1. CREATING A REFUGE: CLINICAL CASE MANAGEMENT WITH FAMILIES

2. Clinical Case Management With Families Takes a both and approach to the seeming duality of different models of change and different types of change Takes a both and approach to the seeming duality of different models of change and different types of change -First order change – ex. medical model -Second Order Change – ex. recovery mode l Watzlawick, Weakland & Fish. (1974). Change: Principle of Problems Formation and Problem Resolution. W.W. Norton

3. Winnicott’s Definition of Casework Casework might be described as the professional aspect of this normal function of parents and of local social units, a ‘holding’ of persons and of situations, while growth tendencies are given a chance. These growth tendencies are present all the time in every individual, except where hopelessness … has led to an organized withdrawal. These tendencies have been described in terms of integration, of the psyche coming to terms with the body, the one becoming linked to the other. (1961, p.107). Casework might be described as the professional aspect of this normal function of parents and of local social units, a ‘holding’ of persons and of situations, while growth tendencies are given a chance. These growth tendencies are present all the time in every individual, except where hopelessness … has led to an organized withdrawal. These tendencies have been described in terms of integration, of the psyche coming to terms with the body, the one becoming linked to the other. (1961, p.107).

4. Clinical Case Management With Families What is therapeutic involves both first order and second order change. What is therapeutic involves both first order and second order change. What is therapeutic involves attention to both symptoms and tangible needs as well as attention to attachments and re-connection. What is therapeutic involves attention to both symptoms and tangible needs as well as attention to attachments and re-connection.

5. Assessment: What Type Of Change Is Needed? First order changes are measurable, observable and amenable to quantitative methods. First order changes are measurable, observable and amenable to quantitative methods. Ex: Symptoms, tangible needsEx: Symptoms, tangible needs Second order changes are subjective and are amenable to qualitative methods Second order changes are subjective and are amenable to qualitative methods Ex: Spirituality, values, beliefsEx: Spirituality, values, beliefs

6. Assessment: Refuge or War Zone? How safe is the family? The Crisis Chain Stage # 1More of the sameStage # 1More of the same Stage # 2Seek helpStage # 2Seek help Stage # 3Inversion of valuesStage # 3Inversion of values Stage # 4Ritual suicideStage # 4Ritual suicide Stage # 5Family in runawayStage # 5Family in runaway David, Kantor & William Lehr. (1975) Inside the Family. Jossey-Bass

7. MORE OF THE SAME GET HELP RITUAL SUICIDE RUN AWAY INVERSION VIOLENCE = LOVE HELP = ENABLE GOOD = BAD CRISIS CHAIN

8. BEFORE The home is a bunker. There is a hierarchical difference between the partners. Their embarrassment contributes to rigid closed boundaries between themselves and the world AFTER The home is a refuge. The hierarchical differences have been eliminated and the boundaries between the couple and the outside world and more open. Mattie Bystander Ron Victim Mattie-Ron Ron and Mattie

9. REFUGE GET HELP COMBAT RUN AWAY INVERSION VIOLENCE = LOVE HELP = ENABLE GOOD = BAD ALLAN AND BRANDY

10. References Kantor, D., Lehr, W. (1975). Inside the Family. San Francisco, CA: Jossey-Bass Kantor, D., Lehr, W. (1975). Inside the Family. San Francisco, CA: Jossey-Bass Winnicott, D.W. (1961) “Varieties of psychotherapy.” A talk given to Mental Illness Association Social and Medical Aspects, Cambridge 6 March 1961. In Winnicott, C., Sheperd, R., Davis, M., (Eds). (1986). Home is where we start from. New York: W.W. Norton. Winnicott, D.W. (1961) “Varieties of psychotherapy.” A talk given to Mental Illness Association Social and Medical Aspects, Cambridge 6 March 1961. In Winnicott, C., Sheperd, R., Davis, M., (Eds). (1986). Home is where we start from. New York: W.W. Norton.