Tertiary Interventions in Family Counseling
When primary prevention has failed, and secondary intervention/screening has helped as much as it can, tertiary prevention becomes the way for the client or the family to receive the specialized treatment that is necessary to aid the situation. Efforts are made to minimize the negative impact of the problem, restore function, and prevent complications. Tertiary prevention aims to lessen the impact of an ongoing illness, issue, or injury that has enduring effects. Examples of such efforts include: rehabilitation programs, chronic disease management programs (for diabetes, pain, depression, etc.), and support groups that allow group members to learn and integrate healthy living strategies. In many health situations, a combination of primary, secondary and tertiary interventions are needed to help people gain appropriate prevention and protection (At Work 80, 2015). Some “prevention experts say that the further “upstream” one is from a negative health outcome, the likelier it is that any intervention will be effective” (At Work 80, 2015).
Sometimes in family counseling situations, it becomes necessary for tertiary measures with one individual member of a family. It is essential for family counselors to be acutely aware of the various systems involved within the family because certain behavioral signs can be indicative of the need for more concentrated help for certain family members. Some signs to be aware of include suicidal ideation or tendencies, addiction issues, and serious medical or behavioral illness. When a family member shows signs of serious behavioral health issues such as symptoms of a personality disorder or psychosis, the family counselor must be aware and able to refer that family member to individual treatment to learn to manage their symptoms (Gurman, Lebow, & Snyder, 2015, p. 672). Family therapy is not the setting to help with more serious individual issues, but it can be a place for the family to discuss how to deal with the issue as a system and how to be supportive to the family member. In addition, Gurman, Lebow, & Snyder (2015) state that “as discussed previously, a violent partner may need to be referred for individual treatment if there has been recent violence or the threat of violence” (p. 623).
Next Steps and Challenges
In my practice, once I have identified any of the aforementioned signs requiring tertiary intervention, I consult with my colleague in my practice to discuss our referral source and identify a few choices that would be appropriate for the individual family member. Once I have the information gathered and available, I speak with the individual after the session to discuss the need for further intervention. I do this before we, together, talk with the family about it. I am cognizant about not making the family member feel bombarded in front of everyone else. There are times, of course, when the family member is not amenable to help, or is in danger or a danger to others. In these cases, it is imperative to maintain safety, and if the situation is unsafe, it is not only ethical but an obligation to get help even without the consent of the family member.
Once a family member begins to receive concurrent treatment, it becomes a challenge to continue the couple/family counseling for a number of reasons. First and foremost, the family member seeing a second helping professional or attending another group/program will be receiving and arriving at insight beyond and above what they may be getting in family sessions since they are in individual care. This can cause said family member to contradict the family counselor if their modality or framework differs than their concurrent treatment. In addition, the family member may expect the family sessions to change or be focused on different items than what they have been as they learn more about themselves and want to utilize that growth to change the course for the family. The family member can also take the victim stance because they feel the support in their concurrent treatment that is focused on themselves, and they sometimes want that same treatment in the family sessions in order to shift blame away from themselves. It is very challenging for a family therapist to navigate these waters, and it often requires a willingness to consult or seek supervision in such cases.