101 More Interventions in Family Therapy

Thorana S Nelson, Terry S Trepper

• Publisher: Routledge
• Year: 2014
• Topic: Psychology
• eBook ISBN:
  9781317791447
• Subtopic: History & Theory in Psychology
• Index: Psychology

Inside 101 More Interventions in Family Therapy, you'll discover many revolutionary and flexible strategies for family counseling intervention that you can tailor, amend, and apply in your own practice. Designed to appeal to professionals of beginning, intermediate, or advanced level status, 101 More Interventions in Family Therapy caters to an even broader range of ethnic, racial, gender, and class contexts than did its well-received predecessor, 101 Interventions in Family Therapy. You'll also find that this volume encompasses a wider variety of family therapy orientations, including strategic, behavioral, family of origin, solution-focused, and narrative.In 101 More Interventions in Family Therapy, you'll have at your fingertips a collection of favorite, tried-and-true interventions compiled, revised, and delivered to you by the professionals who use them--the clinicians themselves. You'll gain valuable insight into:

• effective and useful assessment strategies
  
• therapy that addresses school and career problems
  
• questions to use in solution-focused therapy
  
• questions to use in narrative therapy
  
• ideas for resolving intergenerational issues

Too often, the in-the-trenches accounts you need to help add variety and a high success rate to your own practice come to you piecemeal in journals or newsletters. But in 101 More Interventions in Family Therapy, you'll find 101 handy, easy-to-read, and fun ways to modify your own therapeutic styles for a truly diverse variety of clientele and settings right where you want them--in one volume, in one place. Even after a few chapters, you'll discover 101 reasons to be happy with the prospect of improving your practice. Specifically, some of the interesting tips and techniques you'll read about include:

• applying theater techniques to family therapy
  
• using an alarm clock and rubber band as props in clinical practice with children, couples, and families
  
• utilizing the "play baby" intervention to coach parents on ways to address their child(ren)'s concerns
  
• adopting a "Columbo therapy" approach--one in which the therapist acts confused and asks questions out of a genuine curiosity about the client's experience--to take a one-down position with clients
  
• creating a safe space in therapy and helping clients transfer it into their lives
  
• using homework to increase the likelihood of producing desired therapeutic outcomes

 

—1—

 

Don't Just Do Something, Stand There

Mark B. White

 

INTRODUCTION AND THEORETICAL FOUNDATION

One of the classic interactional patterns familiar to therapists who work with couples is the emotional pursuer-distancer relationship. One member of the couple desires greater intimacy and emotional closeness and pursues his or her partner. The other member of the couple is uncomfortable with greater intimacy and, accordingly, distances. A reciprocal, vicious cycle is then created. The more one partner pursues, the more the other partner distances. When the pursuer tires of pursuing and begins to distance, the roles often reverse, with the former distancer now pursuing the former pursuer (Freeman, 1992; Karpel, 1994).

Until recently, I have not had a great deal of success assisting couples in breaking this cycle. I have tried the intervention described in this chapter several times with limited success; however, it worked quite splendidly with the last couple with which I tried it. As I have reflected on its success, I believe that several variables were associated with this couple and with the way in which the intervention was implemented that have given me a better understanding of how to use it. The essence of this intervention is to encourage the persuer to stand still, neither pursuing nor distancing. This allows the distancer to approach on his or her own terms.

The theoretical foundation for this intervention has three basic elements. First, it begins with the conceptualization of this pattern as a reflection of a basic systems property. The behavior of one person or element in a system perturbs the other persons or elements in the system, who behave in response to this perturbation. Second, to better explain the “fuel” that often drives these interactions, I have turned to Bowen Family Systems Theory (Kerr and Bowen, 1988). In this theory, anxiety is identified as the key emotional process that drives the distance-pursuit cycle. Third, I have framed this emotional process as similar to magnetism in the physical universe. When I was a boy, my father returned from a business trip with a pair of small, white dogs with magnet bases. When the dogs were face to face, an advance by one would result in a retreat by the other. If I held one firmly and advanced the other, I could feel the magnetic “tension” in the relationship. With practice, I could gingerly advance one dog until I began to feel the tension and noticed the other dog beginning to move. This is (he process I hoped to translate into marital interaction. Teaching members of a couple to stand still involves teaching the pursuer to stop pursuing at the onset of the tension and then to stand still and to wait until the partner is able to tolerate increased intimacy or make his or her own overtures for increased closeness.

ASSESSMENT

Recognizing a pursuit-distance cycle tends not to be difficult; most couples come in citing it as part of the presenting problem (e.g., “She's always nagging at me when I try to watch TV and relax after work”; “He often closes up and doesn't want to talk with me after we have sex”; “After that brief fling with my co-worker I've tried everything to get close to her and she keeps pushing me away.”) If not identified at intake, this cycle has a way of revealing itself the first time the therapist prescribes any sort of intimacy-enhancing intervention. The intervention described here is appropriate if the therapist and the clients are in agreement that this pattern is a problem they want to focus on. Other issues, such as sexual dysfunction, power struggles, violence, infidelity, and so on, take precedence. Once these more pressing issues are resolved or made more manageable, then work on the pursuit-distance cycle can proceed.

INTERVENTION

There are five steps to the intervention. First, the couple is asked to identify typical situations that either trigger the pattern or are associated with the pattern. Second, each member of the couple is asked to identify his or her thoughts and feelings throughout the process. Of specific importance are (1) the thoughts and beliefs associated with the anxiety that propels the pursuer and (2) the thoughts and beliefs associated with the need to distance on the part of the distancer. Third, the clients are encouraged to develop new, shared ways to communicate their internal experiences during these times. Simple phrases such as “I need connection right now,” “It's getting too hot in here for me,” or “I'm feeling nervous again” can be agreed upon and then used by the couple in these situations. Fourth, assuming that one partner typically initiates the pursuit pattern, the pursuer is coached in the art of standing still. Standing still involves discontinuing the pursuit, but not distancing. It involves managing the anxiety associated with the distance from the partner by engaging in other activities or seeking out friends or other family members. The critical (and difficult) aspect of standing still occurs when the former distancer makes advances. When this occurs, it is crucial that the former pursuer not pull back by refusing to engage in intimate conversation or by withholding affection or sex. Rather, he or she should cautiously accept the advances, allowing the degree of intimacy to increase gradually. Finally, it is helpful for the therapist to work with the couple in finding a positive metaphor for the process. Although this may include using the shared language discussed previously, it also includes finding ways to depathologize both the pursuer and the distancer roles and encourages the couple to see the relational nature of their “dance.”

RESULTS

My most recent success with this intervention was with a young, traditional, blue-collar couple that sought marital therapy after the wife returned home from a several-month stay with some friends in order to decide the future of her marriage; I will call them Ted and Alice. Alice had left following the revelation that Ted had been unfaithful. Ted reported that he had very little need for intimacy and connection and that Alice's persistent requests for connection and for assurance that he wanted to be in the marriage had pushed him further away. Alice noted that her family of origin was quite dysfunctional and that she was frequently insecure in social relationships, especially her marriage in light of the disclosure of Ted's affair. She was willing to forgive and stay in the relationship if Ted could provide her with some sort of hope for the future. Ted replied that he was there in therapy and that was all the evidence that she ought to need.

Their pursuit-distance cycle was framed in terms of Ted's and Alice's differing intimacy needs as well as Alice taking more than her share of the responsibility for the emotional functioning of the relationship. I assured Ted and Alice that Ted would begin taking more emotional responsibility once space was created for him to do so. Encouraging Alice to stand still was an attempt to create this space. She was quite perplexed by the assignment to stand still. My prescriptions did not possess face validity in her eyes; she did not think that not working hard on the relationship would further its growth. Nevertheless, she complied and indicated that she was willing to try what I recommended. I encouraged her to call or visit friends at those times when she wanted further closeness with Ted and it was apparent that he was not ready. We discussed the language each could use when they needed to manage their anxiety about intimacy. She learned to ask for assurance about the future of the relationship without pursuing further if it was not exactly how she would like it. He learned to ask for time in the “meat cooler” when things were getting too hot.

As Alice stood still and took less responsibility for the relationship, Ted began to take more initiative and responsibility. We met weekly for about a month. During those four weeks, Alice and Ted made significant progress in managing the intimacy and anxiety in their relationship. Both were somewhat confused about how this occurred, but they persisted in playing out their new roles. They terminated somewhat prematurely, in my opinion, because they were moving to another part of the country. However, the last feedback I got about them was that things were going quite well. Standing still appears to have been successful.

CONTRAINDICATIONS

In my experience, a negative correlation exists between the degree of anxiety in the couple system and the potential success of this intervention. In other words, couples for which significant anxiety exists concerning the future of the relationship are not good candidates for “standing still.” It is also crucial that both parties commit to working on the relationship, regardless of the outcome. As a student therapist intern, I was frustrated by my inability to intervene successfully with couples who displayed a pursuit-distance cycle, and I began to develop this intervention. I prescribed standing still for a very dependent man whose wife had recently had an affair and who was seriously considering ending the marriage. Unfortunately, it was impossible for him to stand still. Unlike the couple mentioned above, this man and woman were unable to commit to working on the marriage for a set period of time.

Pursuit-distance patterns can be very frustrating for therapists and couples alike. However, if both individuals are willing to work on the relationship, the level of anxiety is tolerable, and violence or other crises are not present, I recommend standing still as a potential intervention.

REFERENCES

Freeman, D. W. (1992). Family therapy with couples: The family-of-origin approach. Northvale, NJ: Jason Aronson.

Karpel, M. A. (1994). Evaluating couples. New York: W. W. Norton.

Kerr, M. E. and Bowen, M. (1988). Family evaluation. New York: W. W. Norton.

—2—

Mirroring Movement for Increasing Family Cooperation

Daniel J. Wiener

I became interested in applying theater techniques (particularly improvisation) to family therapy in 1985 and have used, modified, and devised many such games and exercises in working clinically since that time (Wiener, 1994). The main advantages of these techniques are twofold: (1) in common with other action techniques, they encourage participation from less verbally-oriented family members (particularly children) who often become bored or feel excluded in “talk-only” therapy; and (2) they create effective learning experiences that often serve as blueprints or models for desirable changes in family interaction. This article features mirroring, an elementary theater exercise that heightens the connection that actors build with one another. I have used mirroring in the form described below in working with over a hundred couples and families.

INSTRUCTIONS FOR MIRRORING

Two players stand facing one another about five feet apart, remaining silent while looking into each other's eyes. The therapist assigns the roles of “leader,” who moves his/her body slowly and continuously, and “follower,” who moves symmetrically in sync with the leader, within their own limitations in physical mobility and flexibility, until the therapist calls “Change!” (usually from twenty seconds to one minute later), at which point they switch roles while movement continues. Movement can be of any sort so long as eye contact is maintained. Care should be taken to instruct the leader to move slowly and in such a way that the follower can keep up and not be forced to break the mirror. After calling a few alternating turns at leading and following, the therapist calls “Mutual!” which signals the participants to give up intentionally leading or following in favor of moving simultaneously. The entire exercise usually lasts less than five minutes.

Mirroring is primarily dyadic but can also be done by three or more family members who face inward in a circle. Then, however, reciprocal eye contact cannot be used, and movement symmetry is no longer mirrorlike for all. Another variation is to have paired family members within a multiple-family group or a couples group maintain mirroring at a much greater distance in a large room where other pairs of players may come between them, necessitating movement that maintains eye contact and an ability to remain focused on one's partner despite considerable visual distraction.

Mirroring promotes attentiveness to one's partner. Since eye contact is held throughout, players use peripheral vision to track the movement of their partners, and they gain a greater awareness of the physical movement capacities and limitations of their partners. Players also come to terms with their attitudes toward cooperation as they experience the constant need to give in, adjust, and trust their own internal impulses. Cooperation entails a willingness to give up what is often experienced as one's prerogative to define self as distinct from others—a partial surrender of freedom of choice. On the other hand, there is an increase in positive emotional energy in receiving cooperation from others. Mirroring is both a test of family members' cooperation and an opportunity for them to practice it. The turns-taking structure of this exercise, where the roles of leader and follower quickly alternate with each other, rewards both players for cooperating.

The phase of mutuality opens the players to the possibility of belonging to a “we-ness” beyond hierarchy. While players usually report a preference for either leading or following, both positions are familiar. Mutuality is an elusive experience for most dyads; some players express doubt that it is even possible to achieve it. I have these clients move their own hands symmetrically and ask which hand was leading. It seems that mutuality comes and goes, easily replaced by leading or following. Yet, the more attentive the players are to each other when a reciprocally cooperative attitude is present, the greater the likelihood for achieving and sustaining mutuality. When attained, mutuality has a transcendent, joyous quality.

PRACTICAL ASPECTS IN CLINICAL APPLICATION

As I view mirroring as a form of cooperative play, I always emphasize that participation is voluntary and support any reluctant clients to wait until they feel ready, rather than coax them to try the exercise. Also, I side with a reluctant client whose family members are pressuring him/her to play. Eventually, nearly all members participate.

Not infrequently, players violate the instructions of this exercise because they experience them as too challenging, too restrictive, or an invitation to oppositional impulses. Of course, the therapist must distinguish instruction-violating responses from those engendered by confusion or inattention. Many leaders playfully or competitively attempt to “fake out” the follower with sudden or acrobatic moves that the follower cannot keep up with, while followers often break eye contact with their partners, moving in an asymmetrical way in relation to the leader. Rather than automatically focusing on attaining compliance, the therapist is often better off “joining the resistance” by adding instructions that encompass the different response, for example, by adding the instruction that players may now break the symmetry of the mirror and move in rh...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• About the Editors
• Contributors
• Preface
• 1. Don't Just Do Something, Stand There
• 2. Mirroring Movement for Increasing Family Cooperation
• 3. Seeing the Obvious: Data Collection in Therapy
• 4. Of Clocks and Rubber Bands: On the Use of Props in Family Therapy
• 5. Know the Enemy's Strategies and You Will Know Your Own Power
• 6. The Race Is On! A Group Contingency Program to Reduce Sibling Aggression
• 7. Attitude as Intervention
• 8. Sculpting Stepfamily Structure
• 9. Taped Supervision as a Reflecting Team
• 10. Becoming the “Alien” Other
• 11. Playing Baby
• 12. Competing Voices : A Narrative Intervention
• 13. Start with Meditation
• 14. Emotional Restructuring: Re-Romancing the Marital Relationship
• 15. It's Bigger Than Both of Us
• 16. Joining with Jenga: An Intervention for Building Trust with Stepfamilies
• 17. Crisis Intervention with Families: A One-Down Position
• 18. Columbo Therapy as One-Down Positioning with Families
• 19. Seeing Change When Clients Don't
• 20. Making the Genogram Solution Based
• 21. From Alienation to Collaboration: Three Techniques for Building Alliances with Adolescents in Family Therapy
• 22. What I Needed versus What I Got: Giving Clients Permission to Grieve
• 23. Starting with the Familiar: Working with “Difficult” Clients
• 24. A Picture Is Worth a Thousand Words: Use of Family Photographs to Promote Parental Nurturance in Family Therapy with Adolescents
• 25. A Fairy-Tale Ending
• 26. The Wall of Defenses
• 27. Single Women and the Grief Circle
• 28. Slaying the Wild Things
• 29. The Nightmare Question: Problem Talk in Solution-Focused Brief Therapy with Alcoholics and Their Families
• 30. I Rewrite with a Little Help from My Friends
• 31. Time and Couples, Part I: The Decompression Chamber
• 32. Time and Couples, Part II: The Sixty-Second Pleasure Point
• 33. Debunking Addictive Religious Belief Systems in Marital Therapy
• 34. Ceremony to Memorialize Old Hurts
• 35. Strategic Journaling
• 36. A Solution-Focused Guessing Game for Children
• 37. The Problem Box Ritual: Helping Families Prepare for Remarriage
• 38. Using Batacca Sticks in Couples Therapy
• 39. Necessity's Way
• 40. Couples Group Psychotherapy with HIV-Affected
• 41. The Grid
• 42. Revisiting the Subject of Emotional Highs and Lows: Two Interventions
• 43. Changing Hats During Therapeutic Impasses
• 44. Reciprocal Double Binds, Amplification of Constructions of Reality, and Change in a Training Context
• 45. The Play Is the Thing: Using Self-Constructed Board Games in Family Therapy
• 46. Therapists Must Be EXPLISSIT
• 47. The Relapse Is Your Friend
• 48. Sculptural Metaphors to Create Discontinuity and Novelty in Family Therapy
• 49. A Therapeutic Remarriage Ritual
• 50. The Complaint Technique
• 51. “Time Out”—Calming the Chaos
• 52. An Empirically Driven Marital Therapy Intervention
• 53. Symbols in Relationships
• 54. Use of Structural Family Therapy to Facilitate Adjustment Among Adolescent Leukemia Patients
• 55. “We versus It”
• 56. The Many Colors of Divorce
• 57. On a Scale from One to Ten …
• 58. Genograms in a Multicultural Perspective
• 59. Using Art to Aid the Process of Externalization
• 60. The “What Are You Prepared to Do?” Question
• 61. Race in Family Therapy: Unnoticeable or Relevant?
• 62. The Extramarital Affair: Honesty and Deconstructive Questioning
• 63. Three Excellent Agreements: Wynona and the Eighteen-Wheeler
• 64. Functions of Behavior in the Adolescent Family
• 65. Together and Apart: Daily Rituals in Divorced and Remarried Families
• 66. Trance and Transformation: Intervention with Verbally Combative Couples
• 67. Many Small Steps Instead of One Intervention
• 68. Metacommunication and Role Reversal as an Intervention
• 69. Sticks and Stones Can Break My Bones: The Verbally Abusive Child
• 70. Binuclear Family Therapy: Conflict Reduction Through Agreeing to Disagree
• 71. The Use of Rogerian Techniques in Marital Therapy
• 72. If You Can't Say Something Nice …
• 73. Seeing the Child in You
• 74. A Picture of Health: Using Guided Imagery to Facilitate Differentiation
• 75. It's Never Too Late to Have a Good Childhood: Reworking at the Source
• 76. The Typical Day Interview: A Play Therapy Intervention
• 77. Peace at Any Price
• 78. Teaching Metaphors
• 79. Fostering Accountability: A Reconstructive Dialogue with a Couple with a History of Violence
• 80. Carols in the Trenches
• 81. We Are Where We Live
• 82. Creating a Safe Space in Therapy
• 83. Family Assessment Using Subjective Genograms
• 84. The Marital Conference
• 85. Policymaking Within Families: A Clinical Example of Family Process and Governance
• 86. Mapping Multiplicity: An Application of the Internal Family Systems Model
• 87. Opening Space and the Two-Story Technique
• 88. Using Art to Externalize and Tame Tempers
• 89. Authoring Success Through Competency-Immersed Therapy
• 90. Finding the Horseshoe Nail
• 91. Reconnecting Through Touch
• 92. The Parents' Closet: A Family Therapy Approach for “Coming to Acceptance” of Gay/Lesbian/Bisexual Children
• 93. Respecting the Purpose of the Old Pattern and the New Pattern
• 94. Notice the Difference
• 95. Mad About You
• 96. Increasing Homework Compliance: The SEA Method, or Effective Use of the 167 “Nontherapy” Hours of a Week
• 97. A Solution-Focused Approach to Physical Abuse Jacqueline Corcoran
• 98. An Older Child or a Young Adult? An Intervention Based on the Integrated Model
• 99. Balloon Bouquets
• 100. Community Service Intervention
• 101. Training in Family Therapy
• Topical Index