EVOLVING STRUCTURAL-STRATEGIC FAMILY THERAPY
Family therapy has been found to be one of the most effective, and long lasting approaches to working with children and adolescents struggling with emotional and behavioral issues. The term "family therapy" can be misleading though because some thinking of the whole family being there every session (Structural Family Therapy), or that the family therapy is only focused on communication and will not address significant issues like anxiety disorders or trauma. A therapist works with a child or teen one hour per week, but a family is with that child or teen the rest of the week, so helping families to carry forward the change from therapy, is a much more effective approach than working with a child or teen individually and leads to lasting change. In family therapy, the therapist may meet with everyone, just the child struggling and the parent(s), sometimes just with the child, sometimes just with the parents, and sometimes one child and one parent (Strategic Family Therapy). My goal is to activate the resources in the family, so that the work I do in therapy with a child or adolescent is continued at home and leads to lasting change.
The approach I use is termed Evolving Structural-Strategic Family Therapy, and is based on James Keim, LCSW's four stage approach to working with children and teens with oppositional defiant disorder. Jim and I have worked together since 2006 and have developed his model to become a transdiagnostic model (one that applies to various disorders), being effective with both externalizing disorders (e.g., oppositional defiant disorder, conduct disorder, substance abuse, anger, ADHD) and internalizing disorders (e.g., anxiety disorders, trauma, depression, self harm, eating disorders). Sometimes, the treatment isn't driven by a mental health concerns, but by life changes or developmental changes (e.g., divorce, death, remarriage, sickness, disability), which family therapy helps to support the family through these changes, and reconfigure to accommodate the change in context. Our integrative model is principal driven, using principals from various effective, evidence-based treatments.
In the first stage, Assessment, we are meeting with children/adolescents and parents to understand what is going on, and determine a treatment plan. In the second stage, Preparation, we meet with the child/adolescent individually to build a relationship and begin developing Cognitive Behavioral Therapy and Dialectical Behavioral Therapy skills. We meet with the parents to obtain history, and in an externalizing situation (acting out), we work on techniques for deescalation and co-regulation. In internalizing situation (without acting out), we teach parents CBT and DBT skills and have sessions with them and their child/adolescent to teach and reinforce the skills at home. In stage 3, Structure, particularly in an externalizing (acting out) situation, we develop a clear behavior plan to reinforce target behaviors and consequences for problematic behaviors. We address angry outbursts, not doing schoolwork, substance abuse, defiance and rule breaking, and aggression. We help create a system for "parenting by values" rather than what children/adolescents sometimes see as "parenting by mood". If there is not acting out, we may skip this stage and come back later, or if in a situation where there are executive functioning difficulties (e.g., ADHD, learning disorders), but not acting out, then we will work on creating systems for success. In stage 4, Attachment, we are use principals of Attachment Based Family Therapy (ABFT) in order to help children and adolescents talk about what they're struggling with, or angry about, or needing to process. This may be anger at a parent, feelings about a divorce, difficulties with peers, experiences of trauma, gender identity, feelings of worthlessness, feelings of inadequacy due to a learning differences, fears, and any other "hot topic" that they can't deal with alone, and need a parent to help them process through. With young children, the therapist can help access and elicit their thoughts and emotions through art, play, and other creative techniques to then help them express themselves to their parents, and for parents to learn the techniques the therapists use to help their children communicate and for parents to understand their experience and needs. When parents can be resources for children and adolescents, depression and anxiety decreases, and parents are able to influence their child/teens values, and help them through their development, as well as create templates for healthy relationships in the future.
These four stages generally are moved through in about 10-12 sessions (many variables can shorter or extend that), and once the child or adolescent has a good container, they are able to go more deeply into addressing their anxiety, trauma, depression, ADHD, etc. Those symptoms will decrease throughout the first 10-12 sessions, and creating that long term charge is often able to be achieved in the following 8-10 sessions. In research settings, a course of an average of 20 sessions is considered a short term family therapy, although many reasons can cause this to take longer (e.g., motivation, comorbidities, co-occuring disorders, trauma, parental mental health struggles, strength of parental relationship). At times, I may have individual sessions with a parent whose trauma is getting triggered, or needs skills for managing their own anxiety or depression using CBT and/or EMDR. I also work with parents on their couples relationship, using Emotionally Focused Couples Therapy (EFT), an evidence based treatment for couples. When working with separated or divorced parents, I work with the chlid/teen with each parent separately (if sharing custody), and work on coparenting.
Ultimately, the goal of family therapy is to put the therapist out of a job, and help the parents to understand how to help their child with their difficulties. Just as in individual therapy, children and adolescents have confidentiality and develop a connected relationship with their therapist, and should experience their therapist as an advocate for them to get their needs met in the family. Mental health issues are addressed using evidence-based individual approaches, such as CBT, DBT, and EMDR, and the family is also taught these skills in order to reinforce at home, leading to lasting change since the therapist is there only 45 min per week, but the family is there the whole rest of the time. Research has found family therapy (e.g., Functional Family Therapy, Multidimensional Family Therapy, Multisystemic Family Therapy, Brief Strategic Family Therapy, Attachment Based Family Therapy) to be the treatment of choice, being both effective, and often showing superior results at follow up, when compared to individual approaches. Through integrating both, we get the best shot as lasting improvement in an efficient, and cost effective amount of time.
Training and Supervision
In addition to working with children, adolescents, and families. I have also been supervising therapists in learning family therapy since 2005, and teaching workshops on family therapy since 2011. I founded the Institute for the Advancement of Psychotherapy (IAP) where we have numerous licensed, experienced clinicians who provide Evolving Structural-Strategic Family Therapy (ESSFT), Cognitive Behavioral Therapy (CBT), Emotionally Focused Couples Therapy (EFT), and Eye Movement Desensitization Reprocessing (EMDR). Additionally, James Keim, LCSW and I offer trainings in ESSFT through workshops, one way mirror training, and individual and group consultation. I also founded Bay Area Community Counseling (BACC), a nonprofit, where we take on training associates and post docs who can see clients at a sliding scale. These training clinicians are supervised by myself, and are taught the evidence based treatments used in IAP. I have also presented at the International Family Therapy Association conference in Bangkok, Thailand.
Background and Training
I have been working with children and adolescents since 1998 in teen shelters, schools, community clinics, a wilderness program, a residential treatment center, and in private practice. My family therapy training has included being trained in Brief Strategic Family Therapy (BSFT) by Olga Hervis, Ph.D., spending a year at the Mental Research Institute training in Strategic Family Therapy with Eileen Bobrow, spending two years training at the Family Institute of Pinole, a year of training in Narrative Therapy with Jim Sparks, Ph.D. I have taken various trainings and workshops including: Narrative Therapy with Michael White, Solution Focused Therapy with Insoo Kim Berg, Ph.D., Brief Therapy with Dick Fisch and Karen Schlanger, Attachment Based Family Therapy with Guy Diamond, Family Trauma Therapy with Scott Sells, Emotionally Focused Family Therapy, Family Based Therapy for Anorexia (Maudsley Method) with Kara Fitzpatrick, and Cognitive Behavioral Therapy with Children with Lynn Lyons. Shorter workshops have included Multidimensional Family Therapy with Howard Little, MultiSystemic Therapy, Parent Child Interaction Therapy, Structural Family Therapy with Salvador Minuchin, and Strategic Family Therapy with Cloe Madanes. I am the past president of the Association of Family Therapists of Northern California (AFTNC), which is a multidisciplinary group of psychologists, psychiatrists, marriage and family therapists, and social workers who all specialize in family therapy, and was a member of the American Family Therapy Academy (AFTA) and International Family Therapy Association (IFTA). I am also the co-founder of Bay Area Therapists Specializing in Adolescents (BATSA). I am a life long learning, and the mission of the Institute for the Advancement of Psychotherapy (IAP) is to advance the field of psychotherapy through integration and development of approaches. I have a created a community of clinicians with a love of learning, and each continues to obtain training, reads, keeps up to date on developments, and innovations in the field, and we come to together and share what we are learning about to help us continue to advance our thinking and increase our efficacy with clients.
To make an appointment for an assessment and/or discuss recommendations for treatment, call (415) 686-9544 or email email@example.com I have offices in San Francisco and Corte Madera and provide phone and/or web sessions for clients who can not come to the office.