1. Strategies for Working with Couples and Families in Spiritual Care
Martin Rovers
Saint Paul University
Couple and Family Program, MA
Couple and Family Diploma

2. Attachment in Family Therapy
PLANTING
Hope
And the Art of
Active Inquiry In
Attachment in Family Therapy
For Individual, Couple, and Family
Spiritual Care Practice

3. Spiritual Care Practice
Theory
A way of thinking
Spiritual Care Practice
A way of doing
… loving others is an art, and in learning the ability to love, we must proceed in mastering this art the same way we do with any other art, such as music or medicine. We need some mastery of the theory and some mastery of the practice.
Fromm (1936), The Art of Loving

4. PLANTING Hope The Doctor and the Counsellor Martin, CASC Supervisor
Martin, Marriage and Family Therapist

5. Family Systems Perspectives
We each have a family of origin, and family of origin is our most powerful formation. 
Childhood gifts and wounds are the “drivers”.
Family is the luck of the draw: if you have a loving family of origin, lucky you: If a dysfunctional family of origin, sorry to hear that, but it was not your fault.
Attachment in Family Therapy (AFT) believes that family is the primary and the most powerful system to which a person belongs.

6. Family Systems Perspectives
There are three main attachment patterns, secure, avoidant, and preoccupied.
Attachment theory believes that our childhood experiences, especially within the family of origin, influences our adult relationships, including our romantic relationships and our spirituality.

7. Family Systems Perspectives
We each have a wound or two, mostly born in the family of origin.
Our wounds play out in our present intimate and spiritual relationships.
Wound(s) are the reason for life, relational, and spiritual difficulties.
Wounds could be about relationship to parents, sibling rivalry, childhood abuse, unfinished business of our past, cognitive distortions, unhealthy schemas, etc.

8. Family Systems Perspectives
The goal of most therapeutic and spiritual care interventions is to name, claim and tame / heal our wound(s) and gently move clients and patients forward in their spiritual, relational, and emotional journey.
Spiritual care practice and intervention is engaged on a spiritual, emotional, thinking, and behavioral level. 
Increased anxiety, at times of illness and dying, are all the more within the family structure, and anxiety can have the effect of making the family more reactive and less thoughtful.  
AFT incorporates attachment interventions to help the patient and their family to recreate a more secure relationship bond through insight, emotional re-engagement, and touch, mostly done in the here and now.

9. Joe, My Patient

10. Active Inquiry
An Active Inquiry approach uses pacing (affirm – affirm – nudge / shove), engaging and directing (choreographs) in the healing process with clinical intuition guided by theoretical understanding. Active inquiry moves beyond following the client and beyond reflecting content and reflecting feelings, to the place of making an (hypothetical) assessment and then actively directing interventions towards healing.
Examples of this can be to encourage the patient to talk about their feelings, or about their relationship with God, or other family members. The intervention / treatment could be using prayer, or the family genogram to help patients better understand relationships. Touch is also powerful, as in the laying on of hands in prayer, or asking partners or family members to hold hands and pray, or hug.
Active inquiry is a conscientious engagement and directing the helping relationship process.

11. Joe and his Family Dynamics

12. Attachment Theory
Each person is inextricably interwoven within broader interactional systems, the most fundamental of which is the family.
Bowlby attachment theory has increased awareness of the importance of early attachment experiences on interpersonal relationships throughout life.
Bowen highlighted the emotional atmosphere of family of origin, including interpersonal relationships patterns.
Attachment in Family Therapy (AFT) believes that family is the primary and the most powerful system to which a person belongs.

13. Joe and His Wounds

14. Attachment Theory
When it comes to loving and being loved, people often tend to react in patterns reflective of the past, specifically attachment patterns absorbed in the family of origin.
These attachment patterns have become interwoven into ways of thinking and being, thus providing an internal diagram or working model for being in a close relationship.
AFT believes that our childhood experiences, especially within the family of origin, influences our adult relationships, especially romantic relationships.

15. Joe and more Family Dynamics

16. Joe and His Healing Word

17. PLANTING Hope Model Presence Listening Assessing Naming the wound
Treatment plan
Inter-person connection
Naming the healing
Growth and soothing

18. HOPE
Implanting hope is also an important aspect of presence. Hope is “a belief and a feeling that a desired outcome is possible.” (Ward & Wampler, 2010) Treatment outcomes become more possible as the therapist implants hope and positive outcome possibilities with clients. The AFT therapist prayer is: Am here with you, and together, we can do good work.

19. Listening
One technique here is effective communication between clients by introducing communication which encourages each person to talk nicely and to actively listen to others.
The goal here is to have people hear each other while holding tight to their emotional reactivity. We need to hear the other, in all love: we do not have to agree!
Joe, what are you hearing Mary saying about her concerns regarding this relationship?
Mary, can you tell Joe what do you hear him saying about how he feels about you?

20. Listening I Statements What I heard you say.... Mirror Back
Listener
Receive/Attend
Ponder
Mirror the Message
What I heard you say....
Mirror Back
Talker : Start Here Prepare Secure a listener
Deliver Message
I Statements

21. Listening
Another technique is the internalized other question used as a means to assess how well clients really hear or know the other, and the needs and wants of the other. This is a measure of emotional connection, empathy, knowledge, com-passion, courage to engage.
Mary, what do you think Joe really want from you?
Joe, knowing Mary as you do, how do you think she is feeling right now?

22. The Genogram and the Adult Attachment Interview
Goals:
Seeking to know the client(s)
Listening and assessing for wound words, attachment style, and unfinished business from childhood.
Helping client(s) know their own wound as well as the wound of their partner.
Wonder about the client direction for healing.

23. Naming my Wound Word and the Healing Word:
Attachment Theory: Healing
Avoidant
Preoccupied
Fearful Towards Secure
Bowen Theory (balancing life’s two forces / needs);
Connection / intimacy Learning Individuation
Independent / individuated Learning connection

24. Naming my Wound Word and the Healing Word:
Erikson Stages of Growth Healing
Trust verses Mistrust Building trust
Autonomy verses shame and doubt Practicing Autonomy
Initiative verses guilt Taking Initiatives
Industry verses inferiority Creating
Identity verses role confusion Sharing who you are
Intimacy verses isolation Daring to love
Generativity verses stagnation Daring to create
Ego integrity verses despair Doing a Life review

25. Naming my Wound Word and the Healing Word:
Young Schema Therapy Healing
Abandonment / Instability Building connection
Mistrust / abuse Courage, compassion
Emotional Deprivation Compassion, empathy
Defectiveness / Shame Self-revelation, humility
Social Isolation / Alienation Celebrating my difference
Dependence / Incompetence Team player, humility
Vulnerability to harm or Illness Self-care, vigilance
Enmeshment / Underdeveloped Self Loyal, team player
Failure Modesty, perseverance

26. Naming my Wound Word and the Healing Word:
Young Schema Therapy Healing
Entitlement / Grandiosity Enthusiastic, assertiveness
Insufficient Self-Control Spontaneity, take initiative
Subjugation Empathy, reliant
Self-Sacrifice Generous, service
Approval Seeking Sensitive to others needs
Negativity / Pessimism Sensitive, concerned
Emotional Inhibition Self-control, tactful
Unrelenting Standards Responsibility, principles
Punitiveness Accountability, justice

27. Naming my Wound Word and the Healing Word:
Wound Healing
Helpless Potential
Lost Purpose
Worthless Valued
Inadequate Adequate
Alone Connected
Insignificant Significant
Loss/ empty Fullness
Hopeless Optimistic / hopeful
Bad Good

28. Case of Joe and his Family
Spiritual Care Practitioner (SCP). (joining) Hello. My name is Martin Rovers. I am from Spiritual Care. Joe. (smiling). Nice to meet you Martin. Martin. (active inquiry) So Joe, how have you and God been getting along lately? Joe. (serious look) Well, not the best, now that you ask. Martin. (Settling in to listen) Tell me more. Joe. This cancer has me thinking, and I am concerned.

29. Case of Joe and his Family
Martin. Name me your concerns. Joe. I am scared, Rev. Martin. I hear the scared … for your future … for the family (assessing for family support)? Joe. You know I have not even told my wife the whole story. Martin. And if she was sitting in that chair there, Joe, what would you want to tell her?

30. Case of Joe and his Family
Joe. The cancer doesn’t look good … stage 4 … the end is looking closer than I ever imagined. Martin. I hear the scared, Joe, I really do. (pause) So, try a few words for your wife. (treatment plan … get it out) Joe. “Mary, I am scared, and I love you”. Martin. (internalized other question) Knowing your wife as you do, how do you think she will hear that? Joe. We will both cry … (pause) … I hate crying. Martin. But you are good at loving her, and you are honest, and it will work out. (planting hope). Besides, God is on our side when it comes to dying. Joe. I haven’t gone to church in years.

31. Case of Joe and his Family
Martin. That is OK. The church is right here coming to you. Joe. I hope God forgives me. Martin. She’ll be happy to … just ask. (Women enters … greets Joe) Joe. This is my wife Mary. Mary, this is the chaplain. Martin. Hello Mary. (moving into marriage spiritual care) How are you feeling about Joe’s situation here? Mary. Joe doesn’t tell me much, but I am worried.

32. Case of Joe and his Family
Martin. Joe was telling me that he is not a big talker, but perhaps he has something to tell you now. (looking at Joe) Joe. You don’t waste any time, Rev., but thanks for the encouragement … Mary, my cancer is stage 4 and I am scared. Mary. I worried that would be the story. Martin. I hear that you are both scared of this next step in your life journey, but it is good that you can be worried together.

33. Case of Joe and his Family
Joe. I am glad that we can talk about this now. Martin. Have you thought of how you might tell the kids? Mary. The two boys will be coming tonight. Chaplain, can you come and join us so we can talk about this together … it would sure make us more comfortable. Martin. I would be happy to. Mary and Joe, can I invite you both to hold hands while I pray.

34. Rationale
AFT seeks to give a therapeutic secure base for people who think as much as they feel and who want to know the why of their present relationship wounds.
AFT is an approach to therapy when client(s) can come in alone, without partners / family. It is an approach to individual therapy through a family systems lens.
AFT provides the therapist with a meta-perspective on healthy adult coping in terms of healing descriptors for everyday living.
AFT used an active inquiry stance, pacing the sessions towards treatment goals and healing.
The use of genogram is a strong visual aid to help clients see and externalize the issues within relationships.

35. References
Rovers, M., Malette, J., & Guirguis-Younger, M. (2017) Touch in the Helping Professions: Theory, Research, Clinical and Ethics. University of Ottawa Press. 278 pages
Rovers, M.W. & Domingue, P. (2014) Attachment: Family Ties That Bind. (pp ) In Demasure, K., Champagne, E., Martinez de Pison, R., & Rovers. M. (2014). Family’s Many Faces: Contemporary Family Patterns, Challenges for Christians. Leuven, BL: Peeters.
Rovers, M. W. (2005) Healing The Wounds in Couple Relationships, Ottawa, Novalis Publications, 216 pages.
Rovers, M. W. (2005). When aging parents come back to us: Family attachment perspectives. Pastoral Sciences, 24,
Rovers, M. W. (2004). Family of origin theory, attachment theory and the genogram: developing a new assessment paradigm for couple therapy. Journal of Couple and Relationship Therapy, 3 (4),