Systemic Case Conceptualization For use with individual, couple, or family clients Date: Clinician: Client/Case #: I. Introduction to Client & Significant Others List persons who will regularly participate in sessions Adult 1 Gender: Select Age: Ethnicity: Select Relational Status: Select Occupation: Other identifier: Adult 2 Gender: Select Age: Ethnicity: Select Relational Status: Select Occupation: Other identifier: Child 1 Gender: Select Age: Ethnicity: Select Grade: School: Other identifier: Child 2 Gender: Select Age: Ethnicity: Select Grade: School: Other identifier: 1 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org Others Participating In Sessions Regularly: II. Presenting Concern(s) Client’s Description(s) of Problem(s): Adult One: Adult Two: Child One: Child Two: Extended Family Description(s) of Problems: Broader System Problem Descriptions: Description of problem from referring party, teachers, relatives, legal system, etc.: III. Background Information Trauma/Abuse History (recent and past): Substance Use/Abuse (current and past; self, family of origin, significant others): Precipitating Events (recent life changes, first symptoms, stressors, etc.): 2 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org Related Historical Background (family history, related issues, previous counseling, medical/mental health history, etc.): IV. Client/Family Strengths and Diversity Strengths and Resources Personal: Relational/Social: Spiritual: Diversity: Resources and Limitations Identify potential resources and limitations available to clients based on their age, gender, sexual orientation, cultural background, socio-economic status, religion, regional community, language, family background, family configuration, abilities, etc. Unique Resources: Potential Limitations: V. Family Structure Family Life Cycle Stage (Check all that apply) Single adult Committed Couple Family with Young Children Family with Adolescent Children Divorce Blended Family Launching Children Later Life 3 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org Describe struggles with mastering developmental tasks in one or more of these stages: Typical style for regulating closeness and distance in couple/family: Boundaries with/between Primary couple Enmeshed Clear Disengaged NA Description/example: Adult 1 & Children Enmeshed Clear Disengaged NA Description/example: Adult 2 & Children Enmeshed Clear Disengaged NA Description/example: Siblings Enmeshed Clear Disengaged NA Description/example: Extended Family Enmeshed Clear Disengaged NA Description/example: Friends/Peers/Others Enmeshed Clear Disengaged NA Description/example: Triangles/Coalitions Cross-generational coalitions: Describe: Coalitions with family of origin: Describe: Other coalitions: Hierarchy between Parents and Children NA Adult One: Effective Insufficient (permissive) Excessive (authoritarian) Inconsistent Adult Two: Effective Insufficient (permissive) Excessive (authoritarian) Inconsistent 4 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org Description/Example to illustrate: Complementary Patterns between and ________________ Pursuer/distance Over/under-functioner Emotional/logical Good/bad parent Other: Example of pattern: Satir Communication Stances: Describe most commonly used stance under stress. Adult One: Congruent Placator Blamer Superreasonable Irrelevant Adult Two: Congruent Placator Blamer Superreasonable Irrelevant Child One: Congruent Placator Blamer Superreasonable Irrelevant Child Two: Congruent Placator Blamer Superreasonable Irrelevant Describe pattern: Gottman’s Divorce Indicators NA is Partner 1; is Partner 2 Criticism Partner 1 Partner 2: Describe: Defensiveness Partner 1 Partner 2: Describe: Contempt Partner 1 Partner 2: Describe: Stonewalling Partner 1 Partner 2: Describe: 5 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org : Failed repair attempts Partner 1 Partner 2: Describe: Not accept Influence Partner 1 Partner 2: Describe: Harsh start up Partner 1 Partner 2: Describe: VI. Interactional Patterns Problem Interaction Pattern (A  B): Start of tension: Conflict/symptom escalation: Return to “normal”/homeostasis: Hypothesized homeostatic function of presenting problem: How might the symptom serve to maintain connection, create independence/distance, establish influence, reestablish connection, or otherwise help create a sense of balance in the family? VII. Intergenerational & Attachment Patterns Construct a family genogram and include all relevant information including:  Names, ages and birth/death dates  Relational patterns  Occupations  Psychiatric disorders and alcohol/substance abuse  Abuse history  Personality adjectives Genogram should be attached to report. Summarize key findings below. 6 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org Substance/Alcohol Abuse: NA History: Sexual/Physical/Emotional Abuse: NA History: Parent/Child Relations: NA History: Physical/Mental Disorders: NA History: History Related to Presenting Problem: NA History: Family strengths: Describe: Attachment Patterns: Describe most common attachment pattern for each Secure Anxious Avoidant Anxious/Avoidant. Describe: Adult One: Adult Two: Secure Anxious Avoidant Anxious/Avoidant. Describe: Child One: Secure Anxious Avoidant Anxious/Avoidant. Describe: Child Two: Secure Anxious Avoidant Anxious/Avoidant. Describe: VIII. Solution-Based Assessment Attempted Solutions that DIDN’T work: 1. 2. 3. 7 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org Exceptions and Unique Outcomes (Solutions that DID work): Times, places, relationships, contexts, etc. when problem is less of a problem; behaviors that seem to make things even slightly better: 1. 2. 3. Miracle Question Answer: If the problem were to be resolved overnight, what would client be doing differently the next day? (Describe in terms of doing X rather than not doing Y). 1. 2. 3. IX. Postmodern and Cultural Discourse Conceptualization Dominant Discourses informing definition of problem:  Ethnic, Class and Religious Discourses: How do key cultural discourses inform what is perceived as a problem and the possible solutions?  Gender and Sexuality Discourses: How do the gender/sexual discourses inform what is perceived as a problem and the possible solutions?  Community, School, and Extended Family Discourses: How do other important community discourses inform what is perceived as a problem and the possible solutions? Identity Narratives: How has the problem shaped each client’s identity? 8 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org Local or Preferred Discourses: What is the client’s preferred identity narrative and/or narrative about the problem? Are there local (alternative) discourses about the problem that are preferred? X. Client Perspectives Areas of Agreement: Based on what the client(s) has(ve) said, what parts of the above assessment do they agree with or are likely to agree with? Areas of Disagreement: What parts do they disagree with or are likely to disagree with? Why? How do you plan to respectfully work with areas of potential disagreement? 9 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org Systemic Case Conceptualization For use with individual, couple, or family clients Date: Clinician: Client/Case #: I. Introduction to Client & Significant Others List persons who will regularly participate in sessions Adult(s) Select Gender Age: Select Gender Age: Select Ethnicity Select Relational Status Occupation: Select Ethnicity Select Relational Status Occupation: Child(ren) Select Gender Age: Select Gender Age: Select Ethnicity Grade: Select Grade School: Select Ethnicity Grade: Select Grade School: Other identifier: Other identifier: Other identifier: Other identifier: Others: II. Presenting Concern(s) Client’s Description(s) of Problem(s): Select Person: Select Person: Select Person: Select Person: Extended Family Description(s) of Problems: Broader System Problem Descriptions: Description of problem from referring party, teachers, relatives, legal system, etc.: Name: Name: III. Background Information Trauma/Abuse History (recent and past): Substance Use/Abuse (current and past; self, family of origin, significant others): Precipitating Events (recent life changes, first symptoms, stressors, etc.): Related Historical Background (family history, related issues, previous counseling, medical/mental health history, etc.): IV. Client/Family Strengths and Diversity Strengths and Resources Personal: Relational/Social: 1 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org Spiritual: Diversity: Resources and Limitations Identify potential resources and limitations available to clients based on their age, gender, sexual orientation, cultural background, socio-economic status, religion, regional community, language, family background, family configuration, abilities, etc. Unique Resources: Potential Limitations: V. Family Structure Family Life Cycle Stage (Check all that apply) Single adult Committed Couple Family with Young Children Family with Adolescent Children Divorce Blended Family Launching Children Later Life Describe struggles with mastering developmental tasks in one or more of these stages: Typical style for regulating closeness and distance in couple/family: Boundaries with/between Primary couple Select & Children Select & Children Siblings Extended Family Friends/Peers/Others Enmeshed Enmeshed Enmeshed Enmeshed Enmeshed Enmeshed Clear Clear Clear Clear Clear Clear Disengaged Disengaged Disengaged Disengaged Disengaged Disengaged NA Description/example: NA Description/example: NA Description/example: NA Description/example: NA Description/example: NA Description/example: Triangles/Coalitions Cross-generational coalitions: Describe: Coalitions with family of origin: Describe: Other coalitions: Hierarchy between Parents and Children NA Select: Effective Insufficient (permissive) Select: Effective Insufficient (permissive) Description/Example to illustrate: Complementary Patterns between Pursuer/distance Over/under-functioner Emotional/logical Good/bad parent Other: and Excessive (authoritarian) Excessive (authoritarian) Inconsistent Inconsistent : 2 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org Example of pattern: Satir Communication Stances: Describe most commonly used stance under stress. Select: Congruent Placator Blamer Superreasonable Irrelevant Select: Congruent Placator Blamer Superreasonable Irrelevant Select: Congruent Placator Blamer Superreasonable Irrelevant Select: Congruent Placator Blamer Superreasonable Irrelevant Describe pattern: Gottman’s Divorce Indicators NA Select is Partner 1; Select is Partner 2 Criticism Partner 1 Defensiveness Partner 1 Contempt Partner 1 Stonewalling Partner 1 Failed repair attempts Partner 1 Not accept Influence Partner 1 Harsh start up Partner 1 Partner 2: Describe: Partner 2: Describe: Partner 2: Describe: Partner 2: Describe: Partner 2: Describe: Partner 2: Describe: Partner 2: Describe: VI. Interactional Patterns Problem Interaction Pattern (A  B): Start of tension: Conflict/symptom escalation: Return to “normal”/homeostasis: Hypothesized homeostatic function of presenting problem: How might the symptom serve to maintain connection, create independence/distance, establish influence, reestablish connection, or otherwise help create a sense of balance in the family? VII. Intergenerational & Attachment Patterns Construct a family genogram and include all relevant information including: ▪ Names, ages and birth/death dates ▪ Relational patterns ▪ Occupations ▪ Psychiatric disorders and alcohol/substance abuse ▪ Abuse history ▪ Personality adjectives Genogram should be attached to report. Summarize key findings below. Substance/Alcohol Abuse: Sexual/Physical/Emotional Abuse: Parent/Child Relations: Physical/Mental Disorders: NA NA NA NA History: History: History: History: 3 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org History Related to Presenting Problem: Family strengths: Describe: NA History: Attachment Patterns: Describe most common attachment pattern for each Select: Secure Anxious Avoidant Anxious/Avoidant. Describe: Select: Secure Anxious Avoidant Anxious/Avoidant. Describe: Select: Secure Anxious Avoidant Anxious/Avoidant. Describe: Select: Secure Anxious Avoidant Anxious/Avoidant. Describe: VIII. Solution-Based Assessment Attempted Solutions that DIDN’T work: 1. 2. 3. Exceptions and Unique Outcomes (Solutions that DID work): Times, places, relationships, contexts, etc. when problem is less of a problem; behaviors that seem to make things even slightly better: 1. 2. 3. Miracle Question Answer: If the problem were to be resolved overnight, what would client be doing differently the next day? (Describe in terms of doing X rather than not doing Y). 1. 2. 3. IX. Postmodern and Cultural Discourse Conceptualization Dominant Discourses informing definition of problem: ▪ Ethnic, Class and Religious Discourses: How do key cultural discourses inform what is perceived as a problem and the possible solutions? ▪ Gender and Sexuality Discourses: How do the gender/sexual discourses inform what is perceived as a problem and the possible solutions? ▪ Community, School, and Extended Family Discourses: How do other important community discourses inform what is perceived as a problem and the possible solutions? Identity Narratives: How has the problem shaped each client’s identity? Local or Preferred Discourses: What is the client’s preferred identity narrative and/or narrative about the problem? Are there local (alternative) discourses about the problem that are preferred? 4 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org X. Client Perspectives Areas of Agreement: Based on what the client(s) has(ve) said, what parts of the above assessment do they agree with or are likely to agree with? Areas of Disagreement: What parts do they disagree with or are likely to disagree with? Why? How do you plan to respectfully work with areas of potential disagreement? 5 © 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy Chapter 9: Symbolic-Experiential & Internal Family Systems © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy SYMBOLIC-EXPERIENTIAL THERAPY • “Therapy of the absurd,” highlighting unconventional and playful wisdom • Focused on emotional process and family structure • Adamant about balancing strong emotional confrontation with warmth and support © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Developed by Carl Whitaker Theory and Treatment Planning in Family Therapy In a Nutshell: The Least You Need to Know © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy THE JUICE: SIGNIFICANT CONTRIBUTIONS TO THE FIELD • Should be won by the therapist, who sets boundaries and limits for therapy • Battle for Initiative: • Needs to be won by the client • Therapists should never work harder than their clients © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Battle for Structure: Theory and Treatment Planning in Family Therapy The Battle for Structure and the Battle for Initiative © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy RUMOR HAS IT: THE PEOPLE AND THEIR STORIES © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Carl Whitaker Theory and Treatment Planning in Family Therapy Significant Contributors © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy THE BIG PICTURE: OVERVIEW OF TREATMENT © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Known as “therapy of the absurd” • Employs specific form of absurdity for specific purpose • Absurdity used to perturb the system in a compassionate and caring way • Sometimes “caring” means speaking a truth no one else will, but the therapist conveys caring behind brutally honest comments Theory and Treatment Planning in Family Therapy Therapy of the Absurd © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy MAKING CONNECTION: THE THERAPEUTIC RELATIONSHIP • Therapist strives to be authentic • Doesn’t follow professional pretenses or follow what is considered appropriate boundaries • Personal Integrity • Willingness to stand up for personal beliefs • Therapist’s Responsibility • Pushes clients to accept full responsibility for their own lives • Stimulating Mutual Growth • The therapist and client grow together through authentic encounter • Use of Co-therapists • Provides a balance of support and challenge © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Therapist’s Authentic Use of Self Theory and Treatment Planning in Family Therapy The Therapeutic Relationship © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy THE VIEWING: CASE CONCEPTUALIZATION AND ASSESSMENT • Relies on in-the-moment authentic encounters to directly experience the other in a holistic way • Therapists focus primarily on family’s emotional system rather than behavioral interactions • When sensing triangles, they focus on emotional exchange between parties rather than actions © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Authentic Encounters Theory and Treatment Planning in Family Therapy Authentic Encounters and the Affective System • Observing how the family responds to the therapist’s interventions and interactions • How It Works • Understand person’s preferred family roles, values, developmental/family histories, and interactional patterns • Two broad patterns: • Structural organization of family • Emotional processes and exchanges within the family © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • What It Is Theory and Treatment Planning in Family Therapy Trial of Labor • Permeable boundaries within the family • Clear boundaries with extended family and larger systems • Role flexibility • Flexible alliances and coalitions • Generation gap • Gender-role flexibility • Transgenerational mandates • “Ghosts” © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Structural Organization Theory and Treatment Planning in Family Therapy Assessing Structural Organization • Differentiation and individuation • Tolerance of conflict • Conflict resolution and problem solving • Sexuality • Loyalty and commitment • Parental empathy • Playfulness, creativity, and humor • Cultural adaptation • Symbolic process © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Emotional Process Theory and Treatment Planning in Family Therapy Assessing Emotional Process • Emphasize strengths, competencies, and resources for change • Families viewed as highly resilient and resourceful • The therapists’ focus is on activating these resources © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Assessing Families Theory and Treatment Planning in Family Therapy Focus on Competency • Symptoms develop when dysfunctional structures and processes persist over time • Healthy families experience periods of dysfunction but do not become chronic • Persistence of dysfunction can occur over generations • Offspring feeling obligated to adhere to family myths and legacies or make up for prior losses © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart How It Works Theory and Treatment Planning in Family Therapy Symptom Development © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy TARGETING CHANGE: GOAL SETTING • Increase family cohesion • Promote personal growth • Expand the family’s symbolic world © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Three Long-term Goals: Theory and Treatment Planning in Family Therapy Goal Setting © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy THE DOING: INTERVENTIONS • Confusion and disorganization breaks family out of rigid interaction patterns • Can be created with: • Absurd comments • Role reversals • Appealing to universal principles at odds with family beliefs © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart How It Works Theory and Treatment Planning in Family Therapy Creating Confusion and Disorganization • Therapists use present-moment interactions and their own affect to promote change • “Nothing worth learning can be taught” • Immediacy is used to highlight and redirect structural change and confront dysfunctional patterns and beliefs © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart How It Works Theory and Treatment Planning in Family Therapy Here-and-Now Experiencing • Redefine symptoms as ineffective efforts toward growth • Uses specific reframe of striving for growth and authenticity • Example: Child’s refusal to do homework is redefined as fear of failing at a new level of challenge at school. • Expands symptom from an individual matter to a family matter • Often extending this to an intergenerational problem © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart How It Works Theory and Treatment Planning in Family Therapy Redefining and Expanding Symptoms • Play builds strong therapeutic relationship, allowing honest confrontation of clients without resistance • Playfulness helps reframe problems that have been unrealistically magnified • Use of humor and play often goes against common stereotypes about therapists and therapy © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Use of Spontaneity and Fun Theory and Treatment Planning in Family Therapy Spontaneity, Play, and “Craziness” • People don’t know how to allow personal autonomy while also being intimately connected with others • How It Works • When clients are unreasonably demanding, therapist help sort out where spheres of influence should begin and end • Example: If a parent is demanding a child play certain instrument or sport that child clearly does not enjoy, the therapist will confront the family about where parenting ends and the child’s autonomy begins. © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • The Problem Theory and Treatment Planning in Family Therapy Separating Interpersonal from Personal Distress • Uses affective confrontation to interrupt rigid patterns • Goals may be: • Raise clients’ awareness when they don’t know how they contribute to problem • Raise taboo subject that client and others have been avoiding • Increase motivation to make changes when there is cognitive awareness but no change in action • Examples • “When did you divorce your husband and marry your son?” • “You are aware that you have abandoned the family to advance your career” © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart How It Works Theory and Treatment Planning in Family Therapy Affective Confrontation of Rigid Patterns and Roles • Used with unrealistically hopeless clients • Exaggerates the client’s symptom so they can see how out of proportion the negative assumptions are with reality • Can be done in a playful way or a more direct and literal way, depending on what would be most useful to client © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart How It Works Theory and Treatment Planning in Family Therapy Augmenting Despair and Amplifying Deviation • Invite clients into absurd fantasy scenarios to shake them out of patterns and make realistic solutions more palatable • Designed to increase family’s flexibility and openness to new behaviors • Gets clients out of habits by playfully perturbing the system so new symbolic meanings, ideas, and perspectives can emerge © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart How It Works Theory and Treatment Planning in Family Therapy Absurd Fantasy Alternatives • Reinforce parental hierarchy and establish generational boundaries between parents and children • Involves: • Supporting parental requests • Parents manage child’s behavior in session • Beginning with parents • Greeting parents first © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Maintaining the Hierarchy Theory and Treatment Planning in Family Therapy Reinforcing Parental Hierarchy • Therapists share stories, free-associate, and offer metaphors to provide powerful images and examples to inspire clients to change • Clients often receive a message more easily through a fictional story or metaphor • Metaphor is about somebody else -less resistance or debate about details © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart How It Works Theory and Treatment Planning in Family Therapy Stories, Free Associations, and Metaphors © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy INTERNAL FAMILY SYSTEMS THERAPY © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • People have healthy core self that therapy aims to restore • Each person’s inner life has multiple parts forming a system • Goal of therapy is to have Self provide inner leadership to various parts • Three basic roles parts assume: exiles, managers, firefighters Theory and Treatment Planning in Family Therapy In a Nutshell: The Least You Need to Know © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy THE JUICE: SIGNIFICANT CONTRIBUTIONS TO THE FIELD • Each part must be understood in context of other parts • Parts have boundaries and form coalitions © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Individuals have an internal system of self parts • Three types of parts: exiles, managers, and the firefighters • Parts work together to maintain homeostasis and handle crisis Theory and Treatment Planning in Family Therapy Juice #1: Individuals as Systems © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Transference and Countertransference • Transference: how clients may relate to therapists as if they were someone from their past • Countertransference: how therapists may respond to clients based on another past relationship Theory and Treatment Planning in Family Therapy Juice #2: Transference and Countertransference © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy RUMOR HAS IT: THE PEOPLE AND THEIR STORIES © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Richard Schwartz Theory and Treatment Planning in Family Therapy Significant Contributors © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy MAKING CONNECTION: THE THERAPEUTIC RELATIONSHIP • Therapist Parts • Must have knowledge of their parts and know how to guide themselves • Use the Self rather than more reactive parts © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Collaboration • Use collaborative approach to build relationship with the client Theory and Treatment Planning in Family Therapy The Therapeutic Relationship © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy THE VIEWING: CASE CONCEPTUALIZATION AND ASSESSMENT • The seat of consciousness and natural leader of internal family system • Boundless state of consciousness and active, compassionate inner leader • When Self leads, experience inner balance and harmony • Parts serve to protect the Self • In trauma or crisis, parts will remove Self from leadership to safeguard it © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart How It Works Theory and Treatment Planning in Family Therapy The Self • Exiles • Managers • Firefighters • Due to trauma or other burdens, parts take on extreme roles and become imbalanced • All parts are considered valuable and having potential to be constructive • Goal of therapy is to help bring parts into balance by enabling Self leadership © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Internal System and Parts • Three types of parts or subpersonalities: Theory and Treatment Planning in Family Therapy Parts: Exiles, Managers, and Firefighters • The more they are repressed, the more they want to get out • Frozen in painful memories of the past • Will do anything for small amounts of love and acceptance © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • The parts that are closeted away due to burdens of shame, guilt, or fear of not being lovable • This group is kept from conscious mind at any cost Theory and Treatment Planning in Family Therapy Exiles © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Keep exiles locked up so they do not flood the person with strong, painful emotions • Work to protect rest of system from exiles and to protect exiles themselves • Common Management Styles: • Controller • Evaluator • Dependent One • Passive Pessimist • Caretaker • Worrier/Sentry • Denier • Entitled One Theory and Treatment Planning in Family Therapy Managers • Have very different methods, often causing conflict between the two © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Rescuers that contain dangerous images, emotions, and sensations • Automatically triggered when exiles are activated; respond forcefully • Strategies involve extreme behavior: cutting, binging, substance abuse, or risky sexual behavior • Firefighters and managers have same goal: containing the exiles Theory and Treatment Planning in Family Therapy Firefighters © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Parts assume leadership in order to protect the self • As one part shifts to an extreme position the other parts must oppose or take a counter role • Tends to self-confirming: the more vulnerable one feels, the more one needs to take extreme protection measures Theory and Treatment Planning in Family Therapy Polarization • Traumatic • Environmental • Legacy • Development • Tangible • Imbalances • Family harmony • Leadership © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Burdens and constrained development Theory and Treatment Planning in Family Therapy External Family System Imbalances • Manager-manager polarizations • Manager-exile polarizations • Manager-firefighter polarizations • Enmeshment between parts © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Patterns of polarization and enmeshment Theory and Treatment Planning in Family Therapy Parts Patterns Between Two People © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy TARGETING CHANGE: GOAL SETTING © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Self organizes parts of the internal system • Parts don’t disappear, they just don’t take polarized roles • Parts less rigid and work together to help problem solve • When parts do conflict the Self is able to step in and mediate • Parts less noticeable to individual because they operate harmoniously Theory and Treatment Planning in Family Therapy Self Leadership © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy THE DOING: INTERVENTIONS • Summarize and reflect what client is saying • “So, it sounds like there is a part of you that wants to stay in the relationship and a part that isn’t so sure if it is what you really want.” • Most clients like identify with having different parts that don’t always agree • Once clients are comfortable with parts language, therapist offers more detailed explanation of the model © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart How It Works Theory and Treatment Planning in Family Therapy Introducing the Language of Parts © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Therapist helps map the client’s internal relationships: • Assessing the relationship between Self and parts • Assessing the relationship between parts • Working to change parts Theory and Treatment Planning in Family Therapy Assessing Internal Relationships • Fear that exiles will take over the system; blend with the Self • Work with exiled parts, blending must be controlled so managers and firefighters don’t activate • How It Works • Asks client’s Self not to let managers interfere and then approach the exiles • Therapist can help client’s Self engage the child-like exiles to learn about why they hurt and how to help them feel safer © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • What It Is Theory and Treatment Planning in Family Therapy Controlling Blending © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart In-sight • Client develops an image of the part • Visual image often helps client further externalize and better relate to parts • Therapists help clients in identifying images for their parts Theory and Treatment Planning in Family Therapy In-sight and Imagery • A type of boundary making • How It Works • Client puts part in a separate room, closes the door, and observes the part from a window • Used when client first encounters a part that is overwhelming © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • What IT IS Theory and Treatment Planning in Family Therapy The Room Technique • Therapist directly talks with parts, often by having client switch chairs as they speak from various parts • Approach particularly useful with clients who have difficulty with imagery • How It Works • Therapist interacts directly with parts • Direct access can be used in conjunction with in-sight or withoutinsight work © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • What It Is Theory and Treatment Planning in Family Therapy Direct Access © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy RESEARCH AND THE EVIDENCE BASE • Better coping abilities, greater optimism and hardiness, and better physical health • Core variables of symbolic experiential therapy: • Generating an interpersonal set • Creating a suprasystem • Stimulating a symbolic context • Activating stress within the family • Creating symbolic experience • Moving out of the system © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Find best empirical support from common factors research • Study found that Self-leadership is correlated to psychological functioning Theory and Treatment Planning in Family Therapy Research on Humanistic Principles © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Theory and Treatment Planning in Family Therapy TAPESTRY WEAVING: WORKING WITH DIVERSE POPULATIONS © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Cultural Diversity • Therapist must find out the family’s symbolic meaning to ensure understanding African-Americans and Biracial Individuals • IFS used to explore internalized parts that are informed by their experience of race • Also used for victims of sexual abuse: look at power, privilege and oppression Theory and Treatment Planning in Family Therapy Cultural, Ethnic, and Gender Diversity © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Be mindful of the unique symbols and meaning related to marginalization • Explore the contradictory parts of the Self to develop greater understanding and acceptance Theory and Treatment Planning in Family Therapy Sexual Identity Diversity © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Symbolic-Experiential Therapy • Theory of the absurd • Look at emotional process and family structure • Confrontation balanced with warmth and support Internal Family System Therapy • Goal of therapy increase power of the Self • Three basic roles parts assume: exiles, managers, firefighters Theory and Treatment Planning in Family Therapy In Conclusion © 2016. Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Internal Family Systems: www.selfleadership.org Theory and Treatment Planning in Family Therapy Online Resource
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