Home Uncategorized W#10 FAMILY TREATMENT PLAN (PSYCHOTHERAPY)

Uncategorized

W#10 FAMILY TREATMENT PLAN (PSYCHOTHERAPY)

Throughout the course, you have been participating in discussions and conceptualizing case studies based on specific therapeutic modalities. You will analyze the Floyd Family Case Study and create a therapeutic treatment plan for the family as a unit. You are free to use any of the therapeutic modalities discussed in this course, as long as you can establish an evidence-based practice!

This is an opportunity to show your skills and understanding of best practices in psychotherapy.

– Read the attached article Intimate Partner Violence (PDF)

– Watch the TED Talk Why Domestic Violence Victims Don’t Leave, see link https://www.ted.com/talks/leslie_morgan_steiner_why_domestic_violence_victims_don_t_leave?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare

– Explore TheHotline to read about domestic violence. Link: https://www.thehotline.org/identify-abuse/understand-relationship-abuse/

– Read the Floyd Family Case Study (see attached Word) and answer the questions included in the document.

– Use the Family Therapy Treatment Modalities Handout (Attached PDF) to develop a Treatment Plan for this family as if they were all coming to your office for treatment together.

Course textbook: Corey, G. (2016). Theory and practice of counseling and psychotherapy (10th ed.). Boston, MA: Cengage. ISBN: 9781305263727

The paper submission should be in APA format. Minimum 4 pages.

Free of plagiarism (TURNITIN assignment)

Background: I am currently enrolled in the Psych Mental Health Nurse Practitioner Program, I am a Registered Nurse, and I work in a Psychiatric Hospital.

646 American Family Physician www.aafp.org/afp Volume 94, Number 8 ◆ October 15, 2016

Intimate partner violence (IPV) is a prevalent worldwide health problem, affecting women more commonly than
men. IPV is underreported and underrecognized by health care professionals. Even when IPV is recognized, it
remains an underaddressed issue. In addition to physical injury and death, IPV causes significant physical and psy-
chiatric health problems commonly treated by family physicians. The U.S. Preventive Services Task Force recom-
mends screening all female patients of childbearing age for IPV. There are several brief screening tools that have
been proven effective at detecting IPV and that can be used in the office setting. Identification of IPV allows the
physician to provide better care and improves health outcomes for the survivor. Family physician offices should
provide patients with local and national resources. Thorough documentation of injuries sustained from abuse is
critical. Although caring for patients unready to leave an abusive relationship may be challenging for the physician,
continuous, supportive care improves patient outcomes. (Am Fam Physician. 2016;94(8):646-651. Copyright © 2016
American Academy of Family Physicians.)

Intimate Partner Violence

DANIEL DICOLA, MD, Thomas Jefferson University’s Sidney Kimmel Medical College, Excela Health Family Medicine
Residency, Latrobe, Pennsylvania

ELIZABETH SPAAR, DO, Pittsburgh, Pennsylvania

I
ntimate partner violence (IPV) is a
prevalent worldwide health problem,
affecting women more commonly than
men. It can include physical, emotional,

sexual, and financial abuse, as well as con-
trol over contraception or pregnancy and
medical care. IPV occurs in heterosexual
and same-sex relationships. Patients who are
being abused exhibit chronic physical and
emotional symptoms in addition to injuries
sustained as a result of physical and sexual
violence. They are also at risk of death from
homicide. IPV is largely underrecognized
and underaddressed as a health issue. The
World Health Organization has released
guidelines to help physicians respond to IPV
in women.1

Epidemiology
Because IPV is underreported, estimat-
ing true prevalence is difficult. Conserva-
tive estimates indicate that 20% to 30% of
women in the United States have experi-
enced IPV in their lifetime.2-4 More than
10% of female college students have reported
unwanted sexual intercourse with a partner.2
IPV tends to be repetitive, with an escala-
tion in frequency and severity over time.3
Homicide is a common consequence of IPV,
resulting in more than 1,000 deaths in the
United States each year.4,5 The initial episode
of IPV usually occurs before 25 years of age.6

Factors that increase the risk of IPV
include alcohol consumption, psychiatric
illness, a history of violent relationships
in childhood, and academic and financial
underachievement.3,6,7

Studies have found higher rates of IPV in
Native American and Alaska Native women.6
Immigrants have higher rates of IPV, but it is
much less likely to be reported or recognized
in this population.8 It is also common in
same-sex relationships, among transgender
women,9 and among women who are sur-
vivors of human trafficking.8 The incidence
of IPV in men appears to be less than in
women, but IPV is more likely to be under-
reported in men.3,10

Acute and Chronic Health Outcomes
IPV can lead to acute health outcomes, includ-
ing acute physical injury and homicide, as well
as chronic health burdens. Table 1 lists short-
and long-term health outcomes in women
who are abused.2,11,12 IPV affects pregnancy
outcomes and reproductive health, leading to
higher rates of miscarriage, preterm labor, and
low-birth-weight infants.11 Health care costs
and decreased productivity are significantly
increased in survivors of abuse, amounting to
an estimated $2.3 to $8.3 billion per year in
the United States.6 Long-term consequences
of IPV are more common in female survivors
than in male survivors.4

▲

See related editorial
on page 600.

CME This clinical content
conforms to AAFP criteria
for continuing medical
education (CME). See
CME Quiz Questions on
page 598.

Author disclosure: No rel-
evant financial affiliations.

▲

Patient information:
A handout on this topic is
available at http://www.
aafp.org/afp/2011/0515/
p1173.html.

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Intimate Partner Violence

October 15, 2016 ◆ Volume 94, Number 8 www.aafp.org/afp American Family Physician 647

Children living in homes where they
witness IPV have the same risk of signifi-
cant long-term physical and mental health
problems as children who have been abused
themselves.13,14 Children witnessing IPV can
have increased health care costs and hos-
pitalization rates, higher risk of being in
an abusive relationship as an adult, lower
immunization rates, posttraumatic stress
disorder, school-related problems, and sub-
stance abuse.13

Screening
RECOMMENDATIONS

In 2013, the U.S. Preventive Services Task
Force (USPSTF) began recommending rou-
tine screening for IPV in all female patients
of childbearing age. The USPSTF indicates
that current screening tools for IPV are sen-
sitive and specific, that screening and inter-
vention decrease abuse and harm to patients,
and that there is a low risk of negative effects
from screening.15,16

A 2014 Cochrane review contradicts the
USPSTF and found insufficient evidence that
routine screening improves outcomes. It fur-
ther concluded that there is inadequate proof
that routine screening is benign and cau-
tioned that the lack of sensitivity of screening
tools may lead to false reassurance by showing
lower rates of IPV than the true prevalence.17

The Cochrane review examined fewer
studies than the USPSTF, focusing on
screening alone and excluding studies such
as those of structured clinical interventions.
The Cochrane review included only two

studies that examined outcomes of screen-
ing and found no improvement in health or
reduction in IPV rates as late as 18 months
after screening. It included only one study
that examined possible adverse effects. The
authors justified their focus on screening
alone by stating that it is unrealistic to have
appropriate interventions available in a typi-
cal primary care setting. Review of current

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation
Evidence
rating References

All women of childbearing age should be screened for IPV. There is a
low risk of negative effects from screening.

A 15, 16

Women who screen positive for IPV should receive intervention services. C 15, 18, 26

There are multiple screening tools effective for IPV (Table 2). C 15, 17, 21

IPV = intimate partner violence.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence;
C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the
SORT evidence rating system, go to http://www.aafp.org/afpsort.

Table 1. Short- and Long-term Health Outcomes in
Women Who Are Abused

Endocrine

Chronic abdominal pain

Gastrointestinal effects

Irritable bowel syndrome

Type 2 diabetes mellitus

Gynecologic

Delay in diagnosing gynecologic
malignancy

Dyspareunia

Elective abortion

Pelvic pain

Sexually transmitted infections

Unintended pregnancy

Unsafe sexual behaviors

Musculoskeletal

Chronic pain

Fibromyalgia

Neurologic

Migraine headaches

Information from references 2, 11, and 12.

Psychiatric

Anxiety

Depression

Low self-esteem

Phobias

Posttraumatic stress disorder

Sleep disturbance

Substance abuse

Suicide

Pulmonary

Asthma

Reproductive

Fetal injury

Fetal loss

Low-birth-weight infants

Preterm birth

Intimate Partner Violence

648 American Family Physician www.aafp.org/afp Volume 94, Number 8 ◆ October 15, 2016

research, however, shows that even simple
interventions, such as providing a wallet
card that includes information on IPV, safety
planning, or local domestic violence shelters,
can improve outcomes.17

Major medical bodies, including the
American Academy of Family Physicians,

the American Medical Association, and
the American College of Obstetricians and
Gynecologists, recommend routine screen-
ing for IPV and caution that waiting for
more definitive research before addressing
IPV puts women at risk.18

SCREENING TOOLS

Screening tools are limited by the patient’s
readiness to disclose the abuse. Some
patients may not feel ready to admit that they
are in an abusive situation, or may fear retri-
bution from the abuser even with assurances
of confidentiality by the clinician.2,8 How-
ever, this should not deter physicians from
screening patients with one of the multiple
screening tools (Table 219,20) that have been
proven sensitive and specific for identifying
IPV.15 Shorter, simpler tools are as effective
as longer screening instruments.21

TALKING TO PATIENTS

Research shows that patients, with and with-
out a history of IPV, favor physicians inquir-
ing about IPV at wellness visits. Although
most physicians feel they should screen
patients for IPV, only a small percentage actu-
ally do so, largely because they feel uncom-
fortable having such conversations.17,22

Physicians should begin by explaining
why they are asking about IPV, whether it
be part of screening at a wellness visit or in
response to specific physical or mental health
issues. The most important aspect of these
discussions is for the physician to demon-
strate compassion and avoid condescending
or judgmental behavior. Direct question-
ing about specific abuse experiences should
be avoided in favor of a more open-ended
approach. Simply asking patients what hap-
pened or if they feel safe and valued in their
relationship can be the best way to open the
dialogue.2,23 Table 3 includes tips for discuss-
ing IPV with female patients.24

The patient should always be clothed when
discussing IPV. The patient’s partner or chil-
dren older than three years should not be
present. It may be helpful to establish with
patients and those with them ahead of time
that it is office policy to conduct a portion
of each patient’s visit alone.2,17,23 Physicians

Table 2. Examples of Screening Tools for Intimate Partner
Violence

HITS (Hurt, Insult, Threaten, Scream) – self report or physician
administered

How often does your partner physically hurt you?

How often does your partner insult or talk down to you?

How often does your partner threaten you with physical harm?

How often does your partner scream at you?

Scoring: never = 1 point, rarely = 2 points, sometimes = 3 points, fairly often =
4 points, frequently = 5 points. A score of greater than 10 points is a positive screen.

STAT (Slapped, Threatened, and Throw) – physician administered

Have you ever been in a relationship where your partner has pushed or
slapped you?

Have you ever been in a relationship where your partner threatened you
with violence?

Have you ever been in a relationship where your partner has thrown,
broken, or punched things?

A positive answer to any of these questions is a positive screen.

Information from reference 19.

WAST (Woman Abuse Screening Tool) – self report

In general, how would you describe your relationship? No tension, some
tension, a lot of tension?

Do you and your partner work out arguments with no difficulty, some
difficulty, or great difficulty?

Do arguments ever result in you feeling down or bad about yourself?

Do arguments ever result in hitting, kicking, or pushing?

Do you ever feel frightened about what your partner says or does?

Does your partner ever abuse you physically?

Does your partner ever abuse you emotionally?

Does your partner ever abuse you sexually?

The physician performs scoring subjectively, using clinical judgment.

Adapted with permission from Brown JB, Lent B, Brett PJ, Sas G, Pederson LL. Devel-
opment of the Woman Abuse Screening Tool for use in family practice. Fam Med.
1996;28(6):425.

NOTE: More information on screening tools is available from the Centers for Dis-
ease Control and Prevention at http://www.cdc.gov/violenceprevention/pdf/ipv/
ipvandsvscreening .

Intimate Partner Violence

October 15, 2016 ◆ Volume 94, Number 8 www.aafp.org/afp American Family Physician 649

should be aware of mandatory reporting
and confidentiality laws in their state so they
can inform patients of any limits to doctor-
patient confidentiality at the onset of any
discussion. Some states, for instance, include
IPV witnessed by children in their man-
datory reporting requirements. For more
information about state requirements, go
to https://www.futureswithoutviolence.org/
mandatory-reporting-of-domestic-violence-
by-healthcare-providers/.

Approach to Patients in an Abusive
Relationship
Patients who screen positive for IPV may
respond in unexpected ways. Many will not
be ready to leave the relationship, whether it
be for emotional or more practical reasons,
such as financial or safety concerns (most
homicides by an intimate partner occur
in the year after the abused partner leaves
the relationship). Concern for children and
the hope that a partner will change are also
common reasons for staying in an abusive
relationship.25 Regardless, it is important for
physicians to be supportive and provide or
refer for intervention services.15,18,26 Risk of
immediate harm should be assessed at the
time of IPV identification and at all subse-
quent visits.2,17,23

The assessment of the risk of immediate
harm should include the following questions
(if patients answer “yes” to at least three of
these questions, they are at high risk of harm
or injury, with a sensitivity of 83% and a
specificity of 56%)27:

• Has the physical violence increased over
the past six months?

• Has your partner used a weapon or
threatened you with a weapon?

• Do you believe your partner is capable of
killing you?

• Have you been beaten while pregnant?
• Is your partner violently and constantly

jealous of you?
Information about safety planning should

be offered to the patient. A safety plan helps
prepare the patient to leave if the situation
acutely worsens, and they are at immediate
risk. It may include making copies of personal
documents, making copies of keys, securing

money, and packing a bag with essential
items. The patient should identify a safe place
to go (e.g., a relative’s house, local domestic
violence shelter). Code words should be estab-
lished with trusted friends or family so that
the patient can call and alert them to immi-
nent danger in the presence of the abuser. A
list of local and national resources should be
provided to the patient, including local shel-
ters and the National Domestic Violence hot-
line number (800-799-SAFE). If the patient
does not feel safe taking a wallet card with
this information, important phone numbers
may be programmed into the patient’s phone
under a code name.2,23 Physicians who are
too busy or not comfortable enough to help
establish a complete safety plan should pro-
vide the patient with resources for further
assistance (Table 4).

An ongoing relationship with the same
physician improves patient openness to dis-
cussing IPV. Being aware of a patient’s expe-
riences with IPV allows the physician to
gain insight into the patient’s medical and
emotional problems, and should prompt
the physician to show extra sensitivity with

Table 3. Tips for Discussing Intimate Partner Violence
with Female Patients

Respect confidentiality

Discuss intimate partner violence with patients privately, and be open
about what physician-patient confidentiality does and does not include

Believe and validate the patient’s experiences

Listen respectfully, and let the patient know that intimate partner violence
is a common problem

Acknowledge the injustice; let the patient know that the abuse is not the
patient’s fault and that she does not deserve it

Respect autonomy and the patient’s right to make decisions about what
to do and when

Assess for high risk of harm or injury, including homicide

Help the patient with safety planning

Does the patient have a safe place to go? Provide resources (Table 4)

Promote access to community services

Give information about local shelters in a way that it is safe for the patient
to take with her (e.g., printed on a wallet card, entered into the patient’s
phone under a code name)

Information from Centre for Children and Families in the Justice System. Helping
children thrive. 2004. http://www.lfcc.on.ca/HCT_SWASM_7.html. Accessed April 1,
2016.

Intimate Partner Violence

650 American Family Physician www.aafp.org/afp Volume 94, Number 8 ◆ October 15, 2016

physical examinations (explaining each
next step in the examination and getting the
patient’s approval to move forward is a way
of giving the patient back a sense of control
over her body). It is critical for the physician
to document any injuries thoroughly and
provide a detailed record of what happened,
including direct quotes from the patient
when appropriate. This can aid the patient
if charges are pressed.2,23,26,28,29

Prevention
The World Health Organization rec-
ommends legislative reform and media
campaigns to increase IPV awareness.
School-based education programs deal-
ing with dating violence have been shown
to reduce unwanted sexual advances. Early
intervention services in at-risk families have
been shown to reduce mistreatment of chil-
dren and may reduce violent behaviors later
in life. Comprehensive services from the
health, legal, and law enforcement sectors
should be made available to survivors.25

Data Sources: A literature search was conducted in
PubMed using the term intimate partner violence. Key
sources included USPSTF recommendations and Cochrane
reviews. Search dates: October 2013 and March 2015.

NOTE: This review updates a previous article on this topic
by Cronholm, et al.30

The Authors

DANIEL DICOLA, MD, is a clinical associate professor of
family and community medicine at Thomas Jefferson

University’s Sidney Kimmel Medical College in Phila-
delphia, Pa., and is an attending physician at the Excela
Health Family Medicine Residency in Latrobe, Pa.

ELIZABETH SPAAR, DO, is a physician in Pittsburgh, Pa.

Address correspondence to Daniel DiCola, MD, Sidney
Kimmel Medical College, Thomas Jefferson University,
1 Mellon Way, Latrobe, PA 15650 (e-mail: ddicola@
excelahealth.org). Reprints are not available from the
authors.

REFERENCES

1. World Health Organization. Responding to intimate part-
ner violence and sexual violence against women. 2013.
http://www.who.int/reproductive health/publications/
violence/9789241548595/en/. Accessed May 19, 2015.

2. Chang JC. Intimate partner violence: how you can help
female survivors. Cleve Clin J Med. 2014;81(7):439-446.

3. Carmo R, Grams A, Magalhães T. Men as victims of inti-
mate partner violence. J Forensic Leg Med. 2011;18(8):
355-359.

4. Stöckl H, Devries K, Rotstein A, et al. The global preva-
lence of intimate partner homicide: a systematic review.
Lancet. 2013;382(9895):859-865.

5. Violence Policy Center. When men murder women:
an analysis of 2010 Homicide Data. September
2012. http://www.vpc.org/studies/wmmw2012 .
Accessed April 15, 2015.

6. Breiding MJ, Smith SG, Basile KC, Walters ML, Chen J,
Merrick MT. Prevalence and characteristics of sexual
violence, stalking, and intimate partner violence victim-
ization—national intimate partner and sexual violence
survey, United States, 2011. MMWR Surveill Summ.
2014;63(8):1-18.

7. Centers for Disease Control and Prevention. Inti-
mate partner violence: risk and protective factors.
http: / /www.cdc.gov/ViolencePrevention / intimate
partnerviolence/riskprotectivefactors.html. Accessed
May 10, 2015.

8. Modi MN, Palmer S, Armstrong A. The role of Violence
Against Women Act in addressing intimate partner vio-
lence: a public health issue. J Womens Health (Larchmt).
2014;23(3):253-259.

9. Ard KL, Makadon HJ. Addressing intimate partner vio-
lence in lesbian, gay, bisexual, and transgender patients.
J Gen Intern Med. 2011; 26(8):930-933.

10. Black MC, et al. Prevalence of sexual violence against
women in 23 states and two U.S. territories, BRFSS
2005. Violence Against Women. 2014;20(5):485-499.

11. de Sousa J, Burgess W, Fanslow J. Intimate partner vio-
lence and women’s reproductive health. Obstetr Gyn-
aecol Reprod Med. 2014;24(7): 195-203.

12. Pavey AR, Gorman GH, Kuehn D, Stokes TA, Hisle-
Gorman E. Intimate partner violence increases adverse
outcomes at birth and in early infancy. J Pediatr.
2014;165(5):1034-1039.

13. McFarlane JM, Groff JY, O’Brien JA, Watson K. Behav-
iors of children who are exposed and not exposed
to intimate partner violence. Pediatrics. 2003; 112
(3 pt 1):e202-e207.

14. MacMillan HL, Wathen CN. Children’s exposure to inti-
mate partner violence. Child Adolesc Psychiatr Clin N
Am. 2014;23(2):295-308, viii-ix.

Table 4. National Resources for
Patients Experiencing Intimate
Partner Violence

Futures Without Violence

New Home

Posters, brochures, and safety planning cards

National Coalition Against Domestic Violence

http://www.ncadv.org

Online tool for creating a safety plan

National Domestic Violence Hotline

1-800-799-SAFE or http://www.ndvh.org

Help with safety planning and crisis
interventions

Intimate Partner Violence

October 15, 2016 ◆ Volume 94, Number 8 www.aafp.org/afp American Family Physician 651

15. Moyer VA. Screening for intimate partner violence and
abuse of elderly and vulnerable adults: U.S. Preventive
Services Task Force recommendation statement. Ann
Intern Med. 2013;158(6):478-486.

16. U.S. Preventive Services Task Force. Intimate partner
violence and abuse of elderly and vulnerable adults:
screening. January 2013. http://www.uspreventive
services task force.org/Page/Document/UpdateSum-
maryFinal /intimate-partner-violence-and-abuse-of-
elderly-and-vulnerable-adults-screening. Accessed
April 1, 2016.

17. O’Doherty LJ, Taft A, Hegarty K, Ramsay J, Davidson
LL, Feder G. Screening women for intimate partner vio-
lence in healthcare settings: abridged Cochrane system-
atic review and meta-analysis. BMJ. 2014; 348:g2913.

18. Singh V, Petersen K, Singh SR. Intimate partner violence
victimization: identification and response in primary
care. Prim Care. 2014; 41(2): 261-281.

19. Paranjape A, Liebschutz J. STaT: a three-question
screen for intimate partner violence. J Womens Health
(Larchmt). 2003;12(3):233-239.

20. Brown JB, Lent B, Brett PJ, Sas G, Pederson LL. Develop-
ment of the Woman Abuse Screening Tool for use in
family practice. Fam Med. 1996;28(6):422-428.

21. Rabin RF, Jennings JM, Campbell JC, Bair-Merritt MH.
Intimate partner violence screening tools: a systematic
review. Am J Prev Med. 2009; 36(5):439-445.e4.

22. MacMillan HL, Wathen CN, Jamieson E, et al.;
McMaster Violence Against Women Research Group.
Approaches to screening for intimate partner violence
in health care settings: a randomized trial. JAMA.
2006;296(5):530-536.

23. Friedman LS, Samet JH, Roberts MS, Hudlin M, Hans
P. Inquiry about victimization experiences. A survey of
patient preferences and physician practices. Arch Intern
Med. 1992;152(6):1186-1190.

24. Centre for Children and Families in the Justice System.
Helping children thrive. 2004. http://www.lfcc.on.ca/
HCT_SWASM_7.html. Accessed April 1, 2016.

25. World Health Organization. Understanding and
addressing violence against women: intimate
partner violence. 2012. http://www.who.int/iris/
bitstream/10665/77432/1/WHO_RHR_12.36_eng ?
ua=1.%25202012. Accessed February 3, 2016.

26. American College of Obstetricians and Gynecolo-
gists. ACOG committee opinion no. 554: reproductive
and sexual coercion. Obstet Gynecol. 2013;121(2 pt
1):411-415.

27. Snider C, Webster D, O’Sullivan CS, Campbell J. Intimate
partner violence: development of a brief risk assess-
ment for the emergency department. Acad Emerg Med.
2009;16(11):1208-1216.

28. Shavers CA. Intimate partner violence: a guide for pri-
mary care providers. Nurse Pract. 2013;38(12):39-46.

29. García-Moreno C, Zimmerman C, Morris-Gehring A,
et al. Addressing violence against women: a call to
action [published correction appears in Lancet. 2015;
385(9978):1622]. Lancet. 2015;385(9978):1685-1695.

30. Cronholm PF, Fogarty CT, Ambuel B, Harrison SL. Inti-
mate partner violence. Am Fam Physician. 2011;83
(10):1165-1172.

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FAMILY INFORMATION:	FAMILY CASE STUDY
Father	Jerry Floyd				Age:	32
Mother	Skipper Floyd
		Child	Jerry Floyd, Jr.	15
Mary Floyd	11
Ralph Floyd	8
Milton Floyd	6
Lori Floyd	1 yr. 8 mos.

FAMILY HISTORY

Jerry and Skipper Floyd have been married since 1993. They met in high school. Skipper was pregnant with Jerry Jr. at the time of their marriage during Skipper’s 11th grade year. They remain legally married and have continued to live together, until recently when Skipper moved out of the home on February 14, 2017. Skipper is 10 weeks pregnant with the couple’s 6th child, and decided to leave the relationship due to Jerry’s ongoing volatile outbursts and escalating physical altercations towards Skipper. Skipper recently began an addiction recovery outpatient residential program and will be staying in the sober house while the 5 children remain at home with Jerry.

Family Presentation:

On February 17, 2017 at 11:30pm, it was reported to local law enforcement that two young children were observed walking along a secondary highway, toward a small town in rural Oregon. They were six miles from town, having walked a distance of approximately one mile from their home. Law Enforcement officials picked up the children, who were identified as Mary and Ralph Floyd, ages 11 and 8. The children were cold, frightened, dirty, and soaking wet. It had been raining lightly that evening. They reported that they were running away from home because their father was “drunk” and “high” and was “tearing the house apart”. A call was made to the Division of Child Protective Services and the police and a social worker immediately made a crisis visit to investigate the home.

As a result; Lori, Milton, Ralph, Mary, and Jerry Jr. were taken into emergency protective custody early in the morning on February 18, 2017. The children were placed into three different foster homes throughout the county, which spans a 100-mile radius. o98

After a thorough investigation of the home of Jerry Floyd, the following allegations were substantiated and subsequently adjudicated:

· Jerry Jr., Mary, Ralph, Milton and Lori have been subjects of physical neglect including lack of food, lack of supervision and unsafe living conditions.

· Methamphetamine, marijuana and drug paraphernalia, and 45 empty beer cans were found lying on the coffee table at the time law enforcement entered the home. Jerry Floyd Sr., was passed out on the couch asleep

· Mary, Ralph, and Milton report having witnessed their Mother and Father using drugs and becoming intoxicated to the point they could not adequately supervise or provide care for the children on numerous occasions. There is evidence that Jerry Jr. has often walked a quarter mile to the neighbors reporting they he and his siblings were locked out of their house and asking if he and his siblings could stay at their house and have something to eat.

· Jerry Floyd is reported by Mary and Ralph to have hit their mother numerous times in the recent past, giving her black eyes, and kicking her stomach. He has hit her in the face and made her nose bleed numerous times. Skipper Floyd was observed by law enforcement to have deep scratches on her face and a bruise under her eye at the time the children were taken into emergency protective custody.

· Milton Floyd (age 6) has reported to the Children’s Division investigator that Jerry Jr. does “bad” things to Mary and Lori. Milton will not further elaborate on what “bad” things happened.

· Milton refers to as “bad” things being done to his sisters by Jerry Jr. Mary denies any abuse of any kind by her older brother. She will only say that she does not like him and she wishes her Mommy would move back home. She becomes withdrawn when questioned any further. She and her siblings are receiving therapy at this time to assist them in dealing with the stress of being separated from their Mother, assisting them to adjusting to their new living situation, and in helping sort out what has happened to them. The Children’s Division is hopeful that the therapist will be able to develop a relationship of trust and that more can be learned about the extent to which the children were abused/neglected.

Floyd Family Case Study

· Jerry Jr. is also very protective of his mother and will say very little about what happened in the home. He has talked about his father “beating my Mom” and that he hates him. The children all miss their mother and worry about her. Their paternal grandfather has taken the children to visit her at the shelter once.

Legal History

· Jerry Floyd has been arrested twice on domestic assault charges alleged by Skipper over the past 5 years. He was never charged due to refusal of his wife to testify against him. Jerry Sr. has been incarcerated three times for petty theft, vandalism and drugs. He has been sober for sixteen months after completing court ordered drug treatment when he was arrested for possession of cocaine. However, since Skipper moved out of the home, he recently slipped back into using substances daily. Jerry Floyd Sr. was arrested and placed in county jail on February 19, 2017. He remains in jail awaiting trial on charges of criminal child abuse and neglect and possession of drugs.

· Skipper Floyd is also being investigated for report of child abuse and neglect, but remains living in the sober house at this time. The Children’s Division is continuing to learn more about the abuse that the children were subjected to, although it has not been determined as to what extent the children witnessed abuse.

· Skipper was court ordered for addiction recovery treatment due to public drunkenness at the children’s school concert. She has had past involvement with DCF and accusations of child neglect related to similar incidence. She has been arrested once for an OUI and spent the night in the county jail 2 years ago. This incidence was the catalyst for her beginning treatment for her alcohol use.

Concerns of the Children’s Division

· During a recent home visit, the children division social worker observed Skipper’s parenting of the children to determine if it was safe for the children to be placed back home with her. They raised concerns regarding the discipline style and tendency to become overwhelmed with the needs of her children. The run down condition of the home and yard, the turbulent and unstable relationship between Jerry and Skipper, the substance abuse issues, history of violence in the home, psychological stress and guilt experienced by Mary and Ralph for having told the police what was occurring in their home, anger at Mary and Ralph from Jerry Jr. for having “told on Mom”, and the emotional strain of being separated from their mother.

· Skipper wants to have the children placed with her at home and is open and communicative about the fact that she does need assistance and support in raising them. While the children have been in foster care, Skipper has had two overnight visits with the children. She admits that he gets frustrated that the children “don’t mind” her. Skipper’s parenting style is to be permissive for a period of time until the children become so out of control that she screams at them or uses corporal punishment. She admits he has a short temper. She does appear to have a close bond with the children and they do with her.

· Jerry Jr. is given a great deal of child care responsibilities and he appears to be handling it well. When visiting their father, Jerry Jr. takes primary care of the children while his father and Valerie are at work. The grandfather is nearby if needed. The children are often found to be extremely dirty and running around barefoot in the yard. They do appear to be happy and well-fed, although meals are not always the most nutritionally sound. The children continue to be monitored by a pediatrician and therapist and except for Ralph, appear to be achieving developmental milestones and are inside normal ranges for their height and weight. The children have recently started seeing a therapist.

· The Floyd’s home is a ramshackle trailer that is set on property that has a yard full of discarded and broken machinery, chickens and roosters roam around, and there are numerous dogs. There is no grass and the yard is very rocky. The one bathroom in the home is extremely filthy. The plumbing sometimes does not work and the toilet is often backed up. The children report that they use “outside” as a toilet when this happens.

Prognosis & Recommendations

A family support team meeting has been scheduled. A decision needs to be made as to whether or not the children can be placed with their mother back in the family home. Everyone involved seems to have a different opinion. A Children’s Division licensing worker has conducted a home study on Jerry and Skipper and it is her recommendation that the children be placed with their mother on a 30-day trial home visit. The licensing worker is most concerned about Skipper’s capability to care for Lori, the youngest of the children, while pregnant and in treatment at an outpatient addiction recovery program. She feels that with the right support and guidance and Skipper can become successful at raising the kids. Jerry Floyd’s court date is set for next week to determine if he will be released from jail on parole.

MajorMarriage and Family Therapy Models

Developed by Thorana S. Nelson, PhD and Students

STRUCTURAL FAMILY THERAPY

LEADERS

Salvador Minuchin
Charles Fishman

ASSUMPTIONS:
Problems reside within a family structure

(although not necessarily caused by the
structure)

Changing the structure changes the
experience the client has

Don’t go from problem to solution, we
just move gradually

Children’s problems are often related to
the boundary between the parents (marital
vs. parental subsystem) and the boundary
between parents and children

CONCEPTS:

Family structure

Boundaries
o Rigid
o Clear
o Diffuse
o Disengaged
o Normal Range
o Enmeshment
o Roles
o Rules of who interacts with whom, how,

when, etc.
Hierarchy
Subsystems
Cross-Generational Coalitions
Parentified Child

GOALS OF THERAPY:
Structural Change

o Clarify, realign, mark
boundaries

Individuation of family members
Infer the boundaries from the patterns of

interaction among family members
Change the patterns to realign the

boundaries to make them more closed or
open

ROLE OF THE THERAPIST:
Perturb the system because the structure is too rigid

(chaotic or closed) or too diffuse (enmeshed)
Facilitate the restructuring of the system
Directive, expert—the therapist is the choreographer
See change in therapy session; homework solidifies

change
Directive

ASSESSMENT:
Assess the nature of the boundaries, roles

of family members
Enactment to watch family

interaction/patterns

INTERVENTIONS:
Join and accommodate

o mimesis
Structural mapping
Highlight and modify interactions

Unbalance
Challenge unproductive assumptions
Raise intensity so that system must change

CHANGE:
Raise intensity to upset the system, then

help reorganize the system
Change occurs within session and is

behavioral; insight is not necessary
Emotions change as individuals’

experience of their context changes

Marriage and Family Therapy Models Page 2

Structural Family Therapy, Continued

Interventions

disorganize and reorganize
Shape competence through Enactment

(therapist acts as coach)

TERMINATION:
Problem is gone and the structure

has changed (2nd order change)
Problem is gone and the structure

has NOT changed (1st order change)

SELF OF THE THERAPIST:
The therapist joins with the system to facilitate the

unbalancing of the system
Caution with induction—don’t get sucked in to the content

areas, usually related to personal hot spots

EVALUATION:
Strong support for working with psychosomatic children, adult drug addicts, and anorexia nervosa.

SUPERVISION INTERVENTIONS:

RESOURCES:
Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.
Minuchin, S., & Fishman, H. C. (1981). Family therapy techniques. Cambridge, MA: Harvard University Press.
Minuchin, S., Rosman, B. L., & Baker, L. (1978). Psychosomatic families. Cambridge, MA: Harvard University

Press.
Fishman, H. C. (1988). Treating troubled adolescents: A family therapy approach. New York: Basic Books.
Fishman, H. C. (1993). Intensive structural therapy: Treating families in their social context. New York: Basic

Books.

NOTES

Marriage and Family Therapy Models Page 3

STRATEGIC THERAPY (MRI)

LEADERS:

John
Weakland

Don Jackson
Paul

Watzlawick
Richard Fisch

ASSUMPTIONS:
Family members often perpetuate problems by their own actions (attempted

solutions) –the problem is the problem maintenance (positive feedback
escalations)

Directives tailored to the specific needs of a particular family can sometimes bring
about sudden and decisive change

People resist change
You cannot not communicate–people are ALWAYS communicating
All messages have report and command functions– working with content is not

helpful, look at the process
Symptoms are messages — symptoms help the system survive (some would say

they have a function)
It is only a problem if the family describes it as such
Based on work of Gregory Bateson and Milton Erickson
Need to perturb system – difference that makes a difference (similar enough to be

accepted by system but different enough to make a difference)
Don’t need to examine psychodynamics to work on the problem

CONCEPTS:
Symptoms are messages
Family homeostasis
Family rules — unspoken
Cybernetics

o Feedback Loops
o Positive Feedback
o Negative Feedback

First order change
Second order change
Reframing
Content & Process
Report & Command
Paradox
Paradoxical Injunction
“Go Slow” Messages
Positive Feedback Escalations
Double Binds
“One down” position
Patient position
Attempted solutions maintain problems and

become problems themselves

GOALS OF THERAPY:
Help the family define clear, reachable goals
Break the pattern; perturb the system
First and second order change- ideally second

order change (we cannot make this happen– it is
spontaneous)

ROLE OF THE THERAPIST:
Expert position
Responsible for creating conditions for change
Work with resistance of clients to change
Work with the process, not the content
Directive

ASSESSMENT:
Define the problem clearly and find out what

people have done to try to resolve it
Elicit goals from each family member and

then reframe into one, agreed-upon goal
Assess sequence patterns

Marriage and Family Therapy Models Page 4

Strategic Therapy (MRI), Continued

Interventions

Skeptical of change
Take a lot of credit and responsibility for change;

however, therapist tells clients that they are
responsible for change

Active

INTERVENTIONS:

Paradox
Directives

o Assignments (“homework”) that interrupt
sequences

Interrupt unhelpful sequences of interaction
“Go slow” messages
Prescribe the symptoms

CHANGE:
Interrupting the pattern in any way
Difference that makes a difference
Change occurs outside of session; insession

change is in viewing; homework changes
doing

Change in viewing (reframe) and/or doing
(directives)

Emotions change and are important, but are
inferred and not directly available to the
therapist

TERMINATION:

Client decides when to terminate with the help of the
therapist

When pattern is broken and the client reports that the
problem no longer exists

Therapist decides

SELF OF THE THERAPIST:
Therapist needs to be VERY careful with

ethics in this model; it can be very
manipulative (paradox) and a lot of
responsibility is on the therapist as an expert

EVALUATION:
Very little research done
Do clients report change? If so, then it is effective

SUPERVISION INTERVENTIONS:

RESOURCES:
Watzlawick, P., Weakland, J., &, Fisch, R. (1974). Change: Principles of problem formation and problem

resolution. New York: Norton.
Fisch, Richard, John H. Weakland, and Lynn Segal (1982). The tactics of change: Doing therapy briefly.

San Francisco: Jossey-Bass.
Watzlawick, P., J. B. Bavelas, and D. J. Jackson. (1967). Pragmatics of human communication. New York: W.

W. Norton.
Lederer, W. J., and Don Jackson. (1968). The mirages of marriage. New York: W. W. Norton.

NOTES:

Marriage and Family Therapy Models Page 5

STRATEGIC THERAPY (Haley & Madanes)

LEADERS:

Jay Haley
Cloe Madanes
Influenced by

Minuchin

ASSUMPTIONS:
Family members often perpetuate problems by their own actions (attempted
solutions) –the problem is the problem maintenance (positive feedback
escalations)
Directives tailored to the specific needs of a particular family can sometimes bring
about sudden and decisive change
People resist change
You cannot not communicate–people are ALWAYS communicating
All messages have report and command functions– working with content is not

helpful, look at the process
Communication and messages are metaphorical for family functioning
Symptoms are messages — symptoms help the system survive
It is only a problem if the family describes it as such
Based on work of Gregory Bateson, Milton Erickson, MRI, and Minuchin
Need to perturb system – difference that makes a difference (similar enough to be

accepted by system but different enough to make a difference)
Problems develop in skewed hierarchies
Motivation is power (Haley) or love (Madanes)

CONCEPTS:

Symptoms are messages
Family homeostasis
Family rules – unspoken
Intergenerational collusions
First and second order change
Metaphors
Reframing
Symptoms serve functions
Content & Process
Report & Command
Incongruous Hierarchies
Ordeals (prescribing ordeals)
Paradox
Paradoxical Injunction
Pretend Techniques (Madanes)
“Go Slow” Messages

GOALS OF THERAPY:
Help the family define clear, reachable goals
Break the pattern; perturb the system
First and second order change- ideally second order change

(we cannot make this happen– it is spontaneous)
Realign hierarchy (Madanes)

ROLE OF THE THERAPIST:
Expert position
Responsible for creating conditions for change
Work with resistance of clients to change
Work with the process, not the content
Directive
Skeptical of change
Take a lot of credit and responsibility for change;

however, therapist tells clients that they are
responsible for change
Active

ASSESSMENT:
Define the problem clearly and find out what

people have done to try to resolve it
Hypothesize metaphorical nature of the

problem
Elicit goals from each family member and

then reframe into one, agreed-upon goal
Assess sequence patterns

Marriage and Family Therapy Models Page 6

Strategic Therapy (Haley & Madanes), Continued

INTERVENTIONS:

Paradox
Directives
o Assignments (“homework”) that interrupt
sequences

Interrupt unhelpful sequences of interaction
Metaphors, stories
Ordeals (Haley)
“Go slow” messages
Prescribe the symptoms (Haley)
“Pretend” techniques (Madanes)

CHANGE:
Breaking the pattern in any way
Difference that makes a difference
Change occurs outside of session; insession

change is in viewing; homework changes
doing
Change in viewing (reframe) and/or doing
(directives)

TERMINATION:
Client decides when to terminate with the help of

the therapist
When pattern is broken and the client reports that

the problem no longer exists
Therapist decides

SELF OF THE THERAPIST:
Therapist needs to be VERY careful with
ethics in this model; it can be very
manipulative (paradox) and a lot of
responsibility is on the therapist as an expert

EVALUATION:
Very little research done
Do clients report change? If so, then it is effective

RESOURCES:
Madanes, Cloe. (1981). Strategic family therapy. San Francisco, CA: Jossey-Bass.
Madanes, Cloe. (1984). Behind the one-way mirror: Advances in the practice of strategic therapy. San

Francisco, CA: Jossey-Bass.
Madanes, Cloe. (1990). Sex, love, and violence: Strategies for transformation. New York: W. W. Norton.
Madanes, Cloe. (1995). The violence of men: New techniques for working with abusive families. San Francisco:

Jossey-Bass.
Haley, Jay. (1980). Leaving home. New York: McGraw-Hill.
Haley, Jay. (1984). Ordeal therapy: Unusual ways to change behavior. San Francisco, CA: Jossey Bass.
Haley, Jay. (1987). Problem-solving therapy (2nd Ed.). San Francisco: Jossey-Bass.

NOTES:

Marriage and Family Therapy Models Page 7

MILAN FAMILY THERAPY

LEADERS:

Boscolo
Palazzoli
Prata
Cecchin

ASSUMPTIONS:
problem is maintained by family’s attempts to fix it
therapy can be brief over a long period of time
clients resist change

CONCEPTS:
family games (family’s patterns that maintain the

problem)
o dirty games
o psychotic games

there is a nodal point of pathology
invariant prescriptions
rituals
positive connotation
difference that makes a difference
neutrality
hypothesizing
therapy team
circularity, neutrality
incubation period for change; requires long periods of

time between sessions

GOALS OF THERAPY:
disrupt family games

ROLE OF THERAPIST:
therapist as expert
neutral to each family member – don’t get sucked into

the family game
curious

ASSESSMENT:
Family game
Dysfunctional patterns (patterns that

maintain the problem)

INTERVENTIONS:
Ritualized prescriptions
Rituals
Circular questions
Counter paradox
Odd/even day
Positive connotation
“Date”
Reflecting team
Letters
Prescribe the system

CHANGE:
Family develops a different game

that does not include the symptom
(system change)

Requires incubation period

TERMINATION:
Therapist decides, fewer than 10-12 sessions

EVALUATION:
Not practiced much, therefore not

researched
Follow up contraindicated

SUPERVISION INTERVENTIONS:

Marriage and Family Therapy Models Page 8

Milan Family Therapy, continued

RESOURCES:
Campbell, D., Draper, R., & Huffington, C. (1989). Second thoughts on the theory and practice of the

Milan approach to family therapy. New York: Karnac.
Campbell, D., Draper, R., & Crutchley, E. (1991). The Milan systemic approach to family therapy. In

A. S. Gurman & D. P. Kniskern (Eds.), Handbook of Family Therapy (Vol. II) (pp. 325-362).
New York: Brunner/Mazel.

Cecchin, G. (1987). Hypothesizing, circularity, and neutrality revisited: An invitation to curiosity.
Family Process, 26(4), 405-413.

Cecchin, G. (1992). Constructing therapeutic possibilities. In S. McNamee & K. J. Gergen (Eds.),
Therapy as social construction (pp. 86-95). Newbury Park, CA: Sage.

Palazzoli, M. S., Boscolo, L., Cecchin, G., & Prata, G. (1978). Paradox and counterparadox: A new
model in the therapy of the family in schizophrenic transaction. New York: Jason Aaronson.

Palazzoli, M. S., Boscolo, L., Cecchin, G., & Prata, G. (1978). A ritualized prescription in family
therapy: Odd days and even days. Journal of Marriage and Family Counseling, 48, 3-9.

Palazzoli, M., & Palazzoli, C. (1989). Family games: General models of psychotic processes in the
family. New York: W. W. Norton & Company.

NOTES:

Marriage and Family Therapy Models Page 9

SOLUTION-FOCUSED BRIEF THERAPY

LEADERS:

Steve de
Shazer

Insoo Kim
Berg

Yvonne
Dolan

Eve Lipchik

ASSUMPTIONS:
Clients want to change
There’s no such thing as resistance (clients are telling us how they cooperate)
Focus on present and future except for the past in terms of exceptions; not focused on

the past in terms of cause of changing the past
Change the way people talk about their problems from problem talk to solution talk
Language creates reality
Therapist and client relationship is key
A philosophy, not a set of techniques or theory
Sense of hope, “cheerleader effect”
Nonpathologizing, not interested in pathology or “dysfunction”
Don’t focus on the etiology of the problem: Solutions are not necessarily related to

problems
Assume the client has strengths, resources
Only need a small change, which can snowball into a bigger change
The problem is not occurring all the time

CONCEPTS:

Problem talk/ Solution talk
Exceptions
Smallest difference that makes a

difference
Well-formed goals (small, concrete,

measurable, important to client,
doable, beginning of something, not
end, presence not absence, hard work)

Solution not necessarily related to the
problem

Clients are experts on their lives and
their experiences

Therapeutic relationships:
customer/therapist,
complainant/sympathizer, visitor/host

GOALS OF THERAPY:
Help clients to think or do things differently in order to

increase their satisfaction with their lives
Reach clients’ goals; “good enough”
Shift the client’s language from problem talk to solution talk
Modest goals (clear and specific)
Help translate the goal into something more specific (clarify)
Change language from problem to solution talk

ROLE OF THERAPIST:
Cheerleader/Coach
Offer hope
Nondirective, client-centered

ASSESSMENT:
Assess exceptions—times when problem isn’t there
Assess what has worked in the past, not necessarily related to the

problem; client strengths
Assess what will be different when the problems is gone (becomes

goal that might not be clearly related to the stated problem)

INTERVENTIONS:
Help set clear and achievable goals (clarify)
Help client think about the future and what they

want to be different
Exceptions: Amplify the times they did things that

“worked” when they didn’t have the problem or it
was less severe

Compliments:
-“How did you do that?”
-“Wow! That must have been difficult!”
– “That sounds like it was helpful; how did

you do that?”
-“ I’m impressed with ….”
-“You sound like a good ….”

Marriage and Family Therapy Models Page 10

Solution-Focused Brief Therapy, Continued

Interventions

Formula first session task: Observe what happens in their
life/relationship that they want to continue

Miracle question:
-Used when clients are vague about complaints
-Helps client do things the problem has been obstructing
-Focus on how having problems gone will make a difference
-Relational questions
-follow up with miracle day questions and scaling questions
-pretend to have a miracle day

Scaling questions

Midsession break (with or without
team) to summarize session,
formulate compliments and bridge,
and suggest a task (tasks used less in
recent years; clients develop own
tasks; therapist may make
suggestions or suggest
“experiments”), sometimes called
“feedback” (feeding information
back into the therapy with a
difference)

Predict the next day, then see what
happens

TERMINATION:

Client decides

SELF OF THE THERAPIST:
Accept responsibility for client/therapist relationship
Expert on therapy conversation, not on client’s life or experience of the

difficulty

EVALUATION:
Therapy/Research:

Simple (not necessarily easy)
Can be perceived that therapist as insensitive- “Solution

Forced Therapy”
Crucial that clients are allowed to fully express

struggles and have their own experiences validated,
BEFORE shifting the conversation to strengths

Techniques can obscure therapist’s
intuitive humanity

Many outcome studies show effectiveness,
but no controlled studies

Progress of therapy:

Can clients see exceptions?
Are they using solution talk?

SUPERVISION INTERVENTIONS:

RESOURCES:
de Shazer, S. (1982). Patterns of brief family therapy: An ecosystemic approach. New York: Guilford.
de Shazer, S., Dolan, Y., Korman, H., Trepper, T., McCollum, E., & Berg, I. K. (2007). More than

miracles: The state of the art of solution-focused brief therapy. New York: Haworth.
Berg, I. K., & Miller, S. (1992). Working with the problem drinker. New York: Norton.
Berg, I. K. (1994). Family-based services: A solution-focused approach. New York: Norton.
De Jong, P., & Berg, I. K. (2007). Interviewing for solutions (3rd ed.). Pacific Grove, CA: Brooks/Cole.
Dolan, Y. (1992). Resolving sexual abuse. NY: W.W. Norton.
Lipchik, E. (2002). Beyond technique in solution focused therapy. New York: Guilford.
Miller, S. D., Hubble, M. A., & Duncan Barry L. (Eds.). (1996). Handbook of solution-focused brief therapy.

San Francisco: Jossey-Bass.
Nelson, T. S., & Thomas, F. N. (Eds.). (2007). Handbook of solution-focused brief therapy: Clinical

applications. New York: Haworth.

NOTES:

Marriage and Family Therapy Models Page 11

NARRATIVE THERAPY

LEADERS:

Michael
White

David Epston
Jill Freedman
Gene Combs

ASSUMPTIONS:
Personal experience is ambiguous
Reality is shaped by the language used to describe it – language and experience

(meaning) are recursive
Reality is socially constructed
Truth may not match historic or another person’s truth, but it is true to

the client

Focus on effects of the problem, not the cause (how problem impacts family; how

family affects problem)
Stories organize our experience & shape our behavior
The problem is the problem; the person is not the problem
People “are” the stories they tell
The stories we tell ourselves are often based on messages received from society or

our families (social construction)
People have their own unique filters by which they process messages from society

CONCEPTS:

Dominant Narrative – Beliefs, values, and practices
based on dominant social culture

Subjugated Narrative – a person’s own story that is
suppressed by dominant story

Alternative Story: the story that’s there but not
noticed

Deconstruction: Take apart problem saturated story
in order to externalize & re-author it (Find missing
pieces; “unpacking”)

Problem-saturated Stories – Bogs client down,
allowing problem to persist. (Closed, rigid)

Landscape of action: How people do things
Landscape of consciousness: What meaning the

problem has (landscape of meaning)
Unique outcomes – pieces of deconstructed story that

would not have been predicted by dominant story or
problem-saturated story; exceptions; sparkling
moments

GOALS OF THERAPY:
Change the way the clients view themselves

and assist them in re-authoring their story in
a positive light; find the alternative but
preferred story that is not problem-saturated

Give options to more/different stories that
don’t include problems

ROLE OF THERAPIST:
Genuine curious listener
Question their assumptions
Open space to make room for possibilities

ASSESSMENT:
Getting the family’s story, their experiences

with their problems, and presumptions about
those problems.

Assess alternative stories and unique outcomes
during deconstruction

INTERVENTIONS:

Ask questions
o Landscape of action & landscape of

meaning
o Meaning questions
o Opening space

CHANGE:
Occurs by opening space; cognitive
Client can see that there are numerous

possibilities
Expanded sense of self

Marriage and Family Therapy Models Page 12

Narrative Therapy, Continued

Interventions

o Preference
o Story development
o Deconstruction
o To extend the story into the future

Externalize problems
Effects of problem on family; effects of family on

problem
Restorying or reauthoring

o Self stories
Letters from the therapist
Certificates of award

TERMINATION:
Client determines

SELF OF THE THERAPIST:
Therapist’s ideas, values,

prejudices, etc. need to be
open to client,
“transparent”

Expert on conversation

EVALUATION:
No formal studies

SUPERVISION INTERVENTIONS:

RESOURCES:
Freeman, Jennifer, David Epston, and Dean Lobovits. (1997). Playful approaches to serious problems:

Narrative therapy with children and their families. New York: W.W. Norton.
Freedman, Jill, and Gene Combs. (1996). Narrative therapy: The social construction of preferred realities. New

York: W. W. Norton.
White, Michael, and David Epston (Eds.). (1990). Narrative means to therapeutic ends. New York: W.W.

Norton.
White, Michael. (2007). Maps of narrative practice. New York: W.W. Norton.

NOTES:

Marriage and Family Therapy Models Page 13

COGNITIVE-BEHAVIORAL THERAPY

LEADERS:

Ivan Pavlov
Watson
Thorndike
B. F. Skinner
Bandura
Dattilio

ASSUMPTIONS:
Family relationships, cognitions, emotions, and behavior mutually influence one

another
Cognitive inferences evoke emotion and behavior
Emotion and behavior influence cognition

CONCEPTS:
Schemas- core beliefs about the world, the

acquisition and organization of knowledge
Cognitions- selective attention, perception,

memories, self-talk, beliefs, and expectations
Reinforcement – an event that increases the future

probability of a specific response
Attribution- explaining the motivation or cause of

behavior
Distorted thoughts, generalizations get in way of

clear thinking and thus action

GOALS OF THERAPY:
To modify specific patterns of thinking and/or

behavior to alleviate the presenting symptom

ROLE OF THERAPIST:
Ask a series of question about assumptions, rather

than challenge them directly
Teach the family that emotional problems are

caused by unrealistic beliefs

ASSESSMENT:
Cognitive: distorted thoughts, thought processes
Behavioral: antecedents, consequences, etc.

INTERVENTIONS:
Questions aimed at distorted assumptions (family

members interpret and evaluate one another
unrealistically)

Behavioral assignments
Parent training
Communication skill building
Training in the model

CHANGE:
Behavior will change when the contingencies of

reinforcement are altered
Changed cognitions lead to changed affect and

behaviors

TERMINATION:
When therapist and client determine

SELF OF THE THERAPIST:
Not discussed

EVALUATION:
Many studies, particularly in terms of marital therapy and parenting

SUPERVISION INTERVENTIONS:

Marriage and Family Therapy Models Page 14

RESOURCES:
Jacobson, N. S., & Margolin, G. (1979). Marital therapy: Strategies based on social learning and behavior

exchange principles. New York: Brunner/Mazel.
Jacobson, N. S., & Christensen, A. (1998). Acceptance and Change in Couple Therapy: A Therapist’s Guide to

Transforming Relationships. New York: Norton.
Epstein, N. B., & Baucom, D. H. (2002). Enhanced cognitive-behavioral therapy for couples. Washington, DC:

APA Books.
Resources
Dattilio, F. M. (1998). Case studies in couple and family therapy: Systemic and cognitive perspectives. New
York: Guilford.
Dattilio, F. M., & Padesky, C. (1990). Cognitive therapy with couples. Sarasota, FL: Professional Resource

Press.
Beck, A. T., Reinecke, M. A., & Clark, D. A. (2003). Cognitive therapy across the lifespan: Evidence and

practice. Cambridge, UK: Cambridge University Press.

NOTES:

Marriage and Family Therapy Models Page 15

CONTEXTUAL FAMILY THERAPY

LEADERS:
Ivan

Boszormenyi
-Nagy

ASSUMPTIONS:
Values and ethics are transmitted across generations
Dimensions: (All are intertwined and drive people’s behaviors and relationships)

o Facts
o Psychological
o Relational
o Ethical

Trustworthiness of a relationship (relational ethics): when relationships are not
trustworthy, debts and entitlements that must be paid back pile up; unbalanced ledger
gets balanced in ways that are destructive to individuals and relationships and
posterity (e.g., revolving slate, destructive entitlement)

CONCEPTS:
Loyalty: split, invisible
Entitlement (amount of merit a person has based on

trustworthiness)
Ledger (accounting)
Legacy (we behave in ways that we have been programmed

to behave)
Relational ethics
Destructive entitlement (you were given a bad ledger and it

wasn’t fair so it’s ok to hand it on to the next person—
acting out, neglecting important others)

Revolving slate
Posterity (thinking of future generations when working with

people) this is the only model that does
Rejunctive and disjunctive efforts

GOALS OF THERAPY:
Balanced ledger

ROLE OF THE THERAPIST:
Directive
Expert in terms of assessment

ASSESSMENT:
Debts
Entitlements
Invisible loyalties

INTERVENTIONS:
Process and relational questions
Multi-directional impartiality: Everybody and nobody feel

special—all are attended to but none are more special
Exoneration: Help people understand how they have been

living out legacies and debts-ledgers—exonerate others
Coach toward rejunctive efforts

CHANGE:
Cognitive: Awareness of legacies, debts

and entitlements
Behavioral: Very action oriented—

actions must change

TERMINATION:
Never- totally up to

the client

SELF OF THE THERAPIST:
Must understand own legacies,

entitlements, process of
balancing ledgers, exoneration

EVALUATION:
No empirical evaluation

SUPERVISION INTERVENTIONS:

Marriage and Family Therapy Models Page 16

Contextual Family Therapy, Continued

RESOURCES:
Boszormenyi-Nagy, I. (1987). Foundations of contextual therapy: Collected papers of Ivan Boszormenyi-Nagy.

New York: Brunner/Mazel.
Boszormenyi-Nagy, I., & Krasner, B. (1986). Between give and take: A clinical guide to contextual therapy.

New York: Brunner/Mazel.
Hargrave, T. D., & Pfitzer, F. (2003). The new contextual therapy: Guiding the power of give and take.

New York: Brunner-Routledge.
van Heusden, A., & van den Eerenbeemt, E. (1987). Balance in motion: Ivan Boszormenyi-Nagy and his vision

of individual and family. New York: Brunner/Mazel.

NOTES:

Marriage and Family Therapy Models Page 17

BOWEN FAMILY THERAPY

LEADERS:
Murray

Bowen
Michael Kerr

(works with
natural
systems)

Edwin
Friedman

ASSUMPTIONS:
The past is currently influencing the present
Change can happen—individuals can move along in the process of differentiation
Differentiation: ability to maintain self in the face of high anxiety (remain autonomous

in a highly emotional situation)
o Change in experience of self in the family system
o Change in relationship between thinking and emotional systems

Differentiation is internal and relational—they are isomorphic and recursive
Anxiety inhibits change and needs to be reduced to facilitate change
High intimacy and high autonomy are ideal
Emotions are a physiological process—feelings are the thoughts that name and

mediate emotions, that give them meaning
Symptoms are indicators of stress, anxiety, lower differentiation
Anyone can become symptomatic with enough stress; more differentiated people will

be able to withstand more stress and, when they do become symptomatic, recover
more quickly

CONCEPTS:

Intimacy
Autonomy
Differentiation of Self
Cutoff
Triangulation
Sibling position
Fusion (within individual and within relationships)
Family projection process
Multigenerational transmission process
Nuclear family
Emotional process
4 sub-concepts (ways people manage anxiety; none of

these is bad by itself – it’s when one is used to
exclusion of others or excessively that it can become
problematic for a system):

o Conflict
o Dysfunction in person
o Triangulation
o Distance

Societal emotional process
Undifferentiated family ego mass

GOALS OF THERAPY:
Ultimate—increase differentiation of self

(thoughts/emotions; self/others)
Intermediate—detriangulation, lowering

anxiety to respond instead of react
Decrease emotional reactivity—increase

thoughtful responses
Increased intimacy one-on-one with

important others

ROLE OF THERAPIST:
Coach (objective)
Educator
Therapist is part of the system (non-anxious and

differentiated)
Expert—not a collaborator

ASSESSMENT:
Emotional reactivity
Degree of differentiation of self
Ways that people manage anxiety/ family

themes
Triangles
Repeating intergenerational patterns
Genogram (assessment tool)

Marriage and Family Therapy Models Page 18

Bowen Family Therapy, Continued

INTERVENTIONS:

Genogram (both assessment and change tool)
Plan for intense situations (when things get hot, what

are we going to do – thinking; process questions)
Process questions– thinking questions: “What do you

think about this?” “How does that work?”
Detriangulating one-on-one relationships, one person

with the other two in the triangle
Educating clients about the concepts of the model
Decrease emotional reactivity—increase thoughtful

responses
Therapist as a calm self and calm part of a triangle

with the clients
Coaching for changing own patterns in family of

origin

CHANGE:
Reduced anxiety through separation of

thoughts and emotions – cognitive
Reduced anxiety leads to responsive

thoughts and actions, changed affect,
changed relationships

When we think (respond), change occurs
(planning thinking) — when you know
how you would like to behave in a certain
emotional situation, you plan it, it makes it
easier to carry through with different
consequences

TERMINATION:
Ongoing—we are

never fully
differentiated

SELF OF THE THERAPIST:
Important with this

model; differentiated,
calm therapist is main
tool

We don’t need to join the
system

We must be highly
differentiated so we can
recognize and reduce
reactivity

Our clients can only
become as differentiated
as we are; we need
coaching to increase our
own differentiation of
self

EVALUATION:
Research suggesting validity: not much,

not a lot of outcome
Did not specify symptom reduction
Client report of different thoughts, actions,

responses from others, affect is evidence
of change

SUPERVISION INTERVENTIONS:

RESOURCES:
Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aaronson.
Friedman, E. (1987). Generation to generation: Family process in church and synagogue. New York:

Guilford.
Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen theory. New York: W. W.

Norton and Company.

NOTES:

Marriage and Family Therapy Models Page 19

PSYCHODYNAMIC FAMILY THERAPY (OBJECT RELATIONS)

LEADERS:

Freud
Erik Erikson
Nathan Ackerman
Several others who were

trained, but their models
were not primarily
psychodynamic: Bowen,
Whitaker, etc.

Object relations: Scharff
& Scharff

Attachment theory:
Bowlby

ASSUMPTIONS:
Sexual and aggressive drives are at the heart of human nature
Every human being wants to be appreciated
Symptoms are attempts to cope with unconscious conflicts over sex and

aggression
Internalized objects become projected onto important others; we then

evoke responses from them that fit that object, they comply, and we
react to the projection rather than the real person

Early experiences affect later relationships
Internalized objects affect inner experience and outer relationships

CONCEPTS:
Internal objects- mental images of self and others built from

experience and expectation
Attachment- connection with important others
Separation-individuation- the gradual process of a child

separating from the mother
Mirroring- When parents show understanding and

acceptance
Transference-Attributing qualities of someone else to

another person
Countertransference – Therapist’s attributing qualities of

self onto others
Family Myths- unspoken rules and beliefs that drive

behavior, based on beliefs, not full images of others
Fixation and regression-When families become stuck they

revert back to lower levels of functioning
Invisible loyalties- unconscious commitments to the family

that are detrimental to the individual

GOALS OF THERAPY:
To free family members of

unconscious constraints so that they
can interact as healthy individuals

Separation-Individuation
Differentiation

ROLE OF THERAPIST:
Listener
Expert position
Interpret

ASSESSMENT:
Attachment bonds
Projections (unrealistic attributions)

INTERVENTIONS:
Listening
Showing empathy
Interpretations

(especially projections)
Family of origin
sessions (Framo)

Make a safe holding
environment

CHANGE:
Change occurs when family members expand their insight to realize that

psychological lives are larger than conscious experience and coming to
accept repressed parts of their personalities

Change also occurs when more, full, real aspects of others are revealed
in therapy so that projections fade

Marriage and Family Therapy Models Page 20

Psychodynamic Family Therapy (Object Relations), Continued

TERMINATION:

Not sure how therapy is terminated

EVALUATION:

SUPERVISION INTERVENTIONS:

RESOURCES:
Sander, F. (2004) Psychoanalytic Couples Therapy: Classical Style in Psychoanalytic Inquiry Issue on

Psychoanalytic Treatment of Couples ed. By Feld, B and Livingston, M. Vol 24:373-386.
Scharff, J. (ed.) (1989) Foundations of Object Relations Family Therapy . Jason Aronson, Northvale N.J.
Slipp, S. (1984). Object relations: A dynamic bridge between individual and family treatment. Northvale, NJ:

Jason Aronson.

NOTES:

Marriage and Family Therapy Models Page 21

EXPERIENTIAL FAMILY THERAPY

LEADERS:

Carl Whitaker
Virginia Satir

ASSUMPTIONS:
Family problems are rooted in suppression of feelings, rigidity, denial of impulses,

lack of awareness, emotional deadness, and overuse of defense mechanisms
Families must get in touch with their REAL feelings
Therapy works from the Inside (emotion) Out (behavior)
Expanding the individual’s experience opens them up to their experiences and helps

to improve the functioning of the family group
Commitment to emotional well being

CONCEPTS:

Honest emotion
Suppress repression
Family myths
Mystification
Blaming
Placating
Being irrelevant/irreverent
Being super reasonable
Battle for structure
Battle for initiative

GOALS OF THERAPY:
Promote growth, change, creativity, flexibility, spontaneity,

and playfulness
Make the covert overt
Increase the emotional closeness of spouses and disrupt

rigidity
Unlock defenses, enhance self-esteem, and recover potential

for experiencing
Enhance individuation

ROLE OF THE THERAPIST:
Uses their own personality
Must be open and spontaneous,

empathic, sensitive, and demonstrate
caring and acceptance

Be willing to share and risk, be
genuine, and increase stress within
the family

Teach family effective
communication skills in order to
convey their feelings

Active and directive

ASSESSMENT:
Assess individual self-expression and levels of defensiveness
Assess family interactions that promote or stifle individuation

and healthy interaction

INTERVENTIONS:
Sculpting
Choreography
Conjoint family drawing
Role playing
Use of humor
Puppet interviews
Reconstruction
Sharing feelings and creating an

emotionally intense atmosphere
Modeling and teaching clear

communication skills (Use of “I” messages)
Challenge “stances” (Satir)
Use of self

CHANGE:
Increasing stress among the family members leads to

increased emotional expression and honest, open
communication

Changing experience changes affect; need to get out of
head into emotions; active interventions change
experience, emotions

Marriage and Family Therapy Models Page 22

Experiential Family Therapy, Continued

TERMINATION:

Defenses of family members are broken
down

Family communicating openly
Family members more in touch with their

feelings
Members relate to each other in a more

honest way
Openness for individuation of family

members

SELF OF THE THERAPIST:
Through the use of humor, spontaneity, and personality,

the therapist is able to unbalance the family and bring
about change

The personality of the therapist is key to bringing about
change

EVALUATION:
This model fell out of favor in the 80s and 90s due to its focus on the emotional experience of the individual

while ignoring the role of family structure and communication in the regulation of emotion
Emotionally Focused Couples Therapy (Sue Johnson) and Internal Family Systems Therapy (Richard

Schwartz) are the current trend
Need to assess in-therapy outcomes as a measure of success due the fact that they often result in deeper

emotional experiences (and successful sessions) that have the potential to generalize outside of therapy

SUPERVISION INTERVENTIONS:

RESOURCES:
Satir, V. (1967). Conjoint family therapy. Palo Alto, CA: Science and Behavior Books.
Satir, V. (1972). Peoplemaking. Palo Alto, CA: Science and Behavior Books.
Napier, A. Y., & Whitaker, C. A. (1978). The family crucible. New York: Harper & Row.

NOTES:

Marriage and Family Therapy Models Page 23

EMOTIONALLY FOCUSED THERAPY

LEADERS:

Susan
Johnson

Les
Greenburg

ASSUMPTIONS:
“The inner construction of experience evokes interactional responses that

organize the world in a particular way. These patterns of interaction then reflect,
and in turn, shape inner experience” (Johnson, 2008, p. 109)

Individual identity can be formed and transformed by relationships and
interactions with others

New experiences in therapy can help clients expand their view and make sense of
the world in a new way

Nonpathologizing, not interested in pathology or “dysfunction”
Past is relevant only in how it affects the present.
Emotion is a target and agent of change.
Primary emotions generally draw partners closer. Secondary emotions push

partners away.
Distressed couples get caught in negative repetitive sequences of interaction

where partners express secondary emotions rather than primary emotions.

CONCEPTS:
Attachment needs exist

throughout the life span.
Negative interactional

patterns
Primary and secondary

emotions
Empathic attunement
Cycle de-escalation
Blamer softening
Withdrawer re-engagement

GOALS OF THERAPY:
Identify and break negative interactional patterns
Increase emotional engagement between couple
Identify primary and secondary emotions in the context of

negative interactional pattern
Access, expand, and reorganize key emotional responses
Create a shift in partners’ interactional positions.
Foster the creation of a secure bond between partners

through the creation of new interactional events that redefine
the relationship

ROLE OF THERAPIST:
Client-centered, collaborative
Process consultant
Choreographer of relationship

dance

ASSESSMENT:
Assess relationship factors such as:
o Their cycle
o Action tendencies (behaviors)
o Perceptions
o Secondary emotions
o Primary emotions
o Attachment needs

Relationship history, key events
Brief personal attachment history
Interaction style
Violence/abuse/drug usage
Sexual relationship
Prognostic indicators:
o Degree of reactivity and escalation- intensity of

negative cycle
o Strength of attachment/commitment
o Openness – response to therapist – engagement
o Trust/faith of the female partner (does she believe he

cares about her).

Marriage and Family Therapy Models Page 24

Emotionally Focused Therapy, Continued

INTERVENTIONS
Reflection
Validation
Evocative questions and empathic conjecture
Self-disclosure

Tracking, reflecting, and replaying interactions
Reframe in an attachment frame
Enactments
Softening
Heightening and expanding emotional

experiences

TERMINATION:
Therapy ends when the therapist and clients
collaboratively decide that the following changes
have occurred:

Negative affect has lessened and is regulated
differently

Partners are more accessible and responsive
to each other

Partners perceive each other as people who
want to be close, not as enemies

Negative cycles are contained and positive
cycles are enacted

SELF OF THE THERAPIST:
Accept responsibility for client/therapist

relationship
Expert on process of therapy, not on client’s

life or experience of the difficulty
Collaborator who must sometimes lead and

sometimes follow

EVALUATION:
Therapy/Research:

Difficult model to learn
When using the EFT model, it is

important to move slowly down the
process of therapy. This can be difficult
to do.

Learning to stay with deepened emotions
can sometimes be overwhelming, but the
therapist must continue to reflect and
validate.

Empirically validated, 20 years of
research to back up.

CHANGE:
Change happens as couples have a new corrective

emotional experience with one another.
When couples are able to experience their own

emotions, needs, and fears and express them to
one another and experience the other partner
responding to those emotions, needs, and fears in
an accessible, responsive way.

SUPERVISION INTERVENTIONS:

RESOURCES:
Johnson, S. M. (2004). The practice of emotionally focused couple therapy (2nd ed.). New York: Brunner-Routledge.
Johnson, S. M., Bradely, B., Furrow, J., Lee, A., Palmer, G., Tilley, D., & Wolley, S. (2005). Becoming an

emotionally focused couple therapist: The workbook. New York: Routledge.
Johnson, S. M. (2008). Emotionally focused couple therapy. In A. S. Gurman (Ed.), Clinical handbook of couple

therapy (4th ed., pp. 107-137). New York: Guilford.
Johnson, S. M., & Greenburg, L. S. (1994). The heart of the matter: Perspectives on emotion in marital therapy.

New York: Brunner/Mazel.

Marriage and Family Therapy Models Page 25

Emotionally Focused Therapy, Continued

Notes:

Marriage and Family Therapy Models Page 26

Gottman Method Couple Therapy

LEADERS:

John Gottman
Julie Gottman

ASSUMPTIONS:
Therapy is primarily dyadic
Couples need to be in emotional states to learn how to cope with and

change them
Therapy should be primarily a positive affective experience
Positive sentiment override and friendship base are needed for

communication and affect change

CONCEPTS:
Negative interactions (four horsemen)

decrease acceptance of repair attempts
Most couples present in therapy with low

positive affect
Sound marital house
Softened startup
Love maps

GOALS OF THERAPY:
Empower the couple
Problem solving skills
Positive affect
Creating shared meaning

ROLE OF THE THERAPIST:
Coach
Provide the tools that the couple can use with

one another and make their own

ASSESSMENT:
Four horsemen are present and repair

is ineffective
Absence of positive affect
Sound marital house

INTERVENTIONS:
Sound Marital House
Dreams-within-conflict
Label destructive patterns
Enhancing the Marital friendship
Sentiment override

CHANGE:
Accepting influence
Decrease negative interactions
Increase positive affect

TERMINATION:
When couples can consistently develop their

own interventions that work reasonably well

SELF OF THE THERAPIST:
Not discussed

EVALUATION:
Theory is based on Gottman’s research

SUPERVISION INTERVENTIONS

RESOURCES:
Gottman, J. (1994). Why marriages succeed or fail. New York: Simon & Schuster.
Gottman, J. M. (1999). The marriage clinic. New York: Norton.

Marriage and Family Therapy Models Page 27

Gottman Method Couple Therapy, continued

NOTES

FAMILY TREATMENT PLAN

Members: DOB:

INTAKE DATE: # OF SESSIONS TO DATE: 2

Family DIAGNOSIS:

SYMPTOMS/PROBLEMS. BEHAVIORAL/MEASURABLE GOALS INTERVENTIONS DATE PROGRESS MADE

Long Term:

Short Term:

1.
2.
3.

Each Short term goals should have 3 interventions

1. A.

2. A.

3. A.

Summary of Family Problem Diagnosis and Plan:

INTAKE DATE: # OF SESSIONS TO DATE: 2

Individual DIAGNOSIS:

SYMPTOMS/PROBLEMS. BEHAVIORAL/MEASURABLE GOALS INTERVENTIONS DATE PROGRESS MADE

Long Term:

Short Term:
1.
2.
3.

Each Short term goals should have 3 interventions
1. A.
B.
C.
2. A.
B.
C.
3. A.
B.
C.

INTAKE DATE: # OF SESSIONS TO DATE: 2

Individual DIAGNOSIS:
SYMPTOMS/PROBLEMS. BEHAVIORAL/MEASURABLE GOALS INTERVENTIONS DATE PROGRESS MADE

Long Term:

Short Term:
1.
2.
3.

Each Short term goals should have 3 interventions
1. A.
B.
C.
2. A.
B.
C.
3. A.
B.
C.

INTAKE DATE: # OF SESSIONS TO DATE: 2

Individual DIAGNOSIS:
SYMPTOMS/PROBLEMS. BEHAVIORAL/MEASURABLE GOALS INTERVENTIONS DATE PROGRESS MADE

Long Term:

Short Term:
1.
2.
3.

Each Short term goals should have 3 interventions
1. A.
B.
C.
2. A.
B.
C.
3. A.
B.
C.

INTAKE DATE: # OF SESSIONS TO DATE: 2

Individual DIAGNOSIS:
SYMPTOMS/PROBLEMS. BEHAVIORAL/MEASURABLE GOALS INTERVENTIONS DATE PROGRESS MADE

Long Term:

Short Term:
1.
2.
3.

Each Short term goals should have 3 interventions
1. A.
B.
C.
2. A.
B.
C.
3. A.
B.
C.

INTAKE DATE: # OF SESSIONS TO DATE: 2

Individual DIAGNOSIS:
SYMPTOMS/PROBLEMS. BEHAVIORAL/MEASURABLE GOALS INTERVENTIONS DATE PROGRESS MADE

Long Term:

Short Term:
1.
2.
3.

Each Short term goals should have 3 interventions
1. A.
B.
C.
2. A.
B.
C.
3. A.
B.
C.

INTAKE DATE: # OF SESSIONS TO DATE: 2

Individual DIAGNOSIS:
SYMPTOMS/PROBLEMS. BEHAVIORAL/MEASURABLE GOALS INTERVENTIONS DATE PROGRESS MADE

Long Term:

Short Term:
1.
2.
3.

Each Short term goals should have 3 interventions
1. A.
B.
C.
2. A.
B.
C.
3. A.
B.
C.

INTAKE DATE: # OF SESSIONS TO DATE: 2

Individual DIAGNOSIS:
SYMPTOMS/PROBLEMS. BEHAVIORAL/MEASURABLE GOALS INTERVENTIONS DATE PROGRESS MADE

Long Term:

Short Term:
1.
2.
3.

Each Short term goals should have 3 interventions
1. A.
B.
C.
2. A.
B.
C.
3. A.
B.
C.

INTAKE DATE: # OF SESSIONS TO DATE: 2

Individual DIAGNOSIS:
SYMPTOMS/PROBLEMS. BEHAVIORAL/MEASURABLE GOALS INTERVENTIONS DATE PROGRESS MADE

Long Term:

Short Term:
1.
2.
3.

Each Short term goals should have 3 interventions
1. A.
B.
C.
2. A.
B.
C.
3. A.
B.
C.

INTAKE DATE: # OF SESSIONS TO DATE: 2

Individual DIAGNOSIS:
SYMPTOMS/PROBLEMS. BEHAVIORAL/MEASURABLE GOALS INTERVENTIONS DATE PROGRESS MADE

Long Term:

Short Term:
1.
2.
3.

Each Short term goals should have 3 interventions
1. A.
B.
C.
2. A.
B.
C.
3. A.
B.
C.

Provider Signature:

Family Members Signatures:

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