FAMILY THERAPY Hayley Golledge & Amanda Cran Child & Youth Mental Health Service

1. FAMILY THERAPYHayley Golledge & Amanda Cran Child & Youth Mental Health Service Kindly provided by Occupational Therapy - Townsville MHS

2. WHAT IS A FAMILY? Families come in lots of different shapes and sizes including: • 2 parent families (“intact family”) • single parent families (“solo parent family”) • families which bring together children from different relationships (“blended family”) • families where childcare is shared between different people • families with same sex partners • fosters families Kindly provided by Occupational Therapy - Townsville MHS

3. WHAT IS A WELL-FUNCTIONING FAMILY? • Generally the people in the family like and support one another • Parents’ marriage has the strongest emotional bond. The main axis in which everyone revolves around. • When presented with a problem the family deals with it co-operatively. • Efficient communication without necessarily using a lot of words • Family members can be dependent when they need to be, but can grow up and be autonomous without someone (usually parent) resisting that maturation, or making its acceptance conditional upon conforming to a whole system of regulations about everything from religion to how they do their hair. Kindly provided by Occupational Therapy - Townsville MHS

4. It is from the observation of the parents’ marriage that the child learns how: • Affection and anger are expressed • Power distributed • Communication is managed • Roles allocated • From which notions of marital justice and fairness are derived Kindly provided by Occupational Therapy - Townsville MHS

5. Unattached young adult Joining of families through marriage Launching children and moving on Family with young children Family with Adolescents FAMILY CYCLE The family in later life Kindly provided by Occupational Therapy - Townsville MHS

6. FAMILY CYCLE “family stress is often greatest at transition points from one stage of the family developmental process, and symptoms are most likely to appear when there is an interruption or dislocation in the unfolding family life cycle” Kindly provided by Occupational Therapy - Townsville MHS

7. EVENTS IMPACTING ON THE FAMILY CYCLE • Additions to the family • Chronic illness • Financial setbacks • Divorce • Abuse/neglect • Domestic violence • Grief/loss Kindly provided by Occupational Therapy - Townsville MHS

8. WHAT IS FAMILY THERAPY • A way of working with people with problems. Often these problems are affected by other things that are going on in their family. All sorts of things affect a family and the relationships between family members. • Family therapy is an alternative to working with individual members of the family Kindly provided by Occupational Therapy - Townsville MHS

9. People in families are intimately connected, and focusing on those connections may be a more valid way to understand and promote change in problem-related behaviour than focusing on the perspective of any one individual. Kindly provided by Occupational Therapy - Townsville MHS

10. INDICATIONS FOR FAMILY THERAPY • Symptoms are imbedded in a dysfunctional system of family relationships • Problems presented in terms of a relationship rather than as the problem of and individual family member • Separation difficulties (adolescent) Kindly provided by Occupational Therapy - Townsville MHS

11. AIMS OF THERAPY Therapy requires the family to change either: • Their usual ways of coping with problems • Their relationship with one another • Their modes of communicating • Their discipline, rules, and power hierarchy • Their over-or-under involvement with one another Kindly provided by Occupational Therapy - Townsville MHS

12. GENERAL TREATMENT GOALS 1.To facilitate communication of thoughts and feelings 2.To shift disturbed, inflexible roles and coalitions 3. To increase options and demythologize • To teach ways of dealing with change; and coming to terms with uncertainties of working out their own answers • To promote Clarity of communication and negotiating of differences to cope with ambiguity, change and loss. Kindly provided by Occupational Therapy - Townsville MHS

13. WHAT DO FAMILY THERAPISTS WANT TO KNOW? • FT’s talk to families about their strengths and successes as well as problems that they are facing • They will ask lots of questions and will want to hear from all members of the family who attend • No one is forced to answer any of the therapist’s questions • Discover the families goals and reasons for attendance • May ask about parents family of origin Kindly provided by Occupational Therapy - Townsville MHS

14. Lineal Questions Strategic Questions Leading questions Problem explanation questions Confronting questions Problem definition questions Behavioural effect questions Hypothetical future questions Difference questions Observer perspective questions Circular Questions Reflexive Questions CIRCULAR ASSUMPTIONS TYPES OF QUESTIONING LINEAL ASSUMPTIONS ORIENTING INTENT INFLUENCING INTENT Kindly provided by Occupational Therapy - Townsville MHS

15. Linear Questions • Orientates the therapist to the client’s situation • Intent behind these is predominately investigative • Usually has a beginning and an end • Examples: Who did what?, where?, when?, Why? Kindly provided by Occupational Therapy - Townsville MHS

16. Strategic Questions • These are asked in order to influence the family in a specific manner • Based on linear assumptions about the nature of the therapeutic process • Questions predominately corrective • Therapist behaves like a teacher / instructor / judge, telling family members how they should and shouldn’t behave. • Example: “why don’t you talk to him about your worries instead of the kids?”, “wouldn’t you like to stop worrying rather than being so preoccupied with them?”, “What would happen for the next week at 8am every morning you suggested that he takes some responsibility?” Kindly provided by Occupational Therapy - Townsville MHS

17. Reflexive Questions • Intended to influence the family in an indirect or general manner • Intent behind this is predominately facilitative • Example: “In 6 months time how do you see things in your family?”, “If this depression suddenly disappeared how would your lives be different?” Kindly provided by Occupational Therapy - Townsville MHS

18. Circular Questions • The therapist behaves more like an explorer / researcher /scientist who is out to make a new discovery. • It is assumed that everything is somehow connected to everything else. • The intent behind these are predominately exploratory • Example: “How is it that we find ourselves together today?”, “Who else worries?”, “Who do you think worries the most?”, “Who do you imagine worries the least?”, “What do you think about what mum said?” Kindly provided by Occupational Therapy - Townsville MHS

19. FAMILY THERAPY • At CYMHS - Team discussion to prepare for family - 2 therapists and observing team - Sessions run for approximately 45minutes - Therapists seek feedback from observing team - Brief feedback given to family - Fortnightly appointments Kindly provided by Occupational Therapy - Townsville MHS

20. GIVING FEEDBACK • Metaphors • Strengths • Observed behaviour • Observed processes • Avoid being the expert Kindly provided by Occupational Therapy - Townsville MHS

21. CONTRAINDICATIONS FOR FAMILY THERAPY • Inability to attend appointments • Poor motivation for change • Unavailability of competent family therapists • Malignant, irreversible trend to break up of the family • Destructive motivation • Dishonesty in one or both parents • Family secret • Rigid differences Kindly provided by Occupational Therapy - Townsville MHS

22. REFERENCES • Barker, P. (1998) Basic Family Therapy. Blackwell Publishing. Oxford. • Geldard K. & Geldard D. (n.d.) Family Counselling Workshop: “Looking through Different Lenses” notes • Nothling M. M. (1980) Indications and Contraindications for Family Therapy. Patient Management. • Zuckerman, E. L. (n.d.) Clinician’s Thesaurus: The Guidebook for Writing Psychological Reports. Guilford Press. Kindly provided by Occupational Therapy - Townsville MHS