Engagement and Motivation Phases · Engagement and Motivation Phases With special focus on quiet...

Engagement and Motivation Phases

With special focus on quiet families and high conflict familiesMarch 1, 2017

Julie Elmenhurst, LICSWFFT Therapist, Consultant, and Trainer

Copyright FFT LLC 2016

POST

TREATMENT

MOTIVATION

RELATIONAL

ASSESSMENT

P OOROOEOO

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ENGAGEMENT

GENERALIZATION

BEHAVIORCHANGE

S E S S I O N1 2 3 4 5 6 7 8 +


• Availability• Phone reach out,

• Frequency

• Immediate responsiveness

• Strength-based and relational

• Superficial qualities• Persistence

• Matching

• Enhance perception of responsiveness and credibility

Goals Skills

ActivitiesFocus

Engagement Phase


• Change Focus• Change Meaning

• Strength-based• Relational• Non-judgmental• Respectful

• Interpersonal• Clinical

• Contingent• Responsive

• Decrease conflict• Increase hope• Facilitate

relational focus• Balanced

Alliances Goals Skills

ActivitiesFocus

Motivation Phase:Creating a Context for Change


• Elicit and analyze information about

patterns• Observation

• Within family patterns

• Extra-familial patterns

• Perceptiveness• Understanding

systems and relationships

• Formulate relational assessment

• Plan for behavior change

Goals Skills

ActivitiesFocus

Relational Assessment Phase


Core Values

Family-Based

Accountable to families

• Respectfulness• Non-judgmental• Strength-based

• Relational vs. Individual • Balanced alliances• Matching to individuals,

relationships, family, and environment

• Specific and individualized change

• Fidelity to model


“Match to” clients: Working hard to respect and

understand them, their language, norms, etc

In the Motivation Phase it is “all about them”


FFT is not about creating “healthy” or “normal” families according to someone’s theory or ideal, but …to achieve obtainable changes that will help this family function in more adaptive, acceptable,

productive wayswith their resources …and their value systems…

in their context!!!


Traits

Fearless

• Flexibility• Humble• Compassionate• Warm• Directive

AdvocacyCommittedRelentlessTaking Risks


Decrease Conflict

• Less negative interactions

• Less blame• More positive

attributions• More positive

body language

Instill Hope

• Hopeful attitude

• View they have something to gain

• See potential benefit of therapy or therapist

Facilitate Relational Focus

• Increase family bonding

• Increased sense of familyness


• Sense of being heard and understood

• Sense of being respected

• Viewed with dignity or nobility

Balanced Alliance


Techniques of the Motivation Phase

Change Focus Change Meaning


◦ Process vs Content Do not be afraid of negativity and conflict

◦ Convey understanding, acceptance and respect Via acknowledgement not agreement/validation Via strength-based and relational statements

◦ Be Patient/Try not to Force a New Perspective When family members feel heard and respected,

they are more ready to hear alternatives Don’t get pulled into trying to “fix” the problem


Intervening to do something to interrupt escalation◦ Interrupt by blocking or

intercepting an interaction◦ Diverting flow of communication

Maintain a respectful and strength-based focus


Describing specific steps in an interaction that you observe in the session


Describing interactions or facilitating information about interactions that occurred outside of session


Highlight and point out positive elements in family members’ communications or interactions


◦ Statements that highlight or note a strength about a person in the context of a relationship


Theme hints….1 – don’t take sides2 – don’t tell them overtly that their behavior is “wrong” or

a “problem to be fixed,” 3 – (hopefully) will change the focus away from the “content” of the anger and instead move them to other thoughts, feelings, memories. ..4 – by “hinting” about a possible “cause” (i.e., loss) … even if

the therapist isn’t aware (as we often aren’t in early sessions) of any specific content / history involving

“loss.”


Reframe: Introduces less intense and possibly more benign motives or “reasons” for the negative behavior.

Reframe +: suggests noble but misguided intent with respect to a family member’s negative behavior.


Reframes consist of three simple components:1) Identify and make clear the negative aspects of a

problem behavior / pattern (the one you are going to attempt to reframe);

2) Offer a possible benign (Reframe) or perhaps even noble* (Reframe+) but misguided intent or meaning for the behavior;

3) 3) based on the family members’ reactions (affirming or disaffirming) you refine and elaborate the reframe … or you apologize for “misunderstanding” and move on.


Provide an alternative meaning (experience) of painful past relationship patterns to link the pervasive negative experiences of the past to a possibly hopeful experience of what they may “mean.”

This alternative meaning temporarily provides family members with a sense that they are not defined solely by their past bad behavior(s), but by a shared experience that emerged from misfortune, misguided attempts at positive solutions, and sometimes merely the unfortunate events of living with fewer resources than they need or struggling with others’ mistakes


Plutchik, 1980

◦ Take responsibility – don’t “blame” them or give up. ◦ Acknowledge more.◦ Ask “sequencing” (rather than “blame-

inducing”) and strength based questions◦ Develop new reframes and themes◦ Be more relentless with our hope than they

are with their blame and hopelessness


As the therapist, am I… ◦ Not understanding family

member(s)?◦ Not managing my triggers?◦ Rescuing?◦ Taking sides? ◦ Blaming?◦ Giving up?


We have to make more guesses, and

Be more patient, and Be more active


Therapist may fall into trap of trying to get them to talk.

Doing this risks a subtle (or not so subtle) siding with family members (or authority figures) who are also trying to get this person to talk, or

Siding with people who are angry about the person being quiet.

This reinforces an individual or blaming focus, and This gives the quiet person control over the

session.


How do I make it relational and strength-based?◦ Acknowledge the negativity or blame

(frustration) by a family member (usually parent) that wants the quiet person (usually youth) to talk

How is being quiet being respectful?How is being quiet protective (of themselves or other family members)?Does being quiet represent something other than oppositional behavior?


We have to be more active We have to intervene now We have to be relentless We cannot allow our emotions (hopelessness, frustration or blame) to become part of the process


Use change focus techniques. Focus on process (not content). Focus on (possible) meaning behind

words. Responding to content will put us

on hamster wheel


Therapist may fall into trap of trying to get angry person to be quiet.

Doing this risks a subtle (or not so subtle) siding with family member who is also trying to get this person to stop talking (yelling).

This reinforces an individual or blaming focus, and This gives the angry (yelling) person control over

the session.


How do I make it relational and strength-based?◦ Acknowledge the negativity, blame, or

hopelessness by the quiet family member who wants the angry person to stop talking.

*How is yelling being respectful?*How is yelling protective (of themselves or other family members)?*Does yelling represent something other than oppositional behavior, anger, disrespect? *How is yelling an attempt to solve a problem?


Might this representSadness?Hopelessness?Powerlessness?Lack of confidenceFeeling out of control?Willingness to let other’s needs take center stage?


Develop Balanced Alliance Increase Hope Create Relational Focus Reduce Blame Reduce Negativity

Therapist

Therapist


There may be pros…◦ We learn about risks◦ We learn to whom or to what they attribute the problem◦ They may feel heard◦ We may get information to help make our relational assessments

And there may be cons◦ More blame◦ More negativity◦ More hopelessness◦ More individual focus

So we have to be thoughtful and strategic


Develop Balanced Alliance Increase Hope Create Relational Focus Reduce Blame Reduce Negativity

Family

Family


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