4 6 terapiaFamGB
4 6 terapiaFamGB
4 6 terapiaFamGB
- FAMILY THERAPY
4.6.1.- EVALUATION TOOLS
We used the same evaluation and treatment procedures that we normally do with the
families that participated in this program. However, the first interview was semistructured and included the items that are presented below.
1.
What problem
behavior/problem.)
2.
is
this
family
facing?
(Definition
of
violent
3.
Why or for what reason was the act committed?
(Attribution of meaning)
(Degree of intentionality)
(Blame attribution)
4.
Feelings that violent behavior generates in individual family
members.
5.
(Exploration of family resources)
What was this family like before the problems arose?
What solutions has the family tried?
In what circumstances do problems not arise? (Exceptions to the rule.)
6.
What do you think the family situation will be like when the
problems are solved?
(Expectations for the future)
(Negative predictions)
(Utopian expectations)
7.
(Exploration of motivation vs resistance to change)
On a scale of 1 to 10, how much effort will be needed to solve the
problems?
On a scale of 1 to 10, how willing are the family members to make that
effort?
* The information in parenthesis is related to the exploratory goals of
that item.
4.6.2.- RESULTS
We were able to gather the following inforamtion on the 17 families that were studied:
Ques 1:
WHAT PROBLEM IS THIS FAMILY FACING?
(Definition of the violent
behavior/pro blem)
In 6 of the 17 familes, the answer to question 1 was:
o
He was playing a joke on someone.
o
I got involved with a guy in my neighborhood.
o
He gets punished and needs to get out.
o
Ive got a big mouth.
o
I behave badly and talk back to the teachers.
o
-
PLACE
In 7 cases this type of behavior only occurred at school
In 3 cases this behavior/problem is found at home.
In 7 cases it was found both at school and at home.
2.2
FREQUENCY
In 2 cases, only once.
In 4 cases, every day.
In 7 cases, quite frequently (in 1 case this behavior is attributed to the
death of the father.)
In 4 cases, no response is given to this question (in one of these the
behavior is attributed to changing from primary to secondary school)
2.3
-
2.4
-
SEQUENCE
In 2 cases, copying behavior of peers (a negative leader)
In 1 case, peer pressure
In 3 cases, family dynamics
o
In 2 of these, the adolescent is provoked and then punished by the
parents
o
In 1 of these, the mother is not able to impose her authority and
this causes very worrisome behavior in both the mother and the child
In 4 cases, challenging authority figures at school
In 1 case, the dynamics of peer confrontations at school
In 1 case, teachers and students are provoked at school
In 1 case, there is not always a clear trigger
In 2 cases, no response
In 2 cases, this question was not asked
QUES 5: WHAT WAS THIS FAMILY LIKE BEFORE THE PROBLEMS AROSE?
Of the 17 families, 14 responded and 2 answers were inferred.
him.
-
QUES 6: WHAT DO YOU THINK THE FAMILY SITUATION WILL BE LIKE WHEN THE
PROBLEMS ARE SOLVED?
-
In
In
In
In
6
2
6
3
cases,
cases,
cases,
cases,
In 13 cases, the family did not live with the extended family of origin.
In 3 cases, the family lived with their extended family of origin.
In 1 case, the family lived with the grandparents.
o
Of the 13 cases in which the family did not live with the
parentsfamily of origin
AND
DAUGHTER
WHO
LIVE
WITH
THE
MATERNAL
Siblings: The daughter has been under psychological treatment since her
father left. She has a step-sister from her fathers earlier relationship, but they
do not live together. The relationship between the two sisters is functional (she
mentioned they were both at the same high school.)
Extended family of origin: No data on this relationship.
Case 4:
ONLY CHILD (ADOPTED) WHO LIVES
(SEPARATED) AND HIS MATERNAL GRANDMOTHER
WITH
HIS
MOTHER
Case 13: RECONSTITUTED FAMILY. THE PATIENT LIVES WITH HIS FATHER
AND HIS FATHERS CURRENT PARTNER AND HER THREE CHILDREN. THE
PATIENTS BIOLOGICAL PARENTS SEPARATED 12 YEARS AGO. HE HAS AN
OLDER SISTER WHO LIVES WITH THEIR PATERNAL GRANDMOTHER.
Spouses: The fathers current partner does not attend the session and we
have not further data.
Parents:
Exercised by the father and his partners participation is
implied. The fathers role is mainly affective and not normative as the father was
not around until the boy was 10 years old. The normative (rule-setting) role is
assumed to belong to the fathers partner.
Parent-Child: Good father-son relationship.
Siblings: Distant. The bio logical sister has lived with the grandmother
since the parents separated. The boy was in two orphanages and when he was 8
years old, he went to live with a paternal aunt until his father took him back
when he was 10.
Extended family of origin
o
Maternal: Mother is an only child.
o
Paternal: The patients paternal aunt did not allow him to see his
mother. His father emigrated after the separation. Legacy: the father is
hoping the son will work with him.
Hypothesis: The boy rejects the authority of his fathers partner. The symptom
(he doesnt want to study and he causes a lot of problems) serves to bring the father
and the son closer together and fulfills the fathers expectations about working
together.
Case 14: SINGLE-PARENT FAMILY. PARENTS RECENTLY SEPARATED. THE
MOTHER LIVES WITH HER TWO CHILDREN. THE PATIENT IS THE YOUNGER OF
THE TWO.
Spouses: has been dysfunctional
Parents: The father is very tough as a parent. The mothers parenting
style is an idealized democratic type. The oldest child is treated as a parent.
Parent-Child: The mother was in a filial position before the separation.
Poor relationship with the father because my father is very hard on us.
Siblings: The patient is alone in the child role.
Extended family of origin: No data available.
Case 15: PARENTS LIVE WITH THEIR THREE CHILDREN. THE PATIENT IS THE
OLDEST SON.
Spouses: Functional
Parents: Functional
Parent-Child: Functional. Good relationships.
Siblings: Developmental handicap suspected.
Referred to Childrens
Mental Health Services.
Extended family of origin: Normal relations.
Hypothesis: No apparent dysfunctions. They request help for the boy. Referred to
Childrens Mental Health Unit.
(FOR THE LAST 3 YEARS) AND A NEW PARTNER (FOR 1.5 YEARS). THE
PATIENT IS THE YOUNGER OF THE TWO CHILDREN.
Spouses: No data available.
Parents: Dysfunctional. Biological father criticizes the way the mother
educates the children.
Parent-Child: Father-son (patient) alliance; mother-older son alliance.
Siblings: Poor relationship between the brothers.
Extended family of origin: No information available.
Hypothesis: The conflict between the brothers reflects the problems between the
parents. The disagreement that exists between the parents trickles down to the children
(emotional divorce not complete).
Case 17: PARENTS LIVE WITH THEIR THREE CHILDREN. THE PATIENT IS THE
OLDEST CHILD.
Spouses: Apparently functional
Parents: Mothers role is affective, fathers is normative.
Parent-Child: Functional. Good relations, although the relationship with
the mother could be improved.
Siblings: The patient is the only male. There is a good relationship
between the children. The patient gets along better with the younger sister. We
usually dont argue in our house.
Extended family of origin: Information not available.
Of all of the cases referred due to violente behavior, half of the families did not
admit to having problems at home. This leads us to think that:
The educational context is dysfunctional as a system.
The family context denies difficulties experienced by youth.
As reagards the three cases in which the family states that the problematic behavior
only occurs at home, it seems the parental functions are being assumed by
teachers, given that they seem more motived to get help for the family than the family
itself. As a matter of fact, in these cases, the families minimize the importance of the
childrens bad behavior at school and even though in two cases the parents admitted
there were some problems at home, we were not able to initiate therapy due to a lack
of motivation.
FREQUENCY:
It was suprising that in two cases, the referral was made after only one incident at
school. These two families were indignant about the fact that the school labeled the
incident as a problem.
THE TARGET
This item was not useful since the responses that we obtained are included in the
context.
SEQUENCE
Most problematic sequences occur between the adolescent and the authority figure,
and the common denominator, according to these figures, is the adolescents
challenge of the rules set down by adults. In some cases the child s
i thought to
provoke the adult, i.e. to trigger the sequence. The surprising thing is that,
independent of what is recognized as a stimulating antecedent of the adolescents
behavior, the sequence of events as told by the adults usually names the child as the
instigator of the sequence.
As regards the sequence in which several adolescents are involved, peer pressure is
always mentioned when speaking of disruptive behavior.
3.
ATTRIBUTION OF MEANING
As regards this item, we must clarify a couple of questoins from a methodological point
of view:
Diferentiation: degree of intentionality and blame attribution were not
useful since more than half of the families did not know how to answer this
question.
As regards the question why or for what reason do they commit acts of
violence? only one family responded to the for what reason part of the
question which looks for a purpose for the behavior (getting someones
attention). In the rest of the cases, a linear causality, iniciated in adolescence is
claimed, although the influence of the context is not totally discarded as a
reason. These results were unexpected since the for what reason part of the
question is interventional in nature. Its purpose was to introduce circular
causality into family discourse. This is why we recommend leaving this question
as is, even though we know that family will usually only answer the why part
of the question.
4.
In the great majority of the cases, the feeling that the behavior exhibited by these
young people generates in their parents is one of impotence or overload when their
role is questioned. Three responses were particularly interesting. In these, the parents
considered themselves victims of the situation. We could say that all of these
classifications are related to a feeling of being de-authorized.
5.
Most families said that they had not changed. This coincides with the lack of
recognition of the fact that what happens in the family context can have an
impact on the problem behavior.
As regards other solutions that had been tried by the families, in only three cases was it
stated that parental authority had been reestablished. Other solutions that are worth
mentioning include changing schools and seeking psychogical help.
The question In what circumstances do problems not arise? was only asked in seven
of the cases. However, we do feel it is useful to keep this question in because, when it
is pertinent, if does provide relevant information about the exceptions to the rule.
The most frequent answer to this question was: the child behaved well when
someone pays attention to him.
6 7 FUTURE EXPECTATIONS/REASONS FOR RESISTING CHANGE
The last two items in the interviewed explored topics related to reasons for change by
the family. In most cases, the questions were not asked explicitely, especially item 7.
These items are useful as part of the record and can help us determine the familys
susceptability to therapetic change.
Normally, families that are most resistant to change have negative expectations
about the future and think that it will take a lot of work on their part to solve the
problem. It is worth pointing out that 6 of the 17 familes that were referred felt this
way. Of these six, therapeutic intervention was only possible in two cases.
As for families who insist upon normalizing the situation, in two cases this had to do
with an attempt to deny the possible existance of psychopathologies in youth. In both
cases, we referred the families to the Childrens Mental Health Service. In the other
cases, the families would not admit to having a problem in their family.
In conclusion, as regards motivation, we found that the great majority of the referred
families were not willing to begin family therapy. In fact, only five agreed to complete
therapy. In three cases, the family agreed to therapy although therapeutic contact
never took place and they stopped coming to their appointments. In one case, in spite
of the fact that the family did not agree to therapy, the adolescent was put into the
maturation group.
The fact that intervention was only possible in 8 of the 17 cases (2 were referred to the
Childrens Mental Health Service, 5 to family therapy, 1 group therapy but no family
therapy) makes us think that there is a greater desire on the part of those who give the
referrals to get help for these students than there is on the part of the families
themselves. Nevertheless, intervention was feasible and both families and those who
referred the students think that the results are good (remission of disruptive behavior).
8.
GENOGRAMS
In 11 of the 17 cases, the parents were separated. In 7, the children live with only one
parent. In 5 cases, the kids live in a reconstituted family. The traditional nuclear
family only accounts for one third of the cases.
The main dysfunctions that we found in terms of parental behavior were:
In families in which both parents are involved in parenting, there is
usually some disagreement and they often mutually disqualify one another in
from of their children. Normally one is lax and the other authoritative.
When one of the parents is not involved (main reasons being the fact the
parents are separated), we often find members of the extended family taking on
some of the parental roles (especially grandmothers). Sometimes the oldest
child takes on a parenting role when extended family members are not near by.
This usually results in the mother or father who takes charge of the family
taking on a filial position wihin the family.