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Discussion response #1 Strategic Model

Gloria M.

Strategic family therapists believed that action, not insight fosters change (Metcalf, 2011). In fact, their work is grounded by the focus on action as a concept that is more valued in a therapeutic setting than the process of actually bringing the client to a better understanding (Metcalf, 2011). Additionally, this therapy is noted for being brief, for not considering clients’ pathology, and for asserting that change can happen suddenly and rapidly which can be both beneficial and challenging when applied to different psychological problems. One way in which this rapid solution focused therapy can be helpful is especially pertaining to couples and family therapy. Although the consideration of hierarchy, pathology and extensive sessions is necessary for the treatment of serious mental illnesses, this hands on approach has been found to be highly effective in terms of other issues which require therapy such as relationship troubles.

For instance, for a couple experiencing relationship issues whether they be intimacy, communication or even trust, the therapists could use strategic family therapy tactics such as Ericksons paradox directive techniques to strongly direct the client into behaviors that will eventually address and resolve their partnership issues. Paradox directive(s) are especially good for couples therapy or family therapy because these cases often involve two or more individuals from the same system experiencing issues due to perceived conflict towards the other’s actions. For example, in couples therapy where the girlfriend fears infidelity or communication issues are present her accusations may lead her partner to reciprocating the same beliefs or even avoiding the topic altogether whenever she brings it up. This issue can and has become a huge issue in many relationships and can be managed through the therapist’s suggestion of a clearly absurd resolution. Altogether that is what paradoxical directives are about. This is an instruction given by the therapists which positis the client to participate in a distinct and aburds reaction, which is typically opposite of what common sense would tell one to do, in hopes of displaying to the client their control they truly have over the situations (Metcalf, 2011).

The client will then come to terms with how they can change their situation based off of the realistic reactions and even in the event that they do not address the situation properly, the therapist has been effective in showing them the voluntary freedom they have over their outcome through this exercise. For instance, in the case of the concerned girlfriend, I would utilize paradoxical directives by suggesting that the next time she suspects he is cheating or avoiding the conversation she sings her concerns in a high pitched, opera-like tone non stop until it catches his attention. This is clearly an absurd request to any normal thinking person but if she does question my requests I would reply by stating that by doing this she can advance in explaining that she is singing loud as a result of feeling ignored/ as if he is not really hearing her concerns. This action will not resolve the problem, but it will open up the discussion about what she feels is going on with him and their relationship. Now if the client realizes the absurdity in these requests she may come to terms with the more logical mannerism in handling her problem by confronting him head on and demanding a response or else consequences will apply. In this scenario the girlfriend realizes her equal power she holds as a voluntary partner within her relationship and will either use that power to address the boyfriend or leave the relationship due to it’s unhealthy communication patterns after being blatantly avoided again.

One specific referral issue/presenting problem that may not benefit from strategic family therapies on the other hand is in reference to family issues with immigrants or traditional families who abide by strict traditions and/or rules. For instance, in many middle easterner homes religious views are heavily implemented and positions the father as the head of the household. In America there are many traditions where not only is religion a non factor, but the toxic masculinity often expressed within these religions are also non-existent. So imagine a young muslim boy weds an America girl who is not accustomed to his rituals and beliefs and although she strives to appease his culture these rules later pose a significant issue for their relationship down the road. While strategic family therapy teaches the couples great communication skills and the essential element of hierarchy power in relationships, the difference between logical and illogical reactions (the paradox directives) and more, these concepts can prove to be a hard and almost impossible pill to swallow when dealing with certain cultural groups, especially when those groups believe their tradition and religion outweighs the vitality of therapy and all other traditions as well. The case of religion and cultural customs in a relationship may be exceptionally hard to counsel using strategic family therapy for numerous ethical as well as personal issues. For one, the man may be unwilling to debate or alter many of his expectations towards his American wife due to concerns of family disgrace and obstruction to his religion no matter how illogical the therapist proves his ways to be and vice versa. Nevertheless, this refusal does not equate to ignorance of their reality as being one filled with marital conflict, and it also does not mean that they do not love one another. These issues, as well as some mental disorders which require more extensive training along with deep insight into the clients psychological lineage can all pose significant problems for strategic family therapies.

Some ethical concerns that arise with many of the strategies exerted throughout the text concern issues of imposing harm onto the client and even exploitation of limitations (ACA, 2014). These issues arise because many of the concepts within strategic family therapies concerns suggestive tasks that are focused on immediate behavior change and not the comprehension of the reason for those necessary changes (Metcalf, 2011)

Therefore, in the event that family members are counseled using the theories of control in terms of the perspective that all human interactions are a fight for control,then this can create an even more challenging environment in both intimate and family settings due to everyone fighting for that control. Additionally, in a setting where the therapists suggest the paradox directive technique to create intervention between members of a unit, and the client is does not recognize the absurd requests as being a false suggestions used to prompt the enlightenment of a logical solution and they actually do it, the outcome can be even more devastating convincing the client that their therapists is inadequate as well as imposing further psychological or even physical harm onto themselves and possibly others.

Another ethical concern pertaining to many of these approaches concerns the timeframe of several strategic family therapies. These approaches are noted for their brief timeframe and not all processes for filing, investigating and resolving the clients complaints can be fulfilled in such a rapid mannerism. Therefore, the extent in which the therapist encourages an immediate response in favor of the client may occur, but the overall resolution of their complaints and family issues may reoccur in the future and more dominantly without the proper contemplation and decision making process entailed (American Association for Marriage and Family Therapy, 2015). Altogether many strategies within this theory seems to focus on unfavorable outcomes such as embarrassment of third party members, exclusion and even ultimatums which can fix problems prematurely, but pose significant issues in the long run.

References

American Association for Marriage and Family Therapy. (2015). AAMFT Code of Ethics. Retrieved from https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx

American Counseling Association. (2014). ACA Code of Ethics. Retrieved from org/resources/aca-code-of-ethics.pdf”>https://www.counseling.org/resources/aca-code-of-ethics.pdf

Metcalf, P. L.-S. L.-S. (2011). Marriage and family therapy : A practice-oriented approach. Springer Publishing Company.

Robin A,

RE: Strategic Model

Dr. January and Class,

Metcalf (2015) states that patterns of communication in strategic family therapy are known as feedback loops, having been analyzed and linked together by stimulus and response. A problem can be aggravated by a positive feedback loop and weakened by a negative feedback loop. By placing the focus on those interactions which worsen an existing problem, the issue can be worked with and modified. A client who continues to use coping mechanisms which are not effective in order to solve problems will create a positive feedback loop. This does not take into consideration underlying causes of problems as these are unlikely to change; the negative feedback loop remains stagnant (Metcalf, 2015). The problems and symptoms which are observed during therapy are considered the result of how family members communicate. In order to modify the presenting problem, the way in which family members communicate must change. The therapist observes the family members interacting with one another and gathers insight into the mechanics of the issue. This allows the therapist to create a hypothesis regarding the problem and an active treatment plan (Metcalf, 2015).

Families who are dealing with adolescent issues may find strategic therapy beneficial. Adolescent issues are certainly a broad term and can relate to any number of problems; for this example I will use defiance towards parental decisions. It is not uncommon for teenagers to resent being told what to do by their parents. They may feel that they no longer need adult supervision or a parent telling them how to manage their lives. This can impact the individual family members and the family as a whole. The strategic approach views the problem as serving as a function to the family, one that reflects the difficulty with which the family has in solving the issue (Jiminez, Hildago, Baena, Leon & Lorence, 2019). For example, a teenager who constantly breaks his curfew is grounded by his parents. Because he continues to break curfew, more and more privileges are taken away until finally there is nothing left to punish him with. The family is now in a place where the solution is not working, and they are unable to move forward. Another example is an adolescent who is not doing his schoolwork, thus falling behind. Again, the parents can take away everything possible from him, but it does not have an impact. The therapist recognizes that the parents have tried to correct the behaviors with little result. The consequence then needs to change as the teenagers appear to be immune to the current restrictions, likely taking it in stride. This happened with my oldest son, who was my ‘wild child.’ He would do something that would end with him being grounded and after a bit I realized this was not working. He did not care if he was grounded and began to look at it as a normal part of life. We did not go through therapy, although in hindsight we probably should have. But I decided to loosen the reins a bit and pay attention to the good behaviors over the bad. After a while I noticed a difference, although it was a bit rocky for a time.

Metcalf (2015) notes that strategic family therapy is not appropriate for clients who react with violent and impulsive behaviors. Therapists are not looking to flesh out the root of the problem or delve into the past. This could be a potential problem for clients who want to dig deeper into the family history or are looking to point the finger of blame rather than work with the therapist to solve the current problem. Another example where this may not be an effective form of therapy is a family who has been mandated to attend therapy. This could be the result of a drug abuse in the family, anger issues, or parenting issues (“Guidelines for Court-Involved Therapy,” 2010). Just the idea of being mandated to attend may result in family members not participating in the process and being resentful of it. An example of an ethical issue with paradoxical interventions is a therapist who is treating a family that has been arguing. The therapist can ask the family to argue, even encourage them to do so, to gain insight into the problem. The therapist is using a paradoxical intervention, however, if the clients are not aware of this it could be construed as an ethical issue. Therapists are supposed to be forthcoming with clients and provide them with honest information about the therapy being offered (Barsky, 2018). The ACA Code of Ethics maintains that clients need to have adequate information about the therapeutic process and counselors are obligated to discuss this with them in writing and verbally (“ACA Code of Ethics,” 2014). Without the information being offered up front, there is potential for an ethical challenge.

Linda Metcalf, P. L.-S. L.-S. (2011). Marriage and Family Therapy: A Practice-Oriented Approach. Springer Publishing Company.

Jimenez, L., Hidalgo, V., Baena, S., Leon, A. & Lorence, B. (2019). Effectiveness of structural-strategic family therapy in the treatment of adolescents with mental health problems and their families. MDPI. Retrieved from https://www.mdpi.com/1660-4601/16/7/1255/htm.

Guidelines for Court-Involved Therapy (2010). Association of Family and Conciliation Courts. Retrieved from https://www.afccnet.org/Portals/0/PublicDocuments/CEFCP/Guidelines%20for%20Court%20Involved%20Therapy%20AFCC.pdf.

Barsky, A. (2018). Ethics alive: Ethics of paradoxical intervention in social work. Social Worker. Retrieved from https://www.socialworker.com/feature-articles/ethics-articles/ethics-alive-ethics-of-paradoxical-intervention-in-social-work/.

ACA Code of Ethics. (2014). American Counseling Association. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf.

Discussion #2 Milan systemic Model

Gloria M.

The Milan Systemic models of family therapy seems like a very cohesive yet individual focused approach to family therapy. It involved the process of interviewing the family as a whole, with respect to giving each individual the time to explain their own perspective of the issues bothering them/contributing to the overall family conflict out loud so that the whole family can hear them. The portion of this approach that is most unique and likable is the overall idea of an intensive, five-part interview, which consists of the presession, the session, the intersession, intervention, and the postsession (Metcalf, 2011) The intake and assessment portion of therapy consists of four therapists observing one family unit at the same time. Throughout previous research, two therapists were assigned the interviewing role while the additional two therapists stood behind a two-way mirror and carefully analyzed the families responses to those questions. Afterwards, all of the therapists would reconvene and share their respective perspectives of the interactions they’ve just endured. I enjoy this method of analysis but I can’t help but to wonder how efficient this method of observation is in most therapeutic settings both financially and logically? I understand the input of four professionals instead of one poses the chance of developing a very efficient prescription (aka treatment plan), but this also requires that within one clinical setting, four resources are being used on one case and if the practice is busy then the clientele that could be getting serviced is at a halt due to all of the providers being preoccupied with one case. This is a big concern of mine when considering the application of the Milan Systemic models of family therapy.

Additionally, with finances and time management aside there still remains the concern of individual biases. Even when working with professional therapists we have constantly learned of the personal morals and ethics that seep into therapy. With that said the more therapists we used to decode a families conflict, the more risk there is for different ideas and perspectives of what the issue is and how to effectively resolve it there will also be. This is a worry because we as professionals do not want to further impede or prolong a therapeutic process due to differing views on how to go about the situation, and although collaboration is good in many cases, there is always the possibility that it can actually do more harm than good which is never good for anyone. Other forms of the Milan systemic family therapy that is noteworthy are the various aspects of observation and application. For instance, the positive connotation as well as the circular questioning intervention tactics are exceptionally helpful in the sense that therapy is often associated with the therapists pointing out the clients bad habits, bad cognition and bad behaviors, but as explained throughout the text highlighting the good can be of equal importance for the facilitation of daily progression. People do not always respond to constant criticism and may even become discouraged in their journey when they are constantly told they are not doing anything correctly (Metcalf, 2011). This is why explaining both the good and bad throughout the reframing portion of therapy is advised and associated with hopefulness/progression. Initially, through the reframing of each family member’s symptomatic behaviors in a positive mannerism, the therapist can help the family begin to realize the homeostatic need for the behaviors (Metcalf, 2011). As a result the symptomatic family member is suddenly seen in a more favorable light, and the symptom may actually be welcomed rather than resented and pushed away. Another very beneficial aspect of the Milan systemic family therapy model I would incorporate into my practice is the Milan systemic family therapy template. I can agree that I am a student of psychology who does not recall every psychological test or interviewing tactic verbatim so this guideline would be perfect for providing me with a way to start the interviewing process with each client. I find it exceptionally valuable for keeping therapists on track with the responses they should and should not give each client as this is a process that can easily become confusing when managing multiple clients at once. After the initial inquiries are provided for each section, I would be able to go off of those prompts and dig deeper into the categories of the units conflict. Altogether I can see why this system is not as heavily implemented into the western counseling practices but nevertheless it is still beneficial in many aspects and I could see myself using it in the future.

References

Metcalf, P. L.-S. L.-S. (2011). Marriage and family therapy : A practice-oriented approach. Springer Publishing Company.

Robin A.

Dr. January and Class,

In Milan Systemic family therapy, the therapist is viewed as being a neutral party, one whose main objective is to guide family members to question their knowledge of the family system, leading them to modify their actions. The interviewing technique of circular questioning is one which utilizes the client’s own feedback as a means for the therapist to offer additional questions. This is done with the intent to aid the family in recognizing the ideas and behaviors they hold in a different context (Metcalf, 2011). What I find most intriguing about this technique is that it compels the family to consider the perceptions that each family member has, how each person sees a different situation, and the shift in their actions as a result. This is not always easily done, as it can be difficult for people to walk in the shoes of another, but I believe this is integral in family therapy, especially if sides have been taken over an issue. Metcalf (2011) maintains that using circular questioning expands the beliefs individual family members have by formulating questions which will urge the individual to look at a situation or belief in a new light.

Evans & Whitcombe (2015) note that there are four categories of circular questions therapists employ: questions which help define the problem for the family, questions which invoke a chronological response to situations, triadic questions which invite the family to see how the actions of two family members affect a third, and interventive questions which are based on inviting the family to modify their behaviors. Evans & Whitcombe (2015) use an example of a family struggling to cope with a parent’s memory loss. The questions the therapist puts forth to the family ask who is most affected in the family by the memory loss issue? This can then lead to questions regarding the chronological timeline of the memory loss and the family members reactions to it. Likewise, when it is noted that two or more family members are in disagreement with others, a question can be put forth asking if they recognize what the other family members are experiencing. The focus is more on the impact of the situation and less on the facts of the situation (Evans & Whitcombe, 2015). I would be very receptive to using this in counseling family members. I believe that our behaviors and beliefs are often at odds with other family members, especially in a time of crisis. However, it is very easy to let those differences fester, leading to a communication breakdown in the family. My family was at odds for over a year when my father was ill and after he died. The triadic questions would have provided help in understanding how one family member felt when in dispute with two family members. Ultimately, I believe we all could have benefited from understanding one another more and the reasons behind our actions.

The second technique is that of neutrality, in which the therapist strives to understand the viewpoint of individual family members. Metcalf (2011) points out that remaining entirely neutral and without prejudice is virtually impossible. It has often been misunderstood and viewed by clients as a being cold or distant approach. I agree with this as I cannot imagine a situation where I could remain entirely neutral, especially when there are multiple behaviors and belief patterns present in the family. I recognize that this could certainly be a negative issue on my part and one which could alienate the clients, which makes me abundantly cautious of using it. However, with that being said, neutrality is also viewed as one who is curious, which I can better identify with. I am naturally curious about people but have made it a point in my classes to try to maintain neutrality with my students. Neutrality provides everyone with a voice, and I am particularly drawn to the premise of creating hypotheses about a situation to share with the family members, as noted by Metcalf (2011). I like the ‘what and what if?’ questions that could be asked of the family, such as ‘what if you opened up to your mom about your feelings?’ and ‘what would happen if you tell her how you feel?’ This is a technique I use in my classes when we are discussing ethics. The answers are always interesting, but what I really enjoy is the reaction of students who have differing viewpoints. They may not always be entirely in sync with one another, but often the viewpoints shift and they find common ground.

Metcalf, L. (2011). Marriage and Family Therapy: A Practice-Oriented Approach. Springer Publishing Company.

Evans, N. & Whitcombe, S. (2015) Using circular questions as a tool in qualitative

research. Nurse Researcher. 23, 3, 28-31.

Discussion # 3 Intake and Referral

Darren E.

Hello class and Professor

While in the client’s initial visit, if the writer wasn’t equipped with enough information to help the family to be referred in the right

direction helping them to receive appropriate treatment, there are some questions that the counselor should ask the family. The first question the

counselor should ask the parents will be, on either side of the family history are there mental or substance use in the family history? (Bagly, 2013).

the counselor would expect to see a look of denial, because people don’t usually like to expose this type of information in the beginning of therapy.

In order to get parents to become open-minded and trust the process the counselor should help to guide the direction by explaining to the family the

importance of revealing this information to help the family to receive a more accurate treatment.

The second question the counselor should ask during the intake is what type of family relationship does the family have, do the family have

a great family bond, or are there any problems that is affecting the family relationship? (Bagly, 2013).There should be some type of facial response

having deep thoughts, and the thoughts is from the person who will expose the family problems that is causing the teenage daughter to become

argumentative with the mother. The writer will help the family to acknowledge and understand what can be the nature of the problem. The writer

will try to get to the root of the problem, and have the family to be willing to open up to the writer.

The next question the the counselor should ask the family will be directed to the teenagers, what type of relationship do the siblings have

with each other and with their school mates? (Bagly, 2013). The counselor should understand the teenagers having a look of curiosity not knowing

if they want to discuss any problems they might be having until they grow a sense of trust with the writer. Most likely the teenagers don’t want to

be in the session in the beginning. The writer will use role play as an technique to get the family to open up, also the writer will use somepositive

affirmations to help the family to be motivated to reach an solution to help them to overcome their family problems. “Most counselor/client relationship

begins with the initial intake interview, and process may vary from structured to unstructured models, each with similar information that is

gathered during the intake interview. Effective interviews are considered a balance between gathering information and to develop a therapuetic

working alliance (Whiston, 2009). To become effective in interviewing so that a working alliance is fostered, counselors need to follow

guidelines and receive training to obtain accurate and valid information (Duley, Cancelli, Kratochwill, Bergan & Meredith, (1983).

Reference:

Freeburg, M. and Van Winkle, J. (2011). Increasing intake interview skills: A creative approach American Counseling Association, article_33.pdf

Sutton, R. (2013). The counseling intake process. What counselors need to consider. Retrieved from https://thriveworks.com/blog/the-counseling-intake-process-what-counselors-need-to-consider

Gloria M.

Primarily I enjoy the concept behind constructing an intake form prior to the actually interviewing process of any therapy session. As explained throughout the article, essential information pertaining to the session can be gathered through an initial intake form IF the clients are comfortable disclosing that information on the sheet (Bagley, 2013). However, I would keep the information required to a minimum to ensure that the most vital and groundbreaking disclosures are saved for group therapy sessions so that this information is shared rather than handed on an individual basis. When dealing with group sessions such as this depicted scenario, it may prove to be a challenge due to adolescent and family conflict and comfort zones. What I mean by this is that children, especially those who are not seeing eye to eye with their parents may be very secretive or weary of what they share with them for numerous reasons. Additionally, parents oftentimes do not share every small, or big detail of their lives with their children for authoritative purposes as well as other boundaries which may have been set over time within their family circle. Therefore, to prevent stepping on any toes or making any one feel targeted and uncomfortable I would start off with simple questions that can result in deeper elaboration such as “so what brings you here today?”. It is essential that every client is able to answer this question in its entirety, without being interrupted by others to feel secure that this is a safe place to get their concerns across to the others (Metcalf, 2011). This question would hopefully allow the child, as well as the parents to disclose any reasons why they decided to seek counseling for their relationship troubles.

The Milan approach is key for adequate intake assessments because it provides many detailed theories on how to assess contributing systems to the families overall dysfunction. For instance, if I ask each individual their thoughts on why they need counseling and by the time I reached the teenager daughter with this question the mother chimes in and answers for her, or the parents display some form of disruption while she speaks I can take note of that behavior as a possible contributor to the child’s aggressive and argumentative behavior. Another elaborative question which does not jump right into the core of the problems being experienced is for me to question “what is something going on in your life that you feel is good?”. I think this question will allow for each person to give insight on their personal preferences, social life and the extent in which they are compatible in their family environment. I have noticed that when children associate good qualities of life with friends and social settings it is often because they feel connected with their peer environments and this has been noted as an essential part of life for everyone’s well being. Therefore, if a lack of interest in social interest altogether or disclosed information of experiencing trouble in the friend/social aspect of life is provided this may lead to further analysis on why the children display such anger or backlash towards their family in terms of both displacement and/or the development of a possible serious mood dysregulation/disorder.

Lastly, I would challenge the entire family to think and then share what they feel the ideal family looks like. This prompt would allow me, as well as them to be honest about their picture of an ideal family system and then compare that imagery to their own circumstances. Through this exercise I would be getting the family as a whole to actively confront their view of the family which is essential for constructing a treatment plan that confronts the dysfunctional as well as beneficial symptoms contributing to their overall dynamic (Metcalf, 2013). Through all of these initial, yet simple prompts I feel the session would be off to a good start whereas the family is able to constructively come to the realization of their issues on an independent and overall level. The intake process is essential in leading therapy and if the wrong questions are asked there is a greater risk of further hindering the rehabilitation and progression process dramatically. That is also why I believe several of the intervention tactics developed by the Milan group are useful, especially in family and group assessment sessions (Metcalf, 2013).

References

Bagley A. (2013). The counseling intake process: What counselors need to consider. Thriveworks. Retrieved from https://thriveworks.com/blog/counseling-intake-process/

Metcalf, P. L.-S. L.-S. (2011). Marriage and Family Therapy : A Practice-Oriented Approach. Springer Publishing Company.


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