1. Mindfulness-Based Family Therapy A Brief Overview Copyright 2011 by Charlton Hall, MMFT, LMFT www.mindfulfamilytherapy.com

2. Mindfulness-Based Family Therapy A Brief Overview Mindfulness-Based Family Therapy (MBFT) is a blending of Mindfulness and Family Systems Therapy. In this overview, we will examine Family Systems Theory and Mindfulness Skills, and how these two concepts work together.

3. Mindfulness-Based Family Therapy A Brief Overview Part One: Family Systems Theory Part Two: Mindfulness Part Three: Integrating Family Therapy and Mindfulness Part Four: Mindfulness-Based Family Therapy (MBFT) and Substance Abuse Treatment

4. Mindfulness-Based Family Therapy Part One: Family Systems Theory

5. A Post-Modernist Approach Elements of Postmodernism relevant to Family Systems Theory: Theory Influences Observations The Observer Changes the Observed Equipment Constructs Results Either-Or Ideological Immunity, or the Planck Problem "Why People Believe Weird Things" Michael Shermer, PhD

6. Family Systems Theory Theory Influences Observations Confirmation Bias Flat Earth vs. Round Earth Reality is Jointly Constructed (Daylight Saving Time) Paradigm Shifts

7. Family Systems Theory The Observer Changes the Observed Star Trek’s ‘Prime Directive’ Experimenter’s presence alters the experiment (Heisenberg’s Uncertainty Principle) Therapist’s presence alters the family system Do families behave differently at home than in the therapy office?

8. Family Systems Theory Equipment Constructs Results The Fishnet If your fishnet has 2” holes, you might conclude that no fish smaller than 2” exist If your area of expertise is Borderline Personality Disorder, everybody looks Borderline

9. Family Systems Theory Either-Or False Dichotomy or False Dilemma Also known as ‘Black or White’ Thinking Leads to ‘I’m right and you’re wrong’ Systems Theory = toleration of ambiguity (everything is subjective) Dialectical Behavior Therapy (DBT) Based on the Hegelian Dialectic Thesis-Antithesis-Synthesis (next slide)

10. Family Systems Theory Either-Or Hegelian Dialectic

11. Family Systems Theory Ideological Immunity or the Planck Problem "An important scientific innovation rarely makes its way by gradually winning over and converting its opponents: it rarely happens that Saul becomes Paul. What does happen is that its opponents gradually die out and that the growing generation is familiarized with the idea from the beginning" -Max Planck

12. Family Systems Theory Ideological Immunity or the Planck Problem "New and revolutionary systems of science tend to be resisted rather than welcomed with open arms, because every successful scientist has a vested intellectual, social, and even financial interest in maintaining the status quo. If every revolutionary new idea were welcomed with open arms, utter chaos would be the result" - I. Bernard Cohen

13. Family Systems Theory Ideological Immunity or the Planck Problem Bottom Line: We resist change! Change means giving up cherished notions Change means having to do something differently Change means leaving the familiar “Better the Devil you know…” As therapists, we need to be aware of this inherent resistance to change What is the function of the dysfunction? “All behavior is purposeful” –Alvin Adler

14. Family Systems Theory Cybernetic Systems Theory ‘Cybernetic’ = ‘self-governing systems’ Self-governing systems work to maintain homeostasis (Thermostat vs. Thermometer) Family Systems are self-governing systems Homeostatic systems resist change!

15. Family Systems Theory Cybernetics and Systems Theory Individual Psychology Observer outside the system Focuses on the individual Asks ‘Why’ Linear cause/effect Deterministic/reactive Objective Individualistic Focus on Content Absolutistic Systemic Family Therapy Observer part of the system Focuses on interactions Asks ‘What’ Reciprocal causality ‘Wholistic’/proactive Subjective Relational Focus on Process Relativistic

16. Family Systems Theory Cybernetics and Systems Theory The Observer in the System Watson’s Black Box ? BehaviorismCognitive Behaviorism (CBT)

17. Family Systems Theory Cybernetics and Systems Theory Simple Cybernetics (CBT)

18. Family Systems Theory Cybernetics and Systems Theory Cybernetics of Cybernetics (MFT)

19. Family Systems Theory Cybernetics and Systems Theory What do you see?

20. Family Systems Theory Cybernetics and Systems Theory The way you see the picture informs your perspective Your theory/paradigm informs your perspective Your own personal narrative informs your perspective This includes: Your culture Your sex/gender Your religious/spiritual orientation Your race Your age Your overall approach to life

21. Family Systems Theory Cybernetics and Systems Theory First Order Change vs. Second Order Change: First Order Change = Changing the way you play the game Can lead to a ‘game without end’ Second Order Change = Changing the rules of the game so it’s possible to win

22. Family Systems Theory Cybernetics and Systems Theory Second-Order Change: The Nine Dot Puzzle

23. Family Systems Theory Cybernetics and Systems Theory Second Order Change “Thinking Outside of the Box” Don’t assume rules that aren’t there (there was no rule that you couldn’t go ‘outside the box’ on the 9-dot Puzzle) First Order Change = playing by the same rules but expecting different results (the unspoken rule was that there was a ‘box’ there) Second Order Change = changing the rules so the game can be won (realizing that there is no ‘box’) Second Order Change may seem crazy, illogical or paradoxical when considered within the rules of the system (Flat Earth vs. Spherical Earth) Game without End = continuing to achieve the same results by engaging in the same behaviors (definition of ‘insanity) Change of Context can break the cycle Example: George Costanza

24. George Costanza Does the Opposite

25. Family Systems Theory Cybernetics and Systems Theory Is Second Order Change More Lasting and Fundamental? Once a Second Order change has occurred, you can’t see things in the same way again (in the 9-dot puzzle, once you know the solution you can’t ‘unlearn’ it; it will always be with you when you see the puzzle again) The ‘rules of the game’ have been fundamentally changed The old context has been permanently changed-you can’t go back to old ways of thinking because they no longer make sense The Mermaid Story

26. Family Systems Theory Cybernetics and Systems Theory Is Second Order Change More Lasting and Fundamental? Nosce te Ipsum “Know Thyself”

27. Family Systems Theory Cybernetics and Systems Theory Mindfulness is a type of Second-Order Change! More on this later!

28. Family Systems Therapy Solution-Focused Therapy Approach Carving an Elephant Focus on what’s working, not on what’s not working Theoretically, you can do therapy without even knowing what the problem is

29. Family Systems Therapy Fused Relationships Codependency Feel emotionally responsible for each other (“You MADE me feel this way!”) Poor (or nonexistent) boundaries Poor assertiveness skills Poor emotional regulation To ‘de-fuse’ a relationship, increase differentiation

30. Family Systems Therapy Fused Relationships A story on Boundary-Setting: The Bridge

31. Family Systems Therapy Externalization The person is not the problem, the problem is the problem Externalization = technique of separating the problem from the person “I am not my problems” The ‘Angry Monster’

32. Family Systems Therapy Bowenian Family Therapy Murray Bowen was an American psychiatrist and a professor in Psychiatry at the Georgetown University Creator of Bowenian Family Therapy, sometimes called ‘Natural Systems Therapy’ or ‘Family Systems Therapy’

33. Family Systems Therapy Bowenian Family Therapy Bowen summarized his theory using eight interlocking concepts: Differentiation of Self (the most important concept) Nuclear Family Emotional System Triangles Family Projection Process Multigenerational Transmission Process Emotional Cutoff Sibling Position Societal Emotional Process

34. Family Systems Therapy Differentiation of Self Being responsible for your own emotional wellbeing Allowing others to be responsible for their own emotional wellbeing You can’t change anyone else’s behavior … you can only change yourself By changing your behavior, you ‘get off the seesaw’

35. Family Systems Therapy Nuclear Family Emotional System Describes four basic relationship patterns that govern where problems develop in a family: 1.Marital conflict 2.Dysfunction in one spouse 3.Impairment of one or more children 4.Emotional distance

36. Family Systems Therapy Nuclear Family Emotional System 1. Marital conflict As family tension increases and the spouses get more anxious, each spouse externalizes his or her anxiety into the marital relationship. Each focuses on what is wrong with the other, each tries to control the other, and each resists the other's efforts at control.

37. Family Systems Therapy Nuclear Family Emotional System 2. Dysfunction in one spouse One spouse pressures the other to think and act in certain ways and the other yields to the pressure. Both spouses accommodate to preserve harmony, but one does more of it. The interaction is comfortable for both people up to a point, but if family tension rises further, the subordinate spouse may yield so much self-control that his or her anxiety increases significantly. The anxiety fuels, if other necessary factors are present, the development of a psychiatric, medical, or social dysfunction.

38. Family Systems Therapy Nuclear Family Emotional System 3. Impairment of one or more children The spouses focus their anxieties on one or more of their children. They worry excessively and usually have an idealized or negative view of the child. The more the parents focus on the child the more the child focuses on them. He is more reactive than his siblings to the attitudes, needs, and expectations of the parents. The process undercuts the child's differentiation from the family and makes him vulnerable to act out or internalize family tensions. The child's anxiety can impair his school performance, social relationships, and even his health.

39. Family Systems Therapy Nuclear Family Emotional System 4. Emotional distance This pattern is consistently associated with the others. People distance from each other to reduce the intensity of the relationship, but risk becoming too isolated.

40. Family Systems Therapy Triangulation When a dyad has problems communicating, they recruit a ‘go-between’ This ‘go-between’ absorbs the anxiety that the dyad would normally direct at each other This creates a ‘triangle’ of anxiety distribution If you hear someone say, “I feel caught in the middle,” there’s probably a triangle going on!

41. Family Systems Therapy Triangulation Triangulation is decreased by increasing differentiation Increase differentiation by having each family member take responsibility for their own emotional wellbeing Strengthen boundaries by using ‘I-Position’ communication (more on this later!)

42. Family Systems Therapy

43. Family Projection Process Three-Step Process: 1.The parent focuses on a child out of fear that something is wrong with the child; 2.The parent interprets the child's behavior as confirming the fear; and 3.The parent treats the child as if something is really wrong with the child

44. Family Systems Therapy Family Projection Process In following the Three-Step process outlined above, the parent has effectively projected her own anxiety onto the child, who then inherits the anxiety and passes it on to the next generation, etc. (Pygmalion Effect, or Self-Fulfilling Prophecy)

45. Family Systems Therapy Multigenerational Transmission Process Small differences in the levels of differentiation between parents and their offspring lead over many generations to marked differences in differentiation among the members of a multigenerational family The ‘Butterfly Effect’

46. Family Systems Therapy Multigenerational Transmission Process People tend to choose partners with levels of differentiation similar to their own Over time, high levels of differentiation increase; low levels of differentiation increase as well Problems tend to become amplified from one generation to the next

47. Family Systems Therapy Emotional Cutoffs Emotional cutoffs = when two or more family members feel so threatened by communicating with each other that they avoid communication altogether Fear of conflict = type of emotional cutoff Emotional cutoffs could be the result of emotional blocks Emotional cutoffs can lead to triangulation

48. Family Systems Therapy Sibling Position Position in order of birth tends to determine some behaviors Oldest children tend to gravitate to leadership positions Youngest children often prefer to be followers

49. Family Systems Therapy Sibling Position Middle children exhibit the functional characteristics of two sibling positions Example: If a girl has an older brother and a younger sister, she usually has some of the characteristics of both a younger sister of a brother and an older sister of a sister

50. Family Systems Therapy Sibling Position The sibling positions of a person's parents are also important An oldest child whose parents are both youngests encounters a different set of parental expectations than an oldest child whose parents are both oldests

51. Family Systems Therapy Societal Emotional Process How the emotional system governs behavior on a societal level Human societies undergo periods of regression and progression in their history These periods are regulated by cultural and societal norms about how emotions are expressed and regulated

52. Family Systems Therapy Societal Emotional Process Example: Victorian Era vs. ‘Sexual Revolution’ of the 1960s Example: The current ‘Borderline Nation’ in America Example: Asian cultural norms vs. U.S. cultural norms regarding emotional expression Example: “Bible Belt” vs. New York City

53. Family Systems Therapy Societal Emotional Process Emotional processes are learned within the boundaries of a family’s Societal Emotional Process These norms should be taken into consideration when working with families Could be an issue of cultural diversity as well

54. Family Systems Therapy Family Resilience

55. Family Systems Therapy Family Resilience Positive attachments and relationships Interpersonal Skills Emotional Competence Cognitive competence Community support Food, clothing, shelter & love Self-esteem

56. Mindfulness-Based Family Therapy Part Two: Mindfulness

57. What is Mindfulness? "Mindfulness is the energy of being aware and awake to the present moment. It is the continuous practice of touching life deeply in every moment of daily life. To be mindful is to be truly alive and present with those around you and with what you are doing. We bring our body and mind into harmony while we wash the dishes, drive the car or take our morning cup of tea." -- Thich Nhat Hanh

58. Mindfulness What is Mindfulness? CBT provides the ‘What’ (i.e., the ‘belief’ that needs changing) Mindfulness provides the ‘How’ (to change the belief) Mindfulness involves a paradigm shift to a new way of being in the world Mindfulness is a type of Second Order Change!

59. Mindfulness Mindful Awareness Shift from 'Doing Mode' into 'Being Mode‘ Shift from ‘Thinking Mode’ into ‘Sensing Mode’ Mindful Awareness involves the skills of Observing Describing Fully Participating Being Non-Judgmental Focusing on One Thing at a Time

60. Mindfulness Mindfulness Skills: Observing Leave Doing Mode and enter Being Mode Leave Thinking Mode and enter Sensing Mode Engage all the senses Become an artist/musician/chef etc.

61. Mindfulness Mindfulness Skills: Describing

62. Mindfulness Mindfulness Skills: Describing What does an apple sound like? The last M & M Observing and describing exercise

63. Mindfulness Mindfulness Skills: Fully Participating By leaving Doing Mode and entering Being Mode, mental energy is freed up for fully taking part in what’s happening right now By leaving Thinking Mode and entering Sensing Mode, you are more able to let go of the past and the future and simply focus on the ‘now’ By fully participating in life right now, every M & M becomes ‘the last M & M’

64. Mindfulness Mindfulness Skills: Living in the Moment Think of three or four things that have stressed you out recently How many of those have to do with something that happened in the past? How many have to do with something that may or may not happen in the future? How many have to do with what’s going on right now?

65. Mindfulness Mindfulness Skills: Living in the Moment Living in the moment creates some ‘space’ between the individual and the individual’s overpowering thoughts and feelings In addiction treatment, if you focus on the craving ‘in the moment,’ you realize that it will eventually pass Living in the moment prevents hasty and rash decisions

66. Mindfulness Mindfulness Skills: Focusing on One Thing at a Time Automaticization (driving a car) Automatic thoughts and feelings Acting deliberately and with intention Having a purpose for every action The Japanese Tea Ceremony

67. Mindfulness Mindfulness Skills: Being Non-Judgmental We are very conditioned to placing judgments on our observations These judgments lead to assumptions Incorrect assumptions lead to interpersonal conflict & problems By withholding judgment all the negative things we tell ourselves is cut off When negativity stops, healing becomes possible

68. Mindfulness Mindfulness Skills: Being Non-Judgmental Crystal Ball Thinking: “Past history is not a guarantee of future performance” Unless you have a crystal ball, you can’t predict the future Unless you have a crystal ball, you can’t tell what another person is thinking Best way to know what someone is thinking = ASK Best way to know what will happen in the future = WAIT AND SEE

69. Mindfulness A Basic Mindful Meditation

70. Mindfulness The Power of Intention “If you don’t know where you’re going, any road will get you there” What is your intention, really? REALLY? The ‘Miracle Question’ Formulating your intention: Three Questions 1.Does this need to be said at all? 2.Does this need to be said right now? 3.Does this need to be said by me?

71. Mindfulness A Demonstration of The Power of Intention Mind over matter: The Chair

72. Mindfulness Acceptance vs. Change Strategies God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference. …Serenity Prayer

73. Mindfulness Acceptance vs. Change Strategies "The curious paradox is that when I accept myself just as I am, then I can change.“ …Carl Rogers

74. Mindfulness Acceptance vs. Change Strategies What is ‘perfect?’ What if this is as good as it gets? It’s already here Radical Acceptance We are not our thoughts We are not our emotions We are in control The choice is ours

75. Mindfulness Radical Acceptance Ways to deal with a problem: 1.Solve it. If you can’t solve it, then… 2. Change the way you think about it. If you can’t change the way you think about it, then… 3. Accept it. If you can’t accept it, then…

76. Mindfulness Radical Acceptance You’ll just have to stay miserable!

77. Mindfulness Living in True Self Real Self vs. Ideal Self (Carl Rogers) Perceived Self vs. True Self You are not your thoughts If you catch yourself thinking, what is it that did the ‘catching?’ “I think therefore I am” Does this mean that if you stop thinking, you cease to exist?

78. Mindfulness Living in True Self True Self = what we are when we acknowledge our dreams and aspirations of ourselves Who we are without limitations and expectations placed on us by others or ourselves Who we would be if all this ‘stuff’ wasn’t in the way Corollary: We’re in control of the ‘stuff’ “Argue for your limitations, and sure enough, they’re yours.” --Richard Bach

79. Mindfulness Living in True Self Tombstone Test

80. Mindfulness Living in True Self “Live every day as if it will be your last, because one of these days you’re going to be right.” …Ray Charles

81. Mindfulness Mindful Awareness Shift from 'Doing Mode' into 'Being Mode‘ Shift from ‘Thinking Mode’ into ‘Sensing Mode’ Mindful Awareness involves the skills of Observing Describing Fully Participating Being Non-Judgmental Focusing on One Thing at a Time

82. Mindfulness Wise Mind

83. Mindfulness Letting Go Letting go of the stress and anxiety doesn’t necessarily mean letting go of the problem itself The energy you might have used worrying about a situation could be put to better use in trying to come up with solutions Radical acceptance leads to letting go

84. Mindfulness Living in the Moment The past is already gone The future isn’t here yet They call it the ‘present’ because it’s a gift! By living in the moment, you free yourself from past mistakes and future worries

85. Mindfulness Centering Centering is getting in touch with your True Self It is allowing yourself to realize that you are perfect just as you are, even with your imperfections If you accept your imperfections and integrate them into your way of thinking and feeling about yourself, you will obtain peace of mind, and you will be centered Jung called this ‘embracing the Shadow’

86. Mindfulness Centering Example: Anger Anger management doesn’t mean never allowing yourself to feel anger Anger management means learning to express your anger in positive and productive ways ‘Embracing your Shadow’ =acknowledging darker impulses so they may be expressed in positive and productive ways Examples: MADD, Martin Luther King, Gandhi

87. Mindfulness Connecting Attachment injuries ‘Connecting’ allows you to heal old attachment injuries through ‘emotionally corrective experiences’ Spirituality = Connectedness Inspiring moments = moments of being connected Connection also means connecting to True Self

88. Mindfulness Mindful Body Scan Helps to become aware of how emotions manifest in our bodies Also helps to become aware of how cravings manifest in our bodies Your body’s going to do what it’s going to do, but you don’t have to let it push you around!

89. Mindfulness Mindful Body Scan A demonstration of the Mindful Body Scan

90. Mindfulness-Based Family Therapy Part Three: Integrating Family Systems Theory and Mindfulness

91. Mindfulness-Based Family Therapy What is it? MBFT = integration of MFT and Mindfulness If CBT is the ‘what,’ then MBFT is the ‘how’

92. Mindfulness-Based Family Therapy Solution-Focused Therapy and The Power of Intention Solution-Focused = carving the elephant (do more of what works, do less of what doesn’t work) Power of Intention = acting deliberately Focus on the positive, not the negative Power of Intention used to facilitate and maintain a Solution-Focused approach

93. Mindfulness-Based Family Therapy Differentiation of Self and Acceptance vs. Change Strategies One way to increase differentiation is to know the difference between what you can change and what you have to accept You can’t change anybody but yourself If others are responsible for your happiness, what happens when they go away? True happiness comes from within

94. Mindfulness-Based Family Therapy Externalization and Living in True Self True Self = We are not our thoughts or feelings We are something more than our thoughts and feelings If we are having thoughts or feelings that are leading to consequences we don’t want, we don’t have to accept them as part of ourselves Externalization is the process of seeing thoughts and feelings as separate from the True Self

95. Mindfulness-Based Family Therapy Emotional Cutoffs and Radical Acceptance Emotional cutoffs = emotional blocks Unacknowledged emotional pain & conflicts Leads to ‘shutdowns’ and ‘cutoffs’ Radical Acceptance = accepting someone, “warts and all” Set boundaries first!

96. Mindfulness-Based Family Therapy Triangulation and Mindful Awareness Triangulation = result of emotional cutoffs “Monkey in the middle” Mindful Awareness = being aware of the process & the feelings behind it Being aware of emotional roadblocks to communication Process vs. content

97. Mindfulness-Based Family Therapy Fused Relationships and Wise Mind Fused Relationship = ‘Smothering’ relationship Fused relationships often feel emotionally overwhelmed by the other person Wise Mind = Emotional Mind + Rational Mind Wise Mind = Acceptance + Change 1 st Rule of Change: You can only change YOU! 2 nd Rule of Change: Only YOU can be responsible for your own emotional wellbeing!

98. Mindfulness-Based Family Therapy Family Projection Process and Letting Go EXAMPLE: “You are responsible for MY happiness” The Pygmalion Effect Letting Go = Allowing others to be responsible for and in control of their own lives 1 st Rule of Change: You can’t change anybody but YOU!

99. Mindfulness-Based Family Therapy Multigenerational Transmission Process and Living in the Moment MTP = Differences in differentiation tend to amplify over time MTP = Differences in differentiation tend to amplify across generations Children respond to parents’ moods and affect Living in the Moment = Letting go of past disappointments and future worries

100. Mindfulness-Based Family Therapy Societal Emotional Process and Centering SEP = How the emotional system governs behavior on a societal level Regressive period = period where the focus is on short-term relief of anxiety rather than the long-term view Focus on short-term gratification leads to a social environment of emotional instability

101. Mindfulness-Based Family Therapy Societal Emotional Process and Centering

102. Mindfulness-Based Family Therapy Societal Emotional Process and Centering

103. Mindfulness-Based Family Therapy Societal Emotional Process and Centering

104. Mindfulness-Based Family Therapy Societal Emotional Process and Centering Consider the 1960s Instead of dealing with anxiety generated by society, we were encouraged to, “Tune in, turn on, and drop out;” i.e., self-medicate and deal with strong emotions through substance abuse (short- term fix) rather than taking a long-term view

105. Mindfulness-Based Family Therapy Societal Emotional Process and Centering Agrarian vs. Industrial “Store up for the winter” vs. “Run down to the corner convenience store” Industrial Age has conditioned us for instant self- gratification, often at the expense of long-term wellbeing

106. Mindfulness-Based Family Therapy Societal Emotional Process and Centering Centering = Knowing who you are and what you want; i.e., communicating with your True Self Doing more of what doesn’t work = maintaining the problem (Definition of Insanity) Centering = using your True Self to determine what’s not working Centering = having the self-confidence to go against society when necessary

107. Mindfulness-Based Family Therapy Family Resilience and Connecting Positive attachments and relationships (Compassion) Interpersonal Skills (Communication) Emotional Competence (Control) Cognitive competence (Choices) Community support (Consequences) Food, clothing, shelter & love (Consistency) Self-esteem (Confidence) …more on the 7Cs of MBFT later!

108. Mindfulness-Based Family Therapy Changing Choices and Consequences ABCD Model Activating Circumstance (Action) Belief (about the activating circumstance) Consequence (as a result of the belief) Dispute (the belief) Evaluate (did changing the belief lead to a consequence you wanted? The only part you can control is the BELIEF You can only change the CONSEQUENCE indirectly This is done by changing the belief

109. Mindfulness-Based Family Therapy Memes A Meme is an idea, a belief or a behavior that gets passed down from generation to generation Memes are to behaviors as genes are to traits (hair color, eye color, etc.) From a Family Systems perspective, we get our beliefs and behaviors from our family of origin, just as a person raised in an English-speaking house would only know how to speak English In order to change behaviors, we have to change beliefs We have to learn a ‘language’ that we may not have learned from our family of origin

110. Mindfulness-Based Family Therapy Meme Triads (Triangles) Memes have three components: What, Why and How All three components are necessary for a meme to exist All three components are interrelated ‘What’ = What is the nature of the problem? ‘Why’ = Why exactly is this a problem? ‘How’ = How is the problem maintained? Doing ‘more of the same’ doesn’t solve the problem The definition of insanity = doing the same thing the same way and expecting different results The Fisherman and His Son

111. Mindfulness-Based Family Therapy Meme Triads (Triangles)

112. Mindfulness-Based Family Therapy Meme Triads: Assumptions/Perceptions/Reality

113. Mindfulness-Based Family Therapy MBFT Summary Change and Acceptance build family resiliency Seven characteristics of family resiliency are: Compassion Communication Control Choices Consequences Consistency Confidence

114. Mindfulness-Based Family Therapy MBFT Summary Change in beliefs, behaviors, and consequences comes through the ABCDE Model The only thing you have control over is the BELIEF Changing the BELIEF changes the CONSEQUENCES Beliefs and behaviors are ‘inherited’ from family of origin through memes Memes have three components: What, Why and How These components are inter-related and interdependent Change one component, and they all change Change one component, and the meme changes Change your thoughts, and change your reality!

115. Mindfulness-Based Family Therapy Part Four: MBFT and Substance Abuse Treatment

116. MBFT & Substance Abuse Treatment

117. Families and Treatment The frog = the person with addiction problems The pot = the family If you ‘fix’ the frog without turning down the temperature on the family as well…

118. MBFT & Substance Abuse Treatment Families and Treatment Either The frog boils (family problems)! or The frog runs away (relapse)!

119. MBFT & Substance Abuse Treatment Five Levels of Family Therapy 1.Counselor has little or no involvement with family 2.Counselor provides psychoeducation and advice 3.Counselor addresses family members’ feelings and provides support 4.Counselor provides systemic assessment and planned intervention 5.Family Therapy

120. Five Levels of Family Therapy 1. Counselor has little or no involvement with family Counselor contacts family for practical and legal reasons and provides no services Counselor sees only the individual and may even feel that the client should be protected from family contact during treatment

121. Five Levels of Family Therapy 2. Counselor provides psychoeducation and advice Advises family about how to handle client’s needs Channels communications through one or two key family members Identifies gross family dysfunction that may interfere with substance abuse treatment Refers family for specialized family therapy

122. Five Levels of Family Therapy 3. Counselor addresses family members’ feelings and provides support Facilitate discussion among family members about client’s condition and how it impacts the family Evoke empathy for family’s feelings and when necessary, normalizing those feelings Provide preliminary family assessments concerning the client’s condition Encouraging coping skills Identify family dysfunctions and tailor treatment to meet each individual family’s needs

123. Five Levels of Family Therapy 4. Counselor provides systemic assessment and planned intervention Engage all family members, including reluctant or withdrawn ones, in sessions Allow all members to express themselves Systemically assess family’s level of functioning Support individual members while avoiding coalitions (triangling) Reframing to solution-focused options Help family members generate their own solutions Help family members support each other without sacrificing autonomy Connect to community and natural supports

124. Five Levels of Family Therapy 5. Family Therapy Engage family members who are difficult to engage (the one who stays home is usually the problem!) Generate and test hypotheses about interactional dysfunctions by creating enactments Raise anxiety in a controlled manner in order to break stalemates/standoffs Dealing constructively with resistance to change (prescribing the symptom, restraining change) Create collaborative relationships with other community resources/agencies: Treatment Team

125. MBFT & Substance Abuse Treatment Family Therapy vs. Substance Abuse Treatment Family-Involved Therapy vs. Family Therapy Denial Substance Abuse Family Interventions Spirituality Process vs. Content Focus Identity of the Client Use of Self-Disclosure

126. Family Therapy vs. Substance Abuse Treatment Family-Involved Therapy vs. Family Therapy Family-Involved Therapy Educating family members about family patterns involved in substance abuse Family may participate to a limited extent, but the individual client is the main focus Family Therapy Educating family members about family dynamics & interactions The family system is the main focus

127. Family Therapy vs. Substance Abuse Treatment Denial In Family-Involved Therapy, denial is seen as a failure to acknowledge the problem behavior In Family Therapy, denial is seen as a coping mechanism utilized to maintain family stability From a Solution-Focused perspective, the client/family does not have to acknowledge that a problem exists in order to move towards a solution

128. Family Therapy vs. Substance Abuse Treatment Substance Abuse Substance Abuse Treatment relies on the Disease Model, and considers substance abuse a disease that afflicts a family Family Therapy views substance abuse as a symptom of a larger dysfunction in the family If the dysfunction is eliminated, the symptoms go away In Family Therapy, the focus is on changing dysfunctional interactions within the family system

129. Family Therapy vs. Substance Abuse Treatment Family Interventions In Substance Abuse Treatment, interventions usually involve the family confronting the identified patient in an effort to urge treatment Family Therapy is less confrontational, preferring to focus on modifying family interactions to facilitate change Family Therapy is usually a longer process than Substance Abuse Treatment due to the deeper exploration of family interactions

130. Family Therapy vs. Substance Abuse Treatment Spirituality In Substance Abuse Treatment, spirituality occupies a central role In Family Therapy, spirituality is only central to treatment if the family feels it is a significant factor

131. Family Therapy vs. Substance Abuse Treatment Process vs. Content Substance Abuse Treatment tends to focus on the content of the client’s experiences Family Therapy tends to focus more on the family process, observing and identifying problematic interactions and modifying dysfunctional ones

132. Family Therapy vs. Substance Abuse Treatment Focus For Substance Abuse Counselors, the focus is on the problematic behavior (substance abuse) For Family Therapists, the focus is on problematic interactions within the family system

133. Family Therapy vs. Substance Abuse Treatment Identity of the Client In Substance Abuse Treatment, the client is the person with the substance abuse problem In Family Therapy, the whole family is the client

134. Family Therapy vs. Substance Abuse Treatment Use of Self-Disclosure Many Substance Abuse Counselors are in recovery themselves and are comfortable with self-disclosure as a means to facilitate change Family Therapists prefer to modify the process of interaction among family members, and usually do not rely as much on self-disclosure In Family Therapy, the focus is more on enactments than on dialogue

135. MBFT & Substance Abuse Treatment Integrating Families into Treatment Complete a Genogram for at least three generations Identify and target problem interactions 7Cs of MBFT Compassion Communication Control Choices Consequences Consistency Confidence

136. MBFT & Substance Abuse Treatment Integrating Families into Treatment: Genogram

137. MBFT & Substance Abuse Treatment Integrating Families into Treatment: Genogram Identifying and targeting problem interactions

138. MBFT & Substance Abuse Treatment Genograms and Memes Genograms help target problem memes that have been passed down from generation to generation For each person on the genogram, ask: Tell me one helpful thing about this person Tell me one not-so-helpful thing about this person In addition to identifying memes, these questions help identify natural supports

139. MBFT & Substance Abuse Treatment The 7C Method The 7 Cs are: Compassion Communication Control Choices Consequences Consistency Confidence

140. MBFT & Substance Abuse Treatment The 7C Method Look for problem memes related to each of the 7Cs The goal is to build family resilience by changing problem memes By changing problem memes, behavior changes Changing memes = Second Order Change Changing how you ‘think about thinking’ Changing the rules so the game can be won (remember the 9 Dot Puzzle)

141. MBFT & Substance Abuse Treatment The 7C Method: Compassion Being Non-judgmental Radical Acceptance What am I trying to accomplish here? Are my thoughts, feelings and actions going to help me accomplish it? Forgiveness starts with forgiving yourself

142. MBFT & Substance Abuse Treatment The 7C Method: Communication The I-Position Star Assertive vs. Aggressive Remember old lady/young lady?

143. MBFT & Substance Abuse Treatment The 7C Method: Communication Facilitating Mindful Communication Skills: The I-Position Star

144. MBFT & Substance Abuse Treatment The 7C Method: Control We all like to feel that we have control over our lives In reality, the only person you can control is YOU Acceptance vs. Change: can you change others? Anger is often the result of failed attempts to control others Anger leads to drinking (and drugging) at someone

145. MBFT & Substance Abuse Treatment The 7C Method: Control

146. MBFT & Substance Abuse Treatment The 7C Method: Choices True Self vs. Perceived Self Ideal Self vs. Real Self (Rogers) True Self (Ideal Self) is the one in control True Self makes the choices Our beliefs are a result of our thoughts & feelings True Self chooses which thoughts & feelings get expressed or ‘internalized’

147. MBFT & Substance Abuse Treatment The 7C Method: Choices True Self can choose to externalize unproductive thoughts and feelings Our beliefs are a result of our thoughts & feelings If our beliefs are leading to consequences we don’t want, we can consciously change those thoughts and beliefs to create consequences that we do want Change your thoughts, change your world!

148. MBFT & Substance Abuse Treatment The 7C Method: Consequences Every action has a consequence Every belief has a consequence Negative emotions lead to consequences, as do happiness and positive emotions By examining the consequences of our thoughts, feelings and beliefs, we learn to create different consequences Mindfulness allows us to create emotional ‘space’ around feelings and beliefs so that choices can be made

149. MBFT & Substance Abuse Treatment The 7C Method: Consistency One key to developing consistency is to change the way you think about things Such a Second-Order change becomes possible by living in the moment How many things that upset you have to do with the past? How many have to do with what may or may not happen in the future? By shifting the focus to the present, we regain control of our moods

150. MBFT & Substance Abuse Treatment The 7C Method: Confidence What is ‘perfect?’ You are human, and that you’re going to occasionally make mistakes Your value as a human being doesn’t concern how many (or few) mistakes you make It’s how you deal with those mistakes Knowing you are human allows you to let go Realizing that others are human as well, allows you to forgive and forget, and to start over This is CONFIDENCE.