Direct Interventions or Injunctions

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Since family therapy aims to help families find new ways of functioning, a simple and straightforward approach is to offer the family suggestions, designed to help them make the changes that the assessment has shown to be needed in their way of functioning. The suggestions might be concerned with how family members could behave differently toward each other, or communicate more effectively, or alter their respective roles in the family—or whatever appears to be needed. They will also be related to the therapist's theory of change.

Direct injunctions should be more than the giving of common-sense advice, because they must be based on a careful assessment of the changes the family needs to make. Families presenting for therapy, while aware that they have problems, or that family members have symptoms, often do not know what changes are needed to achieve the objectives they desire. Indeed, when asked what they are seeking from therapy,

Family Therapy many family members reply by saying that they want answers to "why" questions such as: "Why is my child stealing?" "Why won't my teenager daughter eat properly?" ''Why have my husband and I drifted so far apart?''

"Why" questions are not unreasonable, but giving definitive answers to them is often difficult and frequently impossible. Who really knows the true motivation of anyone doing anything? It is generally better to focus on the changes that are desired by the participants, and how these may be achieved, than to spend time discussing the possible reasons why problems exist. The family members may be asked to describe, preferably in some detail, how things will be when treatment has come to a successful conclusion. (It is better to talk about when, not if, treatment has been successful; this is the process of ''programming for success.'') The desired state is sometimes referred to as the "outcome frame."

Once the outcome frame has been established the therapist, using the information that has been obtained during the assessment of the family, can then devise some interventions. Direct ones should probably be the first to be used, unless the history shows that they have been given a fair trial previously and have proved unsuccessful. Examples of direct interventions are:

• Rehearsing the family in communication techniques; these might aim to promote the direct, clear, and sufficient communication of information, opinions, and feelings between family members;

• Discussing the roles the various family members have been playing, and how these might be altered if it appears that alterations would be helpful;

• Proposing behavioral interventions to deal with un-desired behaviors, or promote desired behaviors, on the part of the children;

• Suggesting, or modeling, more respectful ways for the family members to interact with each other;

• Helping family members to affirm and support each other, instead of the mutual criticism that is often encountered in families with problems.

Behavioral family therapy tends to use predominantly direct methods. The contingencies that appear to be controlling the behaviors that need to be changed are addressed directly.

Therapists of most schools are open to addressing dysfunctional patterns of interaction directly, and in some families this approach proves effective, especially when it is used in the context of a high degree of rapport. Unfortunately, especially in the more severely dysfunctional families, direct injunctions may be rejected or are not given an adequate trial even if lip service is paid to implementing them.

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