NEW SOUTH WALESNEW SOUTH WALES

1

Lyndal PowerClinical Coordinator RAPS Adolescent

Family Therapy and Mediation Service 98901500

Email lyndalp@ransw.org.au

Working with Adolescents and their

Families

NEW SOUTH WALES

2

RAPS

• Adolescent Family Therapy and Mediation Service• See teenagers, siblings and parents together• 11-20• Serious difficulties

» Conflict parents and teenagers» Truanting and school suspension» Running away» Violence» Drug use, criminal behaviour

• RAPS established 1990 to prevent youth homelessness

NEW SOUTH WALES

3

RAPS

• Social Workers/ Psychologists with postgraduate training in family therapy

• Family therapy consultant- ‘live’ supervision of family therapy

• See clients across Sydney, based in Parramatta, some outreach

• Sliding scale of fees• Systemic- work with schools, juvenile

justice etc• Other work

• parenting seminars including refugee parent groups• Provide training in family therapy

NEW SOUTH WALES

4

Research- Role of Family

• Family offers a secure base (caring, connectedness and belonging)- linked to positive outcomes (Luthar 2006) (Rayner & Montague 2000)

• Benefits of parental monitoring and limit setting (Luthar 2006)

• Low monitoring linked to negative outcomes: antisocial behaviour, substance use, sexual risk taking (Hayes et al 2004)

• Parents continue to advise and support young adults- parents underestimated their support- highly valued by young adults (Vassallo et al 2009)

• Family Relationships- source of pain for those cut off- desire for connection, deeply held (Dwyer & Miller 2006)

NEW SOUTH WALES

5

Research- Family Therapy

• Family based therapies- among most effective for adolescent substance use (Carr 2009) (Hogue and Liddle 2009)

• Family based treatments effective for depression, eating disorders, conduct disorders, anxiety, school refusal, OCD, grief, bipolar disorder, attempted suicide and somatic problems (Carr 2009) (Cottrell & Boston 2002)

• Multisystemic therapy- effective for delinquency- improved family relations, decrease in behavioural problems and out of home placements (Utting et al 2006)

– (Multisystemic- strength based family intervention- problems are multi-determined- assess range of risk and protective factors

NEW SOUTH WALES

6

Adolescents need

nurturance• Western societies- overemphasis on individuation

of adolescents as though this equates with separation from parents (Mackey 1996)

• Importance of nurturance and connection for adolescents is neglected (Mackey 1996)

• Studies show individuation fostered by connection to parents

• Strengthening relationships between parents and adolescents is essential in therapy (Mackey 1996)

• Secure attachment to parents may lessen negative influence of peers and increase adolescent responding to parental limits (Mackey 1996)

NEW SOUTH WALES

7

Three dimensions of Adolescent Attachment

1. Felt security- firm

2. Use parent for emotional support- warm

3.Parent supporting child’s growing autonomy- enabling

NEW SOUTH WALES

8

Balance of Connection

and Control

control

connectionchaotic

authoritativeauthoritarian

laissez-faire

Baumrind’s Four Types of Parenting

NEW SOUTH WALES

9

Balance of Connection and Limits

• Parents in a position of hierarchy• Children on track when balance between

connection and limits• Parents may need to work more on one

dimension for balance• Issue of parents soft/hard split• Importance of working together• Past issues may lead to separated parents

undermining

NEW SOUTH WALES

10

Relationship Discourse

• Web of relationships- To understand a dyad need to consider impact of other family relationships eg Girl (14) runs away, Fa had died, brother became closer to mother, Mo-Dau more distant.

• Parents describe identified teenager as being of bad behaviour or character eg “He’s defiant” or “She’s selfish”

• By establishing a relationship discourse, through asking relationship questions- family members begin to be seen in terms of relationships

• Shift from ‘bad’ kid to ‘sad’ kid• Asking relationship questions at every session keeps

adolescent- parent relationships central

NEW SOUTH WALES

11

Misbehaving child

• Misbehaving child tends to have lowest scoring relationships with parents

Child misbehaves Parent distances/critical

NEW SOUTH WALES

12

Conducting a Family Session

NEW SOUTH WALES

13

Getting the whole family in

• Always easier to work from broader ie whole family to fewer members. eg harder to get a father in if not there at first session.

• If mo and children there and not partner, therapy work may be undermined at home

• At RAPS, we encourage whole household to come in. We avoid seeing a mother and her children if the father is not there eg may see her on her own to help her to get other family members in eg partner and teenager.

• We explain why we need partner/siblings there- we need their perspectives. We can work faster if we have all family member’s perspectives.

NEW SOUTH WALES

14

• Explain context of agency- confidentiality• Joining- each parent, oldest to youngest child• Concerns- each person • Exploration- sequence, understanding of problem,

or impact of event eg trauma, separation, attachment disruption, relationship questions.

• Break- opinion- affirmations to each, understanding of how family got to be here eg stresses on family, interactional pattern, perhaps task

• Point to areas of work for future sessions

Summary of Stages- First Family Session

NEW SOUTH WALES

15

Family Session-

Concerns• Each person’s experience- not trying to persuade them to see

another’s worry• Ask each parent the worries that have brought them to RAPS• To children/ teenager, “What are the things that worry/bother you?”• To child/ teenager, if no answer or “nothing”-

-“If you were worried about something, would it be more likely to be something at school or home?” Unpack

-If no answer, “Who in your family would most know what worries you?” Obtain from member then check with child/teenager, “How is your mum reading you?” Sometimes children will add a comment.

NEW SOUTH WALES

16

Drawing out children’s concerns

• May need to re-phrase a question to ‘warm up’ child. First response is often minimal. “What worries you?” or “What bothers you?” “If you had 3 wishes and could change things…”

• Draw out children’s experiences- younger children often talk about “the fights”. This releases info to members about effects of conflict on children

• “How do the fights affect you?” “What do you do?”• “Which two people fight the most, then which two?”

and so on

NEW SOUTH WALES

17

Obtaining a sequence

• A behavioural sequence is who did what, when• Introduce sequence

– “Id like to find out step by step what happened the other day when …” (eg worst incident or most recent)

• Start at beginning, before conflict. Ask one person about another’s behaviour- releases more info. “When you said that, what did your Dad do then?”“What did your daughter do next?”

• Focus is on behaviour but can also explore meanings, feelings, beliefs (try to understand what was going on emotionally for each)

• Eg “When your dad said ‘Get out!’ what did that mean to you?”

• Sequence- reveals coalitions, patterns, highlights work

NEW SOUTH WALES

18

Conceptualisation

• What is your understanding of child/teenager’s difficulties?

• Use several lenses- structural, behavioural, attachment, relationship, developmental. – V.Goldner (1990)- each lens can enrich to →

fuller explanation• A structural lens can be a check on psychologising a

problem→ stuck – eg this teenager needs to be at school

• Do the parents need to work more on connection or limits or both?

NEW SOUTH WALES

19

Setting Goals

• To set therapist’s goals for therapy- “If I had a magic wand, what would I wish for this family?” (Dr. L.MacKinnon)

• Like a basketball hoop- need to know where you are aiming. Have tools but must know what you are building (Miccuci 2009)

• Look at goals- where should we start? Where will we get most effect from intervening– Getting teenager into school/work eg addressing hitting

or criticism• Look for links between family goals and therapist’s goals eg

less fighting- no hitting commitment• Use openings

NEW SOUTH WALES

20

Keeping engagement with both parents and

teenagers

• Neutrality (Milan)- on everyone’s side and yet no-one’s side• Lean in equally to parents’ and teenagers’ experiences- be curious

– “You said your mum takes your brother’s side, what does she do to show that?”

– “ You said your daughter is aggressive, what does she do? (Releases information about each person’s behaviour)

• If parents and teenagers start bickering/ getting reactive, get each to talk/look at you, not each other

– To parent/ teenager, “Talk to me, what are you most upset about?”

(Block interruptions, uncover person’s experience through unpacking)

• Teenagers become reactive if parents make negative comments about them or their friends

• Try to keep both parents and teenagers in the room together- may need to split session if cannot be contained

NEW SOUTH WALES

21

Summary- Relationship Scan

• Allow time• Crucial members present• Introduce discussion-it’s not about love, sometimes

closer, other times, more distant• Ask easier relationships first• Ask outside the relationship before inside

- ask relationship description - unpack to build full description- ask closeness scaling question

• Ask inside the relationship • Reflect on low scoring relationships

NEW SOUTH WALES

22

Asking about Parent-Child/Teenager

Relationships

• Ask outside- ask person A, about relationship between B and C – To mother, “How would you describe the relationship between

father and daughter?” Unpack to build a full description– Then scaling question, “Out of 10, if 10 is close and 0 is not

close, how close are they?”• Ask inside- ask person B about relationship with C

– To father, “How do you see the relationship with your daughter?” Unpack and then ask scaling question

• Ask inside- person C about relationship with B– To daughter, “How do you see your relationship with your

father?” Unpack and then ask scaling question

NEW SOUTH WALES

23

Relationship in the Past • When was the relationship different?

eg, When 10 years old?

“ What was the relationship like? ” Ask young person last

• Unpack: “ What do you remember? ”

“ When did the relationship change? ” Nodal point

“ How was it different? ”

• Elicit losses: “ What do you miss? ”

NEW SOUTH WALES

24

Comparison Questions

• “How would you compare the relationship with your mum, to your sister’s relationship with your mum?” “What is different?”

• “How would you compare the relationship with your mum to your friend’s relationship with her mum?”

NEW SOUTH WALES

25

Relationships in the future

• “What sort of relationship do you want to have with your daughter?” What sort of relationship do you want to have with your mother?” (ask teenager last)

• “What sort of relationship do you want to have with your daughter when she is 25 ?”

• Hypothetical questions- “If…”- “If you were to spend more time together, what difference

would that make to your relationship?”

NEW SOUTH WALES

26

Linking behaviour to relationship

• Can explore how changes in behaviour lead to changes in relationship– “You said you have been trying to ‘bite your tongue’

(be less critical) lately, how come?” – “What difference has biting your tongue (change in

behaviour) made to your relationship with your daughter?” Could also ask the other parent as well as teenager

– To parent, “When your son does his chores when asked, what difference does it make to you?” “What difference does it make to your relationship with him?”

• Behaviour is linked to relationships-furthers the relationship discourse

NEW SOUTH WALES

27

Confronting parents

• Use leverage- what motivates parents to change their behaviour

Eg Father who wanted son to gain education

– Parents do not intend to damage their relationship with teenagers

• See parents without teenager to confront-– Can lean into their frustration– Point out link between parent’s behaviour→

effects on relationship and teenager’s misbehaviour

– Gain commitment to not use misbehaviour again

– Bring in teenager, parent shares commitment– Check in subsequent sessions

NEW SOUTH WALES

28

Cup of Anger

• Teenager may be angry about present or past

• Find out about teenager’s anger– “What are you angry about?” Get list and ask

teenager to draw layers of cup (pie graph) on board

– “Are there reasons why you are more angry than other 15 year olds? What has happened to you? What goes into your cup of anger?”

NEW SOUTH WALES

29

Imago- Couple’s dialogue

• Teenager (speaker)Says a paragraph about what is upsetting

(When teenager is fully heard, swap roles)

• Parent (listener)• Mirroring- “What I hear you saying is…”• Validating- “That makes sense to me/ I can

understand that• Empathising- “You must be feeling…(one

or two words)• “Tell me more…”(H.Hendrix and LaKelly Hunt 1997)

NEW SOUTH WALES

30

Guidelines One to One Time

• 1:1 not cancelled because of misbehaviour

- use other consequences

• 1:1 time- not with others present

- ‘low person’ begins to feel no. 1

• Frequent short, better than infrequent long

• My wish- every parent 10 minutes a day with child/teenager

NEW SOUTH WALES

31

Physical Connection

• Teenagers and elderly- least physical connection. eg girl who pinched her mother

• Teenagers need physical connection but may ‘pretend’ to object because of the independent part

• “3 hugs a day” to be healthy (V.Satir)

• Generally, best way to comfort someone is to hold them

• Rituals of connection (W.Doherty)

NEW SOUTH WALES

32

Summary

• Adolescents need a balance between connection and limits from parents to reach adulthood

• Must consider the ‘web’ of attachment- further a relationship discourse

• Importance of seeing parents and children/teenagers together

• Help parents to set limits out of concern• Work to repair connection

NEW SOUTH WALES

33

References

• Allan, D and Power, L (2011) Family Therapy with Adolescents.. In Rhodes, P, and Wallis, A, “A Practical Guide to Family Therapy: Structured Guidelines and Skills”. IP Communications:Melbourne

• Cunningham, PB and Henggeler SW (1999) Engaging Multiproblem Families in Treatment… Family Process, 38, No (3):265-286

• Goldner, V et al (1990) Love and Violence: Gender Paradoxes in Volatile Attachments. Family Process, 29, No (4): 343-364

• Gottman, J (1999) The Marriage Clinic: A Scientifically Based Marital Therapy. W.W Norton and co. N.Y

NEW SOUTH WALES

34

References

• Gurman, A and Kniskern, D (1991) Handbook of Family Therapy

• Hendrix, H and LaKelly Hunt, H (1997) Giving the Love that Heals: a Guide for Parents, Atria Books, N.Y

• Mackey, S (1996) Nurturance: a neglected dimension in family therapy with adolescents, Journal of Marital and Family Therapy, 22 (4), 489-508

• MacKinnon, L (1998)Trust and Betrayal in the Treatment of Child Abuse. Guilford Press: New York

NEW SOUTH WALES

35

References

• Micucci J (2009) The Adolescent in Family Therapy. The Guilford Press: New York

• Rhodes, P and Wallis, A (2011) A Practical Guide to Family Therapy: Structured Guidelines and Skills. IP communications: Melbourne.

• Robinson, E, Power, L and Allan, D (2010) What works with adolescents?... Australian Family Relationships Clearinghouse Briefing 16, 2010

• Sells, S (2004) Treating the Tough Adolescent. Guilford

Press: New York