Alexander Ch. 6- Motivation phase

Hey Guys, Sorry I feel really dumb. I wrote this before my client yesterday and then I came home and totally forgot to post it until this morning. 

Motivation represents the gateway for lasting change…therefore it = IMPORTANT!

From the first contact, therapist begin working towards specific goals:

• Establishing balanced therapeutic alliances with indivual family members
• Reducing negativity and blame
• Instilling a sense of hope (e.g., “I have something to gain by being a part of this process”); and
• Creating a family focus, rather than an indiviaul focus, for both problems and strengths

-Family members have developed rigid or defensive cognitive schemata through which all information is filtered. This is what fuels and sustains the negative interactions. Over time they become automatic.

•  Think about areas or rituals where you have automatic processing (driving, mundane tasks), you begin to do and respond to things automatically with very little conscious thought.

-Disrupting these automatic responses and interactions is a critical first step in the FFT treatment process.

The goal: intervene in the moment to create a different experience that disrupts the family’s automatic responses

• This can be difficult as the family strives towards being more controlled and deliberate, so its important for the therapist to have a lot of relational capital (therapeutic alliance).
• In the early stages, the intent may not be to change attitudes and attributions, or other cognition, but rather to disrupt rigid, negative patterns and create an opportunity for family members to experience that something new and more hopeful is possible.

THERAPIST CHARACTERISTICS: ADOPTING A STRENGTH-BASED AND RELATIONAL FOCUS

The emphasis early on in FFT is on creating a context in which family members begin to experience one another in new and more positive ways.

• Fundamentally, therapists must believe in and be committed to a relational and strength-based approach, even when positive strengths and goodwill in the family are not at all apparent.
• The intensity of the problems and behaviors can be a challenge for therapists and can push therapist’s personal buttons.

Traps that the therapist can fall into:

• taking sides
• Challenging a manipulative behavior to protect vulnerable family member
• using interventions that validate one family member but blame/distance another
• engage in a disproportional of supportive interventions towards family members whom they see as being the victim

-To stick to the relentless relational focus in a way that is sensitive to the diversity of individuals and issues presented in the context of treatment, Therapists must have courage and resilience.

“Fearless empathy”

The beginnings of empathy:

• send the message that the therapist is totally committed to understanding their inner world. Individuals need to feel acceptance from the therapist.
• therapist needs to be aware of potential biasing influence from his/her background
• Send the message that the therapist is not personally overwhelmed, shocked, or frightened, disgusted, or intimidated by the intensity or nature of the family members’ emotions and attributions. It is important that the therapist has non-avoidant ways of dealing with the conflict

To successfully play your role as a therapist, there must be creativity, a willingness to introduce new perspectives and frames, and the flexibility to approach conflict in the man different ways until the therapist gets something that sticks (e.g. creates hope).

SPECIFIC INTERVENTION STRATEGIES IN THE MOTIVATION PHASE

Change-Focus Techniques- Intended to disrupt unproductive family interactions

                Divert-Interrupt

• divert and interrupt escalating negativing and blaming behavior during session. This helps families de-escalate the family’s toxic negativity.

Pointing Process Technique

• Commenting on interactions or events that occur during therapy sessions.  Therapists can describe interactions from a strength-based approach. This serves to defuse or at least lessen the negativity by shifting the focus from the specific content being discussed to relational aspects that underlie it but are hidden from the family members at the current moment.

Systematically Attending to Positive Elements

• It is easy for the therapist to become trapped in focusing on problems and blame. Keep an intent to look for positive elements that exist midst the rapid processing of information. These interventions have 

There are more techniques but I, without thinking, went home after my session, spaced posting this blog entry, and also spaced that I had been using Austin's book at the clinic and don't have my own copy to add onto it. They were all pretty simple techniques, however, and should be easy to scan over in your book.

Functional Family Therapy ch. 7- Relational Assessment Phase

It addresses 2 family domains:

1. the degree of connection between family members
2. the hierarchical pattern involved in those connections

This treatment doesn't de-emphasize genetics, or trauma, or anything like that that affects families, but by the time you use this treatment it's hard to know cause from effect- these behaviors don't emerge overnight.

Goals and tasks of the relational assessment phase

• How do the two things above relate to the problems in the family?
• This assessment helps you to know specific interventions to target specific behaviors. 

FFT helps dysfunctional families become functional and better versions of themselves. This is done by working on relationship configurations to provide them with alternative, more adaptive ways to express these configurations.

Relational Functions as the Linchpin for Behavior Change 

• FFT therapists focus on the relational function of the problem behavior- like someone who is looking for comfort and stress reduction through drugs and unprotected sex. The FFT therapist doesn't try to take away the relational function (comfort and stress reduction) of the behavior but they try to change the cognitive, physiological, emotional, and behavioral strategies they use to meet the relational function. 

Assessment of Relational Functions

Relational Connection

• "midpointing" is optimal for teenager/parent functioning. Same level of closeness as autonomy. Teens can do things on their own but then feel close with the parents when together. 
• Each 3 of these states can be adaptive and they can all be maladaptive. "The problem is not what the relational function is, but how it is expressed and met."
• The important part of this is that FFT doesn't say what every family should look like. They respect individual and family wishes and accept diversity of families and what they want to do/what works for them. If they want an autonomous family, that's fine. If they want to be close, no worries. We just help them get there. 
• It is important to look at the strength of the interaction patterns, not necessarily the strength of emotion. (i.e. the difference between an abused woman fleeing with her child trying to create distance vs. indifference between family members creating just as much distance)

Relational Hierarchy

• Sorry, I don't know how to rotate the picture. 
• The balance of control and power is an important factor to consider in FFT
• IT's important for parents to exercise control through relational connection and relational quality. 
• FFT therapists work hard to create a situation where youth are influenced by parents because they love their parents instead of to avoid consequences. 
• We also want parents to provide guidance through caring, not just in order to control youth.

FFF Ch 4 - Matching and General Parameters of FFT

Matching

• "Matching in FFT means attempting to create an interpersonal relationship in which family members are in sync with the therapist and are consequently able to move through subsequent steps in the process with the fewest impediments.  Matching is related to but not the same as the construct of mirroring.
• Examples
• If a parent reaches out warmly to the therapist, a matching therapist response would be reflected in the same warm manner.  If a family member comes across as cold and distant, the therapist would respond with more interpersonally distant behaviors:  less smiling, more formal speech, fewer emotionally charged words.
• "To use more colloquial language, good FFT therapists are not simply ubiquitous "warm fuzzes."  Instead, they know when and how to behave with emotional distance, embracing warmth, overt control, and unassertive acceptance, depending, of course, on what the circumstances and family member presentations call for."
• "We start therapy very actively, rather than simply by asking lots of questions or allowing blame and sullenness to linger.  We also work very hard, at the outset, to give families the idea that we are looking for understand and solutions rather than adopting the stance of telling them what is wrong with them or proposing solutions without first getting to know them and developing trust and mutual respect."

Structured Parameters

• "By parameters, we mean how FFT is linked to other systems, who participates in treatment, where sessions are located, what the average number of sessions is in the typical course of treatment, anyhow booster sessions are used."  These are not rigid parameters!!!
• Who attends sessions?
• The decisions on who participates in FFT sessions is based on the understanding of which family members will be important in the therapy process to begin change or hinder the process of change from occurring with the referred youth.  It's a functional decision rather than simply grabbing everyone that lives in the home.
• Location
• Be flexible.  Go to their home, come to your office, a community center, wherever
• Number of Sessions by Phase
• Average length of treatment is 12 - 14 sessions over 3 - 4 months
• 5-9 sessions have the primary focus of behavior change.  3-4 sessions in which the primary focus is generalization
• Timing of sessions
• With high-risk families you probably need to have more than 1 session per week for the first 2 weeks.  The spacing of those sessions depends on the severity of the case.
• Booster Sessions
• These can happen over the phone or in person
• Flow of Treatment
• Just look at pages 74 - 76 to see their outline.  I just don't want to retype the entire thing. It's a very quick read.

11/1/14: FFT Ch 5 Engagement Phase

Engagement Phase

Engaging External Systems

• FFT therapists try to establish positive links with every referral source and respond immediately to each referral.  
• They provide as much info about themselves as possible to referral sources to foster a relationship of openness, collaboration, and willingness to help.
• As appropriate, they provide the referral systems with info about tx attendance, progress, need for ancillary care, or other info the systems might need for their own accountability.  
• Most FFT clients come after working with lots of different systems (medical, mental health, private groups, juvy, etc.) and those relationships have to be based on respectfulness, matching, and perspective taking.

Assessment: Pretreatment and During Engagement

• Referral info ("James--runaway", "James--Drug Dealer", etc.) can help to gain as much understanding as possible about the context therapy is about to occur in.
• Formal assessment is only used when specific questions can't be answered in direct clinical contact.  
• FFT emphasizes the identification of the interpersonal impact of the behavior on each family member

Engaging the Family System

• The goal of Engagement is to maximize family members' initial expectations of positive change.  This is accomplished through
• High availability
• Effective management of the intake process
• presentation of tx enhancing the therapist's credibility.
• Engage people who are the major players in the youth's referral and problem behaviors.  This might include people the referral source has left out (live-in boyfriends of mom, etc.)
• It helps to frame it like, "Would you be willing to attend one session so I can get a broader picture of what is going on?  I think your perspective will be very valuable."
• Whatever we can do to get parents and kids in their together from the outset is worth the effort for the increased retention rates and ability to move through the FFT stages more quickly. 
• See them anywhere--Jail, RTC, community shelter, school, etc.
• The first call requires some skills:
• matching
• nonjudgmental attitude
• strength-based focus
• respect
• persistence
• Schedule 1st session ASAP and offer to go to the home if necessary

"Engagement is not therapy--the only goal is to get them into the session so therapy can begin. " 

10/6/14-LLL Session 10

Chapter 10-Latitude through understanding self

A. What is latitude?--"Wiggle room" for children to have their own unique personalities.  Not the opposite of limits, the child needs both latitude and limits.  But within the limits, the parent can validate and encourage children's own unique preferences to encourage latitude.  

         - Story about a father who once forced his son to eat his vegetables and watched while his son held the vegetables in his mouth with tears streaming down his eyes for a few minutes.  The father was ashamed at forcing him to do this.   

        - Another story about the same son sort of deciding to rebel against the family norms.  He started listening to hard punk rock and the dad just put up with it because he didn't appreciate the music, but didn't want to lose a relationship with his son over it.  His son also got an earring and he just laughed it off the same way.  But at the same time, his son was cutting classes and failing school.  When the dad went to have the conversation about not cutting classes, he was hoping he'd have enough money in the emotional bank account for his son to listen to him.  He did.  His son started salvaging his grades and doing better.  

^^Children need the experience of listening to their own voices and hearing what they want and learning how to get it.  Otherwise they'll grow up and not know how to do this.^^

1.  Simpler Skills of Latitude

a.  Emotion coaching helps children feel validated in their own opinions.  

b. Letting children lead.  a.k.a. Don't do for kids what they can do themselves.  Only step in when they are about to give up or are frustrated.  

2. More Challenging skills of Latitude: Understanding yourself

a. The part of you're self you're born with.  (Generic hand-me-down)--Examples: a child who is soothed by physical touch will be soothed by it later, and vice versa.  or Less active children grow into less active adults.  Etc.

b. The part of "you" you learned (social hand-me-downs)--Just like clay, everyone who touches us in some way leaves an impression.  The most influential sculptor of a child is the family--how they interact informs how the child will interact in the world with others.  Then, you invite the parents to reflect on how their FOO has affected them and how that might affect their parenting.

c. How you make sense of the world (internal working model).  What our family teaches us eventually moves inside of us so that even when we are far far away from our family, their unspoken rules guide how we live our life.  What are your internal dialogues and beliefs about yourself?  How does this impact how you parent your children?

d. Keep the good; change the bad. There are no perfect parents, you have the power to become a transitional character.  

B.  Skills at Home

Homework to think a lot about themselves and see how it impacts their parenting, etc. etc. etc.  

LLL Session 11

1. Children have difficult moments

-everyone has difficult moments (due to mood, fatigue, hunger), kids are no exception. In fact, they can be even more susceptible to these things.

-When this happens, it’s important to help children to feel that you are registering their opinions because they tend to be more sensitive than normal.

-Some children have difficulties that make them chronically inflexible (i.e. learning disabilities, ADHD, autism).

-Some kids have difficult temperaments, sensitivity to tastes, sounds, and touch, and difficulty adjusting to transitions. These are often difficult for adults to understand but they are very real inabilities.

2. Difference between unwillingness and inability

-As a parent it’s hard to differentiate between being unable and unwilling. What we think is the reason behind it can greatly influence our ability to patient.

Cues to help know if it’s genuinely difficult for the child:

-Be carefully in tune with how your child thinks and feels and their emotional signals. If you understand your child well, it will be easier to tell when they are overwhelmed.

-Watch for situations where your child’s emotions overwhelm them and learn what more vulnerable situations (hunger, sleep, change) are where they have a higher likelihood of “losing it”.

-Are there situations that almost always seem to be hard for your kid? What patterns do you see in parenting? There may be things that simple seem to come harder for your child or situations that are especially upsetting.

3. Explosive Episodes

-In difficult moments, children become more inflexible and unable to meet further demands. They become more and more frustrated and then their ability to control themselves decreases until they are out of control.

-This is not because they are manipulative or because their parents can’t handle them. It’s because they are delayed in their development of problem-solving skills and frustration tolerance.

In these situations, parents have to make a strategic choice: a. insist on the demands they have made or b. look for another way to settle the child down in order to help them work through their frustration. This choice leads to calming and resolution or toward explosive behavior.

*Remember--They are not trying to be manipulative. Punishing at this point only makes it work.

Inflexible Children + Inflexible Parents = Explosive Behavior

-if your child is truly overwhelmed, you may need to adapt as the parent.

4. Why latitude is better than traditional limit setting in difficult settings

-In difficult moments, traditional limit setting will not work because children are not capable of remembering, following through, or staying on task. When overwhelmed, they are truly “out of control”.

-To get your child back in control, parents need to find ways to sooth and quiet them so they can regain the ability to think.

-Sometimes parents take it personally when the child gets upset.

5. Responding with Flexibility

      a. Avoiding situations in the first place

      -hard situations can damage bonds with your child. Here are some skills to help avoid these       situations:

     -Lead-time warning. Warn your child ten minutes because they need to do something (come for dinner, bedtime) and then again at 5 minutes, and again at one minute.

    -Change your schedule, when possible, to fit better with the child’s capabilities. Making sure they are home to get a nap.

     -Be positive with your child as possible. Keep the “emotional bank account” filled.

     -Try to understand how you may be contributing to the problem.

    -Work on your own frame of mind. Parents need to avoid meltdowns too.

        b. Catching problems in early stages

-Once you see the warning signs you need to act quickly.

      c. Parenting strategies: Plan A, Plan B, and Plan C.

      -Your decision making progress should maybe involve three alternative plans:

      -Plan B is where learning occurs. Plan A is where you have to hold the line, and Plan C is where you graciously let it go to preserve or rebuild the relationship.

       -Plan A.  Using plan A means moving ahead with a
“parent-in-control” attitude. There are some issues that parents must insist on like issues of safety. An explosion may be unavoidable and may have to be tolerated. Plan A should be used be kept to as few behaviors as possible.

      -Plan B. There are some issues that, with patience and skill, parents may be able to help the child work though and understand. These are good opportunities to teach your child. You can help with emotion coaching, validating, and problem solving.

     -Plan C. Some issues aren’t worth insisting on and need to be forgotten or put on the backburner because there are more important things to be resolved. You might do this to 1. Preserve the relationship, 2. Work on other behaviors, or 3. The behaviors in question aren’t ones you can keep track of or enforce.

Questions to ask yourself:

1. How important is it that she be able to master this frustrating situation right now? Is it a high priority?

2. is she able or capable of learning  the skills needed now? Is she mature enough?

3. With my help and support, can she make it through this situation successfully?

*If the answer to all three of these questions is yes, the situation falls into Plan B.

6. Skills to help children learn to deal with frustration

-Help Children learn to recognize and express their frustration appropriately

-Get the child’s permission to help

-Teach children how to compromise

-Help your child with social skills

-Help the child see the situation from another perspective

-Practice good communication skills in your house

7. Children who need even more flexible parents

-Activity. More active, restless, constantly on the go

-Concentration. Easily distracted, or difficulty paying attention

-Intensity. Loud, loud laughing, loud crying, loud everything.

-Regularity. Not predictable in patterns of sleep, appetite, and bowl habits.

-Persistence. Negative persistence: relentless and stubborn when they want something. Difficulty changing activities.

-Sensory Activity. Gets over stimulated from noise, bright lights, colors, smells, pain, warm weather, tastes, the texture and feel of clothes.

-Adaptability. Difficulty with transition and change.

-Mood. Serious, unhappy, cranky.

-Initial Withdrawal. Initial response to newness—new places, people, food, clothes—is to withdraw. 

LLL ch. 12

This chapter was all about putting all of the skills together. It just had a lot of practice and role plays to discuss and know which skills to do when. 

There really wasn't any new information.