Connecting using the Phases of Therapy
Joining entails the development of a relationship with and a commitment to each member of the family. Establishing a clear understanding of the members’ multiple perspectives of the crisis fosters therapist connection with and responsiveness to the whole family.
During your visit you increasingly notice that each member has developed varying perspectives about this current crisis. Joining with this family will require an approach that acknowledges each person’s understanding about the cancer diagnosis and its personal impact. Mom may struggle shifting focus on her medical management while attempting to juggle the demands of work and home and the most recent issues concerning her daughter’s behavior. Dad’s absence may make it difficult to personally join with him, however, efforts made during treatment to ask each member to hypothesize on Dad’s experiences and perceptions may provide him a voice. Mary, Carmelita, and Angela may resent being present in treatment since they tend to naturally seek relationships outside of the family. Inquiring about each one’s reaction to the news of hearing about mom’s cancer may generate an opportunity for each to express their thoughts and experiences as well as feelings of personal vulnerability. Your explicit expression of your intentions to provide a respectful space for each one to share while valuing the others’ experiences can invite this family to think about the crisis as something they share. Additional overt efforts to address the cultural implications of family togetherness coupled with the stresses of assimilating into the present context would invite members to share their views and efforts to do this.
Establishment of an accurate assessment entails an understanding the type of crisis the family has faced. Next, the therapist determines the individual and family resources and perceptions associated with the crisis and the family’s ability to manage and adapt to the crisis. Finally, the assessment includes a consideration of the individual member and family resiliencies and vulnerabilities.
While Carmen and Jo have historically had a strong relationship, a shift has occurred in which they have become emotionally disconnected from each other. While family cohesion has been a hallmark of this family’s interactions with each other, assessment of their adaptability would explore the possible ongoing developmental crisis associated with their responses to the three adolescents’ would need to be explored. Mom’s diagnosis appears to have been a bolt-from-the-blue crisis that has simultaneously occurred and resulting in a pile up of stressors.
Contracting involves the obtaining of, not only family consent, but also the “buy-in” necessary to collaboratively address the crisis with the family members. Goals are focused on accomplishing both short-term relief while placing the priority on long-term, sustainable solutions that moderate the effects of stressors.
Therapeutic focus on short-term relief combined with long-term direction would entail addressing the stresses associated with learning of a potentially fatal diagnosis while attending to the family’s efforts to adjust to the adolescents’ developmental tasks. The contract would need to incorporate goals that involve family members in substantive ways to support mom while addressing personal feelings and growing concerns. Additional goals would address ways the family can acknowledge the adolescent efforts to individuate while experiencing increased emotional connections and improving family support. Helping this family to acknowledge and adjust to the co-occurring developmental and bolt-from-the-blue crises could enable members to identify ways to address the current crisis within the context of the ongoing struggles they have faced.
Effective interventions provide opportunities to highlight larger patterns of family crisis responses. Interventions also identify available resources, explore alternative perceptions, foster improved individual and family resiliencies, and minimize individual and family vulnerabilities.
Each intervention would need to suggest ways to address current issue while exploring ways to generalize the skills and efforts to be applied to other issues and circumstances. Use of the family’s unique and cultural history to inform the development of interventions will provide them with the connections to their broader values and expectations while acknowledging their available strengths and resiliencies. Integrating changes within their cultural frames of reference will provide basis for achieving sustainable change.
A family is ready for termination when they manage and adapt to a crisis effectively, generalize learning and coping to other stressful issues, discover and behaviorally demonstrate alternative narratives that do not incorporate crisis-perpetuating patterns, and express reduced fears or concerns about handling stressful situations.
Termination can effectively occur when the family members consistently demonstrate a level of cohesion and adaptation that addresses support for mom’s condition and while adjusting to the ongoing member developmental changes.