Family Interventions/Approaches to Treatment

Lorraine M. Torres-Sena, Ph.D.

New Mexico VA Healthcare System

Functional Family Therapy (Alexander and Parsons, 1982) Family-based Approach

* Initially developed for treating juvenile delinquency

* Integrates behavioral, systems and cognitive intervention strategies

Functional Family Therapy (FFT)

Three Phases – dynamic and overlapping

* Engagement/Motivation

* Behavior Change

* Generalization

Engagement/Motivation (Early Phase)

Goals of Phase

* Develop Therapeutic Alliance

* Reduce Negative Communication

* Minimize Hopelessness

* Refocus Solution Attempts

* Reduce Dropout

* Increase Motivation for Change

Engagement/Motivation (Early Phase)

Risks and Protective Factors* Risks

* Negativity and Blaming* Hopelessness* Lack of Motivation

* Protective* Credibility* Alliance* Treatment Availability

Engagement/Motivation (Early Phase)

Assessment Focus

* Behavioral

* Presenting Problem

* Risk and Protective Factors

* Relational

* Contextual

* Risk and Protective Factors

Early Phase Treatment Adherence

Give Rationale for Family Treatment

(Session 1)

Inquires About Treatment Expectations (Session 1)

Early Phase Treatment Adherence

Reducing/Managing Hostility (All Sessions)

* Interrupts

* Divert Hostile Interactions Using “starting and stopping” reframes

* Process Comments

* Shifting the Focus

Early Phase Treatment Adherence

Positive Expectation for Treatment

* Statements about Hope

* Normalizing

* Goal Identification

Early Phase Treatment Adherence

Relational Definition of the Problems

* Relationship Focus

* Interrelates thoughts, feelings and behaviors between family members

* De-emphasize Individual Focus

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

Behavior Change (Middle Phase)

Goals

* Individualized Plan

* Relational Skills

* Communication

* Parenting

* Problem-Solving

Behavior Change (Middle Phase)

Risks* Poor Parenting* Negative/Blaming Communication

Protective* Positive Parenting* Supportive Communication

Context* Parental Pathology* Development Level

Behavior Change (Middle Phase)

Assessment Focus

* Quality of Relational Skills

* Compliance with Behavior Change

* Relational Problem Sequence

Communication

Listening Skills

* Level 1 – Repeating

* Level 2 – Rewording

* Level 3 – Paraphrasing

* Level 4 – Reflection of Feeling

Communication cont…

Assertiveness Training

* Passive versus Aggressive

* Assertive Formula

* Anger Management

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

Communication cont…

DON’Ts of Communication* Long Lectures* Blaming* Vague Statements* Poor Listening* Interrupting* Put-downs* Yelling, screaming, etc…* Sarcasm* “Mind reading”* Laundry Listing

Parenting

ABCs of Understanding Behavior* Antecedents* Behaviors* Consequences

Reinforcements* Using Positive Reinforcements* Withdrawal of Positive Reinforcements* Punishment* Stability and Consistency

Effective Communication

Problem-Solving

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

Trauma Themes (Resick, 1988)

Safety Trust Power/Competence Esteem Intimacy

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

Generalization (Late Phase)

Goals

* Maintain/Generalize Change

* Relapse Prevention

* Community Support

* Resources to Maintain Change

Generalization (Late Phase)

Risks

* Poor Relationships – School/Community

* Low Social Support

Protective

* Positive Relationships – School/Community

Generalization (Late Phase)

Assessment Focus

* Multi-systemic Community Resources Needed

* Maintenance of Change

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

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 1st appt

Behavioral Couples Therapy

Conjoint Therapy Not Recommended when:

* Serious Domestic Violence

* Spouse Not in Relationship

* “Malignant” Aggression/Distress

* Strong Preference to not have Partner

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

Behavioral Couples Therapy

Couple-Related Functional Analysis

* Couple Behaviors that Reinforce

* How Couple Spends time Together

* Problems Couple is Experiencing

* Communication and Problem-Solving

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

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)

Reciprocity Enhancement

Increase Shared/Recreational Activities Anger, Frustration and Avoidance Development of Positive Interactions

* Catch partner doing something “nice”

* “Love” days

Questions?

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

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

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

Questions?