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• Necessary to develop a good map. • Refers to knowing where to focus your attention while you are listening. • A skill that is continually developed and refined throughout one’s career. • Case conceptualization • Technical term for therapeutic art of viewing. • Sometimes called assessment. • Enables therapists to generate new perspectives, which enable them to be helpful to clients. © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Master the art of viewing. Mastering Competencies in Family Therapy (2 nd ed. ) Mapping the Territory (Step 1)

• • • Introduction to client Presenting concern Background information Client/family strengths and diversity Family structure Interactional pattern Intergenerational and attachment patterns Solution-based assessment Postmodern and cultural discourse conceptualization Client perspectives © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Components of a systemic case conceptualization: Mastering Competencies in Family Therapy (2 nd ed. ) Overview of Case Conceptualization

• Individual • Couple • Family • Identifying most salient demographic features that relate to treatment: • • • Age Ethnicity Gender Sexual orientation/HIV status Current occupation (work status/grade in school) © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Identifying who the client is. Mastering Competencies in Family Therapy (2 nd ed. ) Introduction to Client

• Each person involved has a different definition of the problem. • Allows therapist to remain adaptable and creative. • Honor each person’s perspective and refer to it throughout treatment. • Should include: • • • Reason each client states he/she is in counseling or why referred. Information from referring agent and their description of problem. A brief history of the problem and family. Descriptions of attempted solutions and outcomes. Any other relevant problem related information. © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • How all parties involved are defining the problem. • Collaborative therapy Mastering Competencies in Family Therapy (2 nd ed. ) Presenting Concern

• • History of trauma and abuse Substance use and abuse Precipitating events Related historical background • Recommended that this information be written in a positive and hopeful light. © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Traditionally included is: Mastering Competencies in Family Therapy (2 nd ed. ) Background Information

• Can include strengths at several levels: • Personal/individual strengths • Relational/social strengths and resources • Spiritual resources © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Should be the first thing assessed. Mastering Competencies in Family Therapy (2 nd ed. ) Strengths and Diversity Resources

• Consider past, present, and future. • Can increase client’s sense of hope and confidence to address the issue at hand. • May provide creative problem solving ideas. • Personal qualities • What brings client’s to therapy is usually flip side of a strength. • Ex. Someone who worries too much is likely a diligent and productive worker. © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Abilities Mastering Competencies in Family Therapy (2 nd ed. ) Personal or Individual Strengths

• • Physical Emotional Community Spiritual © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Social support network that helps client in various ways. Mastering Competencies in Family Therapy (2 nd ed. ) Relational or Social Strengths and Resources

• • • Strong support network Sense of community and connection, purpose and direction Resources for problem-solving Beliefs that provide comfort Access to social services • Common limitations due to diversity: • • • Experiences of harassment/discrimination Isolation/difficulty meeting others Difficulty finding opportunity and accessing services Difficulty communicating with institutions Lack of resources © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Common resources due to diversity: Mastering Competencies in Family Therapy (2 nd ed. ) Diversity Resources and Limitations

• • • Family life cycle stage Boundaries Triangles/coalitions Hierarchy between parents and children Satir’s communication stances Gottman’s divorce indicators © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Can be used with individuals, couples or families. • Includes: Mastering Competencies in Family Therapy (2 nd ed. ) Family Structure

• Assessment of family structure often begins with this. • The stages include: • • Leaving home — the single adult Committed relationship Families with young children Families with adolescent children Divorce Blended families Launching children Family in later life © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Family life cycle stage Mastering Competencies in Family Therapy (2 nd ed. ) Family Life Cycle

• Most commonly associated with structural family therapy. • The rules for negotiating interpersonal closeness and distance. • Strongly influenced by culture. • Can be clear, diffuse, or rigid. © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Boundaries regulate closeness and distance. Mastering Competencies in Family Therapy (2 nd ed. ) Boundaries

• Negotiation of a healthy balance between closeness and separation. • Collectivist cultures: More closeness. • Individualistic cultures: Value greater independence. Diffuse boundaries and enmeshed relationships • When couples or families overvalue togetherness at the expense of respecting each other’s individuality. Rigid boundaries • When couples or families privilege independence over togetherness. © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Clear boundaries and cultural variance Mastering Competencies in Family Therapy (2 nd ed. ) Boundaries

• May include inanimate objects or processes as “third” • Ex. : Drinking, drug use, work • Assessed in several ways: • • Client overtly describes another as playing role in their tension. Description of a confidant. Finding an unmet need in a third party. When therapy is “stuck, ” there is often a triangle at work. © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Tension between two people is resolved by drawing in a third person to stabilize the original dyad. Mastering Competencies in Family Therapy (2 nd ed. ) Triangles and Coalitions

• • Excessive Insufficient Effective Inconsistent • Can be helpful to consider the balance of roles within the parental subsystem. • Business roles • Personal roles © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Is hierarchy developmentally and culturally appropriate? • Assessing hierarchy tell therapists where and how to intervene. Mastering Competencies in Family Therapy (2 nd ed. ) Hierarchy Between Child and Parent

• Each person takes on opposite or complementary ranging from functional to problematic. • Ex. : Pursuer/distancer, emotional/logical • Most couples readily identify complementary roles in their complaints about the relationship. © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Complementary patterns Mastering Competencies in Family Therapy (2 nd ed. ) Complementary Patterns

• Placating • Blaming • Superreasonable • Irrelevant • Congruent © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • An approach for assessing communication. • Based on five communication stances: Mastering Competencies in Family Therapy (2 nd ed. ) Satir’s Communication Stances

• Model for healthy communication. • Other four are survival stances. • Each stance recognizes different elements of self, other, and context. © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Congruent Mastering Competencies in Family Therapy (2 nd ed. ) Satir’s Communication Stances

Recognizes Congruent Self, other, context None Placator Other, context Self Blamer Self, context Other Superreasonable Context Self, other Irrelevant None Self, other, context I Ignores © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart Style Mastering Competencies in Family Therapy (2 nd ed. ) Satir’s Communication Stances

• Over 30 years research on couples and communication. • Can predict divorce with 97. 5% accuracy by assessing 5 variables (Four Horsemen and repair attempts). • The Four Horseman of the Apocalypse: • • Criticism Defensiveness Contempt Stonewalling © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • John Gottman Mastering Competencies in Family Therapy (2 nd ed. ) Gottman’s Divorce Indicators

• 5: 1 ratio • Interactions to assess for frequency include: • Failed repair attempts • Rejection of influence • Harsh start-up © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Presence of “Four Horsemen” not only indicator; frequency of these differs in happy couples. Mastering Competencies in Family Therapy (2 nd ed. ) Gottman’s Divorce Indicators

• Ex. : How person A responds to person B and vice versa. • Three phases: • Start of tension • Conflict/symptom escalation • Return to normal/homeostasis © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • One of hallmarks of family therapy. • Therapist traces reciprocal relation patterns. Mastering Competencies in Family Therapy (2 nd ed. ) Problem Interaction Patterns

• Working hypothesis about problem. • Role symptom plays in maintaining homeostasis. • Strategies for developing hypotheses: • Client language and metaphors • Positive connotation • Love and power © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Developed after assessing family structure and interaction patterns. Mastering Competencies in Family Therapy (2 nd ed. ) Systemic Hypothesis

Family strengths and resources Substance and alcohol abuse and dependence Sexual, physical, and emotional abuse Personal qualities and/or family roles; complementary roles (e. g. , black sheep, rebellious one, overachiever/underachiever, etc. ) • Physical and mental health issues (e. g. , diabetes, cancer, depression, psychosis, etc. ) • Historical incidents of the presenting problem, either with the same people or how other generations and family members have managed this problem • • © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Easiest when using a genogram. • Patterns often included in genograms: Mastering Competencies in Family Therapy (2 nd ed. ) Intergenerational Patterns

• Secure • Anxious and hyperactivated • Avoidance • Combination anxious and avoidant © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Often central in psychodynamic and EFT approaches. • Sue Johnson indicates four categories of attachment: Mastering Competencies in Family Therapy (2 nd ed. ) Attachment Patterns

• Address previous solutions that did work. • Exceptions and unique outcomes. • Difficult because most clients are unaware of when the problem was not a problem. • Miracle question © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Address previous solutions that did not work. Mastering Competencies in Family Therapy (2 nd ed. ) Solution-Based Assessment

• Dominant discourses • Identity narratives • Local and preferred discourses © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Outline broader contexts in which client’s problems occur. Mastering Competencies in Family Therapy (2 nd ed. ) Narratives and Social Discourses

• • • Age Cultural background Socioeconomic status Gender Sexual orientation • Often more difficult when client is very similar to therapist. © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • Therapists should reflect on areas of client agreement and disagreement with a case conceptualization. • Particularly important when client differs from therapist in: Mastering Competencies in Family Therapy (2 nd ed. ) Client Perspectives

• No objective standards upon which a person can be measured. • Role of culture. © 2014. Brooks/Cole, Cengage Learning. All rights reserved. For classroom use only. Diane R. Gehart • General problem with assessment and case conceptualization. Mastering Competencies in Family Therapy (2 nd ed. ) Case Conceptualization, Diversity, & Sameness