worksheet - amazon s3€¦ · case studies. these pages will compliment your video lesson #2 and...

Module 5: Lesson 2

Your Family’s Top Seed and Symptoms

and Setting the Goals of Therapy

Worksheet

FST Digital Advanced Training Course12 FST Techniques to Become a Family Trauma Expert

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Lesson 2Your Family’s Top Seed and Symptoms

and Setting the Goals of TherapyThis worksheet will help you with templates and rule of thumb tips to better deliver the two mini-steps of Step 3 & 5 within Phase I that support your Lesson #2 video:

Phase I - Identify Symptoms (Stressors) & Set the Goals for Therapy

Step 3: The Top Seed and Symptom Selections

Step 5: Setting the Goals of Therapy

This worksheet is designed to help you:

• Use the template for your family’s seed and symptom picks (Table 1) to help facilitate this part of FST treatment.

• Use the template for the FST therapist’s seed and symptom picks (Table 2) to help you facilitate this part of FST treatment.

• Set written goals of treatment based on the family’s seed and symptom picks, your picks, and the path you are recommending (stabilization, active trauma, or hybrid).

Four Action Steps#1 – �Read�Chapter�5�(pgs.�134-144)�of�Your�Resource�BookPlease read Chapter 5 – pgs. 134-144 (10 pages long). This will provide you with the timing of Steps 3 and 5, along with transition scripts and case studies. These pages will compliment your video lesson #2 and this worksheet.

#2 – �Family�Seed�and�Symptom�PicksAfter completing the seed/tree diagram, the family is now ready to vote on their top two or three seed and symptom picks, with supporting rationale. You will use the template in Table 1.

My suggestion is to pre-write the template on a flip chart or whiteboard and cover it up until you are ready to use it. Not only will this visual have a dramatic impact, but it will keep both you and the family on point.

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After the family’s selections, you, the FST therapist, will present your seed and symptom picks with supporting rationale.

Once this Step 3 is completed, you will use your internal three rules of thumb +1 to decide which path to recommend (stabilization, direct trauma work, or hybrid), and then set the goals for therapy (Step 5).

Transition StatementAs illustrated in Lesson #2, the following transition statement is used before you show Table 1. This statement is used to introduce this step in treatment:

“Now that we have defined all the seeds… I will go around the room starting with ________ [name of child or adolescent] and ask each of you for your top two seed picks with your reasons

And then your top two problems listed on the stress chart that you want to work on first.

For the sake of time, you will list your reasons for your seed picks, but we will not go into detail. We will do that in our next session.

I will write your answers on the flip chart in our seed and symptom pick table. After you are finished, I will give you my seed and symptom picks with my reasons.”

Table 1: Template for Family Seed and Symptom Picks

Child’s Seed & Symptom Picks

Parent’s Seed & Symptom Picks

Village’s Seed & Symptom Picks

#1- Seed Pick: ___________Reasons:

#2 Seed Pick: ___________Reasons:





Top Two Problem Picks (Symptoms)

• •


• •


• •

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Why is this Such an Important Step in Your Treatment?Seed and symptom picks by your child and family represent a monumental departure from traditional therapy. This is because, in traditional therapy, it is the therapist who usually provides the diagnosis after gathering pertinent information from a psychosocial assessment. Then the therapist renders a DSM V diagnosis with treatment recommendations.

In this traditional context, your client is a passive participant. However, in FST treatment, your family members are active participants and asked to be co-detectives in the process. This happens when clients fill out their stress chart and top three problems, then the Toxic Seed Handout, and finally reveal their seed and symptoms picks to everyone in the room. And this all takes place before the therapist makes their selections or diagnosis public.

At first glance, this may not look that significant, but it is. We are giving our traumatized families a voice with a clear “connect the dots” pathway. From this position of empowerment, your families will be much more cooperative and bought in if treatment begins with a collaborative and strengths-based position.

For therapy to end properly, it must begin properly.

Re-Watch AJ and Robin’s Seed and Symptom Picks ( 7:33–13:12)It is recommended that you re-watch the video clip of AJ and Robin, giving their seed and symptom picks. It will allow you to see how I deliver this step. You can then replicate the same process with your family.

AJ and His Family’s Seed and Problem Picks

AJ’s Seed & Symptom Picks Grandparent’s Seed & Symptom Picks

Mom’s Seed & Symptom Picks

#1- Seed Pick: Unhealed WoundsReasons: Dad’s death, uncle

#2 Seed Pick: ImpairmentReasons: Feelings of depression, made fun of

#1- Seed Pick: Unhealed WoundsReasons: Things from past (numbness) relationship with mom

#2 Seed Pick: Misuse of PowerReasons: Not on same page

#1- Seed Pick: Unhealed WoundsReasons: Dad. some abandonment

#2 Seed Pick: Connection with God-Primal NeedReasons: None


• Poor choices • Not always truthful


• Poor choices • Not always truthful


• Not always truthful •

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Important Rules of Thumb in Your Delivery#1-Stick and MoveWhen you ask a child, parent, or extended family for their picks, there is a high risk they will go into too much detail too fast. This can happen even after you tell them not to:

“For the sake of time, you will list your reasons for your seed picks, but we will not go into detail. We will do that in our next session.”

The reason is that clients want to vent. Up to this point in time, they have used a lot of psychic energy to bury their feelings and emotions. So, when given the opportunity to be experts with a voice, the probability is high of anger, frustration, finger-pointing, and blame will emerge in rapid-fire succession.

As a result, you must be poised at the edge of your seat to cut the family member off, redirect, reframe, or block. In essence, “stick and move” (see Module #2, Lesson #2, Worksheet for more information). If you don’t, your session will quickly escalate out of control with raw emotions. Once this happens, you will lose control of your session, and it will end badly.

#2-Summarize, Track, and ClarifyYou need to summarize, track, and often clarify with this simple statement:

“Let me see if I am tracking you. You said ________ [insert their seed pick or problem symptom here] am I close or way off?”

This simple statement not only allows your family members to feel heard, but if you miss something important, you can self-correct in real-time. And it helps slow down the process.

Finally, if your assumptions are incorrect or you heard your family wrong, the implications are that it can negatively impact your seed and problem picks and goals for treatment. For example, the child might be talking about “abandonment” as their problem or symptom pick, and you might have misheard it as “not feeling heard or disrespected.” The child and family may then be too polite or nonassertive to correct your error. If this happens, your recommendations for treatment may be incorrect.

#3 – �The�FST�Therapist�Seed�and�Symptom�PicksAfter the family’s seed and symptom picks, it is time for you, the FST therapist, to make your selections with supporting rationale. Here is the transition statement used:

“Thank you for your seed and problem list. I will now give you my picks with my reasons why. I will then take these picks and convert them into what I call “the

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goals of therapy” or what we want to accomplish together to help your child or teenager and heal their wounds, as well as the rest of the family’s wounds at the same time. Let’s begin with my top two seed picks, and why I chose them.”

As with your family’s seed and symptom picks, you will also use a written template (see Table 2) on a flip chart, or dry erase board. Your template should be ideally placed side by side with your families. This will allow your family an easy visual compare and contrast. To help further clarify this process, I placed a blank template next to a sample completed one side by side in Table 2.

Table 1: Template for Family Seed and Symptom Picks

FST Therapist’s Seed & Symptom Picks

FST Therapist’s Seed & Symptom Picks Example

#1- Seed Pick: ________Reasons:

#2 Seed Pick: ________Reasons:

#1- Seed Pick: Mental and Physical ImpairmentReasons: As soon as mom’s depression hit, she shut down. After she shut down, Max felt as though he needed to take on the parent role and take care of his little sister, Jamie.

#2 Seed Pick: Unhealed WoundsReasons: Everyone picked this seed, and I also see multiple wounds in this family. Max and his sister not seeing their dad, mom’s depression, and Max’s worry about mom and subsequent feeling like he had to step up and take on the parental role and take care of Jamie, being placed in foster care. Dad’s wound of his “lost” kids and mom’s wounds from the divorce and feeling a lack of support. And Max not knowing how to deal with his grandfather’s health issues.

#3 Seed Pick: Misuse of PowerReasons: Because of the wounds and Max stepping into the parental role, it is normal for a child to overtake the authority and take charge of the household eventually. Max did not do this in a mean-spirited way; he just adapted to the situation. Over time, though, the lack of limits led to an imbalance of power.


• •


• Safety Issue to stop the bullying in school • Limit setting around any disrespect and to ensure no aggression

with pets or sister

• Possible Bonus – Meet with mom and dad to set up special outings with dad with clear parameters to rebuild trust and in accordance with the CPS plan

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Important Rules of Thumb in Your Delivery#1- Deliver Your Picks with Charisma, Enthusiasm, and Confidence

This is a dramatic and important moment in treatment. It is like you are a famous trial attorney. You will win or lose your case depending on how good your closing arguments to the jury. Or a great actor in the closing scene of a Broadway show.

Great trial lawyers and great actors get paid big bucks when they can deliver a closing argument or scene with charisma and are convincing. When I watch the video of this part of treatment in supervision, it is either a dud or a stud. If the FST therapist lacks energy or confidence, their seed and symptom picks fail to inspire. And an uninspired family goes nowhere. They will not follow you, the FST therapist, out of the tunnel and onto the field.

So, remember this. You must deliver your seed, and symptom picks with confidence and high energy. Get up and move around. You cannot just sit in your seat.

#2- Use Your Props and ChartsSo many FST therapists I see on video fail to use their props and charts. For example, if I am delivering the seed of unhealed wounds, I dramatically point to the family members’ seed and symptom chart next to mine who agreed with me. Or I will dramatically point to the top three problems on the stress chart that align with my symptom picks. I am LITERALLY and VISUALLY connecting the dots and telling a story.

And my secret weapon is a laser pointer. Family members love the drama when I pull out of my back pocket a laser pointer and start to literally connect my picks on my template in Table 2 with their picks with a red laser. I will even point the laser on their body (not the eyes) when I am connecting my story with theirs. For example, in my pick of unhealed wounds in Table 2, I could say something like:

“I picked the seed of unhealed wounds for two reasons. First, everyone in your family picked it and did a fantastic job supporting this pick. I look at your stress chart [point to it with your laser pointer or finger], and I see what Max said about his worry for you, Mom, and the stress from going to foster care. And I see, Dad, your whopping 80% stress reduction if you could reconnect with both kids.”

#3- Keep the Rationale Simple, and To the PointYou can reveal your pathway recommendation (stabilization, active trauma, or hybrid) at the end of your picks. This can be a great transition. But as you provide your picks, you do not want to not go into long explanations or go into the weeds. Even though in Table 2,

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I illustrated the reasons in writing, it was done only to illustrate the process. But when you are in the moment, say your reason succinctly and to the point. I may write short bullet points answers to my rationale but not waste everyone’s time with writing down complete sentences. Be short and to the point like a great trial attorney in front of a jury. The jury, in this case, is the family you are trying to convince to follow your leadership.

#1- Seed Pick: Mental and Physical ImpairmentReasons: As soon as mom’s depression hit, she shut down. After she shut down, Max felt as though he needed to take on the parent role and take care of his little sister, Jamie.

A Vote of “Yes” or “No”After your picks and rationale are presented, the family is asked to vote “yes” or “no” on your picks using this transition statement:

“Before we move on, I just wanted to pause and go around the room to ask each of you if you agree with my seed and problem picks with a simple ‘yes’ or ‘no.’ If you disagree, no problem, it will not hurt my feelings. But if you disagree, please tell me and tell me why. I want to find out why because I don’t want to set the goals until we are on the same page. Does that make sense?”

You, as the FST therapist, must have this litmus test before going forward to know if there will be a battle for structure or not. And the therapist does not want to recommend a path to take (stabilization, direct trauma work, or a hybrid) or goals for therapy unless key family members are on board.

Otherwise, the family and therapist are working at cross-purposes. The must-have and yes votes are needed from the parents or caregivers, caseworkers, or probation officers. These are the individuals who have the power to return the child or adolescent back to further treatment. The “nice-to-haves” come from the child, adolescent, and siblings.

If a “no” vote comes from one of these nice-to-have individuals, it may be because they intuitively know that the family might be changed in a way that might limit their current power and authority. Another reason might be that the child or adolescent does not yet trust the therapist.

Nevertheless, if the parents like your seed and problem picks, they will almost always return, and the child’s “no” can change into a “yes” later as he or she sees the positive changes in the family.

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#4 – �Setting�the�Goals�of�TreatmentSetting your goals for treatment in a clear and written format is arguably the most important step in the entire FST treatment model. If your goals are unclear and there is open disagreement over the goals of therapy, treatment ends here before it even begins.

You must also navigate the choppy waters of assuming the role of “system irritant” to realign your stuck family with the normal paradox of the family communicating that they want to change but also stay the same.

To begin this final step in Phase I, the following transition statement is used:

“Thank you for the vote of confidence on my seed and problem picks. I will now translate these into our goals for our work together. Here are our next action steps to solve the problems you told me on your stress chart that you want to heal with [child’s or adolescent’s name]. I am simply going to write them out here for all to see. [Write them out.]

People do well with clear goals that are written rather than verbally stated. As the following example illustrates, the goals should not be “clinical,” but written in easy-to-understand everyday language.”

Re-Watch AJ and Robin’s Seed and Symptom Picks (17:25–20:45)Re-watch the video clip of my clear and written goals with Ruby’s family.

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As illustrated in the PowerPoint slide, there are three important steps

1. Goals are written, not verbal – Too often, our goals are either verbal or unusable for the family but mainly for insurance or agency purposes (i.e., the client will make 2 positive self-statements about themselves per week).

2. The Recommended Path is Stated – Here, you state with the rationale the recommended path. In Ruby’s family, it was to (a) Stabilize and (b) Emotionally warm-up or a Hybrid approach.

3. Next Action Steps – You will see in your Resource Book (pgs. 150-152) and in your next Module (Module #6- Engaging the Extended Family) the next action step is to determine with the family who needs to attend the next session for maximum impact, or “who?” before “what?”. This is called “Engaging the Extended Family.” In other words, to make these written goals possible, it is critical that the right people in the immediate and extended family attend using this transition statement:

“Based on our goals and your stress chart, who do we need to come to the next meeting? [List them.] And secondly, based on what you saw today, who was not here that should be here? To make these questions super easy to answer, let’s take a few minutes to fill in the village handout together. As we do this, it will become clearer who should come.”

In the next module (Module #6- Engaging the Extended Family) ,you will see how this “village handout” is used and works. So, for now, it is important that you just practice this action step of writing your goals of therapy in clear and written terms with your next family.

Congratulations! You are now ready to go to:

Lesson #3 and Worksheet #3 to use these tools to practice with Sandra’s case consultation.

Success MilestonesAfter you complete this Lesson #1 worksheet look for these success milestones to see immediate positive outcomes in your practice:

✔ Master the Art of Visual Templates – When you use Tables 1,and 2 with your next client or family watch the magic happen:

• Your clients or families will literally tell you something like, “Wow, I love this. It’s written, it’s clear, and it connects all the dots. I have been in

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treatment for years and never left a session or meeting with this much hope and clarity!”.

• It will help you be clearer and more focused. The templates are literally like a “paint-by-numbers” to instantly cut through the white noise of your multi-problem families to get right to the heart of the matter and a clear success path.

✔ Expand Your Range – Let’s face it. Most of us are not Meryl Streep’s or Al Pacino’s. And we often lack a flair for the dramatic. If you take my advice (and buy a laser pointer) and just try the dramatic with your seed and symptom picks along with setting the goals for therapy, you will absolutely love the results! But just like Meryl Streep was not born a great actress, you can’t expect instant results. So, if you try and fail, no big deal. Try again and again until you get better. It does not have to be great to move your family. They are desperate for hope and a clear road map. Therefore, a little will go a long way.

Big Ideas: Lesson 2 VideoTransition Statement: How to Set Up The Families Seed and�Problem�Picks

✔ In Step 3 of the FST Model, you will be asking your family members for their seed and problem picks before you give your picks with a recommendation of stabilization vs. active trauma first path.

✔ You saw the transition statement you will use that is listed in your resource book on pages 137-138 and how it is illustrated with AJ and his family.

✔ You also saw an interesting sidebar with AJ’s family therapist and how he reacts to this kind of structured script.

Child�and�Caregiver:�Top�Seed�and�Problem�Picks ✔ Here you saw the give and take process between the FST therapist (me in this

case) and asking each family member for their seed and problem from their Toxic Seed Handout for Module 4.

✔ AJ lists off his picks as Unhealed Wounds and Mental Impairment and Robin, the grandmother, lists her picks as Unhealed Wounds and Misuse of Power.

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FST�Therapist�Recommendations�and�Goals�of�Treatment ✔ Here you saw my seed and problem picks with both AJ’s case and Ruby’s case.

✔ First, you saw my seed and problem recommendations for AJ, along with the transition statement.

✔ And second, you saw my picks with Ruby and the goals of treatment.

✔ The video case examples underscored how important it is to have clear and written goals at the end of our assessment phase. We often tend only to offer a DSM V diagnosis or something verbal. But our clients and families crave and want written goals.

Please Note: Materials that are included in this course may include interventions and modalities that are beyond your authorized practice as a mental health professional, case manager or parent support liaison. As a professional, you are responsible for reviewing your scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

worksheet - amazon s3€¦ · case studies. these pages will compliment your video lesson #2 and...

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