FAMILY SYSTEMS THERAPY & REUNIFICATION THERAPY
Family Systems Therapy is highly recommended as the foundation for any subsequent therapies (e.g. individual therapy) and as an early intervention for the family experiencing moderate to high conflict. It is, as well, the preferred approach to Reunification Therapy, involving at least both parents and preferably all of the children in the family whenever possible, as is clinically appropriate. It provides a window into how the family functions as a whole and the role each family member plays in the conflict and dysfunction, as well as the resources each member contributes; subsequently, it allows for a more accurate assessment and, therefore, appropriate therapeutic intervention than could be possible when family members are seen by only individual therapists, or when individual family members, as well as other significant persons, are left out of therapy.
Therapists for individual family members have access to only a single perspective, that of their individual client. Under these circumstances it is not uncommon for therapists to end up advocating for their client and by so doing to further exacerbate the often entrenched polarized positions of the parents, between which their children are the collateral damage.
The family rather than the individual is the client in Family Systems Therapy. The therapist does not advocate for individual family members, but rather for the family as a whole with the child's best interests as the guiding principle, and with the goal of promoting the best relationship possible for the child with both parents. (This approach is compatible with cooperative and collaborative law principles: the professional advocates for the family as a whole, though provides strong support to individual family members, collaborates with the other professionals on the team, and is guided by the child's best interests.)
It is my experience that treatment is most effective the earlier it begins in the conflict. The same neutral, non-judgemental therapist (which does not mean that the therapist does not take a firm position when needed and clinically indicated--unacceptable behavior is confronted while respectfully preserving the value of the individual) working with the entire family and providing strong support to all members can help diminish polarization and entrenched positions, as well as the potential for loss of access for a parent to his/her child, and can provide a stabilizing influence that helps the family progress forward.
Co-parent counseling and divorce education or individual therapy alone are often not adequate in meeting the needs of these families. For many parents the holistic choice of this Family Systems Therapy approach, which incorporates parallel and co-parenting strategies, is also the most cost effective option.
If domestic violence is known to have occurred prior to family therapy, depending upon the history (i.e. occurring along a continuum from low to high risk, and from a single incident all the way to the more extreme end of the continuum with an on-going pattern and recent incidence of criminal behavior, and if the battering occurred within the context of intimidation, coercion and/or emotional abuse, or as an expression of anger motivated from fear of abandonment), and whether it is shared couple verses single perpetrator violence (--a detailed assessment of the specific dynamics of the individual family and DV is necessary to performing competent assessment and intervention--) it may be appropriate and necessary to postpone the involvement of the parent-perpetrator in family therapy until she/he has completed a significant portion of a batterers' program, and also parenting classes if these have been ordered. If there is a restraining order involving the other parent in place at this time, appropriate arrangements will be made to accommodate the order around sessions. In general, however, if this parent is assessed as low to moderate DV risk and is actively participating in a batterers' program as court ordered and making progress, she/he will be involved by way of individual therapy sessions (which continues to have a family therapy focus and is not intended for working through intra-psychic issues more appropriate for on-going individual therapy) on an intermittent basis until it is determined that inclusion in sessions with the child(ren) is appropriate, and the family therapist will collaborate with this parent's group therapist, and individual therapist if she/he is in individual therapy. (Collaboration with other professionals is provided for, before therapy begins, within the stipulation and order for counseling.)
The goal and hope is that the parent(s) will come to understand the impact of his/her destructive behavior, develop and demonstrate empathy for those victimized by it, and become accountable for it, then learning new skills for relating and communicating with mutual respect and in consideration of the rights of others. The therapist acknowledges that not all individuals are willing or capable of making these transformations--those with high risk DV typology and anit-social characteristics in particular--and that sometimes the family process is about grieving and processing trauma, which may or may not ultimately include participation of the perpetrator in conjoint or family sessions (and in some cases in which face-to-face contact does not occur, mutual letter writing can be used with the therapist as facilitator); however, therapy begins with the presumption that the individual's free will to choose his/her behavior may lead to transformation, or at least significant behavioral change.
Please read on for a detailed description of my approach to Family Systems & Reunification Therapy.
(Note that the following description is the ideal approach to treatment and may be altered based upon the parents' willingness and resources to participate.)
Family Systems Therapy and Reunification Therapy is provided
according to the following outline.
- The therapist is a neutral professional
- Specializing in the treatment of individuals and families experiencing divorce, custody disputes and high conflict
- Works to maintain a balanced, unbiased view of the family's dynamics and each members contribution to the conflict or problem, as well the strengths and positive contributions of each family member
- Validates the feelings and seriously acknowledges the perceptions of each family member, though does not become an advocate for any individual family member, rather works for the benefit of the whole family with the child's best interest as the guiding principle
- Works from a systems perspective, understanding the circularity of the relationships within the family: every individual's behavior impacts the behavior of the other members
- Is mindful of the systems impact of the professional team (i.e. individual therapists and family therapist, attorneys, custody evaluator and Special Master) on the family and works to facilitate professional collaboration in meeting the family's needs (see Stipulation and Order for Counseling by a Mental Heath Professional, page 7, which provides for this collaboration)
Conducts a comprehensive systems assessment (with clinical interviews and the tools indicated in the following) of historical and recent issues related to: domestic violence, including use of intimidation and coercive control (assessment includes screening tools/checklists with a detailed review of client answers with the client, and may include further assessment utilizing the Spousal Assault Risk Assessment and Danger Assessment),
and anger management issues (and if appropriate, formulates a safety plan and safety rules, and makes arrangements accommodating for any restraining orders, e.g. drop off and pick up times of children for therapy sessions);
substance abuse (assessment includes multiple screening tools)
and mental illness (assessment includes Mental Status Exam and may include the MCMI-III);
parenting competency and warmth, and any
child abuse or neglect;
problem-solving competency; and attachment styles. Any required reports are made (as a therapist is a mandated reporter) to protective services and/or law enforcement; appropriate referrals are provided; and collateral contacts are made if needed (consent for the latter provided for by the client in the stipulation and order for counseling or other signed releases, or by the court)
- May utilize the MCMI-III (Milton Clinical Multiaxial Inventory-III) with parents, as one piece of clinical information to assist the therapist's understanding of the parents functioning. The results are then integrated into the overall clinical assessment and subsequent treatment plan, and are used only for this purpose. The information provided by the results of this tool is considered with caution in that it is not being used as part of a comprehensive evaluation, which would include additional testing instruments. The test results themselves are not provided, but are retained as part of the treatment record
- Facilitates (if assessed to be relevant to the specific family's situation) awareness and understanding of internal somatic warning signals and external signs of danger, and a safety plan for how to respond if confronted with these circumstances
- Conducts a detailed history of relationships within the family as they existed before the separation/divorce process , as contrasted with the current status of these relationships (contributes to assessment of historical estrangement verses rejection of a parent subsequent to the divorce/custody conflict), also taking into account child and family developmental contributions
- Is facilitative, yet structured and often directive
- Provides education regarding the cognitive-behavioral therapeutic approach in the initial session, during which time a listing of cognitive distortions (e.g. all-or-nothing, black/white thinking, or splitting; labeling; overgeneralizing; catastrophizing or minimizing; personalizing; mind reading or jumping to conclusions, etc.) is introduced as being characteristic of ongoing conflict (examples are identified and discussed), and that part of our work together will be to regularly assess for and process these in detail (Clients are provided a list of cognitive distortions to refer to at each session)
- Encourages use of detailed descriptive terms in communicating about problems, people and events, verses use of the above distortions and focusing on conclusions
- Is solution focused in developing effective problem-solving, coping and communication strategies, verses a continual focus on complaints and avoidance of the active working through of issues and problems-collaborates with the family in prioritizing issues to be addressed, and then problem solves each issue, remaining focused on one issue at a time, with collaboratively (whenever possible) identified behavioral goals
- Works to contain reactivity and promote emotional regulation
- Facilitates development of an increasing ability to tune in to one's own internal somatic signals and identify associated feelings with an increasingly sophisticated "feelings vocabulary" (a feelings list is provided for the client to refer to at each session), yet also redirecting parents to refocus their attention to the child's feelings and needs when in session with the child--keeping the child's interest as the priority
- Provides education on active listening and assertive communication skills, and facilitates the development of these
- Facilitates acceptance of personal responsibility with behavioral contracting for specific negotiated behavioral change in relating to the other parent and/or the child, in the best interest of the child
- Role models positive reinforcement via providing acknowledgment and praise for all steps, big and small, toward positive change
- Facilitates the strengthening and/or the development of support networks of neutral persons, whom may be included in sessions as clinically appropriate and needed to support an individual or the family as a whole in working toward meeting therapy goals (persons included in sessions to be approved by both parents and/or the court)
- Facilitates parents' positive expectation via identification of hopes and dreams for their children, their family as a whole, and for themselves as individuals; and facilitates the development of their mission statements, as co-parents, co-leaders and co-decision-makers of their family (in the process facilitating a healing and hopeful narrative about their future), which is then used to help guide the direction of our work together
- Facilitates identification of the unique strengths and contributions of each family member, as well as areas in need of further development now that parents live separately
- Encourages the child's development of effective and active problem-solving skills to cope with being placed in the middle of parental conflict, or feeling in a loyalty bind, that do not include the maladaptive (though not uncommon in high conflict) coping strategies of avoidance and/or: bending the truth; exaggeration, fabrication or lying to protect a parent or oneself; or telling a parent what s/he believes a parent wants to hear (even when completely untrue)--often unconsciously motivated and not intentional--in an effort to feel secure and reduce tension with a parent upon reuniting after time with the other parent (Such false reports from a child upon reuniting with a parent generally mirrors this parent's negative feelings and perspective of the other parent. It is not uncommon that neither parent is fully aware, if aware at all, of the extent to which this process in the child may be contributing to the ongoing parental conflict)
Emphasizes the principle of BALANCE, and works toward developing a balanced view of the other parent,
balanced emotions toward the other parent, and
balanced behavior toward the other parent (and for the child, both parents)
- Educates both parents about the needs of children to maintain a secure relationship with both parents, the behaviors that promote this security and those that hinder and damage it, and how to keep children out of the middle of parental conflict
- Emphasis is placed on parent-child dyads (in particular with the estranged and/or rejected parent), as attachment is a one-to-one phenomenon, with the facilitation of the development of parental responsiveness, accurate mirroring, empathy and attunement with the child, including how to respond to a child's rejecting behavior, as well as to the child's recollections and perceptions of events of which the parent does not agree, and in a non-reactive and empathetic manner
- Facilitates corrective experiences between the child and estranged or rejected parent, and focuses much less on processing complaints; will go into the community when clinically appropriate (there are nearby parks and a down town area conducive to this purpose); and will include extended family and/or friends when clinically appropriate and facilitative of the courts and family's goals (such individuals to be approved by both parents and/or the court)
- Facilitates the estranged or rejected parent's management of difficult emotions, first by building awareness of his/her internal somatic states and associated feelings, and then by building self-monitoring and coping strategies which will prevent the discharge of problematic emotions (e.g. anxiety, frustration and anger) onto the child. Even if expressed only on occasion, such emotional discharge would then reinforce the child's negative internal representation of this parent making it difficult to extinguish (as this would be consistent with an intermittent pattern of reinforcement--the most powerful form of reinforcement)
- Provides additional parent coaching and education to the estranged or rejected parent regarding how to most effectively extinguish the negative image the child holds of him/her, and relating with the child in a manner that consistently contradicts this negative image
- Provides the estranged or rejected parent coaching and education on the parenting strategies and communication skills needed for responding to the child's disrespectful behavior once the attachment between him/herself and the child has become compromised and he/she has lost influence and authority with the child (similar to parenting a child with a compromised attachment or attachment disorder)
- Supports the estranged parent in responding with empathy, with active/reflective listening, and with accountability to the child's legitimate complaints about him/herself
- Educates the parent with whom the child is aligned (in a manner that creates a barrier to relationship with the other parent) on the potential long term damaging effects of this dynamic were it to continue over time, the potential positive long term effects of working toward an improved relationship with the other parent, and how to encourage or discourage the development of this relationship for the child with the other parent
- Facilitates the grieving processes and processing of anger for what has been lost, and promotes boundaries and scheduling of rituals for this process so that parents can remain appropriately focused on the needs of their child
- Promotes the development and celebration of new rituals
- Teaches the importance of providing routines and structure for children to promote a sense of continuity and security
- Works with parents to reconcile differences in parenting philosophy and practice
- Conducts sessions with different configurations of family members as needed (as the focus in therapy changes over time and with circumstances), for example, during the middle of a session with mom and her two children I may request that mom and one child take a break while I meet with the other child alone, or I will ask a child to take a break and meet with mom alone-reasons for doing this include: to avoid confronting a parent in front of the child, to address persistent resistance around a current issue that is more likely to be processed without a family member present, or to support a family member in managing his/her emotions so that the family session can resume in a constructive manner. I also will request that particular family members attend particular sessions as needed depending upon the current therapeutic need
- Parents in high conflict are not seen together in session with their children until or unless they are able to develop the flexible thinking needed to move beyond the entrenched positions characteristic of high conflict
- Works toward the possibility of meeting with both parents together with their children in session
- Promotes parallel parenting strategies when a parent or parents are unable to cope with co-parenting strategies, which requires much more active/involved communication than parallel parenting
- Promotes a holistic perspective of the individual's emotional, physical and family health, encouraging healthy individual and family daily habits, routines and structure
- Educates parents on relevant child development issues, age-appropriate expectations and parenting skills and strategies
Provides Divorce Education for parents utilizing "Children in the Middle," DVD and workbooks, an award winning program endorsed nationally by judges, lawyers, mediators, psychologists, and
- Provides Divorce Education for the child utilizing the "Children in the Middle" child's program. Chapter titles include: "Getting out of the Middle : Using 'I' Messages," "How Divorce Makes You Feel," "Changing Your Thoughts and Activities," and "Getting on with Your Life."
SOME FINAL POINTS:
Individual therapy with a therapist specializing in the issues of divorce/custody is recommended as an adjunct to family therapy for individual family members as needed to address issues beyond the scope of family therapy (e.g. intrusive unprocessed historical trauma that has become activated, entrenched cognitive distortions, aggressive/hostile parenting, or serious enmeshment) that cannot be adequately addressed without intensive individual therapeutic work, and/or when this additional support is needed for the individual. The family systems therapist then takes on the additional case-management function to facilitate collaboration ( which is provided for in the Stipulation & Order for Counseling By A Mental Health Counselor, page 7) amongst therapists and coordinate treatment between therapists (for the reason that the family therapist has access to all family members and, therefore, a more holistic viewpoint), unless there is a
Special Master (Parenting Plan Coordinator) working with the family who has chosen to perform this function, or a case-manager or minor's counsel has been appointed and has taken on this function. When individual members are already involved in their own individual therapy before Family Systems Therapy has begun, the family systems therapist will function to coordinate treatment in this same manner.
If the family and its dynamics have become known to the court so that the courts concerns and behavioral expectations and goals for the parents and family are very clear, then a collaborative approach amongst the therapists providing individual and dyadic (parent-child or co-parenting) therapies may be effective; however, in high conflict families when there is not an appointed family systems therapist to facilitate coordination of treatment, it can be particularly stabilizing for there to be an experienced professional (i.e. Special Master, or PPC; minor's counsel; or case-manager) functioning in this capacity to coordinate treatment amongst the various therapists in addressing the court's concerns and goals for treatment.
This therapeutic approach is most effective when provided early in the conflict, as are most interventions, and is particularly indicated for the multi-problem, high conflict family in which the children have been drawn into the conflict. Accompanied by an initial thorough risk assessment, the Family Systems Therapy approach can, especially when provided early in the conflict, facilitate continual access to both parents by the child, and help prevent entrenched positions and the potential rejection of a parent.
CONFIDENTIALITY for Family Members in Family Therapy
(Please first click on LIMITS OF CONFIDENTIALITY to read the limits of confidentiality for all services)
- Is confidential and privileged if the parties are using a non-adversarial process (parties may choose to authorize the therapist to collaborate with their attorneys via three-way conference, with or without the parties' attendance-both parties must agree)
- However, it provides no confidentiality between parents, as the children's needs are central to the issues addressed, and the child is informed that his/her parents may be spoken with about what took place in conjoint session with him/herself (the child) and the other parent (i.e. parents my be informed about what took place in session with the child and the other parent)
Provides confidentiality for the child when the family therapist meets individually with the child, which occurs frequently in some cases (please review, "Confidentiality for the Child" under "Individual Therapy for the Child" and the
CONSENT TO TREATMENT FOR A MINOR CHILD form). California law provides for the child's own rights to confidentiality and privilege, with the same exceptions as described in
LIMITS OF CONFIDENTIALITY, as indicated above
- Informs the child that when she/he is seen in conjoint session with a parent or in family session that is court ordered therapy, communication within this context is not confidential and may be reported to the court
- Is non-confidential if the parties are engaged in an adversarial process--therapy must, therefore, be court ordered
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