JoEllen Patterson, Lee Williams, Claudia Grauf-Grounds, Larry Chamow
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Subjects -> Health, Mind & Body -> Mental Health -> Compulsive Behavior
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Customer Reviews:
Total reviews: 11
Average rating: 5.0 of 5
Book review 5 out of 5 stars.
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Essential Skills in Family Therapy is a guide of the process of therapy to be used by those learning how to do therapy. The book is also a good refresher for practicing therapists. Chapters cover topics from the beginning of therapy through termination and include special issues like working with children and adolescents.
Getting started
The developmental stages of new therapists are learning the essential skills, learning to conceptualize cases, and dealing with the therapist as self.
Before the initial interview
In the initial contact, therapists should listen and reflect what they hear and assess for crisis. This initial contact contains only basic relevant information and is not the time for interventions, advice, or suggestions. Therapists must know whether they have the knowledge and expertise to treat a problem or if they need to refer the client to someone else. The "business" of therapy, such as policies regarding making and canceling appointments and payment, should be discussed as quickly and efficiently as possible. When beginning therapy, it is helpful to know who made the initial contact and why, although the therapist should build rapport with all involved. A sample intake form is included, and the authors also discuss which family members should be involved in therapy.
Initial interview
The first task of the therapist is to join with the client. The credibility of therapy and/or the therapist may need to be discussed. Goals should be defined, and the therapist should begin to build motivation for change. Administrative issues like confidentiality, videotaping, observation, etc. should also be discussed.
Guidelines for conducting the assessment
The initial assessment is the time to explore the presenting problems, attempted solutions, and crisis and stressful life events. The therapist must constantly be aware of possible issues of harm to either self or others. Suicide, violence, abuse, substance abuse, biological factors, meaning systems, spirituality, family system, and social systems are all considered.
Developing treatment focus
The therapist must select the problem list, examine the history and treatment of problems, select a treatment modality, and determine the length and frequency of treatment. The treatment modality selected will be influenced by the therapist's orientation and experience, research, the financial constraints of the client, and the client's willingness and availability to follow the suggested treatment. Referrals may be considered. The therapist may wish to consult with the client's physician or request psychological testing.
Basic treatment skills
Therapy includes asking questions, normalizing, reframing, providing support, confronting, and pacing the therapy to meet the needs of the client. Handouts may be given to clients. In developing their expertise, beginning therapist should establish their understanding of the theoretical foundation of treatment skills; consider process and content, timing, and clients' anxiety levels; and create a family treatment plan.
Children and adolescents
Parents or primary caretakers should be involved in therapy and as cotherapists during the remainder of the week. In working with adolescents, the family need for maintaining structure must be balanced with the transformational needs of launching the adolescent.
Couples
Each spouse should get his/her turn to talk so that the therapist can understand the needs of both. This chapter deals with some of the common problems that couples present.
Mental illness of family member
Depression, anxiety, and alcoholism and drug abuse are discussed. When a family member is involved with drug or alcohol abuse, the first goal of therapy is to stop the abuse and then the reasons for the abuse can be examined.
Getting Unstuck
Resistance is a normal part of therapy. The familiar is comfortable. Therapy often involves both first and second order change. First order change is behavioral with the goal of acting in a new way. Second order change deals with behavioral, cognitive, affective, and relational realms and seeks to change the entire system. In dealing with cancellations and no shows, therapists need to review goals with the client and possible terminate or go to more infrequent appointments to address other goals.
Termination
Termination can be client initiated, therapist initiated, or mutual. Having clearly defined goals will tell therapists and clients when it is time to terminate therapy. Temporary relapses can be predicted by explaining that we often take two steps forward and one back.
Future effects of managed care
Managed care makes it more important for family therapists to maintain a relationship with family physicians. To meet managed care expectations, therapist need to articulate the problem, possible treatments, the chosen treatment, and expected outcomes.
This is an excellent resource for beginning therapists or those considering studying to become therapists. Therapists should be able to clarify their strengths and limits immediately, and this book can help them do that. The tables on such things as violence and abuse are helpful guides. Meaning systems are defined as cognitions, beliefs, memories, and emotions, which are often a part of culture and have implications for those of us who work cross-culturally. I appreciate the emphasis that the authors placed on developing the relationship between the therapist and the client. Therapists must know their role as they have full responsibility for therapy and for the relationship. As divorce has become so prevalent in the U.S., it is important for us to know that only about half of divorced couples develop cooperative coparenting. Couples need five positive interactions for every negative interaction. Families put energy and resources into being stuck, which is sometimes helpful to point out to them in the course of therapy. I appreciate the explanation of the goals of terminating, which are helping clients consolidate gains made in therapy, empowering clients, and being sensitive to loss issues, as I have not always thought through these goals when terminating therapy.
Editorial Review:
Designed throughout to meet the developmental needs of the beginning family therapist, this handbook provides readers with the basic skills and tools necessary to become empathic, confident, and successful practitioners in today's rapidly changing field of family therapy. From initial client intake to the nuts-and-bolts of the interview, assessment, diagnosis, goal setting, treatment planning, intervention techniques, troubleshooting, and termination, the book translates current research findings into cogent recommendations for practice. Numerous case examples and sample treatment plans, forms, and questionnaires complement the text.
