaviors that Reinforce *How Couple Spends time Together *Problems Couple is Experiencing *Communication and Problem-Solving

31. Functional Analysis Framework Client Assessment Couple Coping Assessment *Triggers & Consequences *Beliefs that Interfere with Positive Coping *Individual Needs Couple Functioning Assessment *Major Problem Areas *Positive Reciprocity *Communication and Problem-solving

32. Behavioral Couples Therapy Assessments *Communication Patterns Questionnaire (Christensen & Shenk, 1991) *Conflict Tactics Scale (Straus, 1979) *Dyadic Adjustment Scale (Spanier & Filsinger, 1983) *Family Environment Scale (Moos & Moos, 1989)

33. Reciprocity Enhancement Increase Shared/Recreational Activities Anger, Frustration and Avoidance Development of Positive Interactions *Catch partner doing something nice *Love days

34. Questions?

35. From Problem to Possibility, From Surviving to Thriving: Solution- Focused, Narrative, Collaborative, Strength-Based Family Therapy Approaches for Children of Parents with PTSD Avron Kriechman, MD

36. Family Therapy Approach for Children of Parents with PTSD Making Contact Entering the Crisis Story Lowering Distress Managing Emotions Enhancing Resolve

37. Family Therapy Approach for Children of Parents with PTSD Co-creating a Survival Story Moving From Problem to Possibility Forming Goals Taking Action: Discovering Past Solutions Co-creating a Thriving Story

38. Questions?