This post is written by Pre-Clinical Fellow Anne Totero, originally posted on Linked In. Anne works as a Marriage and Family Therapist in Madison, WI. She finds her clinical passion is creating new and creative ways to work with individuals, couples, and families.
What was one of the skills that Satir, Minuchin, Whitaker, and the greats of Marriage and Family Therapy have that set them apart? Yes, they were forward thinking and new, bold, intuitive, and skilled. What else?
They had the ability to join with humans on a basic human level. They created genuine connection and an honest relationship. They did not have to disclose their lives, their experiences, or mistakes like leaders often do in order to see sustainable change. They made sure they created a relationship with every family member. Everybody had a voice and they did not just tell the family that; they created a safe environment where that could thrive and exist. Modeling through human connection.
Research shows us after years that the modality of treatment is not what creates efficacy within a psychotherapy setting. Those same research articles are telling us that the relationship and joining on a human level is what is showing results and reduced risk of recidivism.
This brings me back to my Social Psychology professor in college. I was taught about altruism. There are research articles that say that altruism does not exist because even desiring a mere smile or wave as a "thank you," is receiving something in return for your kind act. It's the concept that it does not exist because if someone was to feel slightly hurt, rejected, or even notice that they did not receive some sort of response in return; that alone shows altruism does not exist. This same Psychology professor also introduced me to a book by Aronson titled the Social Animal. Aronson highlighted that humans have an innate desire to be liked and understood. Research is now showing us what we know to be true within our heart of hearts. Being liked and understood.
So I revert back to altruism and the opposing views that it cannot exist. Regardless if it does or does not exist; regardless if it has circumstances of which it exists or what those constraints look like. The human race is meant to find exceptions to rules. It's a safety mechanism and how we have survived and thrived. The complexity of thought and learning how to keep ourselves safe is critical thinking at its finest. I can respect that. Instead of using the complexity of thought to look at what does not work for a few seconds; I invite therapists and mental health professionals to step back. Recognize where our hearts and beliefs are and implement genuine connect and kindness into our work every day. Nope, I am not trying to say we can't be burnt out sometimes or have off days. We can however make an active effort to move towards being kinder people and our clients deserve to see that side.
What is one thing we know to be true from psychotherapists who paved the way for effective intervention, researchers, and from culture across the ages? We are driven by that innate desire to be liked and understood. And guess what? It is no different in our families that we work with every day.
I end this therapeutic reflection with intervention suggestions for hints on initial session highlights for family work:
- Create rules that every one has a voice, this is a safe space, and no one will talk over anyone or else they will be redirected. If it persist, they will be asked to leave. This will give you insight on family member investment.
- Every family member has to be present!
- At intake, ask every client in that room (i.e., I don't care if they are verbal, nonverbal, age, etc.); find a way to ask every client what they feel is going on in the home to get them to this point (i.e., in therapy). Be creative. Use art, movement, sand tray, stuffed animals, sign language. Speak their language.
- Give everyone an equal amount of time to speak. Make the structure very clear in the beginning and follow through. You can tell them they may use less if they choose yet they have that full time. They may not have more.
- Be aware of your "gatekeeper" or the person who holds the key to the family. Don't be tricked by this! This is an art all in itself to join with this individual and not forget about the others' voices. This is also a whole article in itself.
- Set structure and follow through. I will say it again.
- Focus on the connection as much as the follow through. Your kindness and genuine care for the family will go a LONG WAY!
- Instill hope. AND BELIEVE IT! Not false hope or puke too much sunshine. Fake presentations are not entertaining for anyone but you and that one cynical family member that didn't think this was worth while.
- Feel something. No, not break down and cry and say how amazing this family is and how you want to save them. Please don't do that. Allow yourself to be there in the pain. Regardless of how big, small, etc. you may feel the toxicity is within the family setting; accept what emotion they are portraying and take them for what they say. Don't overthink.
- Be honest and transparent (i.e., if that is your style!). Do not self-disclose or start getting too deep. Just be honest about the strengths, improvements, etc.
- Talk minimally and end the session with highlighting a common ground. Which brings me back to above; everyone just wants to be liked and understood. It may look different. Yet it's a core desire.
- Give them something to walk away with after the first session. What that means is the best gift you as a therapist can give to a family when they walk away from that session is: highlighting the common ground (i.e., everyone is not as different as we thought), hope for change (i.e., and even give them some interventions that you can try!), human connection and kindness, and providing a safe place of structure and follow through.
People often ask about my success rates with families and the above are my secrets. The first session sets the rest of their experiences apart. Does that just mean that I gave away my secret ingredient? I feel like it's for a good cause and if I can activate something in other clinicians to treat their consumers with kindness and feeling? I'd say that's a win for the human race.