Advertisement

Disadvantaged, Multi-Stressed Families Adrift in a Sea of Professional Helpers

  • Valentín Escudero
  • Myrna L. Friedlander
Chapter
Part of the Focused Issues in Family Therapy book series (FIFT)

Abstract

Multi-stressed families (those who are experiencing moderate to severe difficulties in social, personal, and financial areas) tend to find it difficult to engage in the therapeutic process, despite a pressing need for help. These families often come to therapy at the insistence of social services (especially child protective services) or family court. These institutions often offer economic help under the condition that the family participates in conjoint treatment. In this chapter we discuss ways to reduce resistance and facilitate engagement through “joining with” and by demonstrating concern, interest, and empathy, including at times visiting the family’s home in order to forge alliances and strengthen motivation. Reframing is essential when the family and therapist have opposing views on the presenting problems, on how the problems should be approached, on the nature of the therapeutic relationship, and on the family’s relation to the agency in which the therapist is working. Next, we describe alliance empowerment strategies geared toward repairing the family’s lack of safety and integrating common ingredients of different collaborative, strength-focused therapy approaches. Specific alliance-fostering strategies include creating an “affected community,” clarifying who is the “real client,” serving as bridge to specialized treatments, and conveying optimism. An extended case example describes varying the format to hold some sessions with the whole family and some with the parents and siblings separately. The case involved a low-income, Haitian immigrant family that was mandated to treatment by social services after a series of serious signs of neglect in two of the family’s four children.

Keywords

Multi-stressed family Multiproblem family Acculturation Affected community Professional network Collaborative therapy Strength-focused interventions Involuntary clients Mandated clients Home-based therapy 

References

  1. Alexander, J. F., Waldron, H. B., Robbins, M. S., & Neeb, A. A. (2013). Functional family therapy for adolescent behavior problems. Washington, DC: American Psychological Association.Google Scholar
  2. Bachler, E., Frúhmann, A., Bachler, H., Aas, B., Strunk, G., & Nickel, M. (2016). Differential effects of the working alliance in family therapeutic home-based treatment of multi problem families. Journal of Family Therapy, 38, 120–148.CrossRefGoogle Scholar
  3. Bodden, D. H. M., & Deković, M. (2016). Multiproblem families referred to youth mental health: What’s in a name? Family Process, 55, 31–47.Google Scholar
  4. Coatsworth, J. D., Santisteban, D. A., McBride, C. K., & Szapocznik, J. (2001). Brief strategic family therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40, 313–332.CrossRefPubMedGoogle Scholar
  5. Curtis, N. M., Ronan, K. R., & Borduin, C. M. (2004). Multisystemic treatment: A meta-analysis of outcome studies. Journal of Family Psychology, 18, 411–419.CrossRefPubMedGoogle Scholar
  6. Escudero, V. (2009). Guía Práctica de la Intervención Familiar I. Junta de Castilla y León.Google Scholar
  7. Escudero, V. (2013). Guía Práctica de la Intervención Familiar II. Intervención en contextos cronificados o de especial dificultad. Junta de Castilla y León.Google Scholar
  8. Friedlander, M. L., Austin, C. L., & Cabrera, P. (2014). When psychotherapy is indefinite and there is no final outcome: Case study of a community mental health clinic. Psychotherapy, 51, 580–594.CrossRefPubMedGoogle Scholar
  9. Friedlander, M. L., Escudero, V., & Heatherington, L. (2006). Therapeutic alliances with couples and families: An empirically-informed guide to practice. Washington, DC: American Psychological Association.Google Scholar
  10. Friedlander, M. L., Heatherington, L., Johnson, B., & Skowron, E. A. (1994). “Sustaining engagement”: A change event in family therapy. Journal of Counseling Psychology, 41, 438–448.CrossRefGoogle Scholar
  11. Liddle, H. A., Rowe, C. L., Dakof, G. A., Henderson, C. E., & Greenbaum, P. E. (2009). Multidimensional family therapy for young adolescent substance abuse: Twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 77, 12–25.CrossRefPubMedGoogle Scholar
  12. Liu, W. M., Soleck, G., Hopps, J., Dunstan, K., & Pickett, T., Jr. (2004). A new framework to understand social class in counseling: The social class worldview model and modern classism theory. Journal of Multicultural Counseling and Development, 32, 95–102.CrossRefGoogle Scholar
  13. Lund, C., De Silva, M., Plagerson, S., Cooper, S., Chisholm, D., Das, J., et al. (2011). Poverty and mental disorders: Breaking the cycle in low-income and middle-income countries. Lancet, 378, 1502–1514.CrossRefPubMedGoogle Scholar
  14. Madsen, W. C. (2007). Collaborative therapy with multi-stressed families. New York: Guilford Press.Google Scholar
  15. Madsen, W. C. (2011). Collaborative helping maps: A tool to guide thinking and action in family-centered services. Family Process, 50, 529–543.CrossRefPubMedGoogle Scholar
  16. Madsen, W. C., & Gillespie, K. (2014). Collaborative helping: A strengths framework for home-based services. New York: Wiley.Google Scholar
  17. Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.Google Scholar
  18. Sotero, L., Cunha, D., Silva, T., Escudero, V. & Relvas, A.P. (in press). Building alliances with (in)voluntary clients: A study focused on therapists’ observable behaviors. Family Process. Google Scholar
  19. Sotero, L., Major, S., Escudero, V., & Relvas, A. P. (2016). The therapeutic alliance with involuntary clients: How does it work? Journal of Family Therapy, 38, 36–58.CrossRefGoogle Scholar
  20. Walsh, F. (2003). Family resilience: A framework for clinical practice. Family Process, 42, 1–18.CrossRefPubMedGoogle Scholar
  21. Walsh, F. (2017). Strengthening family resilience (3rd ed.). New York: Guilford Press.Google Scholar
  22. Witkiewitz, K., King, K., McMahon, R. J., Wu, J., Luk, J., Bierman, K. L., et al. (2013). Evidence for a multi-dimensional latent structural model of externalizing disorders. Journal of Abnormal Child Psychology, 41, 223–237.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Valentín Escudero
    • 1
  • Myrna L. Friedlander
    • 2
  1. 1.University of A CoruñaA CoruñaSpain
  2. 2.University at Albany/SUNYAlbanyUSA

Personalised recommendations