family interventions/approaches to treatment lorraine m. torres-sena, ph.d. new mexico va healthcare...
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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?