ACTIONORIENTED FAMILY THERAPY Youth At Risk Conference Endicott

ACTION-ORIENTED FAMILY THERAPY Youth At Risk Conference; Endicott College, June 1, 2016 Presented By Matthew G. Doyle, LICSW Amy K. Hubbard, LMHC Founding Director Co-Founder

Workshop Objectives: • Review developments in the field of family therapy • Deconstruct the 4 phased model of family therapy • Teach family engagement skills and introduce in-the-moment exercises Action Oriented Family Therapy YAR 2016 AGENDA FOR OUR TIME TOGETHER

INTRODUCTIONS & WARMING UP • Who in the room is…. social worker, mental health counselor, teacher, attorney, parent? • Who has been in our field for 20+, 10+, 5+, 5 years or less Warm up exercise • Mindfulness- fingertip exercise Action Oriented Family Therapy YAR 2016 Show of hands Introductions:

FAMILY THERAPY ROOTS Insoo Kim. Berg Michael White Sal Minuchin Steve De. Shazer Murray Bowen Action Oriented Family Therapy YAR 2016 Carl Whitaker Virginia Satir

ROOTS OF FAMILY THERAPY • Family in context of environment • Structural (Minuchin, Ackerman) • Linking “symptoms” to dysfunctional family structures • Strategic (Erickson, Mandanes, Haley) • Prescribing the symptom • Reframes and paradoxical intervention • Systemic (Murray Bowen) • Differentiation of self • Loosening closed off relationships • Multigenerational ‘sore spots’ within the family of origin • Systemic Family Therapy • Murray Bowen, Karl Whitaker, Virginia Satir • Systemic vs. Individual focus points • Interrelated moving parts and forces • Problems are shared and solved together Action Oriented Family Therapy YAR 2016 • Ecological

CURRENT DEVELOPMENTS IN FAMILY THERAPY • Postmodern viewpoints emphasize the • Empowerment of marginalized clients • Political nature of therapy, and a need for social justice. • Narrative therapy (Michael White) • Highly collaborative • Change occurs through shifting the family narrative • Externalizing the problem and letter writing • Solutions-Focused (Kim. Berg) • Married to Steve De Shazer and together they developed Solution-Focused Brief Therapy • Instead of problem-solving focus on solution-building • No heavy emphasis on history Action Oriented Family Therapy YAR 2016 • Examines sociocultural issues such as how client problems & beliefs become socially constructed,

4 PHASES 1 -2 MONTHS ENGAGEMENT 1 -2 MONTHS PLAN DEVELOPMENT 2 -4 WEEKS PLAN IMPLEMENTATIO N 1 -3 MONTHS Action Oriented Family Therapy YAR 2016 TRANSITION

ENGAGEMENT PHASE Action Oriented Family Therapy YAR 2016

PARENTS TELL THEIR STORY • If we tell the story of our family of origin, we will see patterns that impact our children • We all repeat templates from our own childhood • No one escapes anxiety, loss, points of difficulty • All families offer strengths worth celebrating • Much easier to hear the stories at the beginning than later in the process • It is important for each of us as providers to understand our own family of origin, our own story Action Oriented Family Therapy YAR 2016 • Murray Bowen

COMMON BARRIERS & INFLUENCES • Family Resources: Time, money, extended family support, access to community resources • Goodness of fit between parents and child (Chess & Thomas, longitudinal study of temperament) • Substance misuse- cycles of addiction and relapse • Behavioral Health- cycles of engagement and withdrawal – both for child & adults (e. g. , anxiety, spectrum disorder, attachment) • Family or individual trauma* Action Oriented Family Therapy YAR 2016 • Parents & Caretakers: Experiences within their own childhood and family of origin

DEFINITION OF A TRAUMATIC EXPERIENCE • • witnessing violence physical threat and/or harm emotional maltreatment and bullying abandonment devastating loss disrupted attachments chronic threats to survival (poverty, community violence, inconsistent caretaking) • System Trauma Action Oriented Family Therapy YAR 2016 Stressful experience/s in which a person’s ability to cope is overwhelmed

Relational stance • Collaborative partnership vs. “I am the expert” • Being 100% genuine in the process Adjusting our therapeutic lens • Strengths based conversation- building on what is working well vs. doing more of what isn’t • The “family” is your identified client • Inviting parents and caretakers to tell their story Action Oriented Family Therapy YAR 2016 STRATEGIES FOR FAMILY ENGAGEMENT

STRATEGIES FOR FAMILY ENGAGEMENT • This is one of the first things to suffer under distress • Encourage family members to experience each other more lightheartedly Maintain meeting flexibility • Always have a back-up Plan B Practices, philosophy, and activities of the wraparound model • Family Voice and Choice • Collaboration on the individual, family, and system’s front Action Oriented Family Therapy YAR 2016 Have fun

ENGAGEMENT PHASE- TOOLS & TECHNIQUES • ALSUP “Ross Greene” (handout included) • Family timeline • Rory’s Story Cubes • Books like “ 100 Play Therapy Techniques” • Ubuntu Cards • Art projects • Blindfold Trust Walk • Videos • Family jumping jacks • Pass the Ball • Board games • Obama Cellphone Bling https: //www. youtube. com/watch? feature=player_embedded&v=v. JG 698 U 2 M https: // www. youtube. com/watch? v=hrjs 1 UXC 8 r. U • Modern Family https: //www. youtube. com/watch? v=l. Cgzec. Kwq 9 A ? ? ? Action Oriented Family Therapy YAR 2016 • The Relationship Game

ENGAGEMENT STRATEGIES Action Oriented Family Therapy YAR 2016 • Participant examples:

• Recovery does not lead to “cured”; it means progress, no matter how small. • Trusting others is not easy & takes a long time. • Some families have never experienced the hope that life can get better. Family recovery is challenging, complex and rocky and nonlinear. Action Oriented Family Therapy YAR 2016 ADJUSTING OUR LENS: FAMILY RECOVERY

UNDERSTANDING THE FAMILY RECOVERY PROCESS Fear Isolation Engagement Learning & Growth Self-Empowerment Access to Supports Confidence in Recovery HOPE Collaboration Implementation Building Skills Making Progress Finding What Works Defensiveness Trust Family Action Planning Professional Support Social Support Team Problem Solving Openness Shame & Stigma Family Options, E O Inc. Action Oriented Family Therapy YAR 2016 Connection Feeling Understood Building Trust Collaborative, open stance

THE PATTERN IS THE PROBLEM (BILL MADSEN- COLLABORATIVE THERAPY WITH MULTISTRESSED FAMILIES) Examples of Constraining Family Patterns • Overresponsible/Underresponsible responses • Maximizing/Minimizing • Pursuing/Withdrawing • Demanding of Disclosure/Secrecy and Withdrawal • Correction and Control/Protest and Rebellion Action Oriented Family Therapy YAR 2016 “Focusing on the pattern, rather than simply the people involved, represents a fundamental shift in perspective. In this shift, we are moving from diagnosing and labeling people to diagnosing and labeling patterns…The family is in a relationship with the pattern…. they are not simply victims of the pattern. The pattern may pull them into itself, but they have opportunities to resist that pull and often have numerous experiences with each other outside of the pattern” (p. 59)

WRITING PARENT VISION STATEMENT will buy them anyways and I don’t want the fight (Minimize, Maximizing) • I sound just like my parents used to; nag nag. I can’t believe it when I listen to myself (Pursue/Withdraw) • I get in these power struggles, kind of like “locking horns” with him. It doesn’t even matter what started the battle (Correction & Control/Protest & Rebelli 0 n between dad and son) Parenting strengths, skills, and assets: when am I at my best and most confident ? • We have a great time playing lacrosse together • Friday movie night and popcorn • When I say no, I mean no and stick by it Parent Vision Statement: • I want to live in a house where we spend less time “locking horns” and more time choosing what movie we want to watch on a Friday night. Action Oriented Family Therapy YAR 2016 Parenting trap doors & Constraining Patterns: what do I get tripped up with ? • I always get trapped into buying him (15 y. o. ) cigarettes! I just think he

PLAN DEVELOPMENT & IMPLEMENTATION Action Oriented Family Therapy YAR 2016

S. M. A. R. T. GOALS Action Oriented Family Therapy YAR 2016

VISION STATEMENTS AND PLAN FROM BILL MADSEN: COLLABORATIVE HELPING MAPS Obstacles Supports PLAN MOVING FORWARD Action Oriented Family Therapy YAR 2016 VISION FOR CHANGE

THE PATTERN IS THE PROBLEM (BILL MADSEN- COLLABORATIVE THERAPY WITH MULTISTRESSED FAMILIES) Examples of Constraining Family Patterns • Overresponsible/Underresponsible responses • Maximizing/Minimizing • Pursuing/Withdrawing • Demanding of Disclosure/Secrecy and Withdrawal • Correction and Control/Protest and Rebellion Action Oriented Family Therapy YAR 2016 “Focusing on the pattern, rather than simply the people involved, represents a fundamental shift in perspective. In this shift, we are moving from diagnosing and labeling people to diagnosing and labeling patterns…The family is in a relationship with the pattern…. they are not simply victims of the pattern. The pattern may pull them into itself, but they have opportunities to resist that pull and often have numerous experiences with each other outside of the pattern” (p. 59)

FAMILY ACTION PLANNING FAMILY VISION STATEMENT I (John) will be involved in some sort of learning and keeping my brain active I (John) am being honest with myself and others I (John) have filled all of my time with positive things to do, and enjoying being 15 years old We (mom and dad) are feeling less stressed, and able to refocus on their work Action Oriented Family Therapy YAR 2016 (WHAT WOULD LIFE LOOK LIKE IN 3 -6 MONTHS AS POSITIVE CHANGES HAPPEN)

SUPPORTS AND OBSTACLES WHO OR WHAT SUPPORTS YOUR VISION? John, Matt, Therapist K. , A. and S. Mom and dad carving out time for work, and do not stop mid-stream when J. needs something he can get himself When we go out for sushi on a Friday night Playing my dad in Chess Walking /Rollerblading Exercise Listening to music or watching You. Tube clips Taking my dog for a walk Reading my chemistry book Meeting with Dr. R BOREDOM!! Illicit drugs No structure or plans Hyper-controlling behaviors Feeling hopeless Failing at something outside of my house I have no money Action Oriented Family Therapy YAR 2016 WHAT CREATES OBSTACLES FOR YOUR VISION?

FAMILY ACTION PLAN GOALS AND ACTION STEPS Home Goals For John to find a way to manage his day; leading to a decrease in boredom & potential trouble, and an increase in the skill of creating self-driven structure, while organizing a checks & balances system with his support Team members. WHO IS RESPONSIBLE, WHEN, AND WHERE? Community and Social Goals Connect with community activities, even when uncomfortable : 30 Minutes of Physical Activity each day Community and Social Goals Youth Mentoring with Jimmy o 2 x week o Building skills around: 1) Identifying or going to 1 activity in the community per week 2) Practicing life skills around scheduling, organization, and stepping out of the comfort zone, and 3) Debrief pros and cons of attending activity and future planning o Make apple pies with Mentor to deliver at the local Nursing Home. o Inquire about Volunteering at nursing home Johnny and Dad will have daily check-ins Uncle Owen will work out with John on Fridays Mom will drive John to weekly medication appointments Matt will track and coordinate weekly progress with all Wraparound members Educational Goals 1 hour Writing Assignment and Reading daily Daily online curriculum Educational Goals Tutor Amanda will email with John daily around progress Follow district approved online curriculum Matt will track and coordinate weekly progress with all team members Home Goals Family therapy with Matt and Jimmy o 2 x week (1 Family, and 1 Parent Meetings) o Continue strategizing, recognizing helpful and harmful patterns of interaction, and continue to stay “light” while “cutting each other some slack. ” o Use the Daily Plan. Start every day with a 10 minute family meeting o 1 chore per day- To be determined at family meeting in the AM o 1 hour Minutes of Physical Activity each day o 1 hour Minute Writing Assignment and Reading time each day Matt will track and coordinate weekly progress with the Action Plan Action Oriented Family Therapy YAR 2016

PLAN IMPLEMENTATION • Daily plans • Picture lamination Action Oriented Family Therapy YAR 2016 • Smart goals

WHAT DO YOU BRING TO THE TABLE • I notice that I frequently forget to ask, or omit, questions to parents about…. • I back away from asking these things because…. • (my age, I don’t have kids, trying to avoid hard subjects, I think it is too personal) • Professional Statement • I notice that I frequently do not ask details about story of adoption. In the next month, I will ask a family member to share their story of adoption; paying attention to: • Age, location, and adoption resource • Reasons for adoption Action Oriented Family Therapy YAR 2016 • Vision for engaging parents in therapeutic process

PLANNING FOR SUSTAINABILITY (TRANSITION) • Preparing Youth & Families for the Future • Supporting kids & families skill-building and confidence to be successful • Leaving kids & families with a support system that is functional for them and their community • Helping members to identify their family culture around support and implement that style of support prior to transition • Family work happens on it’s own continuum. The work should be able to continue at a different pace which reflects current needs • Model should wax and wane according to need Action Oriented Family Therapy YAR 2016 • Empowering family members to identify and prioritize things important to them

Wrap Up, Evaluation & Discussion ü ü Did we cover: • The developments in the field of family therapy • A 4 -phased model of family therapy • Family engagement skills • Introduce in-the-moment exercises How can you imagine taking this back to your setting/your role? Any next steps or feedback? Action Oriented Family Therapy YAR 2016 ü

RESOURCE S Bowen, Murray. (1994) Family Therapy in Clinical Practice. Northvale, NJ: Jason Aronson Inc. Publishers. • http: //www. ncsacw. samhsa. gov/files/Training. Package/MOD 6/Mod 6 Powerpoint. pdf. John • https: //signeteducation. com/ • http: //www. livesinthebalance. org/sites/default/files/ALSUP%20 Rev%2011 -12 -12%20 pdf%20(2). pdf • Van. Den. Berg, Ph. D. Overview of the High Fidelity Wraparound Process and Implications for Psychiatrists in the Process. Available at: www. masspartnership. com • Madsen, W. (2007). Collaborative Therapy with Multi-Stressed Families. New York, NY: The Guilford Press. • National Wraparound Initiative. Available at: www. rtc. pdx. edu/nwi. Accessed June 1, 2016. Wraparound User’s Guide • Rast, J. , and Van. Den. Berg, J. (2011). Foundations of High Fidelity Wraparound. Centennial, Colorado: Vroon Van. Den. Berg 213 pages. • Rast, J. , and Van. Den. Berg, J. (2011). Workbook for Initial Training and Tier One Certification for Care Coordinators. Centennial, Colorado: Vroon Van. Den. Berg • Walker, J. S. , Bruns, E. J. , Van. Den. Berg, J. D. , Rast, J. , Osher, T. W. , Miles, P. , Adams, J. , & National Wraparound Initiative Advisory Group (2004). Phases and activities of the wraparound process. Portland, OR: National Wraparound Initiative, Research and Training Center on Family Support and Children’s Mental Health, Portland State University. • http: //www. livesinthebalance. org/sites/default/files/ALSUP%20 Rev%2011 -12 -12%20 pdf%20(2). pdf Action Oriented Family Therapy YAR 2016 •

OUR CONTACT INFORMATION Matthew G. Doyle, LICSW Amy K. Hubbard, LMHC castlehillcounseling@gmail. com info@familyfocusmass. com (617) 817 -1377 (978) 879 -7188 Action Oriented Family Therapy YAR 2016 Please call or email us at any time!