Chapter 4 - Orchestrating Change

This chapter describes the BSFT approach to orchestrating change in the family. The first section describes how BSFT counselors establish a therapeutic relationship, including the importance of joining with the family, the role of tracking family interactions, and what is involved in building a treatment plan. The second section describes strategies for producing change in the family, including focusing on the present, reframing negativity in the family, shifting patterns of interaction through reversals of usual behavior, changing family boundaries and alliances, "detriangulating" family members caught in the middle of others' conflicts, and opening up closed family systems or subsystems by directing new interactions.

The counselor's first step in working with a family is to establish a therapeutic relationship with the family, beginning with the very first contact with family members. The quality of the relationship between the counselor and the family is a strong predictor of whether families will come to, stay in, and improve in treatment (Robbins et al. 1998). In general, studies have found that the therapeutic relationship is a strong predictor of success in many forms of therapy (Rector et al. 1999; Stiles et al. 1998). Validating and supporting the family as a system and attending to each individual family member's experience are particularly important aspects of developing and maintaining a good therapeutic relationship (Diamond et al. 1999; Diamond and Liddle 1996).

Establishing a therapeutic relationship means that the BSFT counselor needs to form a new system--a therapeutic system--made up of the counselor and the family. In this therapeutic system, the counselor is both a member and its leader. One challenge for the BSFT counselor is to establish relationships with all family members, some of whom are likely to be in conflict with each other. For example, drug-abusing adolescents generally begin treatment in conflict with their parent(s) or guardian(s). Both parties approach counseling needing support from the counselor. The counselor's job is to find ways to support the individuals on either side of the conflict. For example, the counselor might say to the adolescent, "I am here to help you explain to your something he or she would like to achieve, the counselor is able to establish a therapeutic alliance with the whole family.

The BSFT approach is based on the view that building a good therapeutic relationship is necessary to bring about change in the family. Several strategies for building a therapeutic relationship, joining, tracking, and building a treatment plan, are discussed below.

Joining

A number of techniques can be used to establish a therapeutic relationship. Some of these techniques fall into the category of "joining," or becoming a temporary member of the family.

Definition of Joining

In BSFT, joining has two aspects. Joining it is the steps a counselor takes to prepare the family for change. Joining also occurs when a therapist gains a position of leadership within the family. Counselors use a number of techniques to prepare the family to accept therapy and to accept the therapist as a leader of change. Some techniques that the therapist can use to facilitate the family's readiness for therapy include presenting oneself as an ally, appealing to family members with the greatest dominance over the family unit, and attempting to fit in with the family by adopting the family's manner of speaking and behaving. A counselor has joined a family when he or she has been accepted as a "special temporary member" of the family for the purpose of treatment. Joining occurs when the therapist has gained the family's trust and has blended with family members. To prepare the family for change and earn a position of leadership, the counselor must show respect and support for each family member and, in turn, earn each one's trust.

One of the most useful strategies a counselor can employ in joining is to support the existing family power structure. The BSFT counselor supports those family members who are in power by showing respect for them. This is done because they are the ones with the power to accept the counselor into the family; they have the power to place the counselor in a leadership role, and they have the power to take the family out of counseling. In most families, the most powerful member needs to agree to a change in the family, including changing himself or herself. For that reason, the counselor's strongest alliance must initially be with the most powerful family member. BSFT counselors must be careful not to defy those in power too early in the process of establishing a therapeutic relationship. Inexperienced family counselors often take the side of one family member against another, behaving as though one were right and the other were obviously wrong. In establishing relationships with the family, the counselor must join all family members, not just those with whom he or she agrees. In fact, frequently, the person with whom it is most critical to establish an alliance or bond is the most powerful and unlikable family member.

Many counselors in the drug abuse field feel somewhat hopeless about helping the families of drug-abusing youths because these families have many serious problems. Counselors who feel this way may find a discussion about becoming a member of the family unhelpful because their previous efforts to change families have been unsuccessful. BSFT teaches counselors how to succeed by approaching families as insiders, not as outsiders. As outsiders, counselors typically attempt to force change on the family, often through confrontation. However, the counselor who has learned how to become part of the system and to work with families from the inside should seldom need to be confrontational. Confrontation erodes the rapport and trust that the counselor has worked hard to earn. Confrontation can change the family's perception of the counselor as being an integral part of the therapeutic system to being an outsider.

The Price of Failed Joining

An example may help illustrate what is meant by powerful family members. The court system referred a family to counseling because its oldest child had behavior problems. The mother was willing to come to counseling with her son, but the mother's live-in boyfriend did not want the family to be in counseling. The counselor advised the mother to come to therapy with the adolescent anyway. The boyfriend felt that his position of power had been threatened by the potential alliance between the mother and the counselor. As a result, the boyfriend reasserted himself, demanding that she stop participating in counseling. She then dropped out of counseling. This is clearly a case in which the counselor's early challenge of the family's way of "operating" caused the entire family to drop out of treatment. The counselor could and should have been more aware and respectful of the family's existing power structure. Respect, in this case, does not mean that the counselor approves of or agrees with the boyfriend's behavior. Rather, it means that the counselor understands how this family is organized and works his or her way into the family through the existing structure.

A more adaptive counseling strategy might be to call the mother's boyfriend, with the mother's permission, to recognize his position of power in the family and request his help with his girlfriend's son.

A Cautionary Note: Family Secrets

As was already stated, joining is about establishing a relationship with every member of the family. Sometimes a family member will try to sabotage the joining process by using family secrets. Some secrets can cause the counselor such serious problems that he or she is forced to refer the family he or she had intended to help to another counselor. Secrets are best dealt with up front. The counselor should not allow himself or herself to get trapped in a special relationship with one family member that is based on sharing a secret that the other family members do not know. A counselor who keeps a secret is caught between family members. The counselor has formed an alliance with one family member to the exclusion of others. In some cases, it is not just an alliance with one family member but also an alliance with one family member against another family member. It means that the family member with the secret can blackmail the counselor with the threat of revealing that the counselor knows this secret and didn't address it with the family. Consequently, a family secret is a very effective strategy that family members can use to sabotage the treatment, if counselors let them.

For these reasons, counselors should make it a rule to announce to each family at the onset of counseling that he or she will not keep secrets. The counselor should also say that if anyone shares special information with the counselor, the counselor will help them share it with the appropriate people in the family. For example, if a wife calls and tells the counselor that she is having an affair, her spouse will need to know, although the children do not need to know the parents' marital issues. In this case, the counselor would say, "This affair is indicative of a problem in your marriage. Let me help you share it with your husband." The counselor must do whatever is needed to continue to help the wife see that affairs are symptoms of marital problems. The affair can be reframed as a cry for help, a call for action, or a basic discontent. If so, these marital issues or problems need to be discussed.

It is possible that despite all the counselor's efforts, the wife will respond with an absolute, "No, I don't want to tell him. He would leave me. Besides, this affair doesn't mean all that much." Typically BSFT therapy only gets into marital issues to the extent that the marital problems are interfering with the parents' abilities to function effectively as parents. However, the counselor has no choice but to help the wife tell her husband about the affair. If the wife absolutely refuses, then the counselor has lost his or her bid for leadership in the counseling process. The wife now has control over the counseling process. For that reason, the counselor must refer the family to another counselor.

Tracking

In the example on p. 27 about the mother's powerful boyfriend, it was recommended that the counselor use the way in which the family is organized, or interacts, with the father figure in a position of power, as a vehicle for getting the family into treatment. This strategy in which the counselor learns how the family interacts and then uses this information to establish a therapeutic plan of action is called "tracking." Tracking is a technique in which the counselor respects how the family interacts but, at the same time, takes advantage of those family interactions for therapeutic purposes. Sometimes families interact spontaneously, permitting the counselor to observe the family dynamics. When this does not happen spontaneously, the counselor must encourage the family to interact.

Encouraging the Family to Interact

When a family is in counseling, family members like to tell the counselor stories about each other. For example, a mother might say to the counselor, "My son did so and so." In contrast to the way in which the counselor functions in other therapy models, the BSFT counselor is not interested in the content of the family members' stories. Instead, the counselor is interested in observing (and correcting) problematic interactions. To observe the family's patterns of interaction, the counselor must ask family members to talk directly to each other about the problem. When this occurs, the counselor can observe or track what happens when the family members discuss the issue. The counselor can then watch the family's interactions: fighting, disagreeing, and struggling with their issues. By tracking, the counselor will not only be able to identify the interactive patterns in the family, but also will be able to determine which of these patterns may be causing the family's problems or symptoms. The added benefit of this kind of tracking is that the counselor shows respect for the family's ways of interacting.

Tracking Content and Process

The difference between "content" and "process" was discussed in Chapter 2 (see p. 13). Content is the subject matter that is being discussed. Process refers to the interactions that underlie the communication. By observing the process, the counselor learns who is dominant, who is submissive, what emotions are expressed in the interaction, and the unwritten rules that appear to guide the family's communication and organization. For example, a mother may mention that her son's drug problem is a concern. The grandmother responds by shouting that the mother is overreacting and needs to back off. The content of the interaction--the son's drug problem--is not nearly as important as the process being displayed--the grandmother undermining the mother and shutting her down. Often the counselor will track or use the family's content because it represents a topic that is important to the family. In this example, the counselor might keep the focus of the counseling session on the son's drug problem because it is an important topic in this family. However, the focus of BSFT is entirely on changing process. What needs to be changed here, as a first step, is the parent figures' inability to agree on the existence of a problem, and, more generally, the grandmother's tendency to invalidate the mother's concerns.

Mimesis

"Mimesis" is a form of tracking for the purpose of joining. It refers to mimicking the family's behavior in an effort to join with the family. Mimesis can be used to join with the whole family. For example, a counselor can act jovial with a jovial family. Mimesis also can be used to join with one family member. Mimesis is used in everyday social situations. For example, by attending to how others dress for a particular activity so that one can dress appropriately, one is attempting to gain and demonstrate acceptance by mimicking the type of dress that is worn by others (e.g., casual). People mimic other people's moods when they act like the other people do in certain situations. For example, at a funeral they would act sad as others do and at a celebration they would act joyful. When the counselor validates a family by mimicking its behavior, family members are more likely to accept the counselor as one of their own.

Mimesis also refers to using a family's own ways of speaking to join with the family. Each family and each family member has its, his, or her own vocabulary and perspective. For instance, if a family member is a carpenter, it might be useful to use the language of carpentry. The therapist might say, "Dealing with your son requires lots of different tools, just like jobs at work do. Sometimes you need to use a hammer and use a lot of force, and sometimes you need to use a soft cloth for a more gentle job." If a family member is an accountant, it may be helpful to speak in terms of assets and liabilities. If a person is religious, it may be helpful to speak of God's will.

Whatever language a family uses should be the language the counselor uses to converse with that family. The counselor should not talk to a family using vocabulary that is found in this manual--words such as "interactions," "restructuring," and "systems." Instead, the BSFT counselor should use the "pots and pans" language that each of the family members uses in his or her everyday life. For example, if families are uncomfortable with the term "counseling," the term "meetings" might be used.

Much of the work the counselor does to establish the therapeutic relationship involves learning how the family interacts to better blend with the family. However, the counselor cannot learn the ways in which the family interacts unless he or she sees family members interacting as they would when the counselor is not present. Getting family members to interact can be difficult because families often come into counseling thinking that their job is to tell the counselor what happened. Therefore, it is essential that counselors decentralize themselves by discouraging communications that are directed at them, and instead encouraging family members to interact so that they can be observed behaving in their usual way.

Building a Treatment Plan

BSFT diagnoses are made to identify adaptive and maladaptive patterns of family interaction so that the counselor can plan practical, strategically efficient interventions. The purpose of the intervention is to improve the family interactions most closely linked to the adolescent's symptoms. This, in turn, will help the family to manage those symptoms.

Enactment: Identifying Maladaptive Interactions

In BSFT, the counselor assesses and diagnoses the family's interactions by allowing the family to interact in the counseling session as it normally does at home. To begin, the counselor asks the family to discuss something. When a family member speaks to the counselor about another family member who is present, the counselor asks the family member who is speaking to repeat what was said directly to the family member about whom it was said. Family interactions that occur as they would at home and that show the family's typical interactional patterns are called "enactments." An enactment can either occur spontaneously, or the counselor can initiate it by asking family members to discuss something among themselves. Creating enactments of family interactions is like placing the counselor on the viewing side of a oneway mirror and letting the family "do its thing" while the counselor observes.

Different therapy models have different explanations for why a family or adolescent is having difficulty, and so they have different targets of intervention. BSFT targets interactional patterns. Because BSFT is a problem-focused therapy approach, it targets those interactional patterns that are most directly related to the symptom for which the family is seeking treatment. Targeting patterns most directly related to the symptom allows BSFT to be brief and strengthens a therapist's relationship with a family by demonstrating that the therapist will help the family solve the problems family members have identified.

Families that develop symptoms tend to be organized or to function around those symptoms. That's because a symptom works like a magnet, organizing the family around it. This is especially true if the symptom is a serious, life-threatening one, such as drug abuse. Therefore, it is most efficient to work with the family by focusing on the symptom around which the family has already organized itself.

Family Crises as Enactments

Enactments are used to observe family interactions in the present and to identify family interactional problems. Family crises are particularly opportune types of enactments because they are highly charged, and family members are emotionally available to try new behaviors. Therefore, families in crisis should be seen immediately. In addition to gaining valuable information about problematic family interactions, the counselor gains considerable rapport with families because he or she is willing to be of service at a time of great need.

A Cautionary Note: Adolescents Attending Therapy Sessions on Drugs

Counselors usually refuse to work with a client who comes into the therapy session on drugs because the client is viewed as "not being all there" to do the treatment work. However, in the case of a family therapy such as BSFT, determining whether to conduct the session is a strategic decision the counselor must make. One possibility in BSFT is to view the adolescent on drugs as an enactment of what the family confronts at home all the time. Thus, when an adolescent comes to therapy on drugs, it can be viewed as an opportunity for the counselor to teach the family how to respond to the adolescent when he or she takes drugs. The BSFT counselor can see how each family member responds to this situation and look for the maladaptive interactions that allow the adolescent to continue this behavior. The counselor can then work with the non-drug-using family members to change their usual way of responding to the adolescent on drugs. Hence, the work in this session is not with the adolescent but with the other family members.

From Diagnosis to Planning

Once a therapeutic relationship has been established and a diagnosis has been formulated, the counselor is ready to develop a treatment plan. The treatment plan lays out the interventions that will be necessary to change those family maladaptive interactional patterns that have been identified as related to the presenting symptom. Problematic patterns of family interaction are diagnosed using the six dimensions of family interaction discussed in Chapter 3 (organization, resonance, developmental stages, life context, identified patient, and conflict resolution). Often some dimensions are more problematic than others. The interventions need to focus more on the most problematic interactions than on the others.

The six dimensions of the family's interactions operate in an interdependent fashion. For this reason, it may not be necessary to plan a separate intervention to address each problem that has been diagnosed. For example, addressing a family's tendency to blame its problems on the adolescent (i.e., the identified patient) may bring the family's ineffective conflict resolution strategies to light. In a similar fashion, addressing a son's role as his mother's confidant (i.e., inappropriate developmental stage) may bring out the rigid and inflexible boundary between the parent figures.

As was stated earlier, the focus of BSFT is to shift the family from maladaptive patterns of interaction to adaptive ones. Counselors can use a number of techniques to facilitate this shift. These techniques, all of which are used to encourage family members to behave differently, fall under the heading of "restructuring." In restructuring, the counselor orchestrates and directs change in the family's patterns of interaction (i.e., structure). Some of the most frequently used restructuring techniques are described in this chapter.

When the family's structure has been shifted from maladaptive toward adaptive, the family develops a mastery of communication and management skills. In turn, this mastery will help them solve both present and future problems. To help family members master these skills, the BSFT counselor works with them to develop new behaviors and use these new behaviors to interact more constructively with one another. After these more adaptive behaviors and interactions occur, the BSFT counselor validates them with positive reinforcements. Subsequently, the counselor gives the family the task of practicing these new behaviors/interactions in naturally occurring situations (e.g., when setting a curfew or when eating meals together) so that family members can practice mastering these skills at home.

Mastering more adaptive interactions provides families with the tools they need to manage the adolescent's drug abuse and related problem behaviors. Some adaptive behaviors/interactions that validate individual family members are self-reinforcing. However, the counselor needs to reinforce those behaviors/interactions that initially are not strongly self-reinforcing (i.e., validated) to better ensure their sustainability. As family members reinforce each other's more adaptive skills, they master the skills needed to behave in adaptive ways. It is very important to note that mastery of adaptive skills is not achieved by criticizing, interpreting, or belittling the individual. Rather, it is achieved by incrementally shaping positive behavior.

The rest of this chapter describes seven frequently used restructuring techniques (i.e., to change families' patterns of interaction). These techniques will give a counselor the basic tools needed to help a family change its patterns of interaction. The seven restructuring techniques are:

• Working in the present
• Reframing negativity
• Reversals
• Working with boundaries and alliances
• Detriangulation
• Opening up closed systems
• Tasks

Working in the Present

Although some types of counseling focus on the past (Bergin and Garfield 1994), BSFT focuses strictly on the present. In BSFT, families do not simply talk about their problems, because talking about problems usually involves telling a story about the past. Working in the present with family interactional processes that are maintaining the family's symptoms is necessary to bring about change in BSFT. Consequently, the BSFT counselor wants the family to engage in interactions within the therapy session--in the same way that it would at home. When this happens and family members enact the way in which they interact routinely, the counselor can respond to help the family members reshape their behavior. Several techniques that require working in the present with family processes are found in subsequent sections within this chapter.

Does BSFT Ever Work in the Past?

Counselors work with the past less than 5 percent of the counseling time. One important example of working in the past can be illustrated by an early counseling session in which the parent and adolescent are in adversarial roles. The parent may be angry or deeply hurt by the youth's behavior. One strategy to overcome this impasse in which neither family member is willing to bend is to ask the parent, "Can you remember when Felix was born? How did you feel?" The parent may say nostalgically: "He was such a beautiful child. The minute I saw him, I was enchanted. I loved him so much I thought my heart would burst."

This kind of intervention is called "reconnection" (cf. Liddle 1994, 1995, 2000). When the parent is hardened by the very difficult experiences he or she has had with a troublesome adolescent, counselors sometimes use the strategy of reconnection to overcome the impasse in which neither the parent nor the youth is willing to bend first. Reconnection is an intervention that helps the parent recall the positive feeling (love) that he or she once had for the child. After the parent expresses his or her early love for the child, the counselor turns to the youth and says: "Did you know your mother loves you so very much? Look at the expression of bliss on her face."

As can be seen, the counseling session digressed into the past for a very short time to reconnect the parent. This was necessary to change the here-and-now interaction between two family members. The reconnection allowed the counselor to transform an interaction characterized by resentment into an interaction characterized by affection. Because the feelings of affection and bonding do not last long, the counselor must move quickly to use reconnection as a bridge that moves the counseling to a more positive interactional terrain.

Reframing: Systemic Cognitive Restructuring

To "reframe," a counselor creates a different perspective or "frame" of reality than the one within which the family has been operating. He or she presents this new frame to the family in a convincing manner --that is, "selling" it to the family and then using this new frame to facilitate change. The purpose of systems-oriented, cognitive restructuring (reframing) is to change perceptions and/or meaning in ways that will enable family members to change their interactions. Most of the time, in families of adolescent drug abusers, negativity needs to be reframed. Negativity is usually exhibited as blaming, pejorative, and invalidating statements ("You are no good." "I can't trust you."), and, in general, "angry fighting." Reframing negativity might involve describing a mother's criticism of her teenage son as her desire that he be successful, or reframing fighting as an attempt to have some sort of connection with another family member.

It has been suggested that "... high levels of negativity interfere with effective problem-solving and communication within the family" (Robbins et al. 1998, p. 174). Robbins and colleagues report that negativity in family therapy sessions is linked to dropping out of family therapy. For those who remain in therapy, negativity is linked to poor family therapy outcomes. Because negativity is bad for the family and for the therapy, most contemporary family therapies target negativity (Alexander et al. 1994). The best-known strategy for transforming negative interactions into positive ones is reframing (Robbins et al. 2000).

While the counselor is encouraged to permit family members to interact with each other in their usual way and to join before orchestrating change, a caveat is necessary when intense negative feelings accompany conflictive interactions. If the family is to remain in counseling, family members must experience some relief from the negative feelings soon after counseling begins. Therefore, counselors are encouraged to use reframing abundantly, if necessary, in the first and perhaps the first few sessions to alleviate the family's intensive negative feelings. Such reframes also may allow family members to discuss their pain and grievances in a meaningful way.

An example will help illustrate the use of reframing negative feelings to create more positive feelings among family members. Anger is a fairly common emotion among families with an adolescent who is involved in antisocial activities. The parents may feel angry that their attempts to guide their child down the "right" path have failed and that the child disrespects their guidance. The adolescent is likely to interpret this anger as uncaring and rejecting. Both parties may feel that the other is an adversary, which severely diminishes the possibility that they can have a genuine dialogue.

The particular reframe that needs to be used is one that changes the emotions from anger, hurt, and fighting (negative) to caring and concern (positive). The counselor must create a more positive reality or frame. The counselor, for example, might say to the parent, "I can see how terribly worried you are about your son. I know you care an awful lot about him, and that is why you are so frustrated about what he is doing to himself."

With this intervention, the counselor helps move both the parent's and the child's perceptions from anger to concern. Typically, most parents would respond by saying, "I am very worried. I want my child to do well and to be successful in life." When the youth hears the parent's concern, he or she may begin to feel less rejected. Instead of rejecting, the parent is now communicating concern, care, and support for the child. Hence, by creating a more positive sense of reality, the counselor transforms an adversarial relationship between the parent(s) and the adolescent, orchestrating opportunities for new channels of communication to emerge and for new interactions to take place between them.

Reframing is among the safest interventions in BSFT, and, consequently, the beginning counselor is encouraged to use it abundantly. Reframing is an intervention that usually does not cause the counselor any loss of rapport. For that reason, the counselor should feel free to use it abundantly, particularly in the most explosive situations.

Affect: Creating Opportunities for New Ways of Behaving

In BSFT, counselors are interested in affect (a feeling or an emotion) as it is reflected in interactions. In BSFT, the counseling strategy is to use emotion as an opportunity to "move" the family to a new, more adaptive set of interactions. One of many possible ways of working with emotion is found in the following example. When a mother cries, the counselor might suggest to the drug-abusing youngster, "Ask your mom to tell you about her tears." An alternative would be, "What do you think your mom's tears are trying to say?" If the youth responds, "I think it is...," the counselor would follow with a directive to the youth, "Ask your mother if what you think her tears mean is why she is crying." In this way, the crying is used to initiate an interaction among family members that acknowledges not only the emotion in crying but also the experience underlying the crying. In other words, the crying is used to promote interactions that show respect for the emotion as well as promote a deeper level of understanding among family members.

In another example, a drug-abusing adolescent and her family come to their first BSFT counseling session. The parents proceed to describe their daughter as disobedient, rebellious, and disrespectful-- a girl who is ruining her life and going nowhere. They are angry and reject this young girl, and they blame her for all the pain in the family. In this instance, the BSFT counselor recognizes that the family is "stuck" about what to do with this girl and that their inability to decide what to do is based on the view they have developed about her and her behavior. To "open up" the family to try new ways to reach the youngster, the BSFT counselor must present a new "frame" or perspective that will enable the family to react differently toward the girl. The BSFT counselor might tell the family that, although she realizes how frustrated and exasperated they must feel about their daughter's behavior, "it is my professional opinion that the main problem with this girl is that she is very depressed and is in a lot of pain that she does not know how to handle." Reframing is a practical tool used to stimulate a change in family interactions. With this new frame, the family may now be able to behave in new ways toward the adolescent, which can include communicating in a caring and nurturing manner. A more collaborative set of relationships within the family will make it easier for the parents to discuss the daughter's drug abuse, to address the issues that may be driving her to abuse drugs, and to develop a family strategy to help the adolescent reduce her drug use.

Reversals

When using the technique called "reversal," the counselor changes a habitual pattern of interacting by coaching one member of the family to do or say the opposite of what he or she usually would. Reversing the established interactional pattern breaks up previously rigid patterns of interacting that give rise to and maintain symptoms, while allowing alternatives to emerge. If an adolescent gets angry because her father nagged her, she yells at her father, and the father and daughter begin to fight, a reversal would entail coaching the father to respond differently to his daughter by saying, "Rachel, I love you when you get angry like that," or "Rachel, I get very frightened when you get angry like that." Reversals make family members interact differently than they did when the family got into trouble.

Working With Boundaries and Alliances

One important determinant of alliances between family members is the psychological barrier between them, or the metaphorical fence that distinguishes one member from another. BSFT counselors call this barrier or fence a "boundary." Counselors aim to have clear boundaries between family members so that there is some privacy and some independence from other family members. However, these should not be rigid boundaries, with which family members would have few shared experiences. By shifting boundaries, BSFT counselors change maladaptive alliances across the generations (e.g., between parent figures and child). For example, in a family in which the mother and the daughter are allied and support each other on almost all issues while excluding the father, the mother may no longer be powerful enough to control her daughter when she becomes an adolescent and may need help. In this case, an alliance between the mother and the father needs to be re-established, while the cross-generational coalition between mother and daughter needs to be eliminated.

It is the BSFT counselor's job to shift the alliances that exist in the family. This means restoring the balance of power to the parents or parent figures so that they can effectively exercise their leadership in the family and control their daughter's behavior. The counselor attempts to achieve these alliance shifts in a very smooth, subtle, and perhaps even sly fashion. Rather than directly confronting the alliance of the mother and daughter, for example, the counselor may begin by encouraging the father to establish some form of interaction with his daughter.

Boundary shifting is accomplished in two ways. Some boundaries need to be loosened, while others need to be strengthened. Loosening boundaries brings disengaged family members (e.g., father and daughter) closer together. This may involve finding areas of common interest between them and encouraging them to pursue these interests together. For instance, in the case of a teenaged son enmeshed with his mother and disengaged from his father, the counselor may direct the father to involve his son in a project or to take his son on regular outings. The counselor also may arrange the seating in counseling sessions to help strengthen some alliances and loosen others.

In addition to bringing family members closer together, the counselor may need to strengthen the boundaries between enmeshed family members to create more separation. One example is the mothergrandmother parenting system in which the grandmother enables her grandson's drug use by protecting him from his mother's attempts to set limits. Rather than confronting the grandmother-adolescent alliance directly, the counselor may first encourage the mother and grandmother to sit down together and design a set of rules and responsibilities for the adolescent. This process of designing rules often requires the parent figures to work out some of the unresolved conflict(s) in their relationship, without the counselor having to address that relationship directly. This brings the mother closer to the grandmother and distances the grandmother from the adolescent, thereby rearranging the family's maladaptive hierarchy and subsystem composition.

It should be noted that, in this case, the counselor tracks the family's content (grandmother hiding adolescent's drug use from mother) as a maneuver to change the nature of the interaction between the mother and the grandmother from an adversarial relationship to one in which they agree on something. The adolescent's drug use provides the content necessary to strengthen the boundaries between the generations and to loosen the boundaries between the parent figures.

Clearly, bringing the mother and grandmother together to the negotiating table is only an intermediate step. After that, the tough work of helping mother and grandmother negotiate their deep-seated resentments and grievances against each other begins. Because the counselor follows a problem-focused approach, he or she does not attempt to resolve all of the problems the parent figures encounter. Instead, the counselor tries to resolve only those aspects of their difficulties with each other that interfere with their ability to resolve the problems they have with the adolescent in the family.

Behavioral Contracting as a Strategy for Setting Limits for Both Parent and Adolescent

From a process perspective, setting clear rules and consequences helps develop the demarcation of boundaries between parent(s) and child(ren). Sometimes when a parent and an adolescent have a very intense conflictive relationship in which there is a constant battle over the violation of rules, the rules and their consequences are vague, and there is considerable lack of consistency in their application. In these cases, it is recommended that the counselor use behavioral contracting to help the parent(s) and the adolescent agree on a set of rules and the resulting consequences if he or she fails to follow these rules. The counselor encourages the parent(s) and the adolescent to negotiate a set of clearly stated and enforceable rules, and encourages both parties to commit to maintaining and following these rules.

Helping parents use behavioral contracting to establish boundaries for themselves in relationship to their adolescent is of tremendous therapeutic value. Parents who have established boundaries can no longer respond to the adolescent's behavior/misbehavior according to how they feel at the time (lax, tired, frustrated, angry). The parents have committed themselves to respond according to agreed-upon rules. From a BSFT point of view, it is very important for the counselor to begin to help the parents develop adequate boundaries with their adolescent children who have behavior problems.

In families that have problems with boundaries, the counselor's most difficult task is to get the parents to stick to their part of the contract. Counselors expect that the adolescent will not keep his or her part of the contract and instead will try to test whether his or her parents will try to stick to their part of the contract. When the adolescent misbehaves, parents tend to behave in their usual way, which may be a reaction to the way they feel at the moment. The counselor's job is to make the parents uphold their side of the agreement. Once parents have set effective boundaries with their adolescent children, most misbehavior quickly diminishes. (Of course, sometimes rules and consequences need to be renegotiated as parents and adolescents begin to acquire experience with the notion of enforceable rules and consequences.)

Boundaries Between the Family and the Outside World

It is important not only to understand the nature of the alliances and boundaries that occur within the family but also to understand the boundaries that exist between the family and the outside world. (See Chapter 3, p. 21 on life context.)

Some families have very rigid boundaries around themselves, prohibiting their members from interacting with the outside world. Other families have very weak boundaries around themselves that allow outsiders to have an undue influence on family members. Either of these extremes can be problematic and is fair ground for BSFT intervention. For example, if parents are uninvolved with their children's school or friends (rigid boundaries), the BSFT counselor works to get the parents to participate more fully in their child's school life and to interact more with their child's friends.

Detriangulation

As was said earlier, triangles occur when a third, usually less powerful, person gets involved in a conflict between two others. It is a basic assumption of BSFT that the only way conflict between two people (called a "dyad") can be resolved is by keeping the conflict between them. Bringing in a third person and forming a triangle becomes an obstacle to resolving the conflict. The third person usually is drawn into a coalition with one of the parties in conflict and against the other. This coalition results in an imbalance within the original dyad. The issues involved in the conflict are detoured through the third person rather than dealt with directly. For example, when parent A has a fight with parent B, parent B may attack the adolescent in retaliation for parent A's behavior (or attempt to enlist the youth's support for his or her side of the argument) rather than expressing his or her anger directly to parent A. Such triangulated adolescents are often blamed for the family's problems, and they may become identified patients and develop symptoms such as drug abuse.

Because triangulation prevents the involved parties from resolving their conflicts, the goal of counseling is to break up the triangle. Detriangulation permits the parents in conflict to discuss issues and feelings directly and more effectively. Detriangulation also frees the third party, the adolescent, from being used as the escape valve for the parents' problems.

One of the ways in which a BSFT counselor achieves detriangulation is by keeping the third party (i.e., the adolescent) from participating in the discussions between the dyad. Another way to set boundaries to detriangulate is to ask the third party not to attend a therapy session so that the two conflicting parties can work on their issues directly. For example, when working with a family in which the son begins to act disrespectfully whenever his parents begin to argue, the counselor might instruct the parents to ignore the son and continue their discussion. If the son's misbehavior becomes unmanageable, the counselor may ask the son to leave the room so that the parents can argue without the son's interference. Eventually, the counselor will ask the parents to collaborate in controlling the son.

Attempts by the Family to Triangulate the Counselor

Triangulation does not necessarily have to involve only family members. Sometimes a counselor can become part of a triangle as well. One of the most common strategies used by family members is to attempt to get the counselor to ally himself or herself with one family member against another. For example, one family member might say to the counselor, "Isn't it true that I am right and he is wrong?" "You know best, you tell him." "We were having this argument last night, and I told her that you had said that...."

Triangulation is always a form of conflict avoidance. Regardless of whether it is the counselor or a family member who is being triangulated, triangulation prevents two family members in conflict from reaching a resolution. The only way two family members can resolve their conflicts is on a one-to-one basis.

An important reason why the counselor does not want to be triangulated is that the person in the middle of a triangle is either rendered powerless or symptomatic. In the case of the counselor, the "symptom" he or she would develop would be ineffectiveness as a therapist, that is an inability to do his or her job well because his or her freedom of movement (e.g., changing alliances, choosing whom to address, etc.) has been restricted. A triangulated counselor is defeated. If the counselor is unable to get out of the triangle, he or she has no hope of being effective, regardless of what else he or she does or says.

When a family member attempts to triangulate the counselor, the counselor has to bring the conflict back to the people who are involved in it. For example, the counselor might say, "Ultimately, it doesn't matter what I think. What matters is what the two of you agree to, together. I am here to help you talk, negotiate, hear each other clearly, and come to an agreement." In this way, the counselor places the focus of the interaction back on the family. The counselor also might respond, "I understand how difficult this is for you, but this is your son, and you have to come to terms with each other, not with me."

Opening Up Closed Systems

Families in which conflicts are not openly expressed need help in discussing the conflict so that it can be a target for change. Sometimes a counselor can work with a family member who has an unexpressed or implicit conflict and help that person discuss the problem so that it can be resolved. This brings conflicts out into the open and facilitates their resolution by intensifying and focusing on covert emotional issues. In families of drug-abusing adolescents, a typical example of unexpressed or suppressed conflict involves disengaged fathers who tend to deny or avoid any discussion of the youth's problems. Asking a surly or sulking adolescent to express what is on his or her mind whenever the father is addressed may help the father break through his denial.

Tasks

Central Role

The use of "tasks" or assignments is central to all work with families. The counselor uses tasks both inside and outside the counseling sessions as the basic tool for orchestrating change. Because the emphasis in BSFT is in promoting new skills among family members, at both the level of individual behaviors and in family interactional relations, tasks serve as the vehicle through which counselors choreograph opportunities for the family to behave differently.

In the example in which mother and son were initially allied and the father was left outside of this alliance, father and son were first assigned the task of doing something together that would interest them both. Later on, the mother and father were assigned the collaborative task of working together to define rules regarding the types of behaviors they would permit in their son and the consequences that they would assign to their son's behavior and misbehavior.

General Rule

It is a general rule that the BSFT counselor must first assign a task for the family to perform in the therapy session so that the counselor has an opportunity to observe and help the family successfully carry out the task. Only after a task has been accomplished successfully in the therapy session can a similar followup task be assigned to the family to be completed outside of therapy.

Moreover, the counselor's aim is to provide the family with a successful experience. Thus, the counselor should try to assign tasks that are sufficiently doable at each step of the counseling process. The counselor should start with easy tasks and work up to more difficult ones, slowly building a foundation of successes with the family before attempting truly difficult restructuring moves.

Hope for the Best; Be Prepared for the Worst

Counselors should never expect the family to accomplish the assigned tasks flawlessly. In fact, if family members were skillful enough to accomplish all assigned tasks successfully, they would not need to be in counseling. When tasks are assigned, counselors should always hope for the best but be prepared for the worst. After all, a task represents a new way of behaving for the family and one that may be difficult given that they have had years of practice engaging in the old ways of behaving.

As the family attempts to carry out a task, the counselor should help the family overcome obstacles it may encounter. However, in spite of the counselor's best efforts, the task is not always accomplished. The counselor's job is to observe and/or uncover what happened and identify the obstacles that prevented the family from achieving the task. When a task fails, the counselor starts over and works to overcome the newly identified obstacles. Unsuccessful attempts to complete tasks are a great source of new and important information regarding the interactions that prevent a family from functioning optimally.

The first task that family counselors give to all of their cases is to bring everyone into the counseling session. Every counselor who works with problem youths and their families knows very well that most of the families who need counseling never reach the first counseling session. Therefore, these families can be described as having failed the first task given them, to come in for counseling. This task, called engagement, is so important that we have devoted the next chapter to it.

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