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6 The New Social Worker WInter 2015
In the Field
I hate doing family therapy!” a col- league of mine once said during group supervision. She was sitting
across from me, and even though her comment was harsh, I could see in her eyes and expression that it wasn’t anger coming through, but frustration and despair. “I’d rather meet with the kid individually than to deal with the chaos that is going on at the kid’s home.” She finished her statement, and everyone else in the group nodded in agreement. This, my fellow social workers, is how some of us have come to view family therapy and treatment—as a burden! I started out wanting to save the world—not unlike many other social workers who make the arduous jour- ney through rigorous undergraduate and graduate work. And, like others, I thought that if I could just impart my clinical understanding and cultural expe- rience with people, I could cure mental illness and save individuals one session at a time. But, as I settled into my first position out of graduate school—a com- munity mental health agency providing services to children and families—I began to realize how ill-prepared I was to begin working with the populations we all had our hearts set on saving! For many new social workers, work- ing with families has become an uphill struggle fraught with missed appoint- ments, hard-to-reach parents, children who can only be seen during school hours, and family members who some- times undermine the clinician’s treat- ment with their own views about mental health. Still, families need help and new social workers are trained to help—so how do we mix the two?
The Do’s and Don’ts of Family Therapy Family therapy is a type of group psychotherapy that involves the treat- ment of two or more family members during the same session. Sounds pretty easy, right? Just provide the same type of
treatment you would give an individual to multiple people, right? Well, not quite. Families have their own culture that includes not only gender, sexual orientation, race, and socioeconomic status, but also themes, roles, myths, and a developed family concept that perme- ates all treatment. They have a resiliency that allows them to “absorb the shock of problems and discover strategies to solve them while finding ways” to meet the whole family’s needs (Van Hook, 2008, p. 11). But it can be tough and challeng- ing to engage families, and it requires a clinician to have “a willingness to ap- proach your anxiety” (Taibbi, 2007, p. 4).
DO Understand the Family’s Identity One of the main things that you must do when you begin family work is to look at how families identify them- selves. A common mistake of most new social workers is to look at the family through the lens of services the family has or their current living situation. The best way to learn how a family identi- fies itself is to simply ask: “Would you say that your family is close or distant?” “Can you detail everyone you consider ‘family’?” You’d be surprised by the answers you receive that can help inform treatment and give you a chance to use informal supports to help the family.
DON’T Chase Chaos When working with families, one of the many barriers that tend to arise
is that they have an uncanny knack for pulling clinicians into their chaos. It can be even more difficult to avoid the chaotic atmosphere of a family when you are doing home visits. The best remedy for managing the family’s chaos and your own anxiety is this: develop a concrete, succinct treatment plan that details each family member’s role in treatment and each family member’s goals for treat- ment. As families begin to succumb to life stressors, it will be easier to redirect the family back to the treatment plan and even link the family’s stressors with what they are working on with you.
DO Respect the Family’s Current State As new social workers, we have a tendency to want to tell our clients what to do—not in an offensive way, but in a naïve, overtly helpful way that allows us to share our information and train- ing. Although that’s all well and good, it does not serve the family, nor does it help develop the therapeutic alliance you’ll need to do deeper work. Being able to respect where each member of the family is in his or her current level of functioning and being able to speak to that level of functioning will show that you are not there to run the fam- ily’s life, but rather you are there as a support for the family to heal and grow. When you are feeling tempted to give suggestions to the family on ways to im- prove their functioning, a good rule of thumb is to ask: “Can the family sustain this suggestion without help from me?” If the answer is no, then be patient as the family develops a new understand- ing of its current challenges and the solutions to them.
DON’T Judge the Family’s Current Skill Set When working with families, it’s of- ten easy to see the patterns and decisions that have led the family to its current state of functioning. We are trained to see
Doing Family Therapy as a New Social Worker: The Do’s and Don’ts
by Mercedes Samudio, MSW
The New Social Worker Winter 2015 7
the systems that affect families and are given the tools to set the family on the right course. But hold on, grasshopper! Being able to be present with the family exactly where they are and guiding them to be a functional family is a very fine line, and it all starts with honoring the family’s current set of skills. Van Hook (2008) suggests that the clinician’s role in the family is to join with the family and enable its members to experience new ways to function. Through your work with the family, they will begin to prac- tice new behaviors. But you have to do one more thing before you can just jump in and get to practicing new skills.
DO Develop a Therapeutic Alliance
Remember in the last paragraph when we talked about joining with a family so they can begin to experience a new way to function? Well, that all occurs when you are able to build a therapeu- tic alliance with the core family and its extended support systems. The therapeu- tic alliance will help create a safe space where each family member can not only practice new skills, but also process bar- riers to mastering those skills. This is the part that many new therapists get hung up on—being able to actively engage with a family that may be resistant to treatment. A few key ways to develop a positive alli- ance, or join, with the family include: • Being on time and present during
the session; • Actively listening and asking for
clarification instead of assuming; • Being flexible with the family’s
schedule; • Delivering value to the family by
triaging needs (remember Maslow?); and
• Allowing the family’s voice to be heard in treatment.
DON’T Ignore Cultural Influences The buzz word of our profession is cultural sensitivity, right? And, more than likely, each class in your graduate program expected you to take a cultural perspective in applying theory to prac- tice. But as you work with families, the cultural lens has to become one of your sharpest assessment tools. Looking at everything from race, gender, and socio- economic status to religious ideals, family rituals, and external support systems will
help you get a good picture of a family’s culture. I encourage new clinicians to not get hung up on what they think are going to be cultural barriers. Take inven- tory of your own ideas about culture and process them in supervision so you can come to families ready to hear and observe their cultural perspectives. One suggestion is to do a cultural assessment of a family that goes deeper than the intakes you perform in your agency. In this assessment, be sure to include all the aforementioned items, as well as the fol- lowing aspects of a family’s culture: • Previous negative experiences in
treatment; • Coping efforts and beliefs about
hope; • Family organization (communica-
tion, leadership, roles); and • The family’s basic needs.
DO Develop a Strategic Treatment Plan Going back to making sure that you do not get caught up in the family’s maladaptive level of functioning, making sure that you have a strategic treatment plan that details the goals of treatment can be one of the keys to facilitating successful family therapy. The treatment plan should illustrate a clinical loop: assessment, diagnosis, goals, and termination. In the assessment, you’ll gather all the important information about the family (history, resources, needs, and commitment to treatment). Next, you’ll assign a mental health diagnosis to the identified patient (usually the person on your referral) that you establish from the assessment. Then, you’ll use the assessment and diagnosis to create a goal that will help the fam- ily decrease symptoms and/or increase coping strategies. Last, you should discuss termination in this plan, so you and the family understand that treatment is not indefinite and will eventually end once goals are met. This clinical loop will help you to assess the progress of the fam- ily’s treatment and allow you to pinpoint where adjustments need to be made as you traverse through treatment. Another benefit to developing a strategic treatment plan is that you can use the plan to discuss the family’s symptoms and progress ef- ficiently during your supervision.
DON’T Underestimate Your Countertransference We all come from families. And if truth be told, a lot of us came into this
field as a result of our experiences with our own families. Honoring this truth can help you build a therapeutic awareness, so you can begin to understand your motivations and difficulties in providing effective family therapy. When we work with families, it’s not always obvious where the barriers to treatment can pres- ent themselves. As clinicians, we have a tendency to look to the families we work with to find answers to barriers in treat- ment. However, we can also look within ourselves to see that our own perspec- tives, experiences, and beliefs about families come into the way we provide services to families. It is important to discuss this countertransference with your supervisor, to rule out whether your experiences are shaping the treatment of the families you serve. And it is impor- tant to be honest with yourself about how your own family history and experiences motivate your work with families, so you do not force or undermine a family’s treatment. The work we do with families can be transformative and life-changing. Whether you’re partial to family work or not, thinking about these Do’s and Don’ts as you serve families will give you a framework with which to do effec- tive, meaningful work in our communi- ties.
References
Taibbi, R. (2007). Doing family therapy: Craft and creativity in clinical practice (2nd Ed.). New York: Guliford Press.
Van Hook, M. P. (2008). Social work practice with families: A resiliency-based approach. Chi- cago: Lyceum Books.
Mercedes Samudio, MSW, is a family/ parent coach who has been work- ing with families for more than six years helping them achieve results in parent-child bonding, decreasing power struggles, and developing effective discipline strategies that foster strong, nurturing relation- ships. She received her MSW from the Univer- sity of Southern California. You can read more about her parenting philosophy at http://thepar- entingskill.com.
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