mindfulness-based family therapy a brief overview copyright 2011 by charlton hall, mmft, lmft

Mindfulness-Based Family Therapy

A Brief OverviewCopyright 2011 by

Charlton Hall, MMFT, LMFT

www.mindfulfamilytherapy.com


A Brief Overview

Mindfulness-Based Family Therapy (MBFT) is a blending of Mindfulness and Family Systems Therapy.

In this overview, we will examine Family Systems Theory and Mindfulness Skills, and how these two concepts work together.


A Brief Overview

Part One: Family Systems Theory

Part Two: Mindfulness

Part Three: Integrating Family Therapy and Mindfulness

Part Four: Mindfulness-Based Family Therapy (MBFT) and Substance Abuse Treatment

Mindfulness-Based

Family Therapy

Part One:

Family Systems Theory

Family Systems TheoryA Post-Modernist Approach

Elements of Postmodernism relevant to Family Systems Theory:•Theory Influences Observations•The Observer Changes the Observed•Equipment Constructs Results•Either-Or•Ideological Immunity, or the Planck Problem

"Why People Believe Weird Things" Michael Shermer, PhD

Family Systems TheoryTheory Influences Observations

•Confirmation Bias•Flat Earth vs. Round Earth•Reality is Jointly Constructed (Daylight Saving Time)•Paradigm Shifts

Family Systems TheoryThe Observer Changes the Observed

•Star Trek’s ‘Prime Directive’•Experimenter’s presence alters the experiment (Heisenberg’s Uncertainty Principle)•Therapist’s presence alters the family system•Do families behave differently at home than in the therapy office?

Family Systems TheoryEquipment Constructs Results

The Fishnet•If your fishnet has 2” holes, you might conclude that no fish smaller than 2” exist

If your area of expertise is Borderline Personality Disorder, everybody looks Borderline

Family Systems TheoryEither-Or

•False Dichotomy or False Dilemma•Also known as ‘Black or White’ Thinking•Leads to ‘I’m right and you’re wrong’•Systems Theory = toleration of ambiguity (everything is subjective)•Dialectical Behavior Therapy (DBT)

•Based on the Hegelian Dialectic•Thesis-Antithesis-Synthesis (next slide)

Family Systems TheoryEither-Or

Hegelian Dialectic

Family Systems TheoryIdeological Immunity

or the Planck Problem

"An important scientific innovation rarely makes its way by gradually winning over and converting its opponents: it rarely happens that Saul becomes Paul. What does happen is that its opponents gradually die out and that the growing generation is familiarized with the idea from the beginning" -Max Planck



"New and revolutionary systems of science tend to be resisted rather than welcomed with open arms, because every successful scientist has a vested intellectual, social, and even financial interest in maintaining the status quo. If every revolutionary new idea were welcomed with open arms, utter chaos would be the result" - I. Bernard Cohen



Bottom Line: We resist change!•Change means giving up cherished notions•Change means having to do something differently•Change means leaving the familiar•“Better the Devil you know…”•As therapists, we need to be aware of this inherent resistance to change•What is the function of the dysfunction?•“All behavior is purposeful” –Alvin Adler

Family Systems TheoryCybernetic Systems Theory

•‘Cybernetic’ = ‘self-governing systems’•Self-governing systems work to maintain homeostasis

•(Thermostat vs. Thermometer)•Family Systems are self-governing systems•Homeostatic systems resist change!

Family Systems TheoryCybernetics and Systems Theory

Individual Psychology•Observer outside the system•Focuses on the individual•Asks ‘Why’•Linear cause/effect•Deterministic/reactive•Objective•Individualistic•Focus on Content•Absolutistic

Systemic Family Therapy•Observer part of the system•Focuses on interactions•Asks ‘What’•Reciprocal causality•‘Wholistic’/proactive•Subjective•Relational•Focus on Process•Relativistic


The Observer in the System

Watson’sBlack Box ?Behaviorism Cognitive

Behaviorism(CBT)


Simple Cybernetics (CBT)


Cybernetics of Cybernetics (MFT)


What do you see?


•The way you see the picture informs your perspective•Your theory/paradigm informs your perspective•Your own personal narrative informs your perspective•This includes:

•Your culture•Your sex/gender•Your religious/spiritual orientation•Your race•Your age•Your overall approach to life


First Order Change vs. Second Order Change:•First Order Change = Changing the way you play the game

•Can lead to a ‘game without end’•Second Order Change = Changing the rules of the game so it’s possible to win


Second-Order Change: The Nine Dot Puzzle


Second Order Change“Thinking Outside of the Box”

•Don’t assume rules that aren’t there (there was no rule that you couldn’t go ‘outside the box’ on the 9-dot Puzzle)•First Order Change = playing by the same rules but expecting different results (the unspoken rule was that there was a ‘box’ there)•Second Order Change = changing the rules so the game can be won (realizing that there is no ‘box’)•Second Order Change may seem crazy, illogical or paradoxical when considered within the rules of the system (Flat Earth vs. Spherical Earth)•Game without End = continuing to achieve the same results by engaging in the same behaviors (definition of ‘insanity)•Change of Context can break the cycle•Example: George Costanza

George Costanza Does the Opposite


Is Second Order Change MoreLasting and Fundamental?

•Once a Second Order change has occurred, you can’t see things in the same way again (in the 9-dot puzzle, once you know the solution you can’t ‘unlearn’ it; it will always be with you when you see the puzzle again)

•The ‘rules of the game’ have been fundamentally changed

•The old context has been permanently changed-you can’t go back to old ways of thinking because they no longer make sense

•The Mermaid Story


Is Second Order Change MoreLasting and Fundamental?

Nosce te Ipsum“Know Thyself”


•Mindfulness is a type of Second-Order Change!

•More on this later!

Family Systems TherapySolution-Focused Therapy Approach

•Carving an Elephant

•Focus on what’s working, not on what’s not working

•Theoretically, you can do therapy without even knowing what the problem is

Family Systems TherapyFused Relationships

•Codependency•Feel emotionally responsible for each other (“You MADE me feel this way!”)•Poor (or nonexistent) boundaries•Poor assertiveness skills•Poor emotional regulation•To ‘de-fuse’ a relationship, increase differentiation

Family Systems TherapyFused Relationships

A story on Boundary-Setting: The Bridge

Family Systems TherapyExternalization

•The person is not the problem, the problem is the problem•Externalization = technique of separating the problem from the person•“I am not my problems”•The ‘Angry Monster’

Family Systems TherapyBowenian Family Therapy

•Murray Bowen was an American psychiatrist and a professor in Psychiatry at the Georgetown University•Creator of Bowenian Family Therapy, sometimes called ‘Natural Systems Therapy’ or ‘Family Systems Therapy’

Family Systems TherapyBowenian Family Therapy

Bowen summarized his theory using eight interlocking concepts:

• Differentiation of Self (the most important concept)• Nuclear Family Emotional System• Triangles• Family Projection Process• Multigenerational Transmission Process• Emotional Cutoff• Sibling Position• Societal Emotional Process

Family Systems TherapyDifferentiation of Self

•Being responsible for your own emotional wellbeing•Allowing others to be responsible for their own emotional wellbeing•You can’t change anyone else’s behavior … you can only change yourself•By changing your behavior, you ‘get off the seesaw’

Family Systems TherapyNuclear Family Emotional System

Describes four basic relationship patterns that govern where problems develop in a family:

1. Marital conflict2. Dysfunction in one spouse3. Impairment of one or more children4. Emotional distance


1. Marital conflict

As family tension increases and the spouses get more anxious, each spouse externalizes his or her anxiety into the marital relationship. Each focuses on what is wrong with the other, each tries to control the other, and each resists the other's efforts at control.


2. Dysfunction in one spouse

One spouse pressures the other to think and act in certain ways and the other yields to the pressure. Both spouses accommodate to preserve harmony, but one does more of it. The interaction is comfortable for both people up to a point, but if family tension rises further, the subordinate spouse may yield so much self-control that his or her anxiety increases significantly. The anxiety fuels, if other necessary factors are present, the development of a psychiatric, medical, or social dysfunction.


3. Impairment of one or more children

The spouses focus their anxieties on one or more of their children. They worry excessively and usually have an idealized or negative view of the child. The more the parents focus on the child the more the child focuses on them. He is more reactive than his siblings to the attitudes, needs, and expectations of the parents. The process undercuts the child's differentiation from the family and makes him vulnerable to act out or internalize family tensions. The child's anxiety can impair his school performance, social relationships, and even his health.


4. Emotional distance

This pattern is consistently associated with the others. People distance from each other to reduce the intensity of the relationship, but risk becoming too isolated.

Family Systems TherapyTriangulation

•When a dyad has problems communicating, they recruit a ‘go-between’•This ‘go-between’ absorbs the anxiety that the dyad would normally direct at each other•This creates a ‘triangle’ of anxiety distribution•If you hear someone say, “I feel caught in the middle,” there’s probably a triangle going on!

Family Systems TherapyTriangulation

•Triangulation is decreased by increasing differentiation•Increase differentiation by having each family member take responsibility for their own emotional wellbeing•Strengthen boundaries by using ‘I-Position’ communication (more on this later!)

Family Systems Therapy

Family Systems TherapyFamily Projection Process

Three-Step Process:1.The parent focuses on a child out of fear that something is wrong with the child;2.The parent interprets the child's behavior as confirming the fear; and3.The parent treats the child as if something is really wrong with the child

Family Systems TherapyFamily Projection Process

In following the Three-Step process outlined above, the parent has effectively projected her own anxiety onto the child, who then inherits the anxiety and passes it on to the next generation, etc. (Pygmalion Effect, or Self-Fulfilling Prophecy)

Family Systems TherapyMultigenerational Transmission Process

•Small differences in the levels of differentiation between parents and their offspring lead over many generations to marked differences in differentiation among the members of a multigenerational family•The ‘Butterfly Effect’

Family Systems TherapyMultigenerational Transmission Process

•People tend to choose partners with levels of differentiation similar to their own•Over time, high levels of differentiation increase; low levels of differentiation increase as well•Problems tend to become amplified from one generation to the next

Family Systems TherapyEmotional Cutoffs

•Emotional cutoffs = when two or more family members feel so threatened by communicating with each other that they avoid communication altogether•Fear of conflict = type of emotional cutoff•Emotional cutoffs could be the result of emotional blocks•Emotional cutoffs can lead to triangulation

Family Systems TherapySibling Position

•Position in order of birth tends to determine some behaviors•Oldest children tend to gravitate to leadership positions •Youngest children often prefer to be followers


•Middle children exhibit the functional characteristics of two sibling positions

•Example: If a girl has an older brother and a younger sister, she usually has some of the characteristics of both a younger sister of a brother and an older sister of a sister


•The sibling positions of a person's parents are also important •An oldest child whose parents are both youngests encounters a different set of parental expectations than an oldest child whose parents are both oldests

Family Systems TherapySocietal Emotional Process

•How the emotional system governs behavior on a societal level•Human societies undergo periods of regression and progression in their history•These periods are regulated by cultural and societal norms about how emotions are expressed and regulated


•Example: Victorian Era vs. ‘Sexual Revolution’ of the 1960s•Example: The current ‘Borderline Nation’ in America•Example: Asian cultural norms vs. U.S. cultural norms regarding emotional expression•Example: “Bible Belt” vs. New York City


•Emotional processes are learned within the boundaries of a family’s Societal Emotional Process•These norms should be taken into consideration when working with families•Could be an issue of cultural diversity as well

Family Systems TherapyFamily Resilience

Family Systems TherapyFamily Resilience

•Positive attachments and relationships•Interpersonal Skills•Emotional Competence•Cognitive competence•Community support•Food, clothing, shelter & love•Self-esteem

Mindfulness-Based

Family Therapy

Part Two:

Mindfulness

MindfulnessWhat is Mindfulness?

"Mindfulness is the energy of being aware and awake to the present moment. It is the continuous practice of touching life deeply in every moment of daily life. To be mindful is to be truly alive and present with those around you and with what you are doing. We bring our body and mind into harmony while we wash the dishes, drive the car or take our morning cup of tea."

-- Thich Nhat Hanh

MindfulnessWhat is Mindfulness?

•CBT provides the ‘What’ (i.e., the ‘belief’ that needs changing)•Mindfulness provides the ‘How’ (to change the belief)•Mindfulness involves a paradigm shift to a new way of being in the world•Mindfulness is a type of Second Order Change!

MindfulnessMindful Awareness

•Shift from 'Doing Mode' into 'Being Mode‘•Shift from ‘Thinking Mode’ into ‘Sensing Mode’•Mindful Awareness involves the skills of

•Observing•Describing•Fully Participating•Being Non-Judgmental•Focusing on One Thing at a Time

MindfulnessMindfulness Skills: Observing

•Leave Doing Mode and enter Being Mode•Leave Thinking Mode and enter Sensing Mode•Engage all the senses•Become an artist/musician/chef etc.

MindfulnessMindfulness Skills: Describing

MindfulnessMindfulness Skills: Describing

•What does an apple sound like?•The last M & M•Observing and describing exercise

MindfulnessMindfulness Skills: Fully Participating

•By leaving Doing Mode and entering Being Mode, mental energy is freed up for fully taking part in what’s happening right now•By leaving Thinking Mode and entering Sensing Mode, you are more able to let go of the past and the future and simply focus on the ‘now’•By fully participating in life right now, every M & M becomes ‘the last M & M’

MindfulnessMindfulness Skills: Living in the Moment

•Think of three or four things that have stressed you out recently•How many of those have to do with something that happened in the past?•How many have to do with something that may or may not happen in the future?•How many have to do with what’s going on right now?

MindfulnessMindfulness Skills: Living in the Moment

•Living in the moment creates some ‘space’ between the individual and the individual’s overpowering thoughts and feelings•In addiction treatment, if you focus on the craving ‘in the moment,’ you realize that it will eventually pass•Living in the moment prevents hasty and rash decisions

MindfulnessMindfulness Skills:

Focusing on One Thing at a Time

•Automaticization (driving a car)•Automatic thoughts and feelings•Acting deliberately and with intention•Having a purpose for every action•The Japanese Tea Ceremony


Being Non-Judgmental•We are very conditioned to placing judgments on our observations•These judgments lead to assumptions•Incorrect assumptions lead to interpersonal conflict & problems•By withholding judgment all the negative things we tell ourselves is cut off •When negativity stops, healing becomes possible


Being Non-Judgmental•Crystal Ball Thinking:•“Past history is not a guarantee of future performance”•Unless you have a crystal ball, you can’t predict the future•Unless you have a crystal ball, you can’t tell what another person is thinking•Best way to know what someone is thinking = ASK•Best way to know what will happen in the future = WAIT AND SEE

MindfulnessA Basic Mindful Meditation

MindfulnessThe Power of Intention

•“If you don’t know where you’re going, any road will get you there”•What is your intention, really? REALLY?•The ‘Miracle Question’•Formulating your intention: Three Questions

1. Does this need to be said at all?2. Does this need to be said right now?3. Does this need to be said by me?

MindfulnessA Demonstration of

The Power of Intention

Mind over matter: The Chair

MindfulnessAcceptance vs. Change Strategies

God grant me the serenityto accept the things I cannot change;courage to change the things I can;and wisdom to know the difference.

…Serenity Prayer


"The curious paradox is that when I accept myself just as I am, then I can change.“

…Carl Rogers


•What is ‘perfect?’•What if this is as good as it gets?•It’s already here•Radical Acceptance

•We are not our thoughts•We are not our emotions•We are in control•The choice is ours

MindfulnessRadical Acceptance

Ways to deal with a problem:1.Solve it.

If you can’t solve it, then…2. Change the way you think about it.

If you can’t change the way you think about it, then…3. Accept it.

If you can’t accept it, then…

MindfulnessRadical Acceptance

You’ll just have to stay miserable!

MindfulnessLiving in True Self

•Real Self vs. Ideal Self (Carl Rogers)•Perceived Self vs. True Self•You are not your thoughts

•If you catch yourself thinking, what is it that did the ‘catching?’•“I think therefore I am”

•Does this mean that if you stop thinking, you cease to exist?


•True Self = what we are when we acknowledge our dreams and aspirations of ourselves•Who we are without limitations and expectations placed on us by others or ourselves•Who we would be if all this ‘stuff’ wasn’t in the way

•Corollary: We’re in control of the ‘stuff’

“Argue for your limitations, and sure enough, they’re yours.” --Richard Bach


•Tombstone Test


“Live every day as if it will be your last, because one of these days you’re going to be right.”

…Ray Charles

MindfulnessMindful Awareness

•Shift from 'Doing Mode' into 'Being Mode‘•Shift from ‘Thinking Mode’ into ‘Sensing Mode’•Mindful Awareness involves the skills of

•Observing•Describing•Fully Participating•Being Non-Judgmental•Focusing on One Thing at a Time

MindfulnessWise Mind

MindfulnessLetting Go

•Letting go of the stress and anxiety doesn’t necessarily mean letting go of the problem itself•The energy you might have used worrying about a situation could be put to better use in trying to come up with solutions•Radical acceptance leads to letting go

MindfulnessLiving in the Moment

•The past is already gone•The future isn’t here yet•They call it the ‘present’ because it’s a gift!•By living in the moment, you free yourself from past mistakes and future worries

MindfulnessCentering

•Centering is getting in touch with your True Self•It is allowing yourself to realize that you are perfect just as you are, even with your imperfections•If you accept your imperfections and integrate them into your way of thinking and feeling about yourself, you will obtain peace of mind, and you will be centered•Jung called this ‘embracing the Shadow’

MindfulnessCentering

Example: Anger•Anger management doesn’t mean never allowing yourself to feel anger•Anger management means learning to express your anger in positive and productive ways•‘Embracing your Shadow’ =acknowledging darker impulses so they may be expressed in positive and productive ways•Examples: MADD, Martin Luther King, Gandhi

MindfulnessConnecting

•Attachment injuries

•‘Connecting’ allows you to heal old attachment injuries through ‘emotionally corrective experiences’

•Spirituality = Connectedness

•Inspiring moments = moments of being connected

•Connection also means connecting to True Self

MindfulnessMindful Body Scan

•Helps to become aware of how emotions manifest in our bodies•Also helps to become aware of how cravings manifest in our bodies•Your body’s going to do what it’s going to do, but you don’t have to let it push you around!

MindfulnessMindful Body Scan

•A demonstration of the Mindful Body Scan

Mindfulness-Based

Family Therapy

Part Three:

Integrating Family Systems Theory and Mindfulness


What is it?

•MBFT = integration of MFT and Mindfulness

•If CBT is the ‘what,’ then MBFT is the ‘how’

Mindfulness-Based Family TherapySolution-Focused Therapy and The Power of Intention

•Solution-Focused = carving the elephant (do more of what works, do less of what doesn’t work)•Power of Intention = acting deliberately•Focus on the positive, not the negative•Power of Intention used to facilitate and maintain a Solution-Focused approach

Mindfulness-Based Family TherapyDifferentiation of Self and

Acceptance vs. Change Strategies

•One way to increase differentiation is to know the difference between what you can change and what you have to accept•You can’t change anybody but yourself•If others are responsible for your happiness, what happens when they go away?•True happiness comes from within

Mindfulness-Based Family TherapyExternalization and Living in True Self

•True Self = We are not our thoughts or feelings•We are something more than our thoughts and feelings•If we are having thoughts or feelings that are leading to consequences we don’t want, we don’t have to accept them as part of ourselves•Externalization is the process of seeing thoughts and feelings as separate from the True Self

Mindfulness-Based Family TherapyEmotional Cutoffs and Radical Acceptance

•Emotional cutoffs = emotional blocks•Unacknowledged emotional pain & conflicts•Leads to ‘shutdowns’ and ‘cutoffs’•Radical Acceptance = accepting someone, “warts and all”•Set boundaries first!

Mindfulness-Based Family TherapyTriangulation and Mindful Awareness

•Triangulation = result of emotional cutoffs•“Monkey in the middle”•Mindful Awareness = being aware of the process & the feelings behind it

•Being aware of emotional roadblocks to communication

•Process vs. content

Mindfulness-Based Family TherapyFused Relationships and Wise Mind

•Fused Relationship = ‘Smothering’ relationship•Fused relationships often feel emotionally overwhelmed by the other person•Wise Mind = Emotional Mind + Rational Mind•Wise Mind = Acceptance + Change•1st Rule of Change: You can only change YOU!•2nd Rule of Change: Only YOU can be responsible for your own emotional wellbeing!

Mindfulness-Based Family TherapyFamily Projection Process and Letting Go

•EXAMPLE: “You are responsible for MY happiness”•The Pygmalion Effect•Letting Go = Allowing others to be responsible for and in control of their own lives•1st Rule of Change: You can’t change anybody but YOU!

Mindfulness-Based Family TherapyMultigenerational Transmission Process

and Living in the Moment

•MTP = Differences in differentiation tend to amplify over time•MTP = Differences in differentiation tend to amplify across generations•Children respond to parents’ moods and affect•Living in the Moment = Letting go of past disappointments and future worries

Mindfulness-Based Family TherapySocietal Emotional Process and Centering

•SEP = How the emotional system governs behavior on a societal level•Regressive period = period where the focus is on short-term relief of anxiety rather than the long-term view•Focus on short-term gratification leads to a social environment of emotional instability


•Consider the 1960s•Instead of dealing with anxiety generated by society, we were encouraged to, “Tune in, turn on, and drop out;” i.e., self-medicate and deal with strong emotions through substance abuse (short-term fix) rather than taking a long-term view


•Agrarian vs. Industrial•“Store up for the winter” vs. “Run down to the corner convenience store”

•Industrial Age has conditioned us for instant self-gratification, often at the expense of long-term wellbeing


•Centering = Knowing who you are and what you want; i.e., communicating with your True Self•Doing more of what doesn’t work = maintaining the problem (Definition of Insanity)•Centering = using your True Self to determine what’s not working•Centering = having the self-confidence to go against society when necessary

Mindfulness-Based Family TherapyFamily Resilience and Connecting

•Positive attachments and relationships (Compassion)•Interpersonal Skills (Communication)•Emotional Competence (Control)•Cognitive competence (Choices)•Community support (Consequences)•Food, clothing, shelter & love (Consistency)•Self-esteem (Confidence)

…more on the 7Cs of MBFT later!

Mindfulness-Based Family TherapyChanging Choices and Consequences

•ABCD Model•Activating Circumstance (Action)•Belief (about the activating circumstance)•Consequence (as a result of the belief)•Dispute (the belief)•Evaluate (did changing the belief lead to a consequence you wanted?

•The only part you can control is the BELIEF•You can only change the CONSEQUENCE indirectly

•This is done by changing the belief

Mindfulness-Based Family TherapyMemes

•A Meme is an idea, a belief or a behavior that gets passed down from generation to generation•Memes are to behaviors as genes are to traits (hair color, eye color, etc.)•From a Family Systems perspective, we get our beliefs and behaviors from our family of origin, just as a person raised in an English-speaking house would only know how to speak English•In order to change behaviors, we have to change beliefs•We have to learn a ‘language’ that we may not have learned from our family of origin

Mindfulness-Based Family TherapyMeme Triads (Triangles)

•Memes have three components: What, Why and How•All three components are necessary for a meme to exist•All three components are interrelated•‘What’ = What is the nature of the problem?•‘Why’ = Why exactly is this a problem?•‘How’ = How is the problem maintained?

•Doing ‘more of the same’ doesn’t solve the problem•The definition of insanity = doing the same thing the same way and expecting different results•The Fisherman and His Son

Mindfulness-Based Family TherapyMeme Triads (Triangles)

Mindfulness-Based Family TherapyMeme Triads: Assumptions/Perceptions/Reality

Mindfulness-Based Family TherapyMBFT Summary

•Change and Acceptance build family resiliency•Seven characteristics of family resiliency are:

•Compassion•Communication•Control•Choices•Consequences•Consistency•Confidence

Mindfulness-Based Family TherapyMBFT Summary

•Change in beliefs, behaviors, and consequences comes through the ABCDE Model•The only thing you have control over is the BELIEF•Changing the BELIEF changes the CONSEQUENCES•Beliefs and behaviors are ‘inherited’ from family of origin through memes•Memes have three components: What, Why and How•These components are inter-related and interdependent•Change one component, and they all change•Change one component, and the meme changes•Change your thoughts, and change your reality!

Mindfulness-Based

Family Therapy

Part Four:

MBFT and Substance Abuse Treatment

MBFT & Substance Abuse Treatment


Families and Treatment

•The frog = the person with addiction problems•The pot = the family•If you ‘fix’ the frog without turning down the temperature on the family as well…


Families and Treatment

EitherThe frog boils(family problems)!

or

The frog runs away (relapse)!


Five Levels of Family Therapy

1. Counselor has little or no involvement with family2. Counselor provides psychoeducation and advice3. Counselor addresses family members’ feelings

and provides support4. Counselor provides systemic assessment and

planned intervention5. Family Therapy


1. Counselor has little or no involvement with family

• Counselor contacts family for practical and legal reasons and provides no services

• Counselor sees only the individual and may even feel that the client should be protected from family contact during treatment


2. Counselor provides psychoeducation and advice

• Advises family about how to handle client’s needs• Channels communications through one or two key

family members• Identifies gross family dysfunction that may

interfere with substance abuse treatment• Refers family for specialized family therapy


3. Counselor addresses family members’ feelings and provides support

• Facilitate discussion among family members about client’s condition and how it impacts the family

• Evoke empathy for family’s feelings and when necessary, normalizing those feelings

• Provide preliminary family assessments concerning the client’s condition

• Encouraging coping skills• Identify family dysfunctions and tailor treatment to

meet each individual family’s needs


4. Counselor provides systemic assessment and planned intervention

• Engage all family members, including reluctant or withdrawn ones, in sessions

• Allow all members to express themselves• Systemically assess family’s level of functioning• Support individual members while avoiding

coalitions (triangling)• Reframing to solution-focused options• Help family members generate their own solutions• Help family members support each other without

sacrificing autonomy• Connect to community and natural supports


5. Family Therapy

• Engage family members who are difficult to engage (the one who stays home is usually the problem!)

• Generate and test hypotheses about interactional dysfunctions by creating enactments

• Raise anxiety in a controlled manner in order to break stalemates/standoffs

• Dealing constructively with resistance to change (prescribing the symptom, restraining change)

• Create collaborative relationships with other community resources/agencies: Treatment Team


Family Therapy vs. Substance Abuse Treatment

• Family-Involved Therapy vs. Family Therapy• Denial• Substance Abuse• Family Interventions• Spirituality• Process vs. Content• Focus• Identity of the Client• Use of Self-Disclosure

Family Therapy vs. Substance Abuse TreatmentFamily-Involved Therapy vs. Family Therapy

• Family-Involved Therapy• Educating family members about family

patterns involved in substance abuse• Family may participate to a limited extent, but

the individual client is the main focus

• Family Therapy• Educating family members about family

dynamics & interactions• The family system is the main focus


Denial

• In Family-Involved Therapy, denial is seen as a failure to acknowledge the problem behavior

• In Family Therapy, denial is seen as a coping mechanism utilized to maintain family stability• From a Solution-Focused perspective, the

client/family does not have to acknowledge that a problem exists in order to move towards a solution


Substance Abuse

• Substance Abuse Treatment relies on the Disease Model, and considers substance abuse a disease that afflicts a family

• Family Therapy views substance abuse as a symptom of a larger dysfunction in the family

• If the dysfunction is eliminated, the symptoms go away

• In Family Therapy, the focus is on changing dysfunctional interactions within the family system


Family Interventions

• In Substance Abuse Treatment, interventions usually involve the family confronting the identified patient in an effort to urge treatment

• Family Therapy is less confrontational, preferring to focus on modifying family interactions to facilitate change

• Family Therapy is usually a longer process than Substance Abuse Treatment due to the deeper exploration of family interactions


Spirituality

• In Substance Abuse Treatment, spirituality occupies a central role

• In Family Therapy, spirituality is only central to treatment if the family feels it is a significant factor


Process vs. Content

• Substance Abuse Treatment tends to focus on the content of the client’s experiences

• Family Therapy tends to focus more on the family process, observing and identifying problematic interactions and modifying dysfunctional ones


Focus

• For Substance Abuse Counselors, the focus is on the problematic behavior (substance abuse)

• For Family Therapists, the focus is on problematic interactions within the family system


Identity of the Client

• In Substance Abuse Treatment, the client is the person with the substance abuse problem

• In Family Therapy, the whole family is the client


Use of Self-Disclosure

• Many Substance Abuse Counselors are in recovery themselves and are comfortable with self-disclosure as a means to facilitate change

• Family Therapists prefer to modify the process of interaction among family members, and usually do not rely as much on self-disclosure

• In Family Therapy, the focus is more on enactments than on dialogue


Integrating Families into Treatment

• Complete a Genogram for at least three generations

• Identify and target problem interactions• 7Cs of MBFT

• Compassion• Communication• Control• Choices• Consequences• Consistency• Confidence


Integrating Families into Treatment: Genogram


Integrating Families into Treatment: Genogram

Identifying and targeting problem interactions


Genograms and Memes

• Genograms help target problem memes that have been passed down from generation to generation

• For each person on the genogram, ask:• Tell me one helpful thing about this person• Tell me one not-so-helpful thing about this

person• In addition to identifying memes, these questions

help identify natural supports


The 7C Method

The 7 Cs are:• Compassion• Communication• Control• Choices• Consequences• Consistency• Confidence


The 7C Method

• Look for problem memes related to each of the 7Cs

• The goal is to build family resilience by changing problem memes

• By changing problem memes, behavior changes• Changing memes = Second Order Change

• Changing how you ‘think about thinking’• Changing the rules so the game can be won

(remember the 9 Dot Puzzle)


The 7C Method: Compassion

• Being Non-judgmental• Radical Acceptance• What am I trying to accomplish here?• Are my thoughts, feelings and actions

going to help me accomplish it?• Forgiveness starts with forgiving yourself


The 7C Method: Communication

• The I-Position Star• Assertive vs.

Aggressive• Remember old

lady/young lady?


The 7C Method: Communication

Facilitating Mindful Communication Skills:The I-Position Star


The 7C Method: Control

• We all like to feel that we have control over our lives

• In reality, the only person you can control is YOU

• Acceptance vs. Change: can you change others?

• Anger is often the result of failed attempts to control others

• Anger leads to drinking (and drugging) at someone


The 7C Method: Control


The 7C Method: Choices

• True Self vs. Perceived Self• Ideal Self vs. Real Self (Rogers)• True Self (Ideal Self) is the one in control• True Self makes the choices• Our beliefs are a result of our thoughts &

feelings• True Self chooses which thoughts &

feelings get expressed or ‘internalized’


The 7C Method: Choices

• True Self can choose to externalize unproductive thoughts and feelings

• Our beliefs are a result of our thoughts & feelings

• If our beliefs are leading to consequences we don’t want, we can consciously change those thoughts and beliefs to create consequences that we do want

• Change your thoughts, change your world!


The 7C Method: Consequences

• Every action has a consequence• Every belief has a consequence• Negative emotions lead to consequences,

as do happiness and positive emotions• By examining the consequences of our

thoughts, feelings and beliefs, we learn to create different consequences

• Mindfulness allows us to create emotional ‘space’ around feelings and beliefs so that choices can be made


The 7C Method: Consistency

• One key to developing consistency is to change the way you think about things

• Such a Second-Order change becomes possible by living in the moment

• How many things that upset you have to do with the past?

• How many have to do with what may or may not happen in the future?

• By shifting the focus to the present, we regain control of our moods


The 7C Method: Confidence

• What is ‘perfect?’• You are human, and that you’re going to

occasionally make mistakes• Your value as a human being doesn’t concern

how many (or few) mistakes you make• It’s how you deal with those mistakes• Knowing you are human allows you to let go• Realizing that others are human as well, allows

you to forgive and forget, and to start over• This is CONFIDENCE.

mindfulness-based family therapy a brief overview copyright 2011 by charlton hall, mmft, lmft

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