Lyndal Power Clinical Coordinator RAPS Adolescent Family Therapy and Mediation Service 98901500

1. Working with Adolescents and their Families Lyndal Power Clinical Coordinator RAPS Adolescent Family Therapy and Mediation Service 98901500 Email lyndalp@ransw.org.au

2. RAPS • Adolescent Family Therapy and Mediation Service • See teenagers, siblings and parents together • 11-20 • Serious difficulties • Conflict parents and teenagers • Truanting and school suspension • Running away • Violence • Drug use, criminal behaviour • RAPS established 1990 to prevent youth homelessness

3. RAPS • Social Workers/ Psychologists with postgraduate training in family therapy • Family therapy consultant- ‘live’ supervision of family therapy • See clients across Sydney, based in Parramatta, some outreach • Sliding scale of fees • Systemic- work with schools, juvenile justice etc • Other work • parenting seminars including refugee parent groups • Provide training in family therapy

4. Research- Role of Family • Family offers a secure base (caring, connectedness and belonging)- linked to positive outcomes (Luthar 2006) (Rayner & Montague 2000) • Benefits of parental monitoring and limit setting (Luthar 2006) • Low monitoring linked to negative outcomes: antisocial behaviour, substance use, sexual risk taking (Hayes et al 2004) • Parents continue to advise and support young adults- parents underestimated their support- highly valued by young adults (Vassallo et al 2009) • Family Relationships- source of pain for those cut off- desire for connection, deeply held (Dwyer & Miller 2006)

5. Research- Family Therapy • Family based therapies- among most effective for adolescent substance use (Carr 2009) (Hogue and Liddle 2009) • Family based treatments effective for depression, eating disorders, conduct disorders, anxiety, school refusal, OCD, grief, bipolar disorder, attempted suicide and somatic problems (Carr 2009) (Cottrell & Boston 2002) • Multisystemic therapy- effective for delinquency- improved family relations, decrease in behavioural problems and out of home placements (Utting et al 2006) • (Multisystemic- strength based family intervention- problems are multi-determined- assess range of risk and protective factors

6. Adolescents need nurturance • Western societies- overemphasis on individuation of adolescents as though this equates with separation from parents (Mackey 1996) • Importance of nurturance and connection for adolescents is neglected (Mackey 1996) • Studies show individuation fostered by connection to parents • Strengthening relationships between parents and adolescents is essential in therapy (Mackey 1996) • Secure attachment to parents may lessen negative influence of peers and increase adolescent responding to parental limits (Mackey 1996)

7. Three dimensions of Adolescent Attachment Felt security- firm 2. Use parent for emotional support- warm 3.Parent supporting child’s growing autonomy- enabling

8. Balance of Connection and Control control authoritative authoritarian connection chaotic laissez-faire Baumrind’s Four Types of Parenting

9. Balance of Connection and Limits Parents in a position of hierarchy Children on track when balance between connection and limits Parents may need to work more on one dimension for balance Issue of parents soft/hard split Importance of working together Past issues may lead to separated parents undermining

10. Relationship Discourse Web of relationships- To understand a dyad need to consider impact of other family relationships eg Girl (14) runs away, Fa had died, brother became closer to mother, Mo-Dau more distant. Parents describe identified teenager as being of bad behaviour or character eg “He’s defiant” or “She’s selfish” By establishing a relationship discourse, through asking relationship questions- family members begin to be seen in terms of relationships Shift from ‘bad’ kid to ‘sad’ kid Asking relationship questions at every session keeps adolescent- parent relationships central

11. Misbehaving child • Misbehaving child tends to have lowest scoring relationships with parents Child misbehaves Parent distances/ critical

12. Conducting a Family Session

13. Getting the whole family in Always easier to work from broader ie whole family to fewer members. eg harder to get a father in if not there at first session. If mo and children there and not partner, therapy work may be undermined at home At RAPS, we encourage whole household to come in. We avoid seeing a mother and her children if the father is not there eg may see her on her own to help her to get other family members in eg partner and teenager. We explain why we need partner/siblings there- we need their perspectives. We can work faster if we have all family member’s perspectives.

14. Summary of Stages- First Family Session • Explain context of agency- confidentiality • Joining- each parent, oldest to youngest child • Concerns- each person • Exploration- sequence, understanding of problem, or impact of event eg trauma, separation, attachment disruption, relationship questions. • Break- opinion- affirmations to each, understanding of how family got to be here eg stresses on family, interactional pattern, perhaps task • Point to areas of work for future sessions

15. Family Session- Concerns • Each person’s experience- not trying to persuade them to see another’s worry • Ask each parent the worries that have brought them to RAPS • To children/ teenager, “What are the things that worry/bother you?” • To child/ teenager, if no answer or “nothing”- -“If you were worried about something, would it be more likely to be something at school or home?” Unpack -If no answer, “Who in your family would most know what worries you?” Obtain from member then check with child/teenager, “How is your mum reading you?” Sometimes children will add a comment.

16. Drawing out children’s concerns • May need to re-phrase a question to ‘warm up’ child. First response is often minimal. “What worries you?” or “What bothers you?” “If you had 3 wishes and could change things…” • Draw out children’s experiences- younger children often talk about “the fights”. This releases info to members about effects of conflict on children • “How do the fights affect you?” “What do you do?” • “Which two people fight the most, then which two?” and so on

17. Obtaining a sequence A behavioural sequence is who did what, when Introduce sequence “Id like to find out step by step what happened the other day when …” (eg worst incident or most recent) Start at beginning, before conflict. Ask one person about another’s behaviour- releases more info. “When you said that, what did your Dad do then?” “What did your daughter do next?” Focus is on behaviour but can also explore meanings, feelings, beliefs (try to understand what was going on emotionally for each) Eg “When your dad said ‘Get out!’ what did that mean to you?” Sequence- reveals coalitions, patterns, highlights work

18. Conceptualisation • What is your understanding of child/teenager’s difficulties? • Use several lenses- structural, behavioural, attachment, relationship, developmental. • V.Goldner (1990)- each lens can enrich to → fuller explanation • A structural lens can be a check on psychologising a problem→ stuck • eg this teenager needs to be at school • Do the parents need to work more on connection or limits or both?

19. Setting Goals • To set therapist’s goals for therapy- “If I had a magic wand, what would I wish for this family?” (Dr. L.MacKinnon) • Like a basketball hoop- need to know where you are aiming. Have tools but must know what you are building (Miccuci 2009) • Look at goals- where should we start? Where will we get most effect from intervening • Getting teenager into school/work eg addressing hitting or criticism • Look for links between family goals and therapist’s goals eg less fighting- no hitting commitment • Use openings

20. Keeping engagement with both parents and teenagers • Neutrality (Milan)- on everyone’s side and yet no-one’s side • Lean in equally to parents’ and teenagers’ experiences- be curious • “You said your mum takes your brother’s side, what does she do to show that?” • “ You said your daughter is aggressive, what does she do? (Releases information about each person’s behaviour) • If parents and teenagers start bickering/ getting reactive, get each to talk/look at you, not each other • To parent/ teenager, “Talk to me, what are you most upset about?” (Block interruptions, uncover person’s experience through unpacking) • Teenagers become reactive if parents make negative comments about them or their friends • Try to keep both parents and teenagers in the room together- may need to split session if cannot be contained

21. Summary- Relationship Scan • Allow time • Crucial members present • Introduce discussion-it’s not about love, sometimes closer, other times, more distant • Ask easier relationships first • Ask outside the relationship before inside - ask relationship description - unpack to build full description - ask closeness scaling question • Ask inside the relationship • Reflect on low scoring relationships

22. Asking about Parent-Child/Teenager Relationships • Ask outside- ask person A, about relationship between B and C • To mother, “How would you describe the relationship between father and daughter?” Unpack to build a full description • Then scaling question, “Out of 10, if 10 is close and 0 is not close, how close are they?” • Ask inside- ask person B about relationship with C • To father, “How do you see the relationship with your daughter?” Unpack and then ask scaling question • Ask inside- person C about relationship with B • To daughter, “How do you see your relationship with your father?” Unpack and then ask scaling question

23. Relationship in the Past • When was the relationship different? eg, When 10 years old? “ What was the relationship like? ” Ask young person last • Unpack: “ What do you remember? ” “ When did the relationship change? ”  Nodal point “ How was it different? ” • Elicit losses: “ What do you miss? ”

24. Comparison Questions • “How would you compare the relationship with your mum, to your sister’s relationship with your mum?” “What is different?” • “How would you compare the relationship with your mum to your friend’s relationship with her mum?”

25. Relationships in the future • “What sort of relationship do you want to have with your daughter?” What sort of relationship do you want to have with your mother?” (ask teenager last) • “What sort of relationship do you want to have with your daughter when she is 25 ?” • Hypothetical questions- “If…” - “If you were to spend more time together, what difference would that make to your relationship?”

26. Linking behaviour to relationship • Can explore how changes in behaviour lead to changes in relationship • “You said you have been trying to ‘bite your tongue’ (be less critical) lately, how come?” • “What difference has biting your tongue (change in behaviour) made to your relationship with your daughter?” Could also ask the other parent as well as teenager • To parent, “When your son does his chores when asked, what difference does it make to you?” “What difference does it make to your relationship with him?” • Behaviour is linked to relationships-furthers the relationship discourse

27. Confronting parents • Use leverage- what motivates parents to change their behaviour Eg Father who wanted son to gain education • Parents do not intend to damage their relationship with teenagers • See parents without teenager to confront- • Can lean into their frustration • Point out link between parent’s behaviour→ effects on relationship and teenager’s misbehaviour • Gain commitment to not use misbehaviour again • Bring in teenager, parent shares commitment • Check in subsequent sessions

28. Cup of Anger • Teenager may be angry about present or past • Find out about teenager’s anger • “What are you angry about?” Get list and ask teenager to draw layers of cup (pie graph) on board • “Are there reasons why you are more angry than other 15 year olds? What has happened to you? What goes into your cup of anger?”

29. Teenager (speaker) Says a paragraph about what is upsetting (When teenager is fully heard, swap roles) Parent (listener) Mirroring- “What I hear you saying is…” Validating- “That makes sense to me/ I can understand that Empathising- “You must be feeling…(one or two words) “Tell me more…” (H.Hendrix and LaKelly Hunt 1997) Imago- Couple’s dialogue

30. Guidelines One to One Time • 1:1 not cancelled because of misbehaviour - use other consequences • 1:1 time- not with others present - ‘low person’ begins to feel no. 1 • Frequent short, better than infrequent long • My wish- every parent 10 minutes a day with child/teenager

31. Physical Connection • Teenagers and elderly- least physical connection. eg girl who pinched her mother • Teenagers need physical connection but may ‘pretend’ to object because of the independent part • “3 hugs a day” to be healthy (V.Satir) • Generally, best way to comfort someone is to hold them • Rituals of connection (W.Doherty)

32. Summary • Adolescents need a balance between connection and limits from parents to reach adulthood • Must consider the ‘web’ of attachment- further a relationship discourse • Importance of seeing parents and children/teenagers together • Help parents to set limits out of concern • Work to repair connection

33. References • Allan, D and Power, L (2011) Family Therapy with Adolescents.. In Rhodes, P, and Wallis, A, “A Practical Guide to Family Therapy: Structured Guidelines and Skills”. IP Communications:Melbourne • Cunningham, PB and Henggeler SW (1999) Engaging Multiproblem Families in Treatment… Family Process, 38, No (3):265-286 • Goldner, V et al (1990) Love and Violence: Gender Paradoxes in Volatile Attachments. Family Process, 29, No (4): 343-364 • Gottman, J (1999) The Marriage Clinic: A Scientifically Based Marital Therapy. W.W Norton and co. N.Y

34. References • Gurman, A and Kniskern, D (1991) Handbook of Family Therapy • Hendrix, H and LaKelly Hunt, H (1997) Giving the Love that Heals: a Guide for Parents, Atria Books, N.Y • Mackey, S (1996) Nurturance: a neglected dimension in family therapy with adolescents, Journal of Marital and Family Therapy, 22 (4), 489-508 • MacKinnon, L (1998)Trust and Betrayal in the Treatment of Child Abuse. Guilford Press: New York

35. References • MicucciJ (2009) The Adolescent in Family Therapy. The Guilford Press: New York • Rhodes, P and Wallis, A (2011) A Practical Guide to Family Therapy: Structured Guidelines and Skills. IP communications: Melbourne. • Robinson, E, Power, L and Allan, D (2010) What works with adolescents?... Australian Family Relationships Clearinghouse Briefing 16, 2010 • Sells, S (2004) Treating the Tough Adolescent. Guilford Press: New York