Notes on Family Therapy and Treatment Stages

Indications for Family Therapy

  • Individual vs. Family Therapy
    • All therapy involving family members impacts the family group dynamically, but is generally referred to as FAMILY THERAPY when all members are involved.
    • Individual therapy may be more appropriate when physical illnesses are the primary issues (e.g., endocrine disorders, infections) where family therapy is not suitable as a first approach.

Basic Conditions for Employing Family Therapy

  1. Evidence of family dysfunction.
  2. Dysfunction must relate to the issues for which help is sought.
    • A nuanced view also includes:
      • Symptoms linked to dysfunctional family relationships.
      • Change targeted in relationships rather than individuals.
      • Issues with separation/independence.
      • Families that are severely disorganized.

Three Views on Indications for Family Therapy

  1. Exclusive approach: Family therapy as the only required treatment.
  2. Treatment-of-last-resort: Family therapy considered only after other methods fail.
  3. Diagnostic aid/differential treatment: Family therapy considered among various treatments to identify the most effective approach.
    • Positions 1 & 2 are seen as extreme.
    • Current perspective: Family therapy is one among many treatment modalities. The primary focus is whether the family system is central to treatment.

Decision Trees for Treatment Selection

  • Clarkin, Frances, and Moodie (1970) outlined a 4-step decision tree to guide treatment selection:
    1. Is family/marital evaluation needed?
    2. Is family/marital treatment indicated?
    3. Duration/intensity of therapy: Crisis, Brief (<6 months), Long-term.
    4. Which family therapy model is appropriate?

Contraindications for Family Therapy

  • Difficulties defining contraindications, but common considerations include:
    1. Involvement unfeasible due to key members being unavailable or unmotivated.
    2. Absence of a skilled family therapist.
    3. Family being in a crisis stage unsuitable for therapy.
    4. Danger due to precarious family member function.
    5. Severe depression or emotional issues in a family member.
    6. Referrals from agencies (court, school) without willingness from family.

Summary: When Family Therapy is Valuable

  1. Problems concerning children or adolescents.
  2. Family dynamics resulting in issues among members.
  3. Difficulty in transitioning through familial or developmental stages.
    • Family therapy is effective in addressing dysfunction and can be combined with individual member treatment when needed.

A Method of Therapy (Chapter 13)

Coherent Approaches to Family Therapy
  • Therapist's approach influenced by:
    1. Personality traits (comfort with humor, directive).
    2. Training background (theoretical views on emotion, behavior).
    3. Personal effective methods.
    • Continuous refinement of therapist skills is necessary.
Treatment by Stages

  1. Establishing Rapport and Alliance

    • Importance of effective communication and establishing initial connections.

  2. Assessing the Family

    • Informal assessment examining desired changes and family strengths.
    • Assessment drives intervention, focusing on positive change rather than labeling.
    • Gather individual views and clarify overlapping problems to set clear, behavioral goals.

  3. Formulating Goals

    • Goals should be:
      • Relevant, positively framed, simple, specific, clear in action expectations, actionable in context.

  4. Introducing Change Strategies

    • Direct approaches: Active intervention, coaching, and directive assignments.
    • Indirect approaches: Focus on altering interaction patterns and meanings; used when direct methods are ineffective.
    • Effective directives should be precise and support mechanisms established.

  5. Following Up and Evaluating Interventions

    • Use standardized and non-standardized evaluations to assess progress.
    • Clarity in goals aids evaluation processes.
    • Methods include numerical scales, expressive graphics, and ongoing interviews.

  6. Termination

    • In family therapy, termination occurs when:
      • Goals are achieved.
      • The therapist believes that relapse is unlikely.
    • Termination processes to be revisited in future chapters.