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 1 st 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?