Essential Skills in Family Therapy NBCC approved.

JoEllen Patterson, PhD
Lee Williams, PhD
Claudia Grauf-Grounds, PhD
Larry Chamow, Ph

Course Outline

Family therapists commonly experience a host of nervous feelings when they begin their clinical work. Even after intense classroom study, students often feel unprepared to address such fundamental practical questions as:

  • What should happen after I complete the intake form?
  • How do I figure out what information from the session is most important?
  • Can clients tell I’m new at this, and that I feel completely inadequate?
  • How will I know when clients are getting better?

An ideal clinical resource and text, this volume provides students and new therapists with the basic skills and tools necessary to become empathic, confident, and successful practitioners in today’s rapidly changing field of family therapy. Easing the transition from academic expertise to therapeutic competence, chapters take readers step by step through the entire therapy process. From initial client intake to the nuts-and-bolts of the interview, assessment, diagnosis, goal setting, treatment planning, intervention techniques, troubleshooting, and termination, the book translates current research findings into cogent recommendations for practice. Numerous case examples and sample treatment plans, forms, and questionnaires complement the text. Special sections on getting started, gaining self-confidence, diagnosing DSM-IV disorders, and understanding managed care offer practical guidance for entering the field. Going beyond the traditional boundaries of family therapy, the book also details selected clinical skills  such as assessing for suicide risk and substance abuse, and gaining a knowledge base in medication management and the ability to consult with physicians – that are particularly relevant for all mental health practitioners today.

Offering a wealth of eminently useful “how-to” information, this comprehensive guide is designed throughout to meet the developmental needs of the beginning family therapist. Its accessible coverage of the basics of good therapy practice makes it an invaluable read for practitioners in any clinical setting.

About Authors

JoEllen Patterson, PhD, is Director of the COAMFTE-approved Marriage, Family, and Child Counseling Program at the University of San Diego and serves on the Behavioral Science faculty of Sharp HealthCare’s Family Practice and Residency.

Lee Williams, PhD, is Assistant Professor in the Marriage, Family, and Child Counseling Program at the University of San Diego. Dr. Williams is a licensed family therapist and an Approved Supervisor of the American Association of Marriage and Family Therapy (AAMFT).

Claudia Grauf-Grounds, PhD, teaches in the Marriage, Family and Child Counseling Program at the University of San Diego. She also serves on the Behavioral Science faculty of Sharp HealthCare’s Family Practice Residency and is Director of San Diego’s New Life Clinics, a multidisciplinary mental health practice.

Larry Chamow, PhD, serves on the faculties of the Marital and Family Therapy Program, University of San Diego and the California School of Professional Psychology. An Approved Supervisor of the AAMFT and a member of the American Family Therapy Academy, he conducts his private practice at the Pacific Family Institute in Carlsbad, California.

Learning Objectives

After completing this course you’ll be able to:

  1. List several ways the beginning therapist can deal with a lack of confidence, being overwhelmed and anxious.
  2. Describe the three stages of therapist development according to McCollum.
  3. Briefly list the seven steps for first-time telephone conversations with potential clients.
  4. List methods of obtaining information about the client during the initial contact.
  5. List the findings of Doherty and Simmons (1995) regarding who should come to therapy.
  6. Define joining.
  7. List three ways to establish credibility.
  8. State two tasks to be resolved after you have an understanding what your clients want from therapy.
  9. List ways motivation is assessed.
  10. State what a videotaping form should include.
  11. List the five guidelines of a general assessment. (Table 4.1)
  12. State the two reasons wives and children remain in abusive environments.
  13. Discuss substance abuse as being one of the major mental health problems in the United States.
  14. Describe the Mental Status Exam.
  15. State why therapists often overlook spirituality in their assessment.
  16. Describe the Marital Adjustment Test and the Dyadic Adjustment Scale.
  17. List the four areas assessed when doing a family assessment.
  18. List three general guidelines that apply to a culturally sensitive assessment.
  19. List the seven steps of an Initial Treatment Plan.
  20. List the four theoretical frameworks and their general purpose.
  21. State the purpose of developing therapeutic goals.
  22. Describe how professional research directs therapy.
  23. State how the length of therapy is determined.
  24. Discuss why therapists may consider medication as a possible treatment.(Griffith & Griffith, 1994).
  25. List several reasons a family therapist would ask for psychological testing.
  26. Discuss ways a therapist can be empathic.
  27. Describe four kinds of questions a therapist may find useful.
  28. List several factors to be considered in determining the pace of therapy.
  29. List four goals for crisis intervention according to Rappaport (1970).
  30. State the three self-assessment questions therapists can use to guide their work. (Table 6.2)
  31. Describe the parent management training (PMT) model.
  32. State why a high number of divorces occur when there are adolescents in the home.
  33. State the most significant ritual for teens in the
    United States.
  34. List the five stages divorcing families go through and the length of time it takes to go through these phases.
  35. Compare the “tender years doctrine” and “best interest of the child” standard.
  36. List the three phases of the family life cycle of the poor according to Colon (1980).
  37. Describe the therapeutic triangles, according to Figure 8.1.
  38. Discuss how marital therapy is effective in treating depressed spouses.
  39. State the major criticism of cognitive-behavioral therapy.
  40. List the two considerations that need to be addressed when providing therapy to same sex couples.
  41. State the three most common DSM-IV disorders.
  42. Discuss why depression occurs twice as often in women as in men.
  43. State the reasons for anxiety disorders to be the most frequently diagnosed problem of children and adolescents.
  44. State why alcoholism and substance abuse are a “family disease.”
  45. List the characteristics of alcoholism.
  46. Describe how resistance is a normal part of therapy.
  47. Describe first order and second order changes.
  48. State why it is important to set clear goals during the first few therapy sessions.
  49. List reasons for “no shows.”
  50. Define isomorphism.
  51. Define transference and counter-transference.
  52. Discuss the three types of termination.
  53. List three goals when terminating therapy.
  54. State a common intervention to achieve termination.
  55. List the four reactions therapists have to client terminations.
  56. State the focus of primary care.
  57. Discuss the results of Consumer Reports (1995) regarding “Does therapy help?”

Course Contents

1. The Beginning Family Therapist: Taking on the Challenge

Getting Started
Managing Anxiety and Issues of Confidence
Stages of Therapist Development
Obsessing about Clinical Work

2. Before the Initial Interview

Dealing with Families’ Expectations and Anxieties about Therapy
Suggestions for Initial Contract with the Client
What Information Should be Obtained?
Who Should Come to Therapy?
Initial Hypothesizing

3. The Initial Interview

Developing a Connection: How to Join with Clients
Establishing Credibility
Defining Client Expectations for Therapy
Building Motivation
Handling Administrative Issues
Conclusion: The First Session and Beyond

4. Guidelines for Conducting Assessment

Initial Assessment
Potential Issues of Harm
Assessing for Substance Abuse
Assessing for Biological Factors
General Psychosocial Assessment

5. Developing a Treatment Focus

Developing an Initial Treatment Plan
Select a Problem List
Examine History of Problems and Previous/Current Treatment
Conceptualize the Case and Make a Diagnosis Using a DSM-IV Multiaxial Assessment
Establishing Long-Term Treatment Goals
Select Treatment Modality, Objectives, and Interventions
Determine Length and Frequency of Treatment
Consider Referrals to Outside Resources

6. Basic Treatment Skills

The Rush to Intervention versus Developing a Relationship
Basic Counseling Skills
The Development of Expertise as a Family Therapist

7. Working with Families and Children

Assessment of Child and Adolescent Disorders
Family Interventions When Children Are the Clients
The Family Life Cycle Revisited
Special Issues with Divorcing and Remarried Families
Mediation with Child Custody Evaluations
Special Issues with Single-Parent Poor Families

8. Working with Couples

Keys to Providing Solid Couple Therapy
Creating a Therapeutic Triangle
When Couple Therapy Might Not Work
Common Problems Presented in Couple Therapy
Longitudinal Research on Couples
Special Topics
Structured Separation

9. When a Family Member Has a Mental Illness

Individual and Family Concepts
Individual Diagnosis in a Family Context
Alcoholism and Drug Abuse

10. Getting Unstuck in Therapy

Understanding Clients’ Ambivalence about Change
Therapist’s Reluctance to Intervene
Therapist-Client Agenda and Timing Mismatch
Therapist’s Lack of Theoretical Clarity
Self-Supervision Questions
Peer Consultation
Doing a Literature Search
Dealing with Cancellations and “No Shows”
Difficulty Getting Other Family Members to Therapy
Handling Secrets
How Agencies Contribute to Being Stuck
Countertransference: How Therapist’s Issues Interfere
Other Personal Influences

11. Termination

Mutual Terminations
Therapist Terminations
Client Terminations

12. Family Therapy in the Future: Pertinent Issues for Beginning Clinicians

Managed Care: Implications for You and Your Clients
What Every Family Therapist Needs to Know
The Question That Binds: What Harms and What Helps?



“An unprecedented clinical primer illustrated with myriad helpful suggestions that take into account the inner dilemmas of the therapist. This comprehensive and up-to-date book serves as a detailed manual of operations for clinicians, one that can be referred to again and again ? when treatment gets “stuck.” Even more crucially, therapists will learn the basis for thinking and acting with a biopsychosocial and integrative view of effective practice in the context of current changes in health care delivery. Trainers, supervisors, and students of family therapy will wonder how they could teach and learn before the publication of this book.” – Celia Jaes Falicov, PhD, University of California at San Diego

“This is the resource that beginning family therapists have anxiously awaited. Nowhere else can they find the day-to-day pragmatics of marital and family treatment spelled out so comprehensively… It is written by seasoned clinicians who teach and supervise beginning students and know their fears, blind spots, and mistakes.” – Richard C. Schwartz, PhD, Family Institute of Northwestern University

“A valuable and welcome text. I was impressed by the wide array of coverage and the clear and practical way in which the material is presented… I will look forward to using [this guide] in my classes to help students on their road to becoming artful, empathic, and knowledgeable therapists. As a trainer and supervisor, I am grateful to these four authors.” – Marcia Lasswell, MA, University of Southern California