Family Therapy and Mental Health University of Guelph Centre for Open Learning and Educational Support

Family Therapy and Mental Health

University of Guelph

Centre for Open Learning and Educational Support

Your Crazy HostsCarlton Brown, M.Sc., M.Div., RMFTAAMFT Approved [email protected]

William Corrigan, B.A., M.T.S., RMFTAAMFT Approved [email protected]

Get the slides: http://www.mftsolutions.ca/Pages/MentalHealthCourse.html

mailto:[email protected]

By the End of Today

Introductions Historical overview of family therapy Models of illness in a developmental

perspective Assessing structure and function (the

McMaster Model) Introduction to the DSM-5 Assignments

Ice Breaker

Pick a card Half the cards depict psychiatric symptoms or

illnesses Half the cards depict psychiatric medications Find your mate!

Introductions

Name Background/experience in mental health What fascinates you about the field of mental

health? What makes you nervous/afraid about the

field of mental health?

Historical Overview of Family Therapy and Mental Health

Early psychotherapy dominated by: Sigmund Freud (1856 – 1939) Carl Rogers (1902 – 1987)

Both assumed that psychopathology arose from unhealthy interactions with others

Treated by a private relationship (client-therapist)

Influence of Social Work

Late nineteenth century Saw the family as the unit of intervention one goal was what is now known as ‘family

preservation’ Family Service Association of America

organization of social work agencies created a handbook for social workers on

marriage counselling in 1943

Marriage Counselling Pioneers include:

Paul Popenoe, American Inst. of Family Relations, 1930, in L.A. Abraham & Hannah Stone, 1930 in N.Y. Emily Hartshorne Mudel, 1932, Marriage Council of Philadelphia

Formed the American Association of Marriage Counsellors, 1945 Produce four publications on marriage counselling between

1945-51 California, 1963, first state to legislate marriage, family and child

counsellors as distinct from psychologists, psychiatrists, and social workers

AAMC renamed AAMFC in 1970; became AAMFT in 1978

Pioneers of Family Therapy John Bell

The “Accidental Family Therapist” Began treating families in 1951 but didn’t publish his ideas until

later, having minimal impact Nathan Ackerman (1909 - 1971)

Psychoanalyst and child psychiatrist Studied mental health problems among the unemployed in a

depression-struck mining town in Pennsylvania By the 1940’s he was seeing whole families 1950, paper entitled “Family Diagnosis: An Approach to the Pre-

School Child” considered the founding document of family therapy by some (Broderick & Schrader, 1991)

1958, The Psychodynamics of Family Life, first book-length treatise of diagnosis and treatment of family relationships

Pioneers of Family Therapy Theodore Lidz (1911–2001)

interest in families of schizophrenics, 1941 developed concepts of ‘marital schism’ (distant and hostile)

and ‘marital skew’ (one partner dominating the other) consulting editor of Family Process in 1961

Lyman Wynne (1924-2007) saw families starting in 1947 1952, worked with families of schizophrenics at NIMH took over for Bowen in 1959 as Chief of Family Research in 1956/57, attended APA meetings with Bowen, Jackson,

Lidz & Ackerman Developed concepts of pseudomutuality and

pseudohostility

Pioneers of Family Therapy

Murray Bowen (1913 – 1990) Psychiatrist specialized in schizophrenia 1951, used a cottage on grounds of Menninger

Clinic in Topeka, Kansas to study families of schizophrenics

developed ideas about mother-child symbiosis 1954, NIMH, hospitalized whole families of

schizophrenics for observation and research Emphasized cost effectiveness of family therapy

– “better results sooner”

Pioneers of Family Therapy Bowen (cont’d)

1959, Bowen published “Intensive Family Therapy”, where he introduced the idea of triangulation

NIMH project was restricted in budget because it was producing results that were “heretical to prevalent ideologies” (according to Bowen); Bowen decided to leave NIMH for Georgetown University

1966, Bowen produces the first major theoretical paper on family systems, “The Use of Family Theory in Clinical Practice” – described six major concepts of Bowen theory

1967, the “Anonymous Paper” was presented at the Family Research Conference to a shocked audience


Carl Whitaker 1943, Oakridge TN – w/John Warkentin, brought

spouses and children into sessions with patients Pioneered the use of cotherapy in treatment 1955-57, saw 30 couples in conjoint marital

therapy Uses a variety of experiential methods to loosen

people up and get them in touch with their immediate experience


Ivan Boszormenyi-Nagy 1957, founded the Eastern Pennsylvania

Psychiatric Institute in Philadelphia, a center for research and training in families and schizophrenia

1965, edited Intensive Family Therapy with James Framo, which brought together work being done on schizophrenia and the family from around the country


Salvador Minuchin Psychiatrist, trained in Argentina Developed a family approach to working with

delinquents and urban slum families Became director of the Philadelphia Child

Guidance Clinic in 1965 and by the 1970’s it was the world’s leading center for Family Therapy and training (Nichols & Schwartz, 1995)

Developed Structural Family Therapy, 1974


Palo Alto Group Bateson, Haley, Weakland, Jackson & Satir 1956, “Toward a Theory of Schizophrenia”, “one of the

most discussed papers in the history of psychiatry” (Broderick & Schrader in Gurman & Kniskern, 1991)

1959, Jackson forms MRI, independent of Bateson project, Satir joins him from Chicago

1959, Jackson coins the term ‘conjoint therapy’ 1960, Jackson agrees w/Ackerman to co-sponsor Family

Process, first journal devoted to family therapy


Palo Alto Group 1967, Beavin, Watzlawick & Jackson produce

The Pragmatics of Human Communication 1967, Watzlawick, Bodin, Weakland & Fisch form

the Brief Therapy Center at MRI January 1968, Don Jackson dies at the age of 48


Palo Alto Group Jackson borrowed from biology and systems

theory and created a new language of psychotherapy: Family homeostasis Symptoms have function Rules hypothesis Complementary/symmetrical Quid pro quo (couples, not gender, make the rules) Double bind


Palo Alto Group Jay Haley – control is everything (M. Erickson)

Symptoms must be outwitted by smart therapists Symptoms are used by the patient to gain control Therapist prescribes treatment Paradoxical prescriptions to “outwit” the patient’s

resistance


Palo Alto Group Benefits

New language Interpersonal instead of intrapsychic Creative

Risks Reduces therapy to a game of control Simplistically applied, it can do harm Implies that interactions cause illness (maybe not)

From Streams to a River March 1957, John Spiegel organized a panel on

Family Research for the Orthopsychiatry Association this was the first national meeting where ideas on family

research on schizophrenia were presented Spiegel, Bowen, Lidz, & David Mendel (who later

developed Multiple Impact Therapy) met and shared their work

June 1957, APA meeting in Chicago, another panel on family research on schizophrenia Ackerman, Jackson, Bowen, & Lidz presented this conference led to Jackson’s book, The Etiology of

Schizophrenia (1959)

From Streams to a River

The way ideas evolve (Chapter 2, Nichols and Schwartz)

Many competing ideas One dominant idea Supplanted by another dominant idea


Arising from competing ideas: The power of the psyche (Freud) Environmental reinforcers (behaviourists) The power of the family (family therapy)


Family Therapy as the Most Recent Big Idea Essentialist (zeal) Transitional (okay, maybe it’s not the miracle cure) Ecological (integrative?)

Family therapy in the 21st Century

Systems still at the core “Intelligent” systems (beyond inanimate)

Differential impact Causal processes Individual symptomatology

Integration of family systems with early theories of psychotherapy

Increasing influence of biology Lebow JL (2005) Handbook of Clinical Family Therapy,

New York: John Wiley & Sons

Break!

The Family Life Cycle and The Family Life Cycle and Coping with IllnessCoping with Illness

William Corrigan, BA, MTSCouple and Family TherapistAAMFT Approved Supervisor

The Family Life CycleThe Family Life Cycle

Individual life cycle is embedded within the family life cycleWe are born into and raised in a context – the family – with a history, rules, roles, etc.View symptoms and dysfunction within the context of the family systemFamilies may become stuck or frozen in one stage of developmentGoal is to help family become unstuck so development can continue


Six stages:1)Leaving Home: Single Young Adults2)The Joining of Families Through Marriage:

The New Couple3)Families with Young Children4)Families with Adolescents5)Launching Children and Moving On6)Families in Later Life


1) Leaving Home: Single Young AdultsAccepting responsibility for oneself financially, emotionallyDifferentiation/individuationDevelopment of intimate peer relationshipsEstablishing oneself in work/careerDevelop identity separate from familyStaying connected in a meaningful wayShifting roles


2) The Joining of Families Through Marriage: The New Couple

Commitment to a new systemRealignment of relationships to include partnerForming new rituals and traditionsCreating new rules and rolesNegotiating boundariesIntimacy ↔ Autonomy

• (do they really know what they’re getting into?)


3) Families with Young ChildrenAccepting new members into the systemAdjustment of marital system to allow for childrenJoining in child rearing, financial and household tasks; values, traditions, rituals, etc.Realignment of relationships to include parenting and grand-parenting rolesTime management and shifting prioritiesBalancing obligations between nuclear family, extended family and outsideFertility issues


4) Families with AdolescentsIncreasing boundaries to allow independenceShifting of relationships to allow adolescent to move in and out of the systemNegotiate roles and responsibilitiesPower struggles and managing conflictRefocus on midlife marital and career issuesBegin shift toward caretaking of older generation (“sandwich” generation)


5) Launching Children and Moving OnAccepting a multitude of exits from and entries to family systemRenegotiation of marital system as a dyadDevelopment of adult-adult relationships with childrenRealignment of relationships to include in-laws and grandchildrenRefocusing energy on self, partner, and futurePlanning for retirementInvolvement in care for older generation


6) Families in Later LifeAccepting shifting generational rolesMaintaining functioning in face of declineSupporting older generation without over-functioning for themDealing with loss of parents and extended familyDealing with loss of spouse, siblings, and peersCoping with illness and disability; loss of functionPreparing for death


“Normal” is defined in many ways, with influence from culture, ethnicity, religion, and wider society (e.g. enmeshment)Stress is often the greatest at transition points between stages as system adapts to changesIt is assumed that developmental tasks that aren’t resolved “pile up” and create stress or further problems in the family systemCan be used to predict challenges for family and to normalize experience

The Family Lifecycle & StressorsThe Family Lifecycle & Stressors

Horizontal stressors include:DevelopmentalUnpredictableHistorical events

Vertical stressors include the impact of past and present issues at various levels of each system at a point in timeSystem levels include:

Individual, immediate family, extended family, community and larger society

The Family Life Cycle & StressorsThe Family Life Cycle & Stressors

Stress on one axis will be greatly compounded by stress on the other axis“When a horizontal stress intersects with a vertical stress, there seems to be a huge leap in anxiety in the system” (Carter, 1978)The onset of symptoms has been found to correlate significantly with the addition or loss of a family member (Hadley, 1974)

Time Phases of Illness (Rolland, Time Phases of Illness (Rolland, 1994)1994)

Shows the dynamic unfolding of the illness process over time (vs. static state)Each phase has its own psychosocial demands and tasks which require different strengths or changes from family

Time Phases of Illness: CrisisTime Phases of Illness: CrisisPull together to cope with immediate crisis (↑ cohesion)Learning to cope with symptoms or disabilityAdapting to health care settings and treatmentsEstablishing and maintaining workable relationships with health care teamFamily must grieve the loss of life they knew before illnessGradually accept illness as permanent while maintaining a sense of continuity between past and futureFamily needs to create a meaning for the illness that maximizes a sense of mastery and competencyDevelop flexibility toward future goals, reorienting hopes and dreams

Time Phases of Illness: ChronicTime Phases of Illness: ChronicTime span between initial diagnosis/readjustment and terminal phaseCan be marked by constancy, progression, or episodic changeReferred to as “the long haul”; day-to-day living with illnessMaintain semblance of normal life while living with illness and uncertaintyFamily may feel saddled with an exhausting problem without endMaintaining maximum autonomy for all family members helps offset trapped, helpless feelings

Time Phases of Illness: TerminalTime Phases of Illness: Terminal

Inevitability of death becomes apparent and dominates family lifeFamily must cope with issues of separation, death, mourning, and resumption of family life beyond lossFamilies that adapt the best are able to shift their view of mastery from controlling the illness to a successful process of letting goOptimal coping involves emotional openness as well as dealing with the myriad of practical tasks at handTension between desire for intimacy and push to let go

Time Phases of IllnessTime Phases of Illness

Interplay between illness, individual and family life cyclesGoodness of fit between psychosocial demands of illness and family style of functioning and resources distinguish successful vs. dysfunctional coping and adaptationTransition periods in illness life cycle are times to re-evaluate structure“Unfinished business” from previous phase can block transition

Time Phases of Illness Time Phases of Illness

Illness and disability tend to push individual and family developmental processes toward transition and increased cohesionWhat is the fit between the psychosocial demands of a condition and family and individual life structures and developmental tasks at a particular point in the life cycle?How will this fit change as the course of the illness unfolds in relation to the family life cycle and the development of each member?

Time Phases of IllnessTime Phases of Illness

When inward pull of illness and phase of the life cycle coincide, there is a risk that they will amplify one another e.g. child-rearingWhen onset of illness coincides with a transition in family or individual life cycle, issues related to previous, current, and anticipated loss will be magnifiedBy adopting a longitudinal perspective, we can stay attuned to future transitions in illness, individual or family life cycles

Exercise: Family SculptingExercise: Family Sculpting

Experiential exercise with families or groupsCreate a sculpture (a.k.a. tableau) of family membersUse physical space to represent issuesExpressed through non-verbals: body posture, closeness/distance, facial expressions, gestures, sometimes propsDivide into small six small groupsSculpt one family w/illness in one life cycle stageTry to depict the issues present

Family Life Cycle and IllnessFamily Life Cycle and Illness

1.Leaving Home: Single Young Adults• Non-normative or “out of sync” w/life cycle• Illness or disability in a young adult may require

a heightened dependency and a return to the family of origin for caretaking

• A serious illness provides a sanctioned reason to return to the “safety” of the child-rearing period (secondary gain)

• Risk of over-protection, triangulation


2. The Joining of Families Through Marriage: The New Couple

• My problem vs. our problem• Boundaries with in-laws• Gender socialization and rigid roles• Sustaining intimacy depends largely on

establishing viable caregiving boundaries• Long-term viability of relationship may

depend on openly discussing and legitimizing both partners’ needs


3. Families with Young Children• Challenge of what to say, how much, and when• Being realistic vs. maintaining hope/optimism• Financial strain of lost wages, time off, etc.• Impact on child-rearing is twofold: one parent lost to

illness and other’s presence diminished by caregiving demands – feels like single-parent family

• Children can become parentified• Grandparents may be recruited to help, creating

other tensions and developmental “detour”


4. Families with Adolescents• Conflict of need for increased cohesion and

increasing need for autonomy• Risk of parentification• Shift in roles and responsibilities can create

resentment/conflict• Challenges of discipline: guilt, acting-out, etc. • Balancing emotional needs and self-care• Fear of abandonment


5. Launching Children and Moving On• Illness can be more disruptive in launching

stage because inward pull for cohesion clashes with need for autonomy

• Loyalty conflicts• Demands of present vs. future planning• Allocating resources• Developmental regression in children


6. Families in Later Life• Longer life expectancy means ever-growing

numbers of families are coping with chronic disorders over an increasingly greater part of life cycle

• Concerns for an ill parent can be projected onto one`s spouse creating conflict or distance

• Attending to unfinished business• Differentiate between each partner’s need for

space vs. distancing from fear

Lunch!

The McMaster Modelof Family Functioning

The McMaster Model

Diagnosis of families requires a conceptual model of family functioning

The MMFF is one attempt to provide a schema to rate clinical observations and assist with diagnosis

The McMaster Model

Started in 1962 with the Family Categories Schema of Epstein, Sigal & Rakoff - study of 110 non-clinical families

Revised several times to current presentation and tested thoroughly for reliability and validity

Provides full spectrum of ratings from health to pathology

Assumptions Underlying the MMFF

1) The parts of the family are interrelated

2) One part of the family cannot be understood in isolation from the rest of the system

3) Family functioning cannot be fully understood by simply understanding

each of the parts

Assumptions (cont’d)

4) A family’s structure and organization are

important factors determining the behaviour of family members

5) Transactional patterns of the family system are among the most important variables that shape the behaviour of family members

Six Dimensions of Family Functioning

1) Problem Solving

2) Communication

3) Role Functioning

4) Affective Responsiveness

5) Affective Involvement

6) Behaviour Control

Problem Solving

Refers to a family’s ability to resolve problems to a level that maintains effective family functioning

Problems are divided into instrumental ($, food, clothing, housing, etc.) and

affective (emotional issues)

Problem Solving

Seven steps to problem solving:1) Identify the problem

2) Communicate it to the right people

3) Develop a set of solutions

4) Decide on one solution

5) Carry out the action required

6) Monitor to ensure action is carried out

7) Evaluate the effectiveness

Communication

Defined as the exchange of information between family members

Also divided into instrumental and affective areas

Assessed on two dimensions: Clear vs. masked Direct vs. indirect

Focused more on verbal communication than non-verbal

Role Functioning Family roles are defined as the repetitive patterns of

behaviour by which family members fulfill family functions

Five areas of function:1) Provision of resources

2) Nurturance and support 3) Adult sexual gratification

4) Personal development5) Maintenance and management of the system

Role Functioning

Two other aspects of role functioning:1) Role allocation – how roles are assigned and

distributed (e.g. appropriate/inappropriate, implicit/explicit, autocratic/democratic, shared among all members)

2) Role accountability – making sure that functions are fulfilled; reinforces commitment and effectiveness

Affective Responsiveness

Defined as the ability to respond to a given stimulus with the appropriate quality and quantity of feelings

Two aspects to consider:1) Responding with a full range of feelings

2) Does the response match the stimulus and/or context

Affective Responsiveness

Distinguish between welfare emotions and emergency emotions

Welfare emotions include: affection, warmth, tenderness, support, love,

consolation, happiness, and joy Emergency emotions include:

Anger, fear, sadness, disappointment, and depression

Affective Involvement

Defined as the extent to which the family shows interest in and values the particular activities and interests of individual family members

Ranges from a complete lack of involvement to extreme involvement

Affective Involvement

Six types of involvement:1) Lack of involvement

2) Involvement devoid of feelings

3) Narcissistic involvement

4) Empathic involvement

5) Over-involvement

6) Symbiotic involvement

Behaviour Control

Defined as the pattern a family adopts for handling behaviour in three areas:

1) Physically dangerous situations

2) Meeting and expressing psychobiological needs (e.g. eating, sleeping, toileting, etc.)

3) Interpersonal socializing behaviour both between people in the family and between family members and outsiders

Behaviour Control

Four styles of behaviour control:1) Rigid – little room for negotiation

2) Flexible – reasonable, with room for negotiation

3) Laissez-faire – no standards

4) Chaotic – unpredictable, shifts between other styles without predictability

72

Case Study

watch the clip use the rating scale to assess this family

72

Break

Introducing the DSM-5

Carl and William

“Open it up. It looks scientific.”

- Robert Spitzer, chair of the task force that created DSM-III

“Suicide rates are unchanged over the last 115 years, so we aren’t

getting anywhere.”

- David Mays, Psychiatrist

Disease

• a condition of a living animal or plant or of one of its parts that impairs normal functioning

• typically manifested by distinguishing signs and symptoms

Signs and Symptoms

• Signs: something you can see that points to the underlying disease

• Symptom: something the patient complains about that indicates something is wrong

Signs and Symptoms

• “I have a fever” is a symptom (something the patient complains about)

• An elevated temperature is a sign (something you can see)

Physical Disease

• Significant research into underlying causes

• e.g. infection->immune response->pyrogens->hypothalamus->raised body temperature

Mental Disorder

• What are the signs and symptoms of a mental disorder?

• Is a mental disorder a disease?

• What do we know about the underlying mechanisms?

DSM vs. ICD

• The World Health Organization created the International Classification of Diseases so that health providers around the world would have a common language to talk about causes of death

ICD-CM

• The Clinical Modification of the ICD so that health providers could talk a common language of disease while treating people who were still alive

DSM

• The Diagnostic and Statistical Manual of Mental Disorders was probably first created as a way of making sure that asylum patients were included in the census

• It later became an expansion of the ICD-CM around mental illness, so that psychiatrists and psychologists around the world could talk the same language

DSM-ICD

• ICD-7 1950ish -> DSM I

• ICD-8 -> DSM II

• ICD-9 1977 -> DSM III

Early DSM

• DSM I and II were descriptive, psychodynamically-based books

• A prototypical description of a particular illness was given

• Clinicians would decide if their patient fit the prototype

Diagnosis by prototype is culturally dependent

• London: Manic-Depressive illness

• New York: Schizophrenia

• Using: same prototype

WHO 1959

• We should at least describe well

• If two people across the globe could come up with the same diagnosis, at least we would be reliable

DSM-III (1980)

• Made a fundamental break with ICD-9

• Became more observational and descriptive, less psychodynamic

• Effort to increase reliability

DSM-III

• Introduced algorithm

• Diagnosis is no longer a clinical art

• Just follow the steps

DSM-IIIR and IV

• Introduced Axes

1. Diagnosis

2. Personality/MR

3. Medical

4. Social

5. GAF

DSM-5 Task Force

• Headed by David Kupfer

• Seconded by Darrel Regier

• Stringent conflict of interest guidelines (no drug companies)

Etiology is Still Unclear, but...

• decided to make DSM-5 more developmentally based, and to speak to etiology

• arranged by common genetics

• narrative on predisposing factors

Elimination of Axes

• Axis I - dystonic (don’t like it, seek treatment)

• Axis II - syntonic (doesn’t seem like a problem, avoid treatment)

Noble Intention, Unforeseen

Consequence

• Personality Disorders and Mental Retardation were put on Axis II so that they would receive attention

• They received increased stigmatization, and less funding for treatment

DSM-5

• Reintegrates personality disorders and developmental delays to reduce stigma, enhance funding for treatment

The Other Axes

• Axis III - already on Axis I of ICD

• Axis IV - psychosocial, integrated as V codes in ICD-9 and Z codes in ICD-10

• Axis V - nobody misses the GAF

In Place of the GAF

• The WHODAS

• See the chapter on assessment measures in the DSM-5

DSM-5

• Better diagnostic tests

• quick screening (WHODAS)

• in depth (PROMIS)

Less Pressure to Find a Single Diagnosis

• You can list as many diagnoses as you like

Change in Epistemology

• Recognizes that life is not categorical, but we need categories anyway

More Psychodynamic

• Reintegrates what was lost from DSM I and II

Not Everyone Hates It

• “I love this book...best DSM ever written.” Jack Klott

Unintended Consequences

• In the DSM-5, each diagnosis has a list of predisposing factors

• e.g. socially isolated child, predisposing factor is severe child abuse

• So what might you conclude if you see a socially isolated child?

plus ca change...

• “The history of the DSM is a history of unintended consequences” - Rich Simon

Specific Changes

• Disruptive Mood Dysregulation Disorder 296.99 (F34.8)

• Hopefully will reduce the diagnosis of bipolar disorder in children

Specific Changes

• PTSD

• Now you not only can get it by being in a traumatic situation

• Now you can also get it by hearing about a traumatic situation

Specific Changes

• What is the only behavioural addiction in the DSM-5?

Specific Changes

• Can you be grieving and depressed at the same time?

Specific Changes

• Does anyone have Asperger’s Disease anymore?

• Porn addiction? Sex addiction? Any addiction?

• Is there such a thing as drug dependence?

Functional Consequences

• Change the way we think about people

• Realize how this diagnosis helps this person get along in the world

• (Sounding more and more like MFTs)

GAD or PTSD?

• A 7-year-old boy who lives in New Orleans with a pervasive, disabling, disruptive fear of hurricanes

• (hint: Mom and Dad lived through Katrina)

DSM-5 will make notetaking more

difficult

• Discourages simple, categorical diagnosis

• Requires more complex, narrative diagnosis

• Much like MFT :)

Maybe Too Complex

• Less clinical usefulness

• Increased concern about third-party funding

• “It could be fun” - Jack Klott

Recommended Reading

• Allen Frances, Essentials of Psychiatric Diagnosis

• Allen Frances, Saving Normal

• Joel Paris, The Intelligent Clinician’s Guide to the DSM-5

• Joel Paris and James Phillips, eds, Making the DSM-5

AssignmentsDate Disorder Presenter

Nov 15 Schizophrenia AmyChris

Bipolar Patti & Karen

Nov 29 DepressionAndrew &

Dulcie

Anxiety/OCD/Trauma Inge & Heather

Dec 6 Sex, Drugs and Food Mimi & Janet

Neurodevelopment Mari

Dec 13 Personality Nany & Monica

OthersNat, Debbie &

Keehan

Class Presentation

• Core elements (DSM-5)

• Family etiology

• Impact on the family

• Treatment of the individual & family

The Quiz

• Is based on what happens in class

• Pay attention

The Final Paper

• Have fun

• Show us you learned something

The Final Paper

• Case study of an individual, couple or family with a mental health disorder

• Fictitious (movie, TV, novel, imagination)

The Final Paper

• Genogram

• Case history

• Family system

• Presenting problem

The Final Paper

• Your treatment of the family as an MFT

• Who else is treating the family?

• How did you get involved?

The Final Paper

• Treatment goals

• Likely progression of the family

• Medications that might be used

The Final Paper

• Contextual considerations

• Future directions

Documents

Family Therapy and Mental Health University of Guelph Centre for Open Learning and Educational Support