1 bruno hillewaere & iris deuss psychologist & family therapist ; social worker & family...

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Bruno Hillewaere & Iris Deuss Psychologist & Family Therapist ; Social worker & Family therapistPTC De Viersprong - Congress solution-focused, Amsterdam - 22 /05/ ‘07

More Families, more More Families, more possibilities, more possibilities, more

solutions?solutions?

‘By nature we have no weakness that could not become a strength’J.W.Goethe

A day care treatment program for Families with adolescents at the Viersprong Institute, Halsteren

Note for the reader: all material from the clients, case-examples, videofragments,… have been removed out of this handouts, out of respect for the clients.Articles from the author can be sended by request

The strengths and possibilities of families…

And their willingness to help!

The day care treatment program for families with

adolescents

1. Introduction: on the origin of the idea of a day care program for families in ‘De Viersprong’

+ some concrete information about the actual program

2. Theoretical View and methodology:1. The changing paradigm in systemic therapy 2. Solution – focused therapy3. Multiple Family Therapy4. Reflecting team

3. The program from intake to finish4. Summary and discussion

Content: Content:

1: On the origin of the idea of 1: On the origin of the idea of a day care treatment a day care treatment

program for families with program for families with adolescents in adolescents in ‘De‘De Viersprong’: The context Viersprong’: The context

From the Viersprong institute as From the Viersprong institute as an oasis …an oasis …

To bridges towards the families…To bridges towards the families…

And other

therapists …

1. Multidisciplinary: 1 psychiatrist, 1 ‘coördinator’ 2 systemic therapists, 3 family workers/trainers

2. Day care treatment: 9 days/ total Intake & home visit 4 * 2 days (Friday & Saturday) + 1 day In total approx. 3 months

3. 3 to 4 Families with adolescents Variety of problems

– Focused problem– Multi – problem: only in a larger therapeuic context

The team and the program The team and the program (some concrete information): (some concrete information):

2. Theoretical view & 2. Theoretical view & methodologymethodology

1. The changing paradigm in systemic therapy

(the larger context)

From modern to postmodernFrom modern to postmodern::From the From the individual at the centerindividual at the center

‘The (w)hole of Lacan’ (Steve de Shazer, words were originally magic)

Attention to individual units leads to blindness of

relationship(Gergen,1999, p.18)

With some blindness:With some blindness:

… … and the therapist as: and the therapist as:

‘master catalyst of change’‘master catalyst of change’

Symptoms as parts of dissipative patterns, that supported family systems to survive at momentsof change (Prigogine & Stengres, 1984)

… … and systems,and systems,with problematic patterns:with problematic patterns:

To ‘postmodern theories’: the not – knowing position

Anderson & Goolishian (1988)Anderson & Goolishian (1988)

Collaborative (language) approach

We learned to use the not-knowing position as a new stance to become involved in conversations that generate - through a crisscrossing of ideas - new meanings toward the dissolving of problems

The art of conversation

Wittgenstein (1978)Wittgenstein (1978)

Words are not a represention or reflection of reality, but they do things.

Words create reality; they create the stories we live.

Postmodernism in family Postmodernism in family therapy: a refreshement…therapy: a refreshement…

Filmfragment:

What the bleep do we know?

All contributed to replacing the belief in absolute and objective knowledge acquired through individual thinking by emphasizing the existence of multiple local truths that are constructed within language

Constructivism, social constructionism, Constructivism, social constructionism, postmodern thinkingpostmodern thinking

‘‘Postmodern’theoriesPostmodern’theories::

Respectfull, equal – ‘Collaborative’ ‘Not- knowing’(Anderson & Goolishian): relative:

– ‘Informed not knowing’ (Epston)– Curiosity ( Cecchin, Epston)

Shared expertise – dialogue More then one perspective or truth Narrative : the man and his stories Solution-focused:the cliënt and his resources

Theoretical View and Theoretical View and methodology:methodology:

2. Solution focused therapy

Solution focused therapy:Solution focused therapy:

Steve de Shazer en Insoo Kim Berg

Brief Family Therapy Center, Milwaukee

(Solution focused brief therapy)

Solution- focused therapy:Solution- focused therapy:The essence (for us):The essence (for us):

Film-FragmentFilm-Fragment

Solution-focused therapy: more Solution-focused therapy: more then miracles!then miracles!

Respectful, equal Client-centered ‘leading from one

step behind’ Strengths Resources Possibilities Small, concrete

steps Future-oriented

1. Introduction2. Vision and methodology:

1. The changing paradigm in systemic therapy 2. Solution – focused therapy3. Multiple Family Therapy: cfr. infra4. Reflecting team: cfr. infra

3. Concrete: from intake to finish1. Intake2. The program3. MFT4. Reflecting team 5. Program from start to finish

4. Summary and discussion

1. Intake: Genograms1. Intake: Genograms:: same story: same story:

From a diagnostic instrument of the therapist

From problematic stories:From problematic stories:

Genograms in Family Assessment (Mc.Goldrick & Gerson,1985)

Genograms: more than Genograms: more than squares and circles… squares and circles…

… … towards a collaborative therapeutic towards a collaborative therapeutic instrumentinstrument

Genograms: Assesment ànd Interventions (Mc.Goldrick & Gerson, 1999)

Narrative and solution-focused Narrative and solution-focused applications using genograms:applications using genograms:

‘From what position does a therapist speak or listen in a storry-telling universe where all tell stories and all stories are valid though not necessarily true?’ (Parry, 1991)

A universe of meanings…A universe of meanings…

Were we create meanings… Were we create meanings…

From ‘Causal ’ thinking in a genogram:From ‘Causal ’ thinking in a genogram:

From ‘thin descriptions’ and a From ‘thin descriptions’ and a problemsaturated story…problemsaturated story…

Towards ‘rich descriptions’ and Towards ‘rich descriptions’ and stories of possibilities stories of possibilities

Narrative and solution- focused Narrative and solution- focused applications:applications:

An exercise…

Genograms: The challengeGenograms: The challenge

Shift from:

The therapist focusing on structure and patterns of pathology

Towards the creativity of the client and the family to create stories of hope and possible solutions

Creating a safe environment and therapeutic relation

You can start with pictures…You can start with pictures…

GenogramsGenograms::

‘Qualities’, positive aspects or characteristics

Hobbies….Stories of hope or strength

‘‘Postmodern’ genograms:Postmodern’ genograms:

Don’t allways lead to more clearness, but do lead to more collaboration … (and fun)

(Note that we let the family draw the genograms)

Genograms: Genograms: A collaborative approach A collaborative approach

Looking for the positive aspects, but without ignoring the problems (re-authoring lives; creating hopefull stories)

Involving all time aspects: Past (timeline), present and future (hope, goals)

Life can only be understood backwards, but it must be lived forwards.

(Soren Kierkegaard)

GenogramsGenograms::

GenogramTimeline (Coping; exceptions!)

Goalsetting:– at first, stay close to the words of the

clients: words are originally magic

1. A) Intake: Stay close to the words from the families! ( Systemic therapists)

‘Words are originally magic’ B) Home – Visit: social workers

2. The day care program: Contract: systemic therapists & social workers Goalsetting as the leading principle and main framework Holding and Containment: non-verbal material,

Drawings, collage…

3. Multiple Family Therapy 4. Reflecting team 5. Program from start to finish:

End: Evaluation & ‘separation’

3. The program: 3. The program:

Goalsetting:Goalsetting:

Some examples

Techniques: verbal and Techniques: verbal and non verbal materialnon verbal material

Drawings Collages Games Post-its Corequalities

Core qualities modelCore qualities model

Another tool:

Core Qualities Model

Opposite Positive -->

Too much

Core Qualities Model

Opposite Positive -->

Too much

3. Multi Family Therapy:3. Multi Family Therapy:

Together and yet ….

Sometimes separate

Multi Family Therapy:Multi Family Therapy:

A video fragment: ….

Families with adolescents: allways looking for the right distance

Sometimes together and sometimes Sometimes together and sometimes separate …separate …

3. Multiple Family Therapy3. Multiple Family Therapy

Same principles and processes as in groups: Support, hope, insights… But also same pitfalls: anxiety, problem-talk,… Teenagers and kids: other language, healthy balance between shared

and seperated experiences

Leading from ‘one step behind’: Family workers Systemic therapists: one & one step behind

MFT: Laquer; Asen; Lemmens, Migerode e.a. (Leuven)

4. Reflecting team

Tom Andersen

Looking for humble, helpful reflections

4. Reflecting team4. Reflecting team Bateson: a small difference that can make a

difference Steve De Shazer:

– Polyocular view: shift in attention – Message from the team: change the pattern (action)

Tom Andersen : – Reflections in action

How to mobilize the families into this process?

5. Program & process:5. Program & process:From start to finish From start to finish

Each weekend another theme, – E.g. strengths and competences, communication, education

Growing process, smal & concrete steps (subgoals) towards the goals

Towards ‘letting go’ – better connecting to better separation (team and families)

Last weekend: survival kit Evaluation: middle and end

4. Summary & discussion:4. Summary & discussion: Different forms offering different possibilities Different families offering different

possibilities The program seems to be most effective when

integrated in a larger process Most struggling point is still the space the

families need for their ‘individual’problems Research has just been started – results will be

for a next congress (we hope)

Summary: Summary: From a problem saturated storyFrom a problem saturated story

Towards a story of possibilitiesTowards a story of possibilities(reflections, actions and systems)(reflections, actions and systems)

Solution-focused MFT: more then miracles Solution-focused MFT: more then miracles

(Story of Bateson)

Reference:

Andersen, T. (1987). The Reflecting Team: Dialogue and metadialogue in clinical work. Family Process, 26, 415-428.

Asen, E. (2002). Multiple Family Therapy: an overview. Journal of Family Therapy, 24:3-16.

Berg, I.K., & De Jong, P. (1998). Interviewing for solutions. New York: Brooks/ Cole.

De Shazer, S. (1991). Putting difference to work. New York: Norton. De Shazer, S. (1994). Word were originally magic. New York: Norton. Hillewaere, B. (2006). Werken met de mogelijkheden van cliënten en families

door middel van kernkwadranten en genogrammen.Tijdschrift voor Psychotherapie, 32, 3, pp. 161 –177.

(English: Strengthening families using genograms and core qualities, subm.) Hillewaere, B., & Lefevere de Ten Hove, M. (2006). Narratieve en

oplossingsgerichte toepassingen bij genogrammes: samen hoopvolle perspectieven creëren. Tijdschrift voor systeemtherapie, 18, 2, pp. 69-87.

(English: Narrative and solution-focused applications of genograms: creating hopeful perspectives, subm.)

Laquer, H.P. (1976). Multiple Family Therapy(pp405-416). In: P.J. Guerin (ed.), Family Therapy: Theory and practice. New York: Gardner Press.

More information / articles:More information / articles:

Bruno.Hillewaere@Deviersprong.nl

Bruno.Hillewaere@skynet.be

Thank you for your attention…Thank you for your attention…And good luck with the families!And good luck with the families!