Doing Family Therapy, Third Edition
Total Page:16
File Type:pdf, Size:1020Kb
ebook THE GUILFORD PRESS DOING FAMILY THERAPY Also by Robert Taibbi Doing Couple Therapy: Craft and Creativity in Work with Intimate Partners Doing Family Therapy Craft and Creativity in Clinical Practice THIRD EDITION Robert Taibbi THE GUILFORD PRESS New York London © 2015 The Guilford Press A Division of Guilford Publications, Inc. 370 Seventh Avenue, Suite 1200, New York, NY 10001 www.guilford.com All rights reserved No part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 The author has checked with sources believed to be reliable in his efforts to provide information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the author, nor the editors and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources. Library of Congress Cataloging-in-Publication Data Taibbi, Robert. Doing family therapy : craft and creativity in clinical practice / Robert Taibbi. — Third edition. pages cm Includes bibliographical references and index. ISBN 978-1-4625-2120-3 (paperback : acid free paper) — ISBN 978-1-4625-2121-0 (hardcover : acid free paper) 1. Family psychotherapy. I. Title. RC488.5.T33 2015 616.89′156—dc23 2015015537 About the Author Robert Taibbi, LCSW, has more than 40 years of experience as a clinician, supervisor, and clinical director, primarily in community mental health, and is currently in private practice in Charlottesville, Virginia. He is the author of several books, including Doing Cou- ple Therapy, as well as over 300 magazine and journal articles, and writes a column entitled Fixing Families for Psychology Today online. He provides training both nationally and internationally in couple therapy, family therapy, brief therapy, and clinical supervision. v Preface As I finish this new edition of Doing Family Therapy, it seems as though much has changed since the previous edition. The fam- ily therapy field continues to grow and morph, incorporating the creative concepts and techniques of practitioners, as well as accom- modating more specialized populations and problems. And the larger therapy landscape has changed too. Clients are no longer left to quietly ask close friends for referrals; technology has taken over. They are going online looking at scores of local clinician profiles, comparing and contrasting styles and qualifications. They show up in your office with clear ideas of what they are looking for and are knowledgeable, thanks to proliferating websites and self-help books about the therapy process and options. This is all good news for the field; the process is less hierarchical than it was 20 years ago—when the therapist knew best—and much more collaborative. But just as the field has changed, so have I. In the past few years I’ve been particularly interested in brief models of therapy and have become more behavioral in style. I’ve also been traveling nationally and internationally, providing training to a wide variety of prac- titioners. I’ve had wonderful opportunities not only to hear what clinicians in the field want, but, through teaching, to clarify my own evolving thoughts and to put them into clearer and more concrete terms. All of these changes are reflected in this edition. In addition to some chapter reorganization, I have added more conceptual and practical information—more detailed guidelines for assessments, vii viii Preface multiple ways of viewing problems, concrete treatment maps for adolescent issues, characteristics of the three stages of family treat- ment, and more detailed suggestions on the dos and don’ts of guid- ing and shaping the session process. This last item is and always has been at the heart of therapy, the place where change unfolds in the space between family and therapist, and it is where beginning family therapists understandably struggle the most. I hope all of this new information will give you something solid to bounce your own ideas and style against, and help you hit the ground running. In spite of these changes, however, the unifying concept of this book remains the same as it was 20 years ago—that is, the realiza- tion that there are multiple paths to families and their problems, and that the most effective therapist is the one who can blend his or her values, personality, and skills to create a unique therapeutic style. Finally, I want to thank those who have been generous with their comments—social workers, psychologists, and counselors in workshops who remember using my book in graduate school; pro- fessors who provided helpful feedback; readers across the country and across the world who sent e-mails; and all of those who have been kind enough to tell me how the book has shaped their clinical work in some small way. My humble gratitude to all of you. Contents 1. Family Therapy: Welcome to Oz 1 2. Core Concepts: Process, Patterns, Problems, 15 and Resistance 3. The Basic Six 26 4. In the Beginning: Great Expectations 47 5. In the Beginning: Running the Sessions 75 6. The Middle Stage: Are We There Yet? 103 7. Endings: Enough Already? 125 8. Billy Has a Problem: Kids in the Family 139 9. Billy: The Story Continues—In the Middle 162 of the Middle 10. “See How She Treats Me!”: 181 The Parent–Adolescent Struggle ix x Contents 11. The Parent–Adolescent Struggle II: 218 The Return of Ms. Harris and Ellen 12. Getting to the Core: Couple Work 240 in Family Therapy 13. The Power of One: Individual Work 274 in a Family Context 14. Staying Sane: Survival Tips for Therapists 289 Suggested Reading 307 References 313 Index 315 DOING FAMILY THERAPY chapter 1 Family Therapy Welcome to Oz They shuffle into your office without saying a word; it’s the first appointment and nobody is happy. The 6-year-old boy imme- diately goes for your desk chair; the mother, a large woman in a faded green dress, nails him before he can hit the seat—“A. J., that’s the lady’s seat. Come sit over here.” She rocks back and forth on the chair without standing up and stretches out one of her massive arms toward him; her tone is moderately firm. A. J. hesitates for a moment, then shrugs his shoulders and sits next to her with his head down. She reaches over and rubs his back. The father is sitting across the room from the mother, and has pulled his chair back so that it’s almost in the corner. In contrast to his wife, he’s as thin as one of the chair legs. He looks like he just got off work. His work boots still have mud on them and his uni- form looks dusty. The name on the pocket says Ed. He doesn’t look up at you but surveys his fingers, then begins to pick at some dirt under one of his nails. Next to you is the daughter, a blond-haired, attractive girl, 13, maybe 14. She’s chewing gum and jiggling her foot, looking straight ahead, staring, it seems, at the molding behind the couch. “So,” you say, “thanks for coming. Glad to see you were all able to make it.” You smile and try to make eye contact with everyone in the room. No one meets your eyes except for the mother, who is now sitting at the edge of her seat. 1 2 DOING FAMILY THERAPY “Momma, I gotta go to the bathroom.” A. J. tugs on his moth- er’s sleeve and wiggles in his chair. The mother gives him a quick glance, raises her index finger to her lips, and pats his knee. “Momma, I gotta go now.” “A. J., sit still!” You’re startled by the loud thud of a command from the father, who is now staring at his son. A. J. ignores him. “Momma, Momma.” His voice is getting whiny; he’s tugging at his mother’s sleeve again and has shifted from wiggling to bouncing up and down on the chair. “Now, you can just wait a few minutes, A. J., while we talk to this lady.” The mother’s voice has a strained sweet tone to it; she reaches over and starts rubbing his back again. “Damn it, Lynn, why didn’t you get him to go before we came?” Time to get to work. “Ed, it seems—” “Because he didn’t need to, that’s why.” Lynn glares and stretches out her neck and words at the same time toward her hus- band. Then she turns to A. J., and her voice shifts back to its sac- charine tone. “Go ahead, honey, if you need to go. Just ask the lady if it’s all right.” “He can wait!” Ed slams both hands down on the arm of his chair. “Momma—” “A. J., shut up!” Ed hooks his hands around the chair arms, threatening to get up. You try again. “Ed, how—” “The boy’s got to go, Ed!” “Hold it, everybody,” you say, raising your voice.