101 Interventions in Family Therapy

Thorana S Nelson, Terry S Trepper

• Publisher: Routledge
• Year: 2014
• Topic: Psychology
• eBook ISBN:
  9781317773290
• Subtopic: History & Theory in Psychology
• Index: Psychology

Here is an exciting collection of favorite and successful family therapy interventions from therapists which inspire more creative therapy methods in your own practice. 101 Interventions in Family Therapy features contributions by a diverse group of well-known leaders in the field, "therapists on the street," and faculty of family therapy training programs. Each clinician presents a creative and useful intervention beginning with a complete description of the method, followed by the specific indications and contraindications for its application, and concludes with a particular case illustration. These engaging and informative stories document helpful interventions that really work, not the exotic and impractical methods of prolific marriage and family authors. Therapists at all levels can learn and incorporate these into their work with families. Practicing clinicians will learn what works for other therapists while graduate-level students and beginning counselors will benefit from the integration of theory and practice exemplified in the practical case examples. The rich and varied writing styles in this enjoyable volume reflect a multitude of personal therapeutic styles. You will find valuable insight and innovative treatment methods on critical family therapy topics such as eating disorders, the adolescent years, marriage counseling, stepfamilies, divorce therapy, communication difficulties, and conflicts with dual career couples. The smorgasbord of interventions found in this book include bibliotherapy, use of touch, creative use of space, ritual enactment, gift-giving, storytelling and countless other interventions, both revolutionary and commonsense, to enhance and improve your therapy with families.

—1—
The Other Side

D. Ray Bardill

Several years ago I agreed to see a highly successful young professional man for the stated purpose of "improving my marriage relationship." From the beginning of the initial interview I sensed an incongruence between his stated reasons for seeking help (improve my marriage relationship) and the words he used to describe his marital situation (reasons to get out of the marriage). In order to more clearly determine what he wanted out of the therapeutic experience I asked him to try something for me. I gave him three pieces of paper and a pencil. First, I asked him to complete in writing the following statement:

"I am coming to see you in-order-to ...." (your statement).

When he had written his response, I asked him to take the second piece of paper and complete the sentence again. However, this time I asked him to fill in the blank with a statement that seemed to him to be totally opposite to the first statement he had written.

"I am coming to see you in-order-to ...." (reason is to be totally opposite to the first statement).

He looked a bit confused, hesitated a moment and wrote his second statement. When he finished I asked him to take the third piece of paper and complete the sentence again. This time he was instructed to "give another reason" for coming to see me.

"I am coming to see you in-order-to ...." (another reason).

This time he hesitated even longer before writing his statement.

When he had written his third statement, he put the pencil down, stared at me momentarily and said, "Now, I know why I am here today." He went on to say that he realized that he had sought help with his marriage, not to improve it; he wanted to be able to tell himself, and others, that he had tried to save the marriage. He did not intend to remain in the marriage. He reported having an extramarital relationship with a woman he intended to marry.

After talking about his affair for awhile he looked directly at me, gave me a sad but knowing facial expression and said, "I know something else." The patient went into a rather lengthy discussion about his awareness that he would not marry this other woman. He was using her to get out of his current marriage. He now knew he did not want to marry his girlfriend.

For the rest of the therapy session the patient went into detail about the marriage, his own tendency to go to great lengths to use other people to do what he wished, and his intention to seek psychotherapy "to resolve my guilt about my need to use other people."

I have used the intervention I call "the other side" many times since that first experience. While the results have been different each time, "the other side" has always provided useful information. As Virginia Satir often said, "We know more than we know we know."

There are at least two important dynamics at play in the "other side" intervention. First, purpose (in-order-to) creates a perceptual medium through which all ideas, actions, and thoughts must go. Purpose establishes a cognitive map, or context, which serves as a guide for whatever follows. When what is said or done does not match the purpose, there is a sense of incongruence, which is experienced at some leve! by the patient. The nature of the incongruence may or may not be apparent to the therapist. A frequent therapist reaction in such a situation is an inability to make any sense out of the patient's presentation of his/her problem. In the ordinary course of events the therapist will probe into a series of different areas of the patient's situation. The probes will be an effort to clarify just why the patient is seeking help. The emotion felt when the basis for the incongruence is resolved is much like the feelings experienced when committee members discover a "hidden agenda." The discovery of that which has interfered with the work of the committee clears the air for the moment. While sometimes painful, the emergence of the hidden agenda ordinarily is accompanied by a sense of relief by the committee members. Such is the sense of relief felt by a patient and the therapist when the underlying purpose for seeking help is revealed.

Second, the "other side" intervention helps differentiate between the "why" (reasons) for seeking help and the purpose (in order-to) dynamics in the therapy process. In this frame, the question is not "why" are you doing what you are doing. Why ordinarily taps into some well thought out, or not so well thought out, justifications for actions. Purpose gets to the background or context within which the patient is behaving. In the case example given above, the patient's actions relating to his request for therapy made sense to him only after he became aware that his intention to get rid of his intense feelings of guilt was his purpose for seeking help. To put it another way, if I tell my therapist I want a more positive relationship with my wife and I then proceed to attack her with every word I utter, my behavior and my stated purpose are incongruent. Exploring this incongruency gets to the purpose that is driving my behavior. When I know the context (purpose) out of which my statements come, I can better understand the meaning of my behavior.

Additionally, the "other side" intervention is firmly rooted in the communications dimension of systemic thinking. Communications theory tells us that disagreement between a stated intention and a strongly held underlying intention(s) has a high probability of showing up in incongruent communication. As in the case above, exploring the basis for the incongruency often clarifies some of the factors behind other troublesome behavior patterns.

The "other side" intervention is most powerful when the therapist does not give any hints about what the patient should, or might, say to complete the in-order-to sentence. The ideas need to be those of the patient. Initially, some patients will resist dealing with alternative ideas. A simple statement such as "just try it, let's see what comes up" is ordinarily enough to move the process forward. When the therapist responds to the second and third "other-side" ideas provided by the patient, alternative interview subjects naturally emerge. The fact of hidden frames for dealing with the issues at hand has been demonstrated through the process.

Now, give me your response to the usefulness of this intervention. Next, give me a response that is totally opposite to your first response. Finally, give me another response. GOOD!

The ideas for this intervention are similar to those suggested in Miller, B., & Maloney, D. (1972). Turn over. Transactional Analysis Journal, 2, 117-121.

— 2—
The Case of the Missing Client: Using Non-Pejorative Language with Strong Denial Systems

Yolanda Reyna
Vincent Taylor

There are occasions when clients come to therapy of their own volition with a growth plan in mind, seeking a psychological guide through the maze of life. This article is not about those clients. Nor is this article about those clients who come to therapy to change anything about themselves. This article should be read only by therapists who have clients who are mandated and often resent having to "waste their time coming to therapy." After all, they aren't the problem, don't have a problem, and are not interested in changing anything about themselves — only the circumstances that coerced them into therapy. While they believe the problem to be imaginary, their covertly and overtly expressed sentiments of anger and denial are very evident. Confrontation, while making the therapist feel better, only makes the denial and anger worse. This article uses a case illustration of an incest offender to demonstrate the advantage of non-pejorative language in therapy to circumvent denial and better monitor the safety of the child.

Anderson and Goolishian (1988) offer a framework for understanding human systems as linguistic systems. They outlined eight tenets to guide the therapeutic interview. This article will apply those eight tenets to the problem of extreme denial in a sexual offender.

Tenet #1

The therapist keeps the inquiry within the parameters of the problem as described by the client.

The client, Mr. C, read a prepared statement in which he described the sexual involvement with his daughter as "massage therapy and desensitization of the lower part of her body for a bedwetting problem." He also described the sexual incidents as education sessions and advice on how to deal with boyfriends. While Mr. C's language was part of the denial process, it was possible to expand his descriptions of his behaviors without challenging his unusual use of language. For example, without getting into any disagreements, Mrs. C was brought into the dialogue and it was clear that she did not describe the abuse in the same language Mr. C used.

Therapist: Did Mr. C share his educational strategies with you and which strategies did you like and which ones did you not like?

Mrs. C: I am a pretty sound sleeper myself and he used to get up to take her to the bathroom about midnight. But I didn't know about the rest.

Therapist: So you agreed that taking your daughter to the bathroom during the night might help the bed-wetting? Did you decide who would take her and when to take her together or did Mr. C just take the responsibility upon himself?

Tenet #2

The therapist entertains multiple and contradictory ideas simultaneously.

From Mr. C's point of view, he loved his daughter and wanted to protect her, as he said, "from the wolves." This protection included monitoring any phone calls to her from boys, reading letters or diaries for explicit discussion of boys, restricting her use of any make-up and ending friendships that were not approved by him. From the judicial system's perspective, including the District Attorney, caseworker, and probation officer, Mr. C's actions demonstrated poor parenting skills, pathological boundaries between family members, and no apparent motivation to remediate his problem or for the family to provide protection for their daughter. As can be seen, Mr. C's and the other system members' perspectives were worlds apart yet the therapist's job was to establish multipartiality (Anderson & Goolishian, 1988) and to simultaneously agree with both perspectives. Agreement would be impossible without viewing both perspectives as double description (Bateson, 1980) of a unified concept. We described both sides as trying their best to protect the girl — a concept that described the legal perspective and Mr. C. However, we acknowledged that they were far apart concerning how to protect her, who best knew how to protect her, and about what she was being protected from. That is when therapy began.

Tenet #3

The therapist chooses cooperative rather than uncooperative language.

At the initial interview, Mr. C came in with a five-page written confession of his sexual involvement with his daughter. His demeanor was nervous but stoic. Often in therapy, choosing a cooperative stance involves what you don't do or say as much as what you do or say. Mr. C's demeanor communicated an expectation that therapy would be an hour of interrogation followed by possible torture. A cooperative stance involved not allowing him to confess in the same manner he had at the Department of Child Protective Services, which made him feel like he paid for his offense and that it was behind him, since he had been forgiven by God and would never do it again.

Therapist: (interrupting after about one minute of Mr. C's prepared statement) I know you wrote this about two weeks ago. I want you to feel free to bring up any additional thoughts or explanations that might help us understand what you are telling us.

Tenet #4

The therapist learns, understands, and converses in the client's language because that language is a metaphor for the client's experiences.

Mr. C viewed his role in the family as the provider, protector and teacher. The metaphor teacher provided an avenue of entrance into his world. Teachers have gone to school to learn what they know. Mr. C revealed that his school began with a very harsh father who sexually abused him once. His further schooling came when he "went with girls just to get what i could get." From this understanding, we were able to dialogue with Mr. C about his "teaching techniques." For example, "There are a lot of guys who would take advantage of your daughter and it is important to help protect her. However, I am concerned that when she becomes eighteen and leaves home she won't have you to shelter her. Is she learning to recognize danger signs herself and learning how to handle herself without your supervision?"

Tenet #5

The therapist is a respectful listener who does not understand too quickly (if ever).

Therapist: I am sure you've talked to other parents. How do the letters your daughter writes differ from those that other girls her age are writing?

Mr. C: I am just concerned that her love letters will give people the wrong impression.

Therapist: If you could have writ...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Foreword
• Preface
• 1. The Other Side
• 2. The Case of the Missing Client: Using Non-Pejorative Language with Strong Denial Systems
• 3. Read Aloud
• 4. Stepfamiiy Enrichment: Assets Feedback
• 5. Ingredients of an Interaction
• 6. The Tug-of-War Toilet
• 7. Metaphors on Space
• 8. The Treatment of Postdivorce Adjustment Problems Through Cognitive Restructuring
• 9. Termination as a Therapeutic Technique
• 10. The Communication Stone
• 11. Termination Rituals
• 12. Growthful Touch
• 13. Using a Funeral Ritual in Therapy: Changing Rigid Interaction Patterns
• 14. Neuro-Linguistic Programming in One-Person Family Therapy
• 15. Clare's Sonata
• 16. Hanging Out: An Intervention for Random Families
• 17. Functional Dysfunctions
• 18. The Absent Expert: A Method of Indirect Confrontation
• 19. Safety for the Little Girl
• 20. Facilitating Marital Dialogue: A Few Fundamental Components
• 21. Multiple Split Opinion
• 22. The Dreaded Transition: Play Therapy from a Meta/Isomorphic Position
• 23. If It Walks Like a Duck ...
• 24. Putting Away Old Loyalties in Later Life
• 25. Problems with Problem Solving: A Metaphor for Investigation of Problematic Process
• 26. Charting the Transactional Map
• 27. Problem Definition and Treatment Protocol for Multi-Problem Families
• 28. Treating Dual Career Couples
• 29. What Is My Part?
• 30. The Comrade Stance
• 31. The Giving of Gifts —A Therapeutic Ritual
• 32. Use of Self and Space
• 33. Unconscious Fears
• 34. Satir's Parts Party with Couples
• 35. The Family as Consultant to the Therapist: A Technique for Facilitating Termination with Reluctant Families
• 36. The Struggler
• 37. Motorcycle Madness: A Structural Intervention with a Life-Threatening Disorder
• 38. Desperately Seeking French Fries
• 39. Termination Rituals
• 40. Self-Esteem: Everyone's Favorite
• 41. A Cross-Cultural Double Date
• 42. Healing of the Memories
• 43. Burning the Affair: A Ritual for Starting Over and Recommitting
• 44. A Strange Thought
• 45. Family Meetings: A Tool for Developing Roles and Rules
• 46. A Family Intervention: Introducing Sex as a Subject
• 47. The Tell-It-Again Intervention
• 48. Family Therapy and Psychoeducation
• 49. Revisiting the Generations
• 50. The Family Regulator of Change Reframe
• 51. A Story
• 52. Beginner's Luck: A First Fortunate Family Encounter
• 53. Defining Conflict as a Demonstration of the Family Problem
• 54. Sculpting Progress and Change
• 55. The Turtle Who Was Afraid He Could
• 56. Making Contact: The First Intervention
• 57. Engaging the Difficult Adolescent from Behind the One-Way Mirror
• 58. The Use of Metaphor in Providing Feedback on Structured Assessment Procedures
• 59. Tommy and His Helpers
• 60. A Basic Intervention in Couples Therapy
• 61. Letter Writing in Family Therapy
• 62. A Change of Names
• 63. The Use of Resistant Family Members as Consultants in Therapy
• 64. The Use of Fantasy in Breaking Through Impasse
• 65. Passing the Baton
• 66. Using Bowen's Differentiation of Self Scale to Help Couples Understand and Resolve Marital Conflict
• 67. Resurrecting the Ghost of the Master: A Split-Team Technique with One Therapist
• 68. Strands of Change
• 69. "Pretend a Miracle Happened": A Brief Therapy Task
• 70. The Addict's Funeral Plans
• 71. The "What-If" Technique
• 72. Cultural Reconnections
• 73. Compliments
• 74. The Use of Gentle Paradox to Address Negative Loyalty
• 75. When Words Fail
• 76. Male Mystique
• 77. What Are Your Children Learning?
• 78. The Use of Meal Therapy in the Treatment of Families with Eating Disorders
• 79. Combining Individual and Conjoint Sessions in Couples Therapy
• 80. What, Where, When, How
• 81. Letters to Families Who Leave Therapy Prematurely
• 82. Captain's Paradise Concluded
• 83. The Divorce Ceremony: A Healing Strategy
• 84. Working with Rigid Parents: Reverse Images and Reframes
• 85. An Application of Programmed Writing: Arguing and Fighting
• 86. Treating Information Processing Errors
• 87. A Family Photograph
• 88. Silence
• 89. The Tape Recorder as a Behavior Modification Device in Couple Therapy
• 90. The Special Child: A Multi-Use Reframe
• 91. Grandma, Come Help!
• 92. Engaging Men
• 93. Dilemma: A Frame for Reframes
• 94. Supervising Client Conversation: A Brief Note on a Contextual Structure for Evoking Therapeutic Creativity
• 95. Engaging Adolescents in Family Therapy: Some Early Phase Skills
• 96. The Blanket
• 97. Frank and Jimmy
• REFLECTIONS ON INTERVENTION
• About the Contributors