It's easy to get stuck in a rut with specific elements of therapy structure.
I have a professor that sees every interaction with a client as part of the therapeutic relationship, and therefore, he interacts intentionally with his clients always, choosing his language and messages carefully based on their therapeutic value.
We don't all view our relationships with our clients in the same way, which means this type of scrutiny may not seem necessary to all of us; however, there is merit in evaluating the detailsof our sessions in order to become aware of habits that may not be yielding the results we desire.
For example, it’s common for opening questions to become casual greetings rather than relationally impactful interactions between therapist and client. Purposeful opening questions are the topic of this post.
In the Get Refreshed Facebook group, I recently posed the question, “What is your favorite question for opening a session?” A few questions on this list came from members of the group; the other questions are ones that I’ve used, or heard others use, in my years of practice and supervision. The following questions fall into three categories: goal-oriented, relationship-oriented, and evaluation-oriented.
1 | Goal-oriented opening questions
What are your best hopes for our talk today? (solution oriented)
What would you like to be different when you walk out of here today? (change oriented)
What is your main concern today? (problem oriented)
These questions spotlight an area of focus for the client that, when identified, will help the therapist have a sense of the clients' goal. In this way, the therapist begins the session by setting a specific topic (or goal) for the therapeutic conversation. In addition, each goal-oriented opening question assists clients in finding a subject for which they are customers.
2 | Relationship-oriented opening questions
Whose idea was it for you to be here today? (for an initial session)
Who is with you in this room today (figuratively speaking)?
With these questions, the therapist immediately invites the client's relational realities into the therapy room, and the therapeutic conversation, by addressing the relational influences that brought the client to therapy, as well as those that are significant for the client.
3 | Evaluation-oriented opening questions
So, what's been going well? (solution-oriented)
What is different today from the last time you were here? (change-oriented)
What, from last session, impacted you this week? (change-oriented)
Beginning the session with these questions allows the therapist to evaluate the clients' experience, including their perspectives on their lives and relational interactions (1), their observations of change between sessions (2), and their experiences of and relationship to the therapeutic process (3). All evaluation-oriented questions provide practical information for the therapist regarding how therapy, and clients' sense of the value of therapy, are developing.
I've listed 7 questions for opening therapy sessions that are useful for providing focus to the therapist and the subsequent therapy session. These questions are a reminder of the power of questions to bring forth information that generates and maintainstherapeutic structure and progress. (For more information on the topic of structure, see Napier and Whitaker's, The Family Crucible).
Addiction and mental illnesses are, in many ways, very private issues. The addict may struggle with legal issues, and severe abuse may begin to cause significant physical damage that can be painful, debilitating or both.
Mental illness can make it difficult for the person to communicate, think clearly or interact with people. These two groups of people – addicts and those with mental illness – may both feel quite isolated, due to the very nature of the issues they’re dealing with, and they may both require a significant amount of therapy and/or medications in order to heal.
Very few people truly live in a vacuum, however. As the condition progresses, the family may suffer right alongside the person. Trust may begin to erode. Communication becomes difficult. Feelings of guilt and shame may arise. In short, the environment that surrounds the person may foster the problems, allowing them to grow. Family therapy is designed to expose those issues and help families develop a healthier way of living.
Understanding the Family
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the word “family” is highly subjective. One person might include only blood relations within the family, while another person might include very close friends within the family circle. For family therapists, a family is defined as a group of people who have very close ties and emotional bonds. Where a support group of a set of coworkers might strive toward a common goal, and they might even have a significant amount in common, a family may not be goal-oriented at all, and they may not share hobbies or common interests. Instead, family members have deep connections that persist regardless of goals, life stages, geography and other matters.
A family tends to work like an organism, with the behavior of one person affecting the behavior of all the other members. If one person in the family becomes agitated and irate, for example, the rest of the family tends to respond with concern or stress, and they might even respond with anger of their own. Researchers sometimes use the word “homeostasis” to describe this process. Homeostasis is a term used to describe balance and calm. Families like to achieve homeostasis, and they’ll do all they can to keep the waters smooth and the relationships even. Homeostasis may be easier to achieve, once the family goes through therapy together.
Going Through a Session
- Improved communication
- Increased understanding
- Stronger relationships
- Increased support
Family therapy strives to apply these goals to each and every member of the family. Where an individual therapist for mental illness or addiction might strive only to help that person, a family therapist tries to help everyone involved improve and feel better. The goals are lofty, but they can be achieved.
According to an article written by a psychologist for the online magazine Psychology Today, many people believe that family therapy sessions involve all members of the family, all the time. The truth is that this sort of scheduling would be almost impossible in today’s modern and hectic world, and a session packed full of people might not allow for everyone to speak and feel comfortable. It’s not always the most useful idea. Instead, family therapy sessions tend to be fluid and flexible, depending on the needs of the person in therapy and the family as a whole. For example, if a teen is dealing with addiction, the therapist might hold some sessions with the teen and the parents, and then hold other sessions with the teen and their siblings and then final sessions with the parents alone. Each person may receive the same sorts of information, but it’s parsed out in different groupings.
- Communication styles
- Delegation of duties
- Listening skills
- Anger management
The person in therapy might need help with time management, budgeting or assertiveness skills. All of these lessons can be included in family therapy sessions.
Since family therapy sessions are based on skills in this manner, they tend to last for only a short time.
Unlike Hollywood depictions of therapy, in which people see their therapists for months or years at a time, making little to no progress, family therapy sessions are designed to move quickly, helping to build skills and then encouraging the individuals to apply those skills right away. It’s an efficient way to provide care.
It’s also important to remember that family therapy isn’t designed to place blame or mete out punishment. Parents won’t be told that they’re “bad” parents or that they’ve ruined their children for good. Spouses won’t be taught that the addiction issue is due to their personality faults. The sessions aren’t designed to do more emotional damage. Instead, they’re designed to expose old wounds and help people build new skills. Fear of blame or guilt shouldn’t keep people away from participation.
There is no such thing as a standard family therapy model, as the treatment is often adjusted radically depending on the needs of that particular person and that particular family. There are some basic models that tend to provide structure for some family therapy sessions, however, according to SAMHSA.
Family Disease Model
This approach is commonly used in cases involving substance abuse. The idea here is that substance abuse can begin with one person’s abuse, and the family tends to enable and support that abuse, whether consciously or subconsciously. Therapy attempts to help families break those destructive habits and encourage the person to develop new habits that don’t include substance abuse.
Family Systems Model
This approach is somewhat similar to the family disease model, in that the therapist attempts to look at how substance abuse has worked its way into the entire family as a group. The focus here tends to be on habits, however. How has the family changed due to the substance abuse? Do members communicate differently when the addict is intoxicated? By answering these sorts of questions, the family can learn new behaviors.
Cognitive Behavioral Model
This approach can be used for addiction or mental illness. The therapist attempts to point out triggers or stresses that could lead to a relapse of the negative behavior on the part of the person in therapy. Perhaps anger in the family leads to depression, which leads to drug use, for example. By spotting the trigger, the family can learn to avoid it.
The idea here is to integrate all of the above ideas into one family session, and include a significant amount of skills training that may or may not be applied within the family itself.
Some therapists use only one approach with their patients, while others adapt their approaches based on the needs of their specific patients. Some therapists use different techniques in each session, depending on how well the person or family is performing in therapy.
Family therapy has been very effective in helping people deal with mental illness.
People who have chronic, recurrent mental illnesses, such as schizophrenia or bipolar disorder, often rely on their families to help them control their disease and lead a normal life. As family therapy progresses, these families grow stronger and more connected, which can make that form of caregiving easier. A relapse into mental illness might be less likely but when it does occur, the family knows just what to do to deal with the issue.
The effectiveness of this approach has been demonstrated in study after study. For example, a study of people with schizophrenia, as published in the journal Archives of General Psychiatry found that 48 percent of people who did not receive family therapy relapsed into symptoms within six months. None of those who received family therapy relapsed. This is a truly remarkable result.
Family therapy can also be amazingly helpful in cases of substance abuse and addiction. Families impacted by addiction may respond with anger, dismay or guilt, and the group may find it extremely difficult to trust one another and work together once this damage has been allowed to go on for months or even years. Family therapy can break through those barriers and help the group to function more effectively.
The National Institute on Drug Abuse has studied family therapy and found that it’s particularly helpful in assisting teen addicts.
The results might not be apparent right away but as time goes on, teens who receive family therapy tend to perform better and stay sober for longer than teens who do not receive family therapy. For example, one study found that 47 percent of teens who received family therapy used drugs or alcohol no more than once in the previous month, compared to 28 percent of teens who received standard individualized counseling. The families seem to learn the skills they’ll need to keep their teens on the right path when formal therapy is over.
If the family held an intervention with the help of a licensed interventionist, that person may be able to provide a significant amount of help and advice in finding a family therapist. Sometimes family doctors can also suggest professionals who can help.
When the family begins to interview counselors, the Mayo Clinic suggests that these questions are good ones to ask:
- Are you licensed by the state?
- Have you dealt with our particular sort of issue in the past?
- Do you accept payments from our insurance company?
- How long do sessions last?
- How much do they cost?
- What are your office hours?
- What is your cancellation policy?
With a therapist chosen and the first appointment made, the family should take some time to prepare for the important sessions to come. Each person involved will likely need to make some sort of change, whether large or small, and it may be helpful to take time to think about those changes and how useful they will be. Walking into sessions with an open mind and a willingness to work hard can be extremely helpful, especially as opposed to entering sessions with a set mind and a refusal to entertain any new ideas. Writing in a journal, looking over old photos or just envisioning how the family will interact in one year might help reluctant family members get into the right frame of mind.
Family therapy can be a revolutionary tool that can help families move forward from dysfunction to healing. It’s an important part of the healing process, both for the person in therapy, and for the entire family as a whole.
If you’d like information on family therapy, or on staging an intervention for your family member in need, contact us today at our toll-free number. Don’t wait another day; call now.