Tuesday, July 3, 2012

Family Therapy Assessment Tools


 Abstract
The role of the therapist requires them to appropriately diagnose and treat individuals experiencing conflict.  Therefore, as clients seek professional assistance, the proper assessment tools and therapeutic strategies must be applied.  When utilized effectively, these techniques enable clients to realize constructive resolutions.  The following illustrates the genogram, structural assessment, behavioral parent training, experiential therapy, and structural family therapy in order to evaluate and assist a family in the midst of detrimental conditions. 
 Scenario
Jeff is a 40-year-old single father with one 13-year-old child, Roger. Jeff’s wife abandoned the family when Roger was only 6. She is a drug user and has serious financial problems. Further, she might even have bipolar disorder since it seems to correspond to her behavior. Also, her mother was diagnosed with bipolar disorder.

Recently, Roger has not been focusing at school, is scoring low academically, and is withdrawing emotionally from everyone. He is also asking his father many questions about his mother. Jeff has informed Roger that his mother is “no good,” and that Roger had better begin to do better in school or he is not going to leave the house except to go to school, as he will be grounded indefinitely.

When he is at home, Roger rarely leaves his room and spends many hours playing video games, some of which contain violent content. Further, his personal hygiene has diminished.

Jeff is an engineer and considers himself to be “the only stable force in Roger’s life.” He prides himself in trying to teach Roger about “a strong work ethic and traditional values.” Recently Jeff has started dating Sherry, a 32-year-old co-worker with whom he is spending an increasing amount of time.

  Family Therapy Assessment Tools
The role of a family therapist requires the practitioner to responsibly and effectively diagnose and treat families experiencing problematic or traumatic issues.  In effort to address and overcome these concerns, one must consider specific circumstances and implications, apply appropriate strategies, and assist the family in achieving favorable, long-term resolutions (Nichols, 2010).  Regarding Jeff and Roger’s given situation, the family is experiencing various problems fostered by abandonment, single-parent crisis, and hereditary depression.  Hence, family therapy would enable the father and son to overcome such issues and create a functional environment beneficial to the welfare of each individual (Nichols, 2010).  In order to properly attend to the father and son, the therapist may begin by utilizing a genogram, apply additional information, identify relative questions, implement strategies to modify behavioral patterns, and employ certain techniques to alter family transactions.  Acknowledgment and usage of the aforementioned factors promotes the probability of success.
Within the initial stage of the therapeutic process, utilizing a genogram would be advantageous.  As an assessment tool, the genogram illustrates the life cycle of families amongst the generations, indicating social relations, medical history, spirituality, and other pertinent facts (Carter & McGoldrick, 2011).  In relation to Roger, the genogram would reveal that his mother and grandmother apparently suffer from bipolar disorder.  This implies that he is prone to such conditions as well as drug abuse or addiction.  Furthermore, a genogram would disclose the occurrence of divorce, culture, religious practices, behavioral patterns, financial status, and the connectedness of the extended family.  However, the effectiveness of this tool is contingent upon the accuracy and detail of the information provided.  In effort to assure cooperation prior to compiling the genogram, effective counseling skills such as eye contact, rephrasing, sensitivity, and encouragement are beneficial.  Furthermore, the therapist should relay how the client’s issues may be related to familial history in order for the client to understand the connection (Counselling Connection, 2012).   Additionally, these considerations may be biased or insufficient.  As the only adult, Jeff is responsible for providing the majority of the data.  Therefore his contribution may be limited.  The therapist must also consider the fact that Jeff has a negative perception of his ex-wife and possibly other family members, which may compromise his opinion of relations or knowledge of occurrences.
Aside from the information provided by the genogram, the therapist should consider additional factors regarding Jeff and Roger.  These include (1) the environment, (2) Roger’s current academic standing, (3) how Jeff and Roger interact and address one another, (4) how much time they spend together, and (5) what types of activities or hobbies they are involved in, joint and separate.  First, a change of environment or a stressful environment may cause anxiety, irregular sleep patterns, low energy, depression, high blood pressure, projected anger, or hopelessness.  Any of these may be triggered from an altered setting or a traumatic or stressful event (The Center for Victims of Violent Crimes, 2010).  Such factors may be affecting Roger.  As he enters his teenage years he has become isolated, careless in regard to hygiene, and experienced an academic decline, each of which could be an indicator of hopelessness or depression.  Second, with a decline in academic performance, the therapist should inquire as to whether or not Roger is in danger of failing his grade level rendering him unable to progress to high school (assuming he is an eighth grader).  This could cause withdrawal and depression as well.  Third, the manner in which Jeff and Roger interact should be taken into consideration.  Does Roger refer to Jeff as dad or father, or merely refer to him as Jeff?  Do they maintain a balanced dialogue, or is Jeff domineering and commanding in his approach?  How often or how much do they communicate on a daily to weekly basis?  What is the typical content of those interactions?  Within the field it is widely considered that, “communication is the vehicle of relationship” (Nichols, 2010, p. 70).  Without effective communication, Jeff and Roger’s relations are obstructed.  Often, individuals attempt to solve issues, yet distressful dialogue or behavior cultivates additional stress (Nelson & Figley, 1990).  Jeff feels as if he is acting as a responsible parent and provider, yet as he condemns Roger and his ex-wife the child is detrimentally affected.  Furthermore, as Jeff overindulges, taking a domineering, intruding role, Roger counters by isolating (Benjamin, 1977).  The key is to focus on interactions which foster conflict, confusion, or inadequacy and then modifying those interactions (Nichols, 2010).  Other factors to be taken into consideration are the amount and quality of time Jeff and Roger actually spend together.  Do they have shared interests?  Is Jeff spending more time with Sherry, his new girlfriend, in comparison to his son, Roger?  Exactly how often does he leave Roger unattended?  Does Roger have any hobbies other than playing video games?  What enjoyment or fulfillment is Roger receiving from playing violent video games in particular?  Answering such questions would provide insight into the quality and dynamics of their familial relations as well as Jeff and Roger’s thought processes (Nichols, 2010).  As a parent takes interest in the child’s hobby, the activity transforms from a child’s pastime to a family pastime.  This may encourage the child to become more active outside of the home and more interactive with others as well.  Additionally, such activities enhance academic proficiency, demonstrate the correlation between work and money, provide a sense of self-satisfaction, and boost confidence (West, 2012).  However, Roger prefers to play violent video games.  Research indicates that violent video games are the foremost risk factor for delinquent behavior.  The therapist should also note that children exposed to these games tend to have enhanced aggressive thoughts and emotions and sexualize women (Karlsson, Pagan, Harris, & Massarelli, 2010).  Furthermore, if Jeff continues to neglect Roger while spending more time with Sherry, Roger may continue to withdraw or begin to act out.  Roger may even feel as if Sherry is trying to replace his mother.  Often, as couples intimately transition, the child’s need for security and connectedness is ignored.  The child’s losses and divided loyalty must be properly addressed (Papernow, 2012).  Additionally, it would behoove Jeff to realize and relay to Roger that Sherry can not replace his ex-wife.  Although she may be an ex-spouse, she is not an ex-mother.  Also, Jeff must understand that a stepfamily can not function as a biological family and work on maintaining a balance of loyalty between his son and his new partner (Lofas, 2011).
Now, in effort to modify Jeff’s behavior, initially, the therapist may utilize behavioral parent training.  This method tends to “accept the parents’ view that the child is the problem” (Nichols, 2010, pp. 250-251).  Hence, an individual’s parenting techniques are modified in order to coerce the child to respond in a favorable manner as opposed to acting out or withdrawing.  This may be achieved by employing operant techniques such as shaping, token economies, contingency contracting, and contingency management (Nichols, 2010).  First, shaping involves a gradual step by step process which progresses toward the desired behavior.  Over time, this technique transforms the child’s actions and response.  Second, the concept of token economies may enable Jeff to reconfigure Roger’s behavior by rewarding appropriate behavior.  This positive reinforcement cultivates improved behavioral patterns.  Third, contingency contracting is a type of agreement which requires Jeff to modify his behavior once Roger has made certain changes.  On the other hand, contingency management requires Jeff to reward or confiscate rewards depending upon Roger’s behavior (Nichols, 2010).  Although time-out is another notable operant technique, it would be disadvantageous and perhaps not age appropriate in regard to Roger.  He is already distant and withdrawn, thus sending him to his room would be potentially hazardous and undoubtedly ineffective.
In terms of directly modifying Roger’s behavior, the therapist may employ an experiential approach.  This methodology requires the practitioner to encourage the client to disclose his or her underlying emotion.  In modern times, underlying emotional issues have emerged as critical to cognitive behavioral formulations (Pascual-Leone & Greenberg, 2007).  In essence, enabling clients to express their emotions “helps them as individuals to discover what they really think and feel – what they want and what they’re afraid of – and it helps them as a family get beyond defensiveness and begin to relate to each other in a more honest and immediate way” (Nichols, 2010, p. 211).  As the therapist explores underneath the surface to Roger’s true feelings and motivations, he or she may begin to break through Roger’s defenses.  Once his defenses are broken down, the therapist is more capable of assisting Roger and Jeff as they reconnect their bond and communication (Nichols, 2010).  The process of evoking, exploring, and restructuring harmful emotion is a beneficial procedure (Pascual-Leone & Greenberg, 2007).
Concerning the negative aspects of behavioral parent training and experiential therapy, both are slightly insufficient in treating Jeff and Roger.  Behavioral parent training may give Jeff a false sense of innocence.  He may feel as if only Roger is responsible for their familial distress and ineffective communication.  Jeff must be made aware of his role in the destruction as well.  Furthermore, experiential therapy may be too focused upon Roger’s emotional experience, omitting the influence of family structure in perpetuating that experience (Nichols, 2010).  Hence, structural family therapy should be utilized in conjunction with the aforementioned methods in effort to modify both participants behavior.
Structural family therapy allows the practitioner to “look beyond their (the disputants) interactions to the organizational framework within which they occur” (Nichols, 2010, p. 169).  More specifically, “structural goals include reorganization of the family structure, and the lessening of rules/roles dictated by narrow bonds of transactions, i.e. an increased flexibility in both families and their members” (Fish & Piercy, 1987, pp. 120-121).  This approach emphasizes how each family member is affected by the whole system and grants a reasonable amount of leeway to each party.  Now, in regard to Jeff and Roger certain patterns of behavior have developed, particularly since the mother abandoned the family.  However, the usage of such patterns limits the full range of obtainable interaction.  Hence, the therapist is inclined to assist them in restructuring these behavioral patterns.  Shifting the organization of the family should shift their issues enabling them to improve familial relations.  To begin this process the therapist must implement a structural assessment.  This may be accomplished by identifying the most evident issue and observing the family’s reaction to it (Nichols, 2010).  In Jeff and Roger’s caes, the presenting problem concerns their varying perspectives of the mother.  Roger is growing up and has become more inquisitive about her.  Yet, Jeff cuts him off and expresses blatant disapproval of the mother.  Then, he counters by attacking Roger’s academic dilemma.  This behavioral pattern spirals into withdrawal and a lack of focus on Roger’s behalf.  As a result, Jeff is displeased and bothered by his son’s response which fosters additional conflict.  Furthermore, Jeff is oblivious as to how these interactions affect Roger emotionally, deterring him at school and within the home.  However, Jeff should realize that Roger is concerned about his mother’s welfare and his connection to her.  Instead of avoiding the issue, Jeff ought to set aside his personal feelings and speak respectfully with his son in terms of the mother.  This fosters an environment in which the child becomes comfortable and respectful as he or she interacts with the parent.  Consequently, Roger’s behavior is influenced by Jeff’s behavior.  Tailoring the father’s communication should in turn alter the child’s conduct (Nichols, 2010).
After the initial assessment, the therapist may implement various therapeutic techniques.  Essentially, structural family therapy consists of the following: (1) joining and accommodating, (2) enactment, (3) structural mapping, (4) highlighting and modifying interactions, (5) boundary making, (6) unbalancing, and (7) challenging unproductive assumptions (Nichols, 2010).  In terms of Jeff and Roger the therapist must implement these steps accordingly:
  1. Joining and Accommodating –  The therapist works to ease the tension among the family, encourages Jeff and Roger to participate, offers empathetic and active listening, persuades Jeff and Roger to acknowledge their need for professional assistance, and motivates them to trust him or her.
  2. Enactment – The therapist encourages Jeff and Roger to role play in their usual manner in effort to observe their communicative patterns.
  3. Structural Mapping – The therapist formats the desired family structure while identifying problematic issues and modifications along the way.
  4. Highlighting and Modifying Interactions – The therapist recognizes problematic behavioral patterns and alters them into functional interactions. 
  5. Boundary Making – The therapist strengthens Jeff and Roger’s interaction while setting certain limitations in effort to foster acceptable behavior and communication.
  6. Unbalancing – The therapist influences Jeff to change how he relates to Roger.
  7. Challenging Unproductive Assumptions – The therapist modifies Jeff and Roger’s perspective from pessimistic to optimistic and productive (Nichols, 2010).
From these techniques, unbalancing would significantly change the communication pattern in this family.  The behavioral cycle which Jeff and Roger are experiencing stems from Jeff’s domineering attitude and lack of constructive attention.  He is denying Roger the knowledge of the mother and commands him to improve academically.  Instead of utilizing argumentative and aggressive techniques, Jeff should begin to answer his son’s questions in an honest and pacifying manner.  In addition, Jeff should offer to assist Roger with his schoolwork and seek practical solutions such as tutoring or a set study time.  Furthermore, Jeff must spend more quality time with Roger as opposed to merely focusing on the new girlfriend, Sherry.  As Jeff begins to show genuine interest in Roger and reestablishes a positive rapport, Roger’s responses are prone to become more positive and interactive versus withdrawn.  In short, Jeff must be made aware of the fact that he sets the tone of their relationship.  If he is able to modify his own behavior, he is likely to directly influence Roger to improve his conduct, strengthen their connection, and restructure the family system.
            In conclusion, families inevitably experience conflict and problematic issues.  Often, these concerns derive from trauma, divorce, transition, or abuse.  In effort to address such issues, the therapist must assess the circumstances on a case by case basis, and then implement applicable strategies in effort to achieve long term, advantageous resolutions.  Specifically in regard to Jeff and Roger, it would be appropriate for the therapist to utilize a genogram and structural assessment to evaluate their conditions.  Following the assessment, individual and joint sessions should include behavioral parent training, experiential therapy, and structural family therapy.  These techniques enable the therapist to assist the family and empower them to modify relations, attain effective communication, and conquer their familial issues.

References:
Benjamin, L. S. (1977). Structural analysis of a family in therapy. Journal of Consulting
            and Clinical Psychology, 45(3), 391-406.
Carter, B. & McGoldrick, M. (2011). The expanded family life cycle (4th ed.). Boston:
Allyn & Bacon.
The Center for Victims of Violence and Crimes. (2010). The Environment and You:
Making the connection to conflict, crime, & violence. Cvvc.org. Retrieved from http://www.cvvc.org/EventsTraining/documents/CVVC_EveBrochure_82710.pdf.
Counselling Connection. (2012). How to construct genograms, Part 2.
CounsellingConnection.com. Retrieved from
http://www.counsellingconnection.com/index.php/2008/06/23/how-to-construct-genograms-part-2/.
Fish, L. S. & Piercy, F. P. (1987). The theory and practice of structural and strategic
            Family therapies: A delphi study. Journal of Marital and Family Therapy, 13(2),
            113-125.
Karlsson, J., Pagan, A., Harris, B., & Massarelli, T. (2010). Video game violence:
            A primary prevention pilot program for school psychologists. The School
            Psychologist Newsletter, 64(3), 7-9.
Lofas, J. (2011). Ten steps for stepparents. Stepfamily.org. Retrieved from
            http://www.stepfamily.org/ten-steps-for-stepparents.html.
Nelson, T. & Figley, C. R. (1990). Basic family therapy skills: III. Brief and strategic
schools of family therapy. Journal of Family Psychology, 4(1), 49-62.
Nichols, M. P. (2010). Family therapy: Concepts and methods (9th ed.). Boston: Allyn &
Bacon.
Papernow, P. (2012). Attachment and intimacy in stepfamilies. At the Psychotherapy
            Networker Symposium [Webinar]. Washington, D.C.
Pascual-Leone, A. & Greenberg, S. (2007). Emotional processing in experiential therapy:
Why ‘the only way out is through.’ Journal of Consulting Psychology, 75(6), 875-887.
West, S. (2012). Children’s hobbies have big payoff. CCETompkins.org. Retrieved from
            http://ccetompkins.org/family/parent-pages/childrens-hobbies-have-big-payoff.

2 comments:

  1. Nice blog, thanks for sharing the information. I will come to look for update. Keep up the good work.

    family therapy massachusetts

    ReplyDelete
  2. Hello there! Thank you for sharing your thoughts about family therapy in your area. I'm glad to stop by your site and know more about family therapy. This is a good read. Keep it up! I will be looking forward to visit your page again and for your other posts as well.
    Family therapy uses a range of counseling and other techniques including attachment-focused family therapy.
    As is true of individual therapy, there are many “brands” of family therapy and marital counseling. Each of these may use somewhat different strategies of intervention depending on how they understand the workings of a family or couple unit.

    family therapy ma

    ReplyDelete