Enlarging The Therapeutic Circle: The Therapists Guide To

The Therapist's Guide To Collaborative Therapy With Families & School

Robert Sherman, Ed.D., Adala Shumsky, Ed.D., Yvonne B. Roundtree, Ph.D.

• Publisher: Routledge
• Year: 1994
• ISBN:
  9781135823115
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

First published in 1995. Finally we have a book that addresses what research and common sense tell us: children who dysfunction do it as a result of the systems in which they reside. Although the data has been available, professionals have not been willing to broaden their therapeutic circles and theoretical frameworks in order to change their professional practices. The exciting thing about Enlarging the Therapeutic Circle is that it will make a real impact The authors present a strong rationale for ecosystemic intervention and a realistic discussion of the types of school and family resistance. The authors have practiced this approach for over 25 years in a variety of settings and truly understand what they are presenting.

CHAPTER 1

WHY ENLARGE THE THERAPEUTIC CIRCLE?

I. INTRODUCTION: THE WORLD OF THE CHILD

There are many advantages for the therapist and child under his or her care to expand on the world inside the child’s head and to go beyond to the total context in which the child lives and interacts.

Obviously, children inhabit many worlds: home, extended family, streets, playgrounds, school, community, and religious institutions. They are imbued with the culture and ethnicity of the family, neighborhood, and larger society. They are immersed in what adults and peers around them are doing. They are exposed to mass media. They do relatively little that is not learned from others and reinforced by the demands and reciprocal behavior of others. Their very identity is shaped by the evaluations and labels put on them by other people and the roles they assume in the various organizations in which they participate, either by choice, social convention, or social pressure. The children often find themselves under the disparate pressures of moving toward both conformity within their many cultures and rebelling against them to establish some form of individual identity and existence in a larger culture that stresses ego and individuality.

Children must somehow adapt to all the diverse cultures of the family, street, church, school, and larger society through which they move. There are relatively few homogeneous neighborhoods in our urban communities. For example, there are well over 100 distinct ethnic groups living in the Queens borough of New York City. Culture specifies how one is to give meaning to and cope with the challenges and stages of life. Both opportunities and constraints in behavior are prescribed—thou shalt and thou shalt not. Each culture is a rich lodestone of myths about life and the world: us and them.

Adler (in Ansbacher & Ansbacher, 1956) proposed long ago that the individual is socially embedded but that he or she approaches each situation and relationship in terms of a unified life-style developed in childhood. Gergen (1991) asserts that in such a diverse society as ours, which lacks homogeneous rules, structures, and definitions of reality, the person is bombarded with inconsistent information and demands and varying concepts of right and wrong, good and true. Gergen claims that the self becomes saturated and diffuse, creating dilemmas of identity. He believes that the person in fact constructs a different personal and systemic reality depending on his or her relationship to each individual, situation, and institution.

Add to the cultural mix the stresses of poverty, drugs, violence, divorce, remarriage, teen births, physical, sexual, and emotional abuse, as well as other social and health disadvantages. These beset so many of our youngsters, especially in the urban environment.

It is not surprising that many families and many neighborhoods appear to function in very chaotic and often oppositional ways. Interestingly, Hawkins (1993) describes such families as “random families,” which “at their best...are creative, vibrant, joyfully disjointed...” (p. 60). The trick, he says, is to turn chaos into creativity by helping them to find lost significant information in the overload of information they receive; pass that information along; make connections with people by staying long enough in the same place; reduce the number of solutions from which to choose; and reduce the number of people involved. He suggests that these types of creative persons are individualistic and have difficulty working cooperatively or in teams.

We find, therefore, that we are dealing with a very complex and confusing set of ingredients that make up the world of children and families, especially those at risk or in therapy.

As the major formal socializing agencies, the home and the school hold the primary responsibility for helping the child make sense of all this complexity and pursue a constructive developmental path through life. Typically, when something is amiss, it is most likely reflected in the behavior within the family and the school. When therapists are called in to assist, it is helpful to pool their resources and work together with the family and the school in a unified way to help the child through the maze. If each of these institutions is pulling and pushing in different directions to “help” the child, the problem may be reinforced rather than alleviated as the child is further “saturated.”

The cultural traditions of many families are such that they are unlikely to seek help from a psychotherapist or to believe in psychotherapy. For such families there are only two points of entry into psychotherapy: a mandate from the courts or from the school. Thus, for many children at risk, it is only through the school that the therapist will even become involved.

II. ADVANTAGES FOR THE THERAPIST OF WORKING WITH FAMILIES AND SCHOOLS

A. Development of Theory and Techniques

The rapid development of family therapy theories and methods makes available to all mental health practitioners a body of knowledge and skills for approaching and working effectively with the family. Most schools of psychotherapy have now evolved family therapy procedures consonant with their own theories. Therefore any mental health practitioner is likely to find a handy family therapy model within her own theoretical orientation. Some basic general principles are described in Chapter 2 to point the direction for practical collaborative family work.

By engaging the family and school, the therapist adds enormously to the therapeutic options and treatment plans available. For example, emotional and practical supports can be created to encourage the child, such as tutoring, different school placements, and changes in child-rearing practices. Family problems affecting the child can be uncovered and attended to. School records, family medical records, and family history may be utilized for diagnosis. The child may be given individualized school assignments or be involved in new school activities.

The therapist has available a host of special structured techniques that can be adapted to her theoretical model and that can be brought into play. For example, The Family Meeting, Nondemand Communication, and the Negotiating Guide (Sherman, Oresky, & Rountree, 1991) and Early Recollections, Creating Analogous Situations, Caring Days, Strategic Alliances, The Winner’s Bet, and creating the Surrogate Family Group (Sherman & Fredman, 1986) can be very useful. Similarly, reframing, stories, experiments, and positive blame are techniques that can be used in school and with parents (Kral in de Shazer & Kral, 1986).

Schaeffer (1988) presents a wide range of techniques, such as photo therapy, videotherapy, animal therapy, and the creation of life books. Nelson and Trepper (1993) gathered 101 techniques, many of which are very helpful tools for working with the family. Albert (1989) describes many techniques and provides a model that can be used in the classroom. Standardized tests are or can be administered by the school. There are a multitude of parent education and marriage enrichment programs commercially available. These are but a few of the many techniques and models described in the literature that add to the therapist’s power and skills when she works with family and school as well as with the individual client.

It is also possible to formulate a treatment plan that may include some ways of impacting on the child’s peer group in school on behalf of the child or through the child. Other children may be encourgaged to behave differently toward the particular child at risk, or the child already in therapy may be encouraged to take on a constructive leadership role among other children who are at risk. Such a plan may induce a powerful spread of effect.

B. The Family

Many institutions and neighborhood peers influence the child or youth. But the most enduring and impactful relationships more typically are those involved in the family. The family has a deep vested interest in its members. It is in the family that the children’s primary needs are likely to be met or unmet and their health and development fostered or frustrated. There is a legacy of history, loyalty, needs, and goals that bind family members together in caring, albeit sometimes angry or hurtful, ways. Many of the children’s strengths that can be utilized for treatment purposes are derived from their position in the family and family values. Similarly, many problems exhibited by the children are rooted in the family system. For example, children who are repeatedly criticized in order to improve performance may well come to believe that they can never be good enough as human beings or successful in life.

The family, because of its more limited size, mission, and caring, usually is an environment more interested in and available to therapeutic influence than most other larger, even more complex systems in the children’s world.

C. The School

Although school truancy is a problem that may bring many children and youths at risk to the attention of family and authorities, the vast majority of children spend 6 to 7 hours each day for 180 or more days per year in school. And movements are now afoot to extend the school year. Next to the family, the school probably has the most enduring influence on most children, even those who are alienated in the school environment. Indeed, the authors observe that many students at risk are in fact alienated at school or hang out with antisocial or “drop-out” groups of youngsters alienated from the system.

The school is a structured environment designed to promote the learning, growth, and development of young people. It is staffed by trained professionals in teaching, administration, and support service personnel, such as psychologists, social workers, counselors, nurses, and other specialists, depending on the size and mission of the school. Few people or institutions attain the ideals to which they subscribe. Nevertheless, schools generally do provide a cadre of caring and interested professionals who work hard on behalf of the children under their care. This is also true of inner city schools across the nation often criticized as failures. Most school personnel are happy to work cooperatively with other experts to help their charges. Their knowledge of the children based on interacting with them for so many hours is invaluable. School resources such as testing programs, counseling services, extracurricular activities, special class placements, observational reports, and supervisory staff are examples of important assets to a therapist who knows how to reach out and connect with them to form creative partnerships.

It is also true that situations in school may promote or reinforce a child’s difficulty, ranging from problems with peers to personality clashes with inept teachers to misplacement educationally to a war of competing wills. School interactions may severely discourage the student and lead to low self-esteem, withdrawal, or rebellious behavior. The criticism, evaluation, and labeling of children in school may also have severe negative consequences in the formulation of a person’s identity as a failure, or not good enough, or stupid, or bad. Correcting such situations may well require the cooperation of school staff.

Because the school to a large degree is a professionally controlled environment, it too is both more susceptible to and open to practical therapeutic intervention than other systems in the child’s world.

The therapist, standing outside the system and respected as an expert in her field, may be able to add valuable perceptions and effective suggestions as part of a treatment plan conjointly developed in a respectful, creative partnership with the school. Chapter 2 provides some general principles for working with the school as a system.

III. LARGER SYSTEMS AND ECOSYSTEMIC THINKING

The idea that it is worthwile to look at and work with an individual, family, and organization in the context of the many larger organizations of which they are a part and the many other organizations with which they interact is becoming increasingly advocated. There is an extensive literature available presenting both ecosystemic thinking and models for working collaboratively with larger systems. Some examples follow.

Adler (in Ansbacher & Ansbacher, 1956) introduced the open forum counseling model shortly after World War I. A referred child was seen with his parents and teachers, in the presence of other parents, teachers and children. The purpose was to normalize difficulties as part of the human condition rather than labeling the child and family as abnormal or sick. Therapist, parents, and child worked together to find understanding and solutions to the problems presented. Since the problem was considered normal, it was also believed that many in the audience would learn from the experience of the group worked with by the therapist. This school/family/therapist collaboration was considered to be very effective and was implemented in 32 child guidance clinics in Vienna by 1932. Various versions of the open forum counseling method are still very actively used today (Christensen & Schramski, 1983; Kern, Hawes, & Christensen, 1989).

Speck and Atteneave (1973) and Rueveni (1979) described models for including all persons from different systems who might be helpful in sessions with the family. This could include the teacher, clergyman, mailman, neighbors, extended family members, and so on. Meyer proposed an ecosystems approach to social work (1983), advocating that the unit of attention (the patient) be considered within her or his entire world of interactions. Freeman and Pennekamp (1988) describe many ways in which the therapist can extend her arena of practice in reaching out to families, schools, agencies, forming groups of professionals across agencies and disciplines, joining with representatives of multicultural communities, participating in community organizations, and studying with other professionals in lifetime continuous education. They strongly recommend the creation of collaborative relationships across all the demarcated institutional boundaries.

Imber-Black (1988) argues that the therapist can bring together representatives of the various larger systems that impact on the clients to develop and coordinate a larger therapeutic system, including the clients, to help the clients and to reduce the clashing demands of different systems on the clients. The combined effort within a larger therapeutic system that can itself be therapeutically influenced is seen as a major advantage over working solely with the client. Similarly, Stanton and Stanton (1984) present a model in which the therapist can bring together in one room all those actively working with the family—school, community agencies, court workers, clergymen, and others. They allow the expression of competing goals, expectations, wishes, and actions. They thereby dramatize the family’s dilemma or impasse and help the family to make decisions that break through the competitive “trajectories” or demands and expectations impacting on them from all these systems.

Some family therapists and family physicians are developing collaborative relationships (Family Therapy News, June, 1991). Many other therapists are forming similar collaborations, especially in relation to physical illness, stress, drug abuse, and behavioral medicine. Family therapists and attorneys are working together in relation to divorce counseling and divorce mediation. Forensic psychologists and psychiatrists have long worked as consultants with the court system.

Freeman and Pennekamp (1988) have developed an ecosystemic theory and what they call a shared theoretical map for collaborative interdisciplinary and interorganizational collaboration with the person and the person in environment. They seek to integrate individual, developmental, group, community, and systemic theories and practices.

Silber (1993), with contributions from Lutkes, reports that the National Institute For Mental Health has initiated the Children and Adolescent Service Program (CASSP). This project has stimulated the development of many demonstration programs nationwide to serve mentally ill children. The programs have been based on interagency collaboration to help maintain such children in their homes and schools and out of mental hospitals. The encouraging results of these programs has led in turn to the passage by Congress in 1992 of the so far poorly funded Children’s and Communities Mental Health Systems Improvement Act to foster collaborative service delivery systems, including direct work with families. In 1988 the Federation of Families for Children’s Mental Health was formed nationally to insist on a parent partnership role in shaping their children’s treatment.

Clearly, many professionals, government policy planners, organizations, and lay people are already thinking and practicing collaboratively across disciplines and institutions and thinking about the child and youth in the context of his larger world. Subsequent chapters of this book describe and discuss many concrete examples of collaborative models with families and schools.

IV. INTEGRATING INDIVIDUAL, GRO...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Table of Contents
• Foreword
• Preface
• Acknowledgment
• 1. Why Enlarge the Therapeutic Circle?
• 2. What Therapists Might Find in Schools
• 3. Examples of Collaborative Consultation Models
• 4. Examples of School-Based Intervention Models
• 5. Collaboration in the Identification And Referral Process
• 6. Collaboration in the Assessment Process
• 7. Collaboration in Feedback, Treatment Plans, and Follow-up
• 8. Multiple Sibling Problem: A Case of Therapist-Family-School Collaboration
• 9. Case Study: Overcoming Abandonment and Culture Shock with Julia C. Greene, C.S.W
• 10. Colleagues or Competitors: A Design for the Future
• Bibliography
• Appendix: Examples of Permission Forms
• Name Index
• Subject Index