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Essential Skills in Family Therapy: From the First Interview to Termination

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This book will take you step-by-step through the process of doing psychotherapy from beginning to end. It is very user-friendly, basic and real. Out of my 8 textbooks this semester to read, this is the one that gets read first because of the valuable information it offers.

This book is an excellent primer for a family therapist, and is written as such. The text does not assume that the reader knows anything. It is a good introduction to family therapy for those who go above and beyond family counseling. As a mental health counseling grad student, I noticed that the text stays within its scope of family therapyt and does not stray from a this model.

I ordered this book as a resource to assist me in my new position as a practitioner. I have found it so helpful I told the director of our organization who is recommending it to all his new hires.

Essential Skills in Family Therapy is a guide of the process of therapy to be used by those learning how to do therapy. The book is also a good refresher for practicing therapists. Chapters cover topics from the beginning of therapy through termination and include special issues like working with children and adolescents.
Getting started
The developmental stages of new therapists are learning the essential skills, learning to conceptualize cases, and dealing with the therapist as self.
Before the initial interview
In the initial contact, therapists should listen and reflect what they hear and assess for crisis. This initial contact contains only basic relevant information and is not the time for interventions, advice, or suggestions. Therapists must know whether they have the knowledge and expertise to treat a problem or if they need to refer the client to someone else. The "business" of therapy, such as policies regarding making and canceling appointments and payment, should be discussed as quickly and efficiently as possible. When beginning therapy, it is helpful to know who made the initial contact and why, although the therapist should build rapport with all involved. A sample intake form is included, and the authors also discuss which family members should be involved in therapy.
Initial interview
The first task of the therapist is to join with the client. The credibility of therapy and/or the therapist may need to be discussed. Goals should be defined, and the therapist should begin to build motivation for change. Administrative issues like confidentiality, videotaping, observation, etc. should also be discussed.
Guidelines for conducting the assessment
The initial assessment is the time to explore the presenting problems, attempted solutions, and crisis and stressful life events. The therapist must constantly be aware of possible issues of harm to either self or others. Suicide, violence, abuse, substance abuse, biological factors, meaning systems, spirituality, family system, and social systems are all considered.
Developing treatment focus
The therapist must select the problem list, examine the history and treatment of problems, select a treatment modality, and determine the length and frequency of treatment. The treatment modality selected will be influenced by the therapist's orientation and experience, research, the financial constraints of the client, and the client's willingness and availability to follow the suggested treatment. Referrals may be considered. The therapist may wish to consult with the client's physician or request psychological testing.
Basic treatment skills
Therapy includes asking questions, normalizing, reframing, providing support, confronting, and pacing the therapy to meet the needs of the client. Handouts may be given to clients. In developing their expertise, beginning therapist should establish their understanding of the theoretical foundation of treatment skills; consider process and content, timing, and clients' anxiety levels; and create a family treatment plan.
Children and adolescents
Parents or primary caretakers should be involved in therapy and as cotherapists during the remainder of the week. In working with adolescents, the family need for maintaining structure must be balanced with the transformational needs of launching the adolescent.
Couples
Each spouse should get his/her turn to talk so that the therapist can understand the needs of both. This chapter deals with some of the common problems that couples present.
Mental illness of family member
Depression, anxiety, and alcoholism and drug abuse are discussed. When a family member is involved with drug or alcohol abuse, the first goal of therapy is to stop the abuse and then the reasons for the abuse can be examined.
Getting Unstuck
Resistance is a normal part of therapy. The familiar is comfortable. Therapy often involves both first and second order change. First order change is behavioral with the goal of acting in a new way. Second order change deals with behavioral, cognitive, affective, and relational realms and seeks to change the entire system. In dealing with cancellations and no shows, therapists need to review goals with the client and possible terminate or go to more infrequent appointments to address other goals.
Termination
Termination can be client initiated, therapist initiated, or mutual. Having clearly defined goals will tell therapists and clients when it is time to terminate therapy. Temporary relapses can be predicted by explaining that we often take two steps forward and one back.
Future effects of managed care
Managed care makes it more important for family therapists to maintain a relationship with family physicians. To meet managed care expectations, therapist need to articulate the problem, possible treatments, the chosen treatment, and expected outcomes.
This is an excellent resource for beginning therapists or those considering studying to become therapists. Therapists should be able to clarify their strengths and limits immediately, and this book can help them do that. The tables on such things as violence and abuse are helpful guides. Meaning systems are defined as cognitions, beliefs, memories, and emotions, which are often a part of culture and have implications for those of us who work cross-culturally. I appreciate the emphasis that the authors placed on developing the relationship between the therapist and the client. Therapists must know their role as they have full responsibility for therapy and for the relationship. As divorce has become so prevalent in the U.S., it is important for us to know that only about half of divorced couples develop cooperative coparenting. Couples need five positive interactions for every negative interaction. Families put energy and resources into being stuck, which is sometimes helpful to point out to them in the course of therapy. I appreciate the explanation of the goals of terminating, which are helping clients consolidate gains made in therapy, empowering clients, and being sensitive to loss issues, as I have not always thought through these goals when terminating therapy.

It is amazing how one text can cover so much ground. This is truly a must have for all beginning therapists as well as a helpful checklist or guideline for the more experienced therapist. What I appreciate is the dual perspective of both what the client is potentially thinking, feeling, desiring, fearing, as well as what the therapist is experiencing during the interview or session. Chapters are very practical, relevant, and specific as types of training or theories are almost always followed by an example or actual case. It is helpful to have different theraputic styles included, allowing the reader to be more widely exposed. Just the many assessment tables, charts and lists, are worth having all under one cover!

I really enjoy this book. It answers questions you have and questions you do not know you have. You read it like a novel, but it is great! It is a step-by-step guide.

I am very satisfied with this product. The quality was new, and the shipment was relatively fast. Although the price wasn't that much of a difference from my bookstore, I needed it and it met my overall needs.

My order arrived timely in the condition promised. Very nice to do business with this seller.

v
Issues addressed in this volume include:
Client expectations for therapy
How to manage the initial interview
What information should be gathered at intake
JoEllen Patterson, et.al, offer readers of this volume a broad overview of foundational skills required in the practice of family therapy. Chapter by chapter the authors present treatment issues/concerns with proposed remedies for those difficulties. Beginning family therapists' questions are dealt with in a respectful and practically helpful manner by the writers. The content of this book is drawn from the authors' many years of instructing and supervising graduate level marriage and family therapy students in one of the premier COAMFTE programs in the U.S.

Family Therapists proceed in the practice of their profession through various developmental stages. Patterson and the other contributors attempt to provide the beginning family therapist with information needed at each of those levels in order to successfully move on to the next. In the authors' model there are three major developmental phases for family therapists:

Stage One: Learning Essential Skills

Stage Two: Learning to Conceptualize Cases

Stage three: The Therapist-as-Self


Who should attend therapy sessions?
How to join with clients
Establishing credibility
Defining goals for therapy
Building motivation
Administrative concerns
Establishing fees
Managing crisis situations (suicide, violence, abuse)
Assessing for substance abuse, biological factors, meaning, spirituality, social systems outside the family, and developmental issues
Developing a treatment focus/plan
Major theoretical models of therapy
Length of therapy
Use of questions
Normalizing, reframing, confronting, supporting, pacing
Working with adolescents and children
Working with couples
Dealing with infidelity, sexual difficulties, mental illness
Getting unstuck in therapy
How to utilize supervision and peer consultation
Handling "no shows", secrets, agency issues, countertransference, burnout
Terminations


This book provides the beginning family therapist with a comprehensive, practical resource for trouble-shooting at the predictable stages of therapist development. It is thoroughly systemic in its approach yet deals with the realities of of individual diagnosis, mental illness, and managed care. For family systems purists that compromise may be problematic. For someone who has taught in a graduate level family therapy program and supervised them for several generations I applaud the effort. This is a "real world" not an "ivory tower" tome. I also commend the authors on their use of relevant research data to support the interventions they propose. Emphasis on self-of-therapist furthermore is a strength of the book. It calls to mind some of Harry Aponte's material. I cannot think of a more comprehensive volume to put in the hands of graduate students in family therapy. I wish I had been given it when I launched my career. I wish I had written it. I will use it from this point forward.

JoEllen Patterson in her book has done an excellent job in giving good hands on approach for those practicing marriage and family therapy. This book has been a great help to me in a practical sense. I'm not a trained marriage and family therapist, and I know my limitations in this area. As a caregiver for a mission organization, the many insights I gained will enhance my ability to assess, understand, and develop avenues of referral to professional therapeutic caregivers such as marital and family therapists.