Class 9_Family interventions

Class 9_Family interventions - Emmy INTERVENTIONS M. In...

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Unformatted text preview: Emmy INTERVENTIONS M. In some flimilies words are like barbed wire, they cut and puncture. in some families messages are like exploding shrapnel, they rip and tear. In some families secrets are like land. mines, step on one and they emth in explosion. in some families even love and affection are tools in the battle. All war, especially the war in families, is at once howible and. dehumanizing and obscenely senseless. 302 CHAPTER l5 Family interventions 303 CHAPTER OirrLiNE BOX lil ’I‘Hl‘i‘. SCHOOL SLUT Multidimentional Treatment Foster Care Parent Education and Training bAMlLY COUNSELING 'llhe Premacle principle Referring the Family for Counseling Logical consequences BOX 1 5.2 EN ‘WiE WAI'T‘iNC ROOM . Family Effectiveness "Training The Nature of Family Counseling go); 154 my YOUR DINNERT, Strategies in Family Counseling _ [351mm Effectiveness Training Problem ownership Active listening Sending inmcsscges Ar’risanarivns AND Aortincrs TO FAMILY COUNSELING BOX 15.3 rsrncwras or srrarrnvas roam Mutuai problem 801,,ng ‘ rocosrzri iN'r'sRvaN'riONS Parent Support Groups Multisystematic Therapy The Family Checkup CONCLUSION As discrissed earlier, the nature of the family structure is shifting in response to changes in social, political, and economic conditions. More and more families are called upon to deal with the stresses of divorce, remarriagc, stepchildren, and the loss of the extended family network. Even negotiating the inevitable developmental changes that are part. of the family life cycle can be highly stressful and can generate family conflict. Sometimes the symp“ toms of family distress emerge when a reasonably healthy family goes through a difficult _ transition, such as the marriage of the first child. in other cases family symptomatology reflects ongoing dysfunction and emerges in response to everyday stresses. l To illustrate, a father might abuse alcohol for several weelrs following a layoff, then engage in productive coping strategies, adiust to the new situation, and return to his pie-layon nonproblematic level of drinking alcohol. Another father may consis- tently go on alcoholic hinges: whenever the extended family gathers, when the mother confronts him, when the children fight, or when the traffic is heavy. The patterns of behavior that the various family members use to cepe with the father’s drinking may in themselves represent symptoms of family dysfunction. For example, particular roles are frequently assumed by family members with an alcoholic parent (Brooks dz Coll, l994; Devine 8: Braithwaite, 1993:). The scapegoat role is played by a child who acts out {fighting in school, setting a fire, failing a class), thus drawing attention away from the alcohol problem. The parents temporarily unite while they deal with the “problem child.” Sometimes the youth whose behavior appears self«destructive and irrational is actually trying to help a family. member. This also inadvertently serves to perpetuate dysfunction (see Box l5. When teachers and counselors become frustrated by the destructive and aggressive behaviors of their students, it is helpful to keep in mind that these behaviors are often goal directed and represent attempts to meet needs (see our discussion of goals of misbehavior in Chapter 9}. Much behavior originates in response to the family dynamics to which the students return every night. 1304 PART 4 Prevention, Iniervemion, ond l’reoirnen'r Approoc'nes i l 5. l g the School Slut wos orwoys ongry with nor, Every 0139 i I lotion oi cortew orew llK'S‘ tires to outta, our the-— toiling grades, lit-2r rooolorron os rho ond inc-r consronr bottles were oll worth a. Bocousc as long os his ori-onrron woe g rocusao tars ongor wrr , ii would bo Gil'ECiE—id o1 her , Anti ; - i , r , i l llQ-fi wool-t rit come into hot srsror coor’m“ \NDUth‘i : ‘ rioro loosi— long rzigi s, llirj—i hideous emptiness, tine vomiting olrorword, fist loost, This ran-cl? stir»: could control. ~ : , - - r r , , r, , _, l and loot ono rooson the iogo ovorwliolrrieo ond consumed ‘Ci yeors rotor: rhor :3 l a worse so tore‘onirol {not her whole body convolsod with ogor‘y, sit-3r sozd, r1 wos nopponrog to ma too l l it is a mistake, however, to attribute all studci‘it problems to some growing malevo~ lcncc in tlic American family. As we have indicated, the tairiily is changing in response to societal trends over which the individual family has little control. Society too often appears eager to blame families for individual problcn'is, as evidenced by attempts to solve those problems by “fixing” families. Blaming familics diverts attention from the fact that our society lacks a coherent national family policy and that this structural supports rcquircd for family life are grossly inadequate (Kagan dz Weissbourd, l994; Lott, 2002). In this chapter we describe: intorvcntions for individual families as one point of entry for addressing the problems of youth at risk. These interventions are family counseling, parent support groups, parcnt education, and parent training. FAMILY COUNSELING working with the entire family is often thc optimal approach for dealing with young pcoplc at rislr for dropout, substance use, pregnancy, delinquency, suicide, or other problems. Wlicn a child or adolescent is contemplating or engaged in life-threatening behavior, it is of utmost importance that the family be involved in efforts to avert the problem. in general, family counseling is appropriate (at) when the presenting problcrns are affected by and affect the family system, (l3) when the child or adolescent is living in the family or is working through unfinished business with the family and is in. contact with them even though. not living at home, and {c} when both the counselor and the client agree that family counseling is an appropriate intervention. Family counseling is not always a viable option. Tho following questions are often considered. in exploring the option of family counseling: Does the family have resources sueli as transportation? Arc there any language or cultural factors that might prohibit or dis— courage the family members from availing themselves of counseling services? is the family willing and able to commit to attending counseling sessions? ls there a family member who has access to counseling services through an employee assistance program or some other y ' CHAPFER 5 family interventions 305 work benefit? Discussion of these questions and familiarity with community resources will set the stage for appropriate referrals. Referring the Family for Counseling For many family members, attending a counseling session is tantamount to acknowledging severe mental illness within the family. When a teacher or counselor believes that a partic— ular family might benefit: from family counseling, several steps can be taken to lay a founn dation for success. First, the family needs to know why. On what basis has the referring professional made this decision? The identified problem—that is, the behavior of the child that attracted attentionwshould be explained in specific and concrete terms. For example, Lidia Diaz’s teacher (Chapter 3) might say: “For three weeks now, Lidia has been witl‘idrawn and quiet. She seems to be avoiding her school friends, she’s refusing to participate in class, and she has cried at school three or four times this week. When i asked her how things were going at. borne, she simply stared at the floor and said, “It's probably my fault anyway.’ This is so different from Lidia’s usual behavior that i thought it was in‘iportant to contact you to talk about some possible ways to help her.” Notice that Lidia’s teacher does not assign blame or sound judgmental; nor does she draw conclusions from her observations. : A second step in family referral is to help the family understand that family coun- seling may help in the achievement of mutual goals. Counseling provides an. opportunity l for the family to work as a cohesive unit; the needs of all family members are considered in developing solutions to problems. Potential benefits include more appropriate behavior . by the “problem child,” increased responsibility among family members for voicing their - opinions and feelings, better grades for the children, and more support and less stress for all family members. The teacher or counselor who knows the general. nature of the prol — lem can identify the benefits appropriate to the specific situation. Family members are often more accepting of recommendations for counseling if a they have a sense of what to expect. When lason Carter ( of Chapter 4) was first seen as a y client, he asked the family counselor, “Where’s your black couch? Aren’t you going to write down everything 1 say?” Adults, too, may have misconceptions. The teacher or counselor i can dispel some of the mystique surrounding counseling by discussing some of the common reasons families go to a counselor and what the process might be like; Common reasons include problems with discipline and communication, lack of trust among family , members, school problems, and tension related to divorce, dating, or remarriage of a _ parent. There are marry approaches to family counseling, and individual therapists vary in style even if they ascribe to the same approach. Families should be encouraged to ask potential counselors, “What do you expect of your clients?” “How long have you been practicing, and what are your credentials?” “What can we expect ofyou?” “How do you structure your counseling sessions?" "How can we make best use of our time and money here?" "Do you have experience working with families like ours?” A family that has a sense of its own role in the therapeutic process may be more willing to con— sider the option of counseling. Some families resist counseling because they are unsure how to begin the process. Let them know that once they call for an appointment, it may be anywhere from a day to a month or more before they have their first session. This first session may be an intake session during which a counselor gathers information about the family’s background and history. The family may work with the intake counselor and in later sessions may be 306 PART. 4 Prevention, intervention, ond Treatment Approaches ‘WOW‘: (I Oi i.r1ri<Tlit‘tggi in the _ ' I: seriously iii tutors. i'riroorirj clement was . .J t . aid ieri iii in (3.: come-r '~.rvoiting to he ' noti behind the: recreation dost reelized who? . z t . g . . . . v-v'onur-zrec'l why she hurt not opproocheo them to {35K tor ossssicoce e do not C; 2 too-Ch o moioriiy a or: : without hrs: . l3 . . c. assigned to a different counselor. if families are unprepared for this sometimes drawnwout process, they may hecorrie frustrated and discontinue prematurely. Some parents rriay want to meet with the counselor first without their children. Sorne counselors may request such an arrangement; others may refuse it. This decision depends on the theoretical orientation and judgment of the counselor. Encourage parents to let the counselor 1know their preference. "Teachers and counselors are more likely to be successful in referring families for counseling if they are lo’iowledgeahle about a variety of local counseling agencies and pracw titioners. it is especially important to make referrals that are consistent with the family’s cultural and language needs. The importance of multicultural competence is increasingly reflected in professional ethics codes and accreditation standards, but all'counselors do not have multicultural training. And certainly marry agencies do not have counselors fluent. in languages other than English, When a counselor or teacher approaches an ethnic minor" ity family, it is irnportant to consider that counseling as We know it has historically been a Western, White, i'niddlew and upper—class phenomenon. Recent immigrants, in particular. will need a thorough explanation of the nature of counseling and may need time to conw sidcr whether it is consistent with tl eir cultural values and practices {see Box 5.2). When referrals are made for farniiy counseling, the family should be provided with accurate information about agencies and practitioners, including addresses, phone nurnm hers, specializations, and whether the agency adjusts fees to the client’s ability to pay. Follow up with the farnily and find out what. might help them to take action if they h aven’t followed through with the referral. For those who follow through? ask for feedback regard— ing the counseling facility for the benefit of future families. The Nature of Family Counseling in family counseling, problerns are examined within the context of the family interactions, or system. 'Prohl ems are viewed not as the result of individual issues but the consequence of the complex dynamics that characterize every family system. Often, the family comes to a counselor expecting that the “problem child” will be fixed. The family counselor’s first task is to assist family members to recognize that a family system is composed of a number ! i l Strategies in CHAPTER i5 i-‘omily interventions 357 of both positive and negative interlocking relationships. Family members must be helped to understand their contribution to the maintenance of the identified client’s symptoms. Finally, the family must agree to work together to change their situation. Working with the entire family is advantageous in many ways, it enables the counselor to establish a more accurate perspective on the problem. The counselor may discover, for example, that what has been described by a l5«year-old son as cruel authoritarianism is a belated attempt by his parents to impose control over curfew limits and homework completion. A mother who describes herselfas loving and affectionate may truly believe she is sow—in comparison with her own unavailable and hostile mother, But the objections and disagreements of her family can be a way to clarify the words loving and affectionate and the expectations that surround them, Watcl‘iing argur'nents in progress provides the counselor with a picture of the family’s interaction that no series of descrip tions could convey. In addition to enhancing problem identification, working with the whole family makes problem solving more cohesive, efficient, and timely. The outcome of family counseling depends on many variables, including the therapist’s skill, the will irigness of family members to exert effort and take risks, their willingness and ability to take responsibility for their behavior, and the range of coping skills they possess. Family Counseling in the l9503 Gregory Bateson and others at the Mental Research institute (MRI) developed a com munication framework for working with families. Focusing on the family as a system (see Chapter 4), family counseling attends to the interactional styles of family members. Notable members of this group include Paul Watzlawick, lohn Weakland, and Don Jackson, as well as Virginia Satir and lay Haley. lackson, Satir, and Haley, and to some extent Murray Bowen and Salvador Minuchin and most other system family theorists, share four core concepts: ( l) two maior tasks are involved in the process of forming and maintaining a relationship, deciding what the rules of the relationship are and negotiating who actually makes the decisions regard- ing the rules; (2) the exchange of messages is accomplished through the task of setting rules and negotiating who has control over the rules; {3) the basic elements of the interactional process are the messages that form the substance of communications between people in the relationshipjand, finally, (4) messages have two major aspects, the communication {the con— tent of the message) and the metacommunication (the message about the message). Thus family counselors attempt to understand the family by analyzing the communi- cation and metacommunicai‘ion aspects of the interactions. They identify problems through observation of the family’s interactions, including such behaviors as seating arrangement, control of the children, who speaks most and least frequently, and so forth. They also some- times employ techniques that include “paradoxical messages” and “prescribing the symp- tom.” Paradoxical messages direct. the family to do something that seems opposite to the stated goal; they are particularly useful with resistant families. For example, a family might be directed to refuse to cooperate during a session. The family has the choice of either coop— erating (to maintain control vis-a~vis the counselor) or continuing their lack of cooperation and thereby give the counselor therapeutic leverage because they are following a directive. The counselor who prescribes the symptom asks the family to continue their prob- lem behavior, perhaps because “1 don’t yet understand it well enough." This technique is also beneficial with resistant families because in order to resist they must change their problem behavior. Relabeling or reforming consists of describing the problem behavior in 30% PART 4 Prevention, intervention, and Treatment Approoches such a way that makes it sound positive. A therapist might relabel an adolescents use of foul language, for example, as a creative way of directing her parents’ attention away from her school performance. After establishing that. this teen is creative and purposeful, the theraw pist can draw upon her creativity to devise more effective means of getting what she wants. Other family counselors focus on the structural context of the family interaction. They examine the organizational dynamics and boundaries both within the family system and between the family and the environment. Boundaries can be seen as a manifestation ofthe rules and regulations governing the system and separating the system from its envi— ronrnern. How the family regulates and modifies these boundaries is of interest to the family counselor. Two fundamental concepts are “differentiation of self” and “triangulation.” A chronic high level of anxiety within a family causes tension to escalate. If unchecked, this tension eventually exceeds the capacity of the family’s normal coping mechanisms, and a vari» ety of family symptoms result. Differentiation of self is the individual’s ability to discriminate between emotional and cognitive processes and to achieve independence from the emotional climate of the family. Highly differentiated family members can respond to conflict on a cognitive. level on the basis of conscious beliefs and values, whereas the undifferentiated individual responds in an emotional and unstable manner. The greater the differentiation of self, the more effectively the family member can cope with anxiety, T he ailure of family men‘rbers to differentiate is termed “fusion.” Fusion, that is, a low level of differentiation, is characterized by inability to separate emotional from intellectual interaction. Poorly differentiated family members are more iilcely to be part of a family triangle. Triangulation occurs when the anxiety in a tworperson system is more than the system can handle and a third person is engaged in the system to diffuse the tension. Triangulation is a specific type of en rneshment (see Chapter 4}. For example, to diffuse marital tension, the mother establishes a close “friendship” with her daughter and together they exclude the father. 'l‘riangulation generally increases problematic communication within a family As a family moves through the stages of the family life cycle (see Chapter 4}, it changes structurally to accommodate changing roles and tasks. Such adaptation occurs through the renegotiation and modification of boundaries. Clear boundaries fall between enmeshed and disengaged boundaries and allow for optimal functioning. Family subsys- tem boundaries that are. pervasively enmeshed or consistently rigid, especially those between the parent and child subsystems, are the primary basis for dysfunction. By identifying the boundaries and transactional patterns within the family system. and subsystems, the family counselor affects the goal of therapy, which is to change the structure of the family so that it is more consistent with the developmental needs of its members. One technique to do this is to present the family with a scenario and assign roles to the individual. members. The roles require them to act out new patterns of behavior. This changes the behavior patterns that support the symptom and alters the sequences between family members, thereby restructuring the family system. There are several ways in which a family counselor might work with the Carter family of Chapter 4. For example, the counselor might help the Carter family identify the sequence of acts in which the family’s problems are embedded. The counselor would note the relationsl'iips among Liois’s constant: negative affect, laelr of eye contact with her hus— band, fatigue, and refusal to 3.le for what she wants and needs; Doug’s telling lason, “if you . . .' , I’ll. . . .” without ever following through, his black—ai'iduwhite views of lason, the “bad one,” and Christie, the “good one," and his sarcastic tone when he talics to his wife; lason’s feeble attempts to cheer up his mother, his belligerence toward his father, and his CHAPTER l5 Family Interventions 309 rapt attention whenever his parents interact; Christie’s subtle teasing of Jason, her aloof primness when aslred a question, and her fingernail biting. rll‘he counselor might attempt to understand how these behaviors maintain or threaten the power balance in the family and might view each symptom as a tactic employed by one person to deal with the others. He or she would see lason’s acting out as his way of defining his relationship with his par~ exits: lason sets the. pace and they respond. The counselor might direct Jason to continue to misbehave at school and at home (assuming his misbehaviors are not dangerous or harm fol) and ask him to keep a log of each misbehavior, noting why he chose each behavior when he did. This use of symptom prescription gives lason the choice of cooperating with the others, setting the stage for change, or resisting the therapist by reducing his symptoms. In another approach the counselor would focus on helping each ot the Carters to sepa— rate emotionality from objective thinking. He or she would begin by looking for ciear and well defined boundaries between family members. The counselor might view Doug’s anger at his wi e and his feelings of inadequacy as overriding his cognitive knowledge of the importance of consistency and consequences in discipline. He or she might view Lois‘s guilty feelings as an indication of her inability to separate her own feelings and behavior-from those of her son. The uncxpressed anger between Lois and-Doug is diffused and focused on 135011, with the result that Doug teeis excluded by both his wife and his son. The counseior might help the couple to express and explain their feelings to each other obiectivcly. As the process of triangulation diminished, the members of the family would achieve a greater: degree of dilitercntiation. Another approach would acknowledge the sociocultural context in. which the Carter family Operates. The counselor: might conceptualize the problem in terms of two stressors: a developmental transition (lason is entering adolescence) and an idiosyncratic problem (Lois is chronically depressed). The family’s dysfunction is a result of their failure to renem gotiate boundaries in response to these stressors. In light of the enmeshed boundaries between lason and his mother and the lack of a defined parental subset, the counselor might worl< to increase the strength of the parental subset by engaging Doug and Lois in tasks together. He or she might ask Jason and Christie to reverse roles as a means ofunbal» ancing the homeostasis and creating an opportunity for change. l 1Each of these strategies or techniques shares an emphasis on the family as a system. A systems framework is often a major foundation for family counseling. But in what other ways might we 'be helpful to families with youth at risk? We now consider alternatives to family counseling. ALTERNATIVES AND ADrUNCTs TO FAMILY Counsemno F or a number of reasons, family counseiing is not always the best way to pursue change. gam— ilies can gain the support, knowledge, and skills they need to address their problems through a number of other channeis. As mentioned earlier (see Chapter 12}, practitioners are more likely to be helpful when they implement intcwentions that have been empirically supported. Unfortunately, even fewer family/«based approaches have been submitted to an expert panel scientific review than individual or school-based interventions. Kumpfcr and Adler (2003), in an extensive review of reviews, identified a number of principles of effective family—iocused i, programs to help practitioners iudge whether a program is worth selecting. Counselors can I then adapt programs that best match their clients age, gender, developmental level, or culture (see Box 153). in this section we describe several alternatives to family counseling. 310 PART A Prevemron‘ Enrer'venrion, and Treoimem‘ Approaches Box Principles of Effective Family«50cused Interventions 1 ‘ Recruirmem ono‘ Rerefirr‘on. Fomfiy recruitmerri and reteefion [in The ronge or 8'0 to 85%} is possébre wiih the use o1: incemiveswrood, Chiid core, i‘ronsoorrotronr‘oius rewards for homework comprel'éonf ohefldonce, and groduotioe. 2. Scope one" Conrem‘. Comprehensive muhicomponenr interventions. thafi oddress romi'iy reiotions, comrrumicoriom end poremo‘; morr‘riorlng : re more erredéve m modifying risk or protec‘iéve roczors iron sirzg‘ie-rcompooem programs. 3, rorger‘, Fomr‘iy—éocesed r‘rogroms rho? en‘rphosize ir‘omiéy sirengi‘hs; resi‘rreficer and r E , ‘ . A 4’ . ‘ . . ‘y. .: 4 orofeo'we rocrors are more erecrwe fror rmprovmg ramriy reioironshrps mom chridvrocused A. Focus F'omfiy programs, railored ro fire cui‘rero? rrad‘iiions the ramiry ore mos? erreciive when they produce cognitive, errecrive‘. and behov‘roroi changes in ramiw dynamics or the environmenr, _ 5. Tror‘nr'rrg Methods. 8M5 rroinmg methods that use lnéeracfiveredr'rmoueSWrole ploy; acrive modering, family and skii? practice sessions—«olong with homework acrivifies one! videos or CDs 0? errecfive and inerfedive parenrmg skills increase dram: safie‘racfion and program eErecfiveness compared ro didaofic recurring and Simpée discuséion, 6. Trainer or leader. We effectiveness 0? the progrore is 'hi'ghry fled re the framers persoeoi eH‘icocy and Confidence, oflecfive c‘naraeterrsfics of geeuirreness, warmzh humor, and empor'hy, and abiliry to si‘ructure sessions ond be d‘rrecrrve. 7. Poem/Fernin Dysfrmcfr‘on. When parents ore very dysfunci‘ronoi, interverafrons beginning eoriy in Ehe iire cycie ore more eHeciéve. 1:} addition," Zincreosed dosage or inrensiry (25 to 50 :hours orrnteruem'ron) Es neeessory wirh hggrrer-rrsnk- ramiii-resfiwan with iow~résk romfiies [5 'ro 2A hours}. I _ _ _ I I 8. Timing and Deveiopmem. Fomiry programe ehouid beagle .ond-deveiopmenrafiy ooproprioie with new vers‘rons ova-Hobie as erriidren rn'orure; fire; rye-ed- So aadress appropriate risk-and Iprotedive-rocrors w-hen rhe-famfly receo’rNe-ro change 9. Empowermem. Deve1opérrg o coilaborotrve procesewhere fomiry members ore encouraged :‘o find éixeir own soiurrons iS efiecri've and dim 'builde aisupporr‘rve relafiorrshie and reduces porenr resistance end dropout Source: Adopted horn Kumorer oneE Ad-ier, QGO3. CHAPTER l5 family interventions 3H Multisystemic Therapy Multisystemic therapy (MST) has emerged as a leading intervention for adolescent delinquent behavior (lienggelcr, lilQQ). Working from. a socioecological model of human development, MST counselors focus on providing parents with skills to effectively mouin tor and discipline their children and on increasing family cohesion. MST discourages continued contact with peers who provide reinforcement for delinquent behavior; it promotes contact with prosocial peers (l—le-nggeler, 1999; they, lrlenggeler, Brondino, d: Pickrel, 2000). When treating conduct problems in young people, helpers must involve multiple systems in treatment and should attend to negative or positive roles that peers play in undermining or facilitating intervention. The Family Checkup The Family Checkup (FCU) is a brief family intervention developed by our friends and. - colleagues Torn i3ishion and Elizabeth Stormshak at the University of Oregon (Dishion et al., 2802; Stormshak dz Dishion, 2002). The ECU is based on principles of motivational interviewing (Miller 6; Rollnick, 2002-, see also Chapter 8) and is designed for families experiencing mild to severe problems. ' The ECU consists of three sessions conducted with the parentts) or caregiverts) and the child or children. The first session is an. interview that takes place in the home when possible so that the family is observed in their usual and familiar setting. rThe second session consists of an assessment of multiple dimensions of the family, including communication, discipline and other aspects of parenting, characteristics of each family member, functioning in home and school settings, and peer relationships, In the third session, the family is presented with feedback that is designed to facilitate several goals: supporting and enhancing positive parenting by identifying strengths and weaknesses; reducing harm by identification ofimpending, serious events, such. as a suicide attempt or school expulsion, and preventing such problems through provision of concrete rec— ommendations; tailoring feedback to maximize motivation for change; and supporting motivation for change through identification of family strengths and resources. During the feedback session, parents provide a self~assessment of their family, and the clinician clarifies and contributes to this assessment using the information gained through the prior assessment stage. This session. culminates in the collaborative development of a , menu of options that emerge logically from the assessment and feedback. The menu of options targets changes that, the family perceives as important and includes Specific 3 behaviors that the parents want to engage in on their own (cg, meeting the parents of the children’s friends, initiating Family Game Night once a week). The menu may also include parent education, parent training, support groups, or individual, couples, or family therapy. Because this three—step model places a strong emphasis on forming a trusting rela- tionship with the family and collaborative identification of concerns, families who may have initially resisted a recommendation for family therapy are often willing to pursue this option after a Family Checkup. There are multiple positive outcomes associated with the Famiiy Checkup, including reductions in family conflict, increased parental monitoring. and reduced substance use and problem behavior over time (Dishion, Nelson, s: Kavanagh, 2003; Dishion et at, 2002; Stormshak dz Dishion, 2002), 3‘12 PAR”? Ki Prevention, intervention, end "ireotrseni Approaches Multidimensional Treatment Foster Care Current research supports multiple interventions aimed first at the family but also toward other parts oftlrc environment. Behavior modification procedures used in halfway houses, for instance, have had immediate results but produce few long—lasting changes after teenagers return to their natural environments. Association with prosocial peers and inclu— sion in a functional, well~adiusted family are both key factors in socializing youth. Close interaction with deviant peers, even while in a treatment program, often increases probw lematic behavior (Dishion, McCord, (Sr Poulin, 1999). Youth outside ofa functional family system are aiso less likely to thrive. The Muttidimensional 'l"reatment Foster Care (MTFC) program combats these two risk factors by recruiting community foster families to be members of a treatment team that monitors daily family and child activities, monitors peer associations, and tracks school behav— ior of the l’llgl’ld‘lfi‘lfi, delinquent youth in the program Chamberlin, Fisher, dz Moore, 2002). These high—risk young people might otherwise be placed in institutional settings with little intervention or monitoring. The program illustrates how multidimensional and ecologically oriented interventions can be very effective for some of our most art—risk adolescents. rlfi'he program responds to the whole ecology of children’s lives. The foster parents receive increased financial compensation in comparison to general foster parents, are con— sidered to be primary members of the treatment team, receive more than 20 hours of pre— service training, attend weekly training and technical assistance meetings, and have Z4~hour, 7~dayswa~weel< on—call access to psychological support staff. The children in the program, who would otherwise be placed in an institutional setting, receive services within a structured, supportive, teaching—oriented family environment; are closely supervised with regard to their whereabouts, activities, and peer associations; receive daily monitoring of their participation and progress in school; receive social skills building from a skilis trainer; and receive individual therapy, The young person’s family oforigin receives inten— sive training and support, has 24vhour, 7—days~a~weel< access to program staff, receives farniiy therapy, and is provided with aftercare services (eg, ongoing support and consul- tation}. The young person’s school is involved in a collaborative support meeting to set up a system before the youth is enrolled and receives support monitoring the child or young adolescents behavior at school through use of a school “card” on which attitude, home work completion, and attendance are all evaluated. The performance ratings on the school card are checked nightly by MTFC foster parents and are linked with a three—level point system to reinforce positive behavior and decrease problematic behavior. in follow—up studies Mllch youth spent 60% fewer days incarcerated than control participants, had 50% fewer subsequent arrests, ran away from the program 3 times less often, returned. to live with parents or relatives more often, and had significantly less hard drug use (Chamberlin et at, 2002). The program cost (nearly $l 30 per day) is substantially less than standard youth detention (Chamberlin et al., 2002). Parent Education and Training {Darent training in child management is a promising family intervention. strategy Kostcrman et at, 2000; Kurnpfer dz Tait, 2000}. It is most effective, however, if parents learn to recog- nize and eal with the signs of risk before their child reaches adoiescence. Training in behav- ior modification, in management of rewards and consequences, and in communication CHAPTER 15 family interventions 3'53 stills is most effective with younger children whose behavioral problems have not yet devel- oped into serious misbehavior. If children already extremely negative. parent training is relatively less effective in reducing the children’s offenses, perhaps because the behaviors have already become part of the young persons’ repertoire because they have already identi tied with deviant peers or because they have achieved a high level of autonomy Dishion, Capaldi, dz Yoerger, 1999:]. Parent education and training refers to programs, support services, and resources offered to parents and caregivers that are designed to provide support and increase skills- and efficacy for raising a family in a healthy and constructive manner. Teachers, coun- selors, and other hinrian service professionals can often provide: effective prevention and intervention in the form of parent education and training. The parents of a student who is acting out sexually may shy away from discussing sex, birth control, and sexually transmit— ted diseases. The parents of a student who doesn’t turn in homework may lack a consistent system for monitoring school progress. The parents of a student who is betligerent and aggressive may have lost control of their child. These issues and others may be effectively addressed by educating parents on dealing with specific aspects of their children’s behav— ior. Family-oriented programs designed to prevent chemical dependency and to strengthen families by teaching parents behavioral trianagement, effective discipline, sex education, nutrition, and family budgeting can. be very effective {Ashery, Robertson, (3? Kumpfer, 1998; Kumpfer, 1998; Kurnpfer dz Alvarado, l995). Cultural appropriateness is critical to the success of parent training programs (Kumpfer dz Alvarado, l995; Norwood, Atkinson, "lizllez, <35 Saldana, 1997). Three useful programs are the Effective Black Par— enting idi‘ogram, Los Nifios Bien Educados http://wwwciccparentingcrg}, and Positive Indian Parenting http://www.irecohio—stateedu/fan'ilife/nnfr/etf/curricuii’97.html). A fourth wellwresearehed program, Family Effectiveness Training, including bieultural effec— tiveness training (BET; Saapocznik, Santisteban, Kurnnes, Perez-Vidal, & l-lervis, l984, Szapocznik, Santisteban, Rio, Perctszidal, dz Kurtines, 3986b), is discussed later. In addi— tion, an important focus for the teacher, counselor, or parent—trainer in getting acquainted with the family is to understand the family culture, values, identity, and practices. Expec— tations tegarding child behavior and accepted modes of child discipline are often associ- ated with culture although level of acculturation influences traditional values and practices (Cronkilton, Paz, 85 Boyle, 2005; l‘larvey 33: Hill, 2004). Before we describe specific parent education and training programs, a few basic prin- ciples of parenting can go a long way to help parents be more effective. Two of our “favorite” parenting principles are: the Premack principle and logical consequences. The Premack principle. The Premack principle, or Grandma’s Rule, is a relatively simple and highly effective guide that parents can quickly put to good use (J. ]. Mew-flutter, l988}. The Premack principtc tells us that “for any pair of responses, the more probable one will reinforce the less probable one” (Premack, 1965, p. 132]. in other words, behaviors that youngsters are quite likely to perform [playing videogarnes, riding a bike, watching televiw sion, talking on the telephone} can serve as reinforcements for those behaviors that they are less likely to perform {completing homework, drying dishes, caring for younger sib- lings, Cleaning their rooms). As Grandma might put it: First you work, then you play. The parents’ task is to identify what their child wants to do and then require that a less—favored activity occur first: “Clean your desk and then we can play a game.” mf’ick up the room before you go out to play.” or “Do the dishes before you watch television.” 314 PART 4 Prevention, Intervention, and Treatment Approoches Application of the Premack principle is most effective when parents break down tasks into subtaslrs (cg, clean desk; put away all loose bool<s and papers; put away all crayons, pens, and pencils; dust desktop, water plant on desk), and sometimes it is also helpful to reward the performance of each. subtask. Frequent small rewards provide more effective reinforcement than infrequent, large rewards. liarents should provide rewards immediately after the behavior is accon'iplished, reward the behavior only after it occurs, and the reward should always be accompar‘ricd with verbal praise. Parents will hear ration- alizations ("But my show will be over by the time l finish the dishesl”), and they are guan anteed to hear many more it they give in to them. Logical consequences. Carrying out a system of logical consequences not only enconrw ages children to take responsibility for their behavior but can greatly reduce the amount of arguing (sec Box 5.4). Consider the Carter family of Chapter 4. Doug Carter is unhappy with the fact that lason stays up very late on weekends watching television. Because he stays up so late, Iason sleeps late the following morning, leaving his chores undone until the afternoon or forgetting them altogether. Jason’s behavior is only one of the problems here; the other problem is that his behavior has no logical consequences. A logical conse‘ quence of staying up very late is to be quite tired when one is roused from sleep to (lo one’s chores. By allowing Jason to sleep late, his parents condone his late-night TV habits. By requiring Iason to get up and do his chores no matter what time he goes to bed, his par— ents would give Jason responsibility for deciding how late to stay up (reducing the lilreliw hood ofa “But I’m l3 years oldl’> argument) and still have the satisfaction of knowing his work is done ( reducing the likelihood of a “You live in this house too” argument). If logical consequences are to work, parents must be prepared to apply them without fail. Table 13.] provides some sample behaviors and their logical consequences. Each con~ seqoencc is modified according to the severity of the misbehavior and the number oftirncs the behavior recurs after consequences have been applied. if a child continues to leave toys about. the house, for example, the parents may remove the toys for 2 or more days at a time. Children should always know the logical consequences of their misbehaviors and be informed when the consequences are changing. With older children, parents may draw up a contract that specifies, for example, rules for using the family car and consequences of failure to follow those rules. By signing thetontract, families formalize the agr‘eelri'ent and establish a clear standard of conduct. Family Effectiveness Training lose Szapocznik and his associates (1986a, W89, 2000) present a prevention model for ilis— panic families of preadolescents who are at rislr for drug abuse. This program is based on the premise that intergenerational family conflict related to the acculturation process may exacerbate existing n‘ialadaptive patterns of interaction in families and contribute to drug use. It is one of only a few empirically tested programs that directly address cultural differr ences. The three components of family effectiveness training (FET) are designed to change maladaptive interactional patterns and to enhance the family’s ability to resolve intergenerational and intercultural conflict. The first component, family development, helps the family to negotiate their childrenls transition to adolescence. Family members learn constructive communication skills and take ii‘icreased responsibility for their own behaviors. Parents develop the slrills to direct their CHAFTE 7’ i Family interventions 33 5 Box 154 V. - 3 Eat Your Dinner! Forests maze bmugifi G .: “Ubiimmiy ciericimci iii-3i“ teeth (33nd teiused to eat 5 i (an iii: : r_ mmfl 559 -.i:e-r ioocfi on tilé'iiomf-Her -- E parents [amended it? 0 number 05' -~c:ys:-ca§gd%rag Wiii‘: the iittla " i ‘ ’ . . '1 .- . i, nrgumg Wli‘i‘; EEGCH oshet, Gaming LED m5: r‘ iesé ‘ Ii'ireasi‘ening the giri, or rewatciirig er and Muicriiii/ cmciudéq 92/ c and tirovidirig cm ..3lfl<}i€‘-XEE med. J‘flet'éitimé‘ :3 iii-’qu htéii," In: (LC/F556;? At iH'S’i the pare-ms horrii act whew we ‘ Jut'ii’ietii flier-n that queence oi Such behavior was It: let h-Z—EV {i412 wéiizoui f-Kli'ir'ig} :mé‘ii 1i'lf:.."n’:3>fi rrw IE WGF; sewed, But timiiy line-y conceded that she- w—i "ia‘y wcuid n- iay he» hung ‘ ' and sgieed 30 try Ibis Omimacii. tip-rm their {in . I w exmicmed ii") he: that ii iha'ew iii-=35 dinner on the Hoot . itiqst Viv” ; '- stie ptompiiy arid pradictabéy Hippsd i . 30;, he: pixerufa pic-3pmed. 1 they didtfii wait or argue or main iii: : z, ti '33: wime ieriiim '4 tit-Ar Him :3 wauid' be a iortg time Limii bra-attest iiz‘eisiied .‘ ir own Ciietinar {irritants cn'mdmg 5:, iii-i r a ‘ H5 , i mess she had made Size kep m OW’GKE‘ i"‘s()Si' at that: night WHE": he] “:EGfi‘iJi C they I. : i i r (finds t bOCK OOWH. ' z r L - ‘ g i: . . . E The next day she ate maniacs; and lamb. wfinou' madam {tun- .; eaten at kitty care; [ rye-0mm? She: com? had never beers C} ptobiemi, oné dinner We nexi evening was Wait)! pioined about the teed, but she ate- mosi 0| 51', The r'mx? evemiig c nc-E: ogoiri cwemtiiect her piate and eudured‘ the some logical Cairasequence. She Cried ior oniy 2 was, that night TWO months loner Mar Grants re owed that she had never 0‘ Oifl overtuz’ned iier' )iGEG and was i i \_, eating {5% least 0 smoii poriion oi everything- rhey sewed he; TABLE 13.}, Sample Logical Consequences Action Consequence Leaving toys out The toys are taken away for one day; oniy one toy aHOWCCi out at a tima Talking on the gimme too iong Ali (23113 are Eimitcd to 3 minutes for 2 days Fighting over a bike The bike is taken away for a day and the Chiidi’fin must play peacefuin together for 30 minutes Violating family curfew Staying home the next evening or weekend Stealing from a store Apoiogizing to the stare manager; returning the item; working to earn the cost of the item and giving the money to the store, a church, or a charity organization 3162 PART Kl Prevention, intervention, and Freeman! Approoches children in a democratic rather than an authoritarian style. This component also includes drug education for the parents so that they can effectively teach their children. about drugs. The second component, bicultural effectiveness training BET; Saapocznik et al., .0984, l986bj, is designed to bring about family change by temporarily placing the blame for the family’s problems on the cultural conflict within the family. Alliances are estabw lished between family members through the development of bicultural skills and mutual appreciation of the values of their two cultures. BET helps the family handle cultural con- flicts more effectively and reduces the likelihood that conflicts will occur. BET is itself an excellent parent training program of obvious value to families of nonrnaiority cultures. The third component of FET is brief strategic family counseling (Szapocznik & Williams, 2000), the most experiential aspect of this model. The FE? counselor meets with the family for 13 two—hour sessions and assists the family in addressing conflicts and improw ing relationships. The FEET model may be modified to deal with issues other than drug use. One final parent education and training program is now described. This one is based on European American norms, but it has potential benefits for other cultural groups as well. Parent Effectiveness Training Parent effectiveness training (PET; Gordon, 1970, 1977) is a method of parent training based on two principles stressed by the psychologist Carl Rogers: unconditional positive regard and empathy. A fundamental premise of the method is that everyone in the family can “win,” with power negotiated and shared by parents and children. Although the pro- gram was originally designed for parents of problem children, its contents are also valuable for parents of well—functioning children. The PET program teaches parents skills in con- frontation, conflict resolution, active listening, and giving l—rnessages. Training provides parents with an opportunity to practice and refine those skills throughout the sessions. These skills enable parents to communicate more effectively with their children and to resolve problems constructively McVVhirter dz Kahn, 1974; Wood & Davidson, 1993). A PET training course is typically 24 hours in duration, ordinarily presented in eight weekly 3~hour sessions. Brief presentations, group discussions, audiotapes, dyads for skill practice, role playing, workbook assignments, and textbook reading are among the training methods used. Gordon continues to develop new applications for his ideas (1989), and in l997 he published a home study version of his program {see Gordon, 2000). Core compo nents of the program include problem ownership, active listening, l-niessages, and mutual problem solving. Problem ownership. in accord with the PET model, parents are trained to identify whether the parent, the child, or the relationship both parent and child} have ownership of the problem. Determining who owns the problem sets the stage for problem resolution. The child owns the problem when he or she is blocked in satisfying a need but his or her behavior does not interfere with the satisfaction of the parent’s needs, A parent owns the problem when the child’s attempts to satisfy a need interfere with the parent’s needs. The relationship owns the problem when neither the child nor the parent is able to satisfy his or her needs. Problem solving is achieved via three different pathways; the choice of path— way depends on problem ownership. Active listening is used when the child owns the prob“ lem, sending lvmcssages is used when the parent owns the problem, and mutual problem solving is used when both own the problem. Cb'lAPlElE l5 toinily interventions 317 Active listening. The purpose of active listening is to communicate a deep sense of acceptance and understanding to the child. The parent tries to understand what the child is feeling and to communicate empathy to the child. The affective and emotional dimenv sions of the communication process are reflected in eye contact, tone of voice, and hotly movement. If parents reflect their children’s feelings accurately, the children will teel understood, freed from the emotion of the problem, and better able to deal with the prob lem. When children amplify and fully express their thoughts and feelings at the heart of the problem, they are moving toward the desired goal and often able to suggest their own solutions. Sometimes active listening helps children accept an unchangeable situa tion (eg, the family must move to a new apartment) and gives them a chance to get their feelings out and experience genuine acceptance. Active listening requires getting inside the child, viewing the world through his or her eyes, and communicating that understanding. Essentially, then, the parent must respond to both the words that. the child uses and the feelings that lie behind the words. The following examples demonstrate the skill. Child 1 (crying): Tommy took my truck away From. me. Parent 1: You sure feel bad about that. You don’t like it when he does that. Child 1: Yeah, it makes me mad. Child 2: Boy, do i have a lousy teacher this year, l don’t like her. She’s an old grouch. Parent 2: Sounds like you are really disappointed with your teacher. Child 2: I sure am; i miss being in Mrs, Chang’s class. She liked me. In each illustration, the parent has accurately understood the child, and the child has responded by verifying the parent’s accuracy and elaborating on the feeling. Each interw change sets the stage for a continued and irieaninghil conversation. Parents should never use active listening to draw out and then put down the child (“Oh, so you want to flunk and go back with Mrs. Chang, do you?”). Parents sometimes hegin active listening but subsequently slam the door shut because their own attitudes get in the way or because of lack of time. At other times, parents simply echo a message to the child without empathy. Over time, this will result in demoralization and mistrust. Sending l-messagcs. When the pattern? determines that he or she owns the problem-— that is, his or her needs are directly and tangibly affectedwthere are several possible responses. For example, the parent can modify the environment, him~ or herself, or the child directly. With younger children, changing the environment often promotes a change in the child’s behavior and solves the parent’s problem. Such changes may include enricl — ing the environment (bringing out crayons and paper or scheduling times for friends to come over and play), simplifying the environment {turning down or turning off the televi- sion or requiring that one activity be cleaned up before another is initiated), or substitut— ing one activity for another (tag on the front lawn instead of wrestling in the living room). Parents who own the problem may also decide to change themselves. For example, a father might decide that he will work on becoming more tolerant of noise in the house and will follow through and supervise his children more after asking them to do a task; a mother might reduce the amount of pressure she puts on her children to behave in a particular 11131111611 33 8 PAW £1 Prevention; intervention, onci ‘lreotment Approaches Finally, the parent can seek to modify the child directly. Sometimes parents use. spanking or some other form of punishment, which may produce shortwterm compliance but is detrimental in. the long term (Gershott, 20021). Verbal punishment is also inettective; it typically consists of derogatory labeling or put~down statements: “You are so lazy.” “You are a real pest." “You are no good; you inst want to be a mean person don’t youl” This kind of communication is called “You—messages.” Rather than punishment or ineffective you—messages, a simple l—message is a power- ful tool in modifying a ch ild’s behavior. in an l-rnessage the adult: clearly expresses to the child the problem and the feelings about the problem while letting the child know that the adult owns the problem. Often the child is willing to modify behavior based on the adults feelings. An Linessage is less apt to provoke rebellion and resistance, and it places the responsibility on the child for changing behavior. The following examples den’ionstrate the contrast between you—messages and l~messages You—message: You didn't do your cl‘iores this morning. You are so lazy and irresponsible! l~messagez l’m angry because you didth do your chores. Comment: The focus is on the problem of the chores and not on. the character or person ality of the child. The parent’s feelings of annoyance and anger are not directly expressed in the you—message; the anger is clear and direct in the l-message. You—message: Stop being such. a pest. You’re always interrupting your mother and me when we are talking. l—message: l am frustrated with you because 1 want to finish my conversation with your mother and you keep interrupting us; this has been happening a lot lately. Comment: The l—message communicates the parent’s feelings, puts responsibility on the child tor the behavior, and does not lower the child’s seltmesteem. By sending an l-message, the adult anticipates that the child will understand the adult’s problem, respect the adults needs, and therefore discontinue acting in a nega tive way. Frequently an l—rncssage is adequate for modifying the child’s behavior. Oeca~ sionally it is necessary to follow the lwrnessage with a change in the environment. For example, after communicating frustration at being interrupted, the father could require the child to go playin another room until he has finished the conversation with the child's mother. Mutual problem solving. Mutual problem solving is the PET strategy used when the problem is owned by both child and parent; that is, when the needs of both the child and the adult are being blocked by a problem. Too often solutions to problems and conflicts result in a win—«lose situation. The loser (adult or child) feels deteated, and regardless of Who loses the child is denied opportunities to develop behavior that is selhdisciplined, sen— sitive to others, and inner directed. Gordon ( l 970) recommends following a six step, nomlose method whenever an adult and a child encounter a conflictmot-needs situation. in this way the parent and the Child can construct a solution that is acceptable to both of them. These steps are comm-on to many problem-solving models. 1. Identify and define the conflict. it is important to determine whether the disagreen‘ient is actually over the issue at hand. Sometimes the conflict is really over a different matter and the current problem reflects another concern. Both parent and child need to be clear on the nature of the conflict. CtiAPTER l 5 Family interventions 3'19 2. Generate possible solutions. Both parent and child need to indicate as many altcrnrr tivc solutions as possible. The child should be encouraged and praised for identifying solutions even when they don’t seem feasible. 3. Evaluate the alternative solutions. The feasibility and potential. effectiveness of each solution is critically evaluated. Both the adult and the child should consider the re various solutions and decide which solutions they can. live with. he parent at this step. For example, the parent should in which the child. also picks out the every time the parent does. for the most acceptable solution. Both must agree to i, including modifying their own behavior as needed. he adult and the child must agree upon consequences of ti The parent does not stop being t nter into false “equal” arrangements not 8 the child gets to use profanity mother’s clothes or 4. Decide on and get commitments commit themselves to the solutior 5. Woer out ways of implementing the solution. T who is going to do what and when it is to be done. 6. Follow up and evaluate how the solution worked. After anagrcedwupon time limit, d review the sohition to determine satisfaction with it. if the parent is following up when the problem and the solution are “easy,” the e trusting and willing-to try out solutions that demand more rislr or parent and chil consistent about child will be mor effort on the child’s part. our, over time, both )rocess of mutually solving the probl lems and and the child will learn to anticipate prob can he resolved in a healthy manner that By engaging the child in the ; child will be. more satisfied, lutions independently. Thus conflicts lly satisfying, constructive, and loving. hy in which respect for the child is upper» parent and generate so builds a relationship that is mutua Effective parenting derives from a philosop most. This means respecting individuality, uniqueness, complexity, idiosyncratic potential, and capacity for making choices. This philosophy is expressed in effective communication. Of course, these skills are just as important to the effective teacher or counselor as they are to parents (Gordon, 1989). The PET program, like all parent training programs, reflects a particular set of values and assumptions. Exploration of parent values is an important pre- requisite to carrying out any parent training program. i in addition to the multiple parent education and training is important to consider programs specifically for other car‘etaliers— such foster parentswwho are often underrepresented in the family intervention treatment literw ature. Foster parents and foster families play key roles in many young people’s lives and may play a critical role in the lives of highwrisk youth. programs just reviewed, it as guardians an cl Parent Support Groups The final alternative or adjunct to family counseling is participation in a parent support group. These groups are also very useful to foster parents and others serving in primary caretaking roles. Many parents would benefit from experiencing a sense of accornpanim ment with other parents who have “been there” or are currently “in the same boat,” Each new generation of parents deals with issues that their own parents never imagined. Your grandparents, for example, are unlikely to have had a son lie, your father) who came home with a pierced nipple. Marry of the underlying issues are the same, however, and are related to the movement through the family life cycle: dealing with stress, change, loss, and anger; problems of communication, discipline, and authority; and passing down values and traditions. Especially in light of the decline of the extended family networlr, a parent 3220 PART. A Prevention, intervention, and Treolmeni Approoches support group is an ideal way for parents to express their concerns and learn what other parents have experienced and attempted. it also allows parents to share the pain and frus— tration as well as the joys and successes ofraising children. Parent support groups are avail» able through local. churches, YMCAS, schools, counseling agencies, rlayucare centers, and workplaces. Many areas of the country also have local parent crisis lines or Parents Anony— mous groups, which can provide information about parent support groups. One parent support group that is active throughout the United States is Toughl..ove. ToughLove is a selfnhelp group for parents and guardians of teenagers who are uncontrol- lable, addicted, abusive, or otherwise in trouble with the school or the law. With more than L500 groups, this organization provides ongoing support, assistance in crises, and referrals to professionals, as well as many practical ideas for helping teenagers stop their selfmdestruc- tive behavior. Parents are encr‘mraged to mal<e their own plans for addressing their teenager’s behavior. The group functions as a sounding board, a source ofsuggestions, and a backup support learn. One Toughiuove mother we know enlisted the help of other Toughlsove parents in planning a constructive confrontation with her drug—abusing daugh- ter. One of the other couples provided an alternate place for the. daughter to stay for a weelc in case she decided she could not stay with her mother after the confrontation. The same mother had iust posted fliers for a ToughLove parent in another part of the country whose runaway son had been seen locally. Alateen and Al—Anon family groups are broadwbased teen and family support groups that operate throughout the country. Teens or families of alcoholics meet together much. like the members of Alcoholics Anonymous. Participating teens and families learn about alcoholism and are helped to achieve a loving detachment from the alcoholic, to increase their self~esteem and independence, and to rely on the group for encouragement and sup port. Through sharing their common problems, members of alcoholics’ families discover that. they are not alone and that they have the ability to cope with their situation. Parent support groups can provide invaluable information and support for parents and guardians who feel hopeless, angry, and alone in dealing with the problems of their troubled children. rl‘oughLove, Alateen, and Al-Anon provide support for family members who may feel trapped in an impossible situation. These are only three such groups; there are literally thousands of others. There are support groups for parents of children with problems ranging from spina bitida and cerebral palsy to bipolar disorder and Schizophrenia. Teachers and counselors can assist families by keeping informed about these resources and. by encourag ing families to contact local chapters of these support groups. Refer to our website for more information, e—mail, and web addresses for many of the-organizations mentioned. CONCLUSION A family systems framework is a realistic and viable way to view the problems of troubled children and adolescents. Too often WGFli with an individual provides Only partial solu— tions. All young people live in a montage of overlapping systems: families, schools, neigh— borhoods, larger comn‘iunitics, the nation. Family counselors address the family as a system in order to change dysfunctional patterns of behavior and communication. Parent training and parent support groups provide alternatives and adiuncts to family counseling. Coun— selors, teachers, and other helping professionals can he of invaluable assistance by provid ing these services or by helping families gain access to such programs. ...
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