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Discussion: Legal and Ethical Considerations for Group and Family Therapy

Considering the Health Insurance Portability and Accountability Act (HIPPA), the idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential. For this Discussion, consider how limited confidentiality and other legal and ethical considerations might impact therapeutic approaches for clients in group and family therapy.

Learning Objectives

Students will:
  • Compare legal and ethical considerations for group and family therapy to legal and ethical considerations for individual therapy
  • Analyze the impact of legal and ethical considerations on therapeutic approaches for clients in group and family therapy
  • Recommend strategies to address legal and ethical considerations for group and family therapy
To prepare:
  • Review this week’s Learning Resources and consider the insights they provide on group and family therapy.
  • View the media, Legal and Ethical Issues for Mental Health Professions, Volume I, and reflect on legal and ethical considerations for group and family therapy and individual therapy.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link and then select Create Thread to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post an explanation of how legal and ethical considerations for group and family therapy differ from those for individual therapy. Then, explain how these differences might impact your therapeutic approaches for clients in group and family therapy. Support your rationale with evidence-based literature.

Discussion: Legal and Ethical Considerations for Group and Family Therapy

Considering the Health Insurance Portability and Accountability Act (HIPPA), the idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential. For this Discussion, consider how limited confidentiality and other legal and ethical considerations might impact therapeutic approaches for clients in group and family therapy.

Learning Objectives

Students will:
  • Compare legal and ethical considerations for group and family therapy to legal and ethical considerations for individual therapy
  • Analyze the impact of legal and ethical considerations on therapeutic approaches for clients in group and family therapy
  • Recommend strategies to address legal and ethical considerations for group and family therapy
To prepare:
  • Review this week’s Learning Resources and consider the insights they provide on group and family therapy.
  • View the media, Legal and Ethical Issues for Mental Health Professions, Volume I, and reflect on legal and ethical considerations for group and family therapy and individual therapy.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link and then select Create Thread to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post an explanation of how legal and ethical considerations for group and family therapy differ from those for individual therapy. Then, explain how these differences might impact your therapeutic approaches for clients in group and family therapy. Support your rationale with evidence-based literature.

Microskills: Family Counseling Techniques 2

Microskills: Family Counseling Techniques 2 Program Transcript

NARRATOR: Aaron in Robyn are seeing a counselor as they are concerned about the alcohol drinking behavior of their adolescent daughter, Michelle. As you watch this segment, observe the techniques used by the counselor.

COUNSELOR: So I’m wondering if you would do something for a minute. I’m wondering if you could share with your dad what he doesn’t get about you. If you were to think about your dad really being in a place of really not knowing what it is that you are or who you are. To be able to say to him, this is what you’re not getting about me. And Dad, I’m wondering if you could just hear what she has to say. And then I want to talk with you a little bit about that.

AARON: I have to be quiet?

COUNSELOR: Yeah.

AARON: That’s going to be hard.

COUNSELOR: Yeah. I’m sure it will, yeah.

AARON: I’ll give it a shot. I’ll give it a shot.

MICHELLE: Well, I’m not a robot. And I’m not your little Barbie doll toy. And I’m not your dancing monkey when we go out places. I don’t like performing for people. And get things that I get– who I am. I am a person. And I want to make my own decisions. And maybe I don’t know what I want to do. And I think that should be OK.

COUNSELOR: Anything else? Now I want to stop for a second. It looked to me, as you were talking to dad, that there were a couple times where you were looking to mom, almost for some reassurance. I wonder if you noticed that, Mom. Yeah. And Dad, what were you hearing? What were you hearing Michelle say?

AARON: I’ve got to be honest with you. My internal language was just telling me to just be quiet and listen to her. So I was hearing my own internal voice at the same time I was trying to listen to her. But I kept hearing words like “Barbie doll” and “dancing monkey.” And that’s not what I want my daughter to think that I want of her.

MICHELLE: You get the message that she feels like you want her to perform.

AARON: Yeah, that’s what I heard. I just… That’s not what I want at all.

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COUNSELOR: So one of the things that may be happening in your family is that you may be making some assumptions about your dad, about what he wants you to do, that may not be his intention. Do you think that he wants to have you dance around like a dancing monkey or to perform and be the perfect person? How does he want you to do that?

MICHELLE: Well, if we’re out somewhere and if I’m not happy, I shouldn’t be forced to smile. Or if we’re out at a church function or something like that, and if I don’t really want to mix and mingle and meet whoever you want, I just don’t feel like I should have to be really happy and go and entertain them or share stories about something that happened at school or share about something that I did. I just don’t feel like I should have to be doing that.

AARON: I’m just very proud of you. You’ve had good grades up until recently. And I’m proud of you. That’s why want you tell folks these things. I’m just so proud of you and the good grades that you make. But I’m worried about the– the drinking’s going to– I get that next report card and it’s going to be all B’s and C’s instead of A’s. And it’s been all A’s ever since. And that’s what I want for you.

ROBYN: You know, she and I have talked about this before. She feels like she’s your trophy. And I know I feel that way sometimes, too. You can’t have a relationship with a trophy.

COUNSELOR: So one of the things that you experience, Robyn, that you experience yourself as a trophy, and not just Michelle– because again, it’s almost like you were talking for Michelle. She feels like you view her as a trophy. But you feel that way, too. And so what does feel to be like a trophy?

ROBYN: That I am in his life just to show off, some other acquisition or evidence of success that he has. And that he doesn’t really care about who I am as a person, or care about our family. You know, he’s gone all during the week and when he comes home, you know what he does? He does and plays golf all day Saturday. So there’s this idea of, you have to be perfect. And you have to be this way. You have to look that way. And you have to do all these things so the rest of the world can see how successful he is or I am. But there’s no connection.

COUNSELOR: It’s interesting. During the week, you don’t have to be a trophy. It’s almost like y’all can get together and just do what you need to do. So in some ways, his working during the week serves you. It helps you to do– to put off the trophy and to live how you want to live.

MICHELLE: Yeah, we can just relax and chill together.

COUNSELOR: And so my hunch is that if that arrangement were to change, that would be pretty interesting to see what would happen in this family. Meaning if

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you weren’t on travel so much, if you were home, that would certainly be different for you and this family.

AARON: Yeah. I wouldn’t have drinking buddies to come home to.

NARRATOR: Well and the other thing, too, Aaron is that I get the sense that you’ve depended upon this partner that you have– who is your equal, who is your wife– to keep the homefront a certain way. And so when you were talking earlier about them being buddies, you don’t like the coziness. And what you’re saying is you don’t like the fact that Robyn has abandoned her parenting role to be a friend.

AARON: Yeah. When I hear “buddies,” I’m just worried about where the parent side of you comes from. That’s my concern. I love that you two get along so well, but I just have a hard time with mom and daughter drinking. I really struggled with that.

COUNSELOR: So what’s your what’s your feeling about that?

ROBYN: Sometimes I do feel like we’re at opposite ends of the spectrum. Here’s this cold, hard, distant dad. And so my job is to make up for it and give her all the relationship for both of us together.

COUNSELOR: So almost like you have to offset that harshness that dad brings in.

ROBYN: Right. Because if I were more parental– by his definition– what would she have? She’d have parents who she felt like didn’t care about her as a person.

COUNSELOR: So drinking with Michelle is a way that you show that you love her.

ROBYN: It’s not really drinking. We just– every once in a while we’ll make some daiquiris together and we just relax. And I guess this last time, we probably put too much rum in the daiquiris she just got drunk. But it’s not like we’re going out driving or going to bars. We’re just hanging out together. We’re just connecting and relaxing before he comes home.

COUNSELOR: Right. And you have this special time together. And it’s just you two. And it doesn’t involve him. And it doesn’t even involve your friends, too.

MICHELLE: I mean, they’ll come over. They know she’s a cool mom. But not all the time.

COUNSELOR: So do your friends know that you drink with your mom?

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MICHELLE: Yeah they know how cool she is. And she understands. And we can talk to her about anything.

COUNSELOR: So being a cool mom is a pretty important thing to you.

ROBYN: Oh, it’s great. I can go out around town, see one of them, they call me “mom,” and come over and hug me. It’s wonderful to have her friends like me. So I get to really stay connected with them and know what’s going on.

COUNSELOR: So you’re a couple of years away from going to college. And I’m wondering what it’s like for you, Robyn, to think about her leaving and–

ROBYN: Oh, I don’t think about it.

COUNSELOR: Because she goes off to college and then you’re home by yourself with a cold-hearted husband who is home on the weekends.

AARON: Never thought of it that way. It’s hard to hear.

COUNSELOR: And that’s where I’m curious. It looks like that it’s really difficult for you hear yourself being perceived that way, like “is this all I am? Just this cold- hearted–“

AARON: In my own head, I provide for my family. And that’s how I show my love. And it’s just hard to hear the talk about cold and hard and not there and all that stuff. Just hard to hear.

ROBYN: But you weren’t always that way. There was a time, when Michelle was really young, we used to go on picnics together and do stuff together. And as she got older and the years when by, work became more important to him than us.

COUNSELOR: And one of the things that you’re saying, Robyn, is that what’s happened over the years is that you’ve grown apart. That you and Aaron have grown apart. Because I hear the family piece. I hear that’s not only has he grown apart from both of you. But you have felt some distance in your relationship. So I wonder if in some ways Michelle has replaced that connection that you seek.

Like she’s somebody– I envision when you have these moments together during the week where you’re together and– yeah it may involve alcohol, but you share things with each other about each other’s lives. And you feel like you’re close friends. And I’m hearing that you don’t– it doesn’t seem obvious that you have that with Aaron.

ROBYN: No. I mean, we still had a good relationship, but she was younger. And we couldn’t really have conversations. And I did feel really, really lonely. And now I don’t feel lonely anymore.

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Microskills: Family Counseling Techniques 2

NARRATOR: Shawn and Weston are seeing a counselor as they are dealing with feelings of “growing apart” in their relationship. As you watch this segment, observe the techniques used by the counselor.

COUNSELOR 2: We’ve got just a few minutes left. And so I think that one of the important things that we do next is to take what we’ve spoken about today and really translate that into action steps. So what I’d like– and I’ll start with you, Weston. I’d like you to summarize the things that you heard Shawn say to you. And the way that I want you to do that is to say, “What I heard you say was–” and again, provide a summary of that. And then close that with, “And in response to that, I will–” Blank Whatever you’re going to do in response to that.

WESTON: OK. What you just said there kind of clicked for me. You’re a man of action versus words. And I tend to be of more words than action. And it’s like two ships that need a better job talking to each other. Because we’re both powerful personalities. I’d like to commit or propose let’s come up with a date night. Whether we just go out for a coffee date, dinner date, dancing date, let’s pick a night where it’s just the two of us. I be home. You be home. We all be home by 4:00 or 5:00. That night’s ours. And it’s sacred. And my guess is that might be an action step where you know that time is yours so we can have fun together.

I think the other thing I’d offer is I will try to keep my downtime when I get home to 45 minutes. Maybe even set an egg timer– mm-ding– and then I check in with you about where I’m at and check in with you about where you’re at for the day. And we see where it goes for the evening.

COUNSELOR 2: I know you’re probably thinking about your response. And before you do formulate that, I think what I’d like to do, Weston is to challenge you a little bit further. You said, “I will try to set an egg timer for the 45 minutes.” I’d really like to hear you commit to that 45-minute downtime period each day.

WESTON: I will commit to the 45-minute period each day.

COUNSELOR 2: OK. And we can certainly test it out for the next week and see what happens. And so there were two things that I heard that you were offering as new possibilities. First of all, there’s this very concrete action that’s the “I will use an egg timer and I will keep my time to 45 minutes, recognizing that you need time, too.” And also, “I want us to have a date night.” And so, really responding to, “here’s what I want, and this is my yearning. And in order to do that, in order to facilitate that, and move us forward to creating this possibility, here’s what I’m willing to do.” What’s it like to have named those things?

WESTON: I think it’s easy to name them. I think where the difficulty will be is the follow-through in the next week or so. I’m excited by them. But I’m also like, now I got to do it. I’m just kind of hesitant, or anxious, or nervous, about making that commitment.

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Microskills: Family Counseling Techniques 2

COUNSELOR 2: OK. So feeling some anxiety over making a commitment that’s going to really be changing. Does it feel at all vulnerable?

WESTON: Vulnerable as in “scary,” no. Vulnerable as in “will it work?” I’m cautious. I want to have hope. But I don’t know if it’s there completely yet.

COUNSELOR 2: OK. Great. So really wanting to move back into connection, yet also wondering if the possibility really exists, and really knowing that you’re sticking your neck in a way by making some changes– or proposing some changes– and really making a concerted effort toward doing that. OK. Now let me ask you. Before you respond to that, what was it like to hear that summary and then the proposal for his commitment and then also his hoped-for outcome of that?

SHAWN: Well, it was nice to hear. And yeah, it was nice. It lets me know that he’s heard what my concerns are and he’s willing to try address them. So that was good. So I’m encouraged. And I agree. I think he’s right. It is nervous in terms of whether or not it is actually going to happen. And I think my nervousness centers around, well, if he doesn’t do it one day, how I going to respond to that? Am I going to be like, well, he is trying. Is trying enough? And I know that in my mind, trying is enough, but like I said earlier, with the zingers, sometimes they just come out before I think about the fact he is trying. So that’s where my nervousness stems from. But I am encouraged, though. Definitely encouraged.

COUNSELOR 2: And the thing I’d like to caution you against is creating a bad scenario before it happens. I think an important thing to do is to give this is an opportunity before saying, but I also know that it may not happen. And here’s what I’m thinking and how I’m going to respond to that. And I’d rather you approach this from a different perspective rather than trying to anticipate how you’ll respond if things don’t happen. I’d like to consider the possibility that these things will happen, and what that might mean for you. And while you’re holding that in your mind, I’d like you to also provide that same summary to Weston that you’ heard him say, Shawn, which is the, “What I heard you say was–” Provide the summary. And then end that with, “And in response to that, I will–” And you fill in the blank.

SHAWN: OK. OK. Well, what I heard you say was that you would like to have a night that’s ours, a date night that we would have between us. We both would get off at around 5:00 and then just make that date our night. And that you’d also be willing to have 45 minutes when you got home for your downtime. And then the other time would be spent processing and talking with me.

And in response to that, I’m willing to allow you to have those 45 minutes by not being in your face as soon as you walk through the door, and allowing you to have that time. And also I’m willing to organize my thoughts, the things that I

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Microskills: Family Counseling Techniques 2

want talk about, and just take away the things that maybe aren’t that important. Because I do recognize that a lot of stuff that happens at the job you don’t want to hear. So I do understand that. And so I will do that so that when we do have that time it’ll be more focused. And so I’m willing to do that.

NARRATOR: Billie is coping with the loss of a significant relationship. For six months, she has been working with a counselor, which is now concluding today. As you watch this segment, observe the techniques used by the counselor.

COUNSELOR 3: Do you have words of wisdom? Things that, if this had been different, if this had been even better, what could we have done differently over this course of these counseling sessions?

BILLIE: What could have been done differently? I think that– I don’t know, it’s really hard to say. I think because of where I was when I came in– I was a whirlwind of mess– and I’m hoping– really on my end, I guess on what could have been differently, if I could have been a bit more receiving at first. It took me a little while to get to the point with working with you that I can be an independent person. That I can coexist with a person as opposed to existing within a person.

COUNSELOR 3: But how could you have? That first day, you were really hurt.

BILLIE: I was. I was. It was really a lack of words. I keep using stormy-type of words, and “tornado,” because I felt totally wiped out. But just being able to do differently for me, I think, is to– as far as in relationships, is to coexist with the person. And in working with individuals, even if I come to see you again, if something happens and I’m really upset about what’s going on, it’s that I’ll know that I’m going to be OK. And that it’s not the end of the world, like I thought it was then. So that’s the only thing I can think of for me doing differently.

COUNSELOR 3: Any thoughts about– if we reestablish therapy, if we start back counseling again, what will you want to acknowledge with me or with whomever you’re seeing that this particular relationship, the way that we do it, although what you said that you’re going to do differently for yourself, are there ways that you want to interact differently with your counselor?

BILLIE: I think how we interacted was appropriate. Nothing seemed out-of-place. We were laughing and we make hit one another. You might hit me or something like that which is perfectly fine.

COUNSELOR 3: We get into it, sometimes.

BILLIE: Right. You know, no. I can’t really think of anything that would need to be different. I think it was fine. It was tumultuous at first, it was kind of stormy. But I think over time it worked its way out. Where do you think, as far as with me

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Microskills: Family Counseling Techniques 2

moving on, anything in particular you think I should take– any bullet points you think I would take away from this experience?

COUNSELOR 3: Well, what I’ve heard from you is that it takes two people that want to be in relationship to be in one. I’ve heard you say in the past that, I’m worthy of a relationship, even if someone doesn’t believe that that’s true. And I want you to stay true to those things you told me. I think if you do that then we’ve been successful.

BILLIE: You know what’s great about that is that you used the words that I used and really facilitating me growing as opposed to just telling me what to do. But facilitate me to grow and to enhance my life and to be centered and authentic with myself. So I appreciate that.

COUNSELOR 3: Well, you are, of course, welcome. But those are all things that you’ve always known but that you somehow didn’t trust because of that break-up, right? I think that all of the things that you’ve told me have come from within you. I wonder what happened along the way, just as we’ve always said, how is it that we come to not trust those things? Or how do we get wrapped up in someone and then we lose it because they’ve left us?

BILLIE: That’s a really good point. That those answers are always there. And you kind of help uncover them and bring them out. And that makes a lot of sense. And I can take that away with me, that even if I can’t connect with you right away, or whatever the case may be, that I can work through them and find those answers within me, that’ll help get me through.

COUNSELOR 3: I appreciate that you’re so willing to take that and believe it. Even though, in the beginning I think you said that you didn’t have that within you.

BILLIE: No, absolutely not. Not in the beginning. Absolutely not. I was not prepared to– I almost needed convincing that I can exist outside of that relationship. And it sounds so crazy now to say that. That I needed to be convinced. And I didn’t even come naturally, on my own, to counseling. My friends were just like, you can’t keep being this way, where you’re just locked in the house by yourself. And you’re not really doing anything.

And they really prompted me to come here, as you know. And it’s just interesting to hear me even say that now, that I needed some level of convincing that I can even exist independent of a person. That I could sit here and actually be sitting up as opposed to all slouched in a chair, my face in my hands, and– I have some hair left.

COUNSELOR 3: Yeah, you didn’t pull it all out.

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BILLIE: I didn’t pull it all out. But it’s amazing to see that kind of growth over time. Even though I’m nervous moving own.

COUNSELOR 3: Well, you did trust your friends enough to come in, right? And you did listen to them when they said, hey something’s up. And I think there’s some relational confidence in knowing that “I can rely on some people that really know me.”

BILLIE: Yeah, that’s right.

COUNSELOR 3: I think there’s some knowledge to say, these people really have something to offer me. And I owe it to them to listen.

BILLIE: Yeah, that’s a good point. You’re right.

COUNSELOR 3: So what do you think they think now?

BILLIE: Oh, wow. Now that I’ve emerged out of my house, I think they think that I’ve made tremendous strides. I’m taking a lot better care of myself. That I’m enjoying life again. I do feel a lot of anxiety around dating again. We talked about that. And trying to move on there. It’s one thing to be able to find strength in self, and be able to find out who you are. But there’s some apprehension around meeting someone else in the future. What is that going to look like?

I’ve heard a couple of them say, that hey, you might want to start dating again, and things of that nature. And that I don’t know. That I’m still a little nervous about. This is new for me, this owning myself, emerging as a person and feeling worthwhile. But moving into a new relationship, I’m still kind of working on that a little bit.

COUNSELOR 3: We acknowledged a number of qualities that you’re going to be looking for if you choose to move into a new relationship with someone. What were some of those things that you identified?

BILLIE: I’m trying to remember. Someone who would value me as a person. That would be first and foremost.

COUNSELOR 3: That’s first.

BILLIE: Right, right. That is respectful of my needs and desires and allows me to be independent of him. And I don’t have to fully immerse myself in a person. And of course, all those things that people want in relationships. Someone that’s kind and nice, and can communicate with me. But really, valuing me as a person, I think, is the key thing you and I talked about.

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COUNSELOR 3: So on a day-to-day basis, what will you be doing differently now?

BILLIE: Differently. OK. I would say that– and some of the things that I had been doing and of course as we’ve been talking, over the course of all this time, is of course not spending my entire day wondering about “what is he doing? What is he doing now? Who is he talking to now? Who is he calling now?” And I’m not doing that. And when I have these moments of feeling really bad for myself, if I allow myself to feel that way, to be able to talk to myself, like, no, I don’t have to be here. I don’t have to be in this place. You know?

That I am worthy and I can move forward. So I think that’s one of the biggest things I’ll do it differently is really doing a lot of self-talk and engaging in my healthy relationships with my friends and coworkers. So really providing a lot more support around me before I jump in the dating pool again. So I think those are some other things I’ll be doing differently this time.

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Microskills: Family Counseling Techniques 1

Microskills: Family Counseling Techniques 1 Program Transcript

NARRATOR: Aaron and Robyn are seeing a counselor as they are concerned about the alcohol drinking behavior of their adolescent daughter, Michelle. As you watch this segment, observe the techniques used by the counselor.

COUNSELOR: So really one of the defaults for you, one of the positions that you take is, honey, because you don’t know what’s going on in our lives. I don’t hear that just about you and Michelle. I hear it’s about, or Michelle’s life, it’s about your lives. We’re living our lives and you’re out working. I mean that’s kind of the sense that I’m getting from you.

And it’s interesting to see the way in which, when you came in today, the way that you sat. You’re very close together. Michelle, it’s almost like you’re between your mom and dad. So I’m wondering if that feels like that way sometimes for you if you feel like you’re kind of in the middle of a, I don’t know, a conflict between mom and dad.

MICHELLE: Well, sometimes, I mean, when he’s gone, everything’s perfectly fine. But then when it comes to the weekends, everything has to change. And that’s when all the conflicts happen. Otherwise, everything’s fine.

COUNSELOR: Yeah, I noticed earlier that one of the things that you said, Aaron, is that you said the rules in my house. And I’m wondering if that’s how it feels like to be a member of this family is that it’s your house and these girls have to follow your rules. I mean, does that feel– you look like that’s really something that happens for you.

ROBYN: I notice with myself, I start getting very stressed on Thursday night, because I know that he’s coming home, and he’s going to be critical of how I parent Michelle, and critical of the decisions I’ve made in the week. It didn’t used to be like that. We used to be a family. And now it’s just him wanting to have things perfect. He’s so worried that someone’s going to see that we’re not perfect, and that we have to work really hard on Thursday night, Friday morning, to make sure everything is the way that’s going to make him happy when he gets home.

COUNSELOR: So one of the ways in which you manifest that things aren’t perfect, is you land here, you’re in my office. I’m wondering if this feels hopeful to you, like finally, we’re at a place where we can start addressing something that hasn’t felt perfect, that we’ve been trying to put up this front about perfection. Does that fit for you? Or does this feel like you are here, because you’re in trouble just like you were taking care of your daughter who was throwing up in the toilet?

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ROBYN: I think right now, more than anything, I’m just kind of scared, because I don’t know what’s going to happen when we leave here.

COUNSELOR: Yeah. What’s your sense about that? What’s your fear about what might happen?

ROBYN: That maybe we’ve been holding it together in this way for so long, we have a system that works. And what happens, what happens if that system no longer works for us? I mean, I don’t want our family to fall apart.

COUNSELOR: As in, you don’t want to get divorced?

ROBYN: Right.

COUNSELOR: Or you don’t want Michelle to run away and leave? Are those part of that kind of fantasy that you have that may happen?

ROBYN: And also, we’re just really good friends. We’re not just mother and daughter. We’re good friends. We have a lot of fun together. And what also happens if we lose our time that we have together, and we’re not as close after all this is over.

COUNSELOR: How might this affect you’re relationship together? What are your fears, Aaron?

AARON: I’ve just kind of got so many right now. My fear is, that this is the first time I’ve heard my wife and daughter use the language like, we’re friends. And somewhere in there, there’s got to be a parent, or in this case, we have to parent. And I’m just a little unsettled with the coziness that I’m seeing here. No, I don’t want a divorce from my wife. I really don’t. I don’t want anything bad to happen to my daughter, but the drinking’s got to stop. It’s really, just really, frustrating and concern. I’m a very concerned dad.

COUNSELOR: Michelle, I’m wondering what kind of fears you might have around this? Because, again, you’ve kind of landed in this counselor’s office, and you’re talking about some very personal things related to your family. I mean, what fears do you have around all this?

MICHELLE: Well, for me, I just don’t want everything to start changing all of a sudden, because I like the way things are, I mean, during the week. Because I get to go out with my friends. I get to do a lot of things that I want to do, everybody comes over and they like my mom, everything’s cool. And I like that, and that’s the part I don’t like to change.

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Because on the weekends, everything has to change. I can’t go out anymore. I have a curfew, and I have all these rules come down on me. And I don’t want that to be the every day thing.

COUNSELOR: That, as in pointing to dad.

MICHELLE: Because he sets all the rules, and then mom changes.

COUNSELOR: He’s kind of the heavy that comes in and says, this is the way that it’s going to be. And mom allows you a lot of freedom to do what you want?

MICHELLE: Well, we did it together. Yeah.

COUNSELOR: Yeah. Because one of the things that I’m curious about, and I just want to have you consider is, I’m wondering if this was your first drinking with your mom? Or when you are with your friends on the weekends, that happens that, with them, too?

MICHELLE: It happens sometimes.

COUNSELOR: Sure. And I appreciate you being open. I understand that that question, in and of itself, probably put you in kind of an uncomfortable position. But again, I think it’s really important that if we’re going to be working towards developing some healthier ways for your family to function, that you have to be honest about this.

So dad’s sense about you coming in, and him seeing you drink for the first time, this hasn’t been the first time for you?

MICHELLE: No, and like, we can have a drink or two at home. It’s me and mom, we’re just relaxing and watching the hills or something. And it’s not a big deal. It’s really not.

COUNSELOR: So this is new for you, and this feels like a big deal for you?

AARON: This is brand new to me. I had no idea that my wife and my daughter were at home drinking while I was away at work making money to bring home, so that we could have a great looking family. This is– I don’t–

ROBYN: So why do you think you had no idea?

AARON: I don’t know. I thought that we set the rules, and those were the rules that we were living by.

ROBYN: I can answer that, because you’re not there. That’s why you had no idea.

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MICHELLE: You haven’t been there in like a while.

AARON: It has been different since my new job. I’ll give you that, but I thought we were really good. I thought we really had the rules set.

COUNSELOR: Well, you know, and it’s interesting, Aaron, the way that you had talked about, just a moment ago, when you said, I work so hard to bring the money home so we can have a good looking family. It wasn’t so we can live a good life. So I’m wondering if the sense that Robyn mentioned earlier about needing to have appearances really is a big thing for you. About making sure that the face that this family puts on in the world is a respectable one, one that doesn’t have problems like this.

AARON: We live in a very small community. Everybody knows everybody. We all shop at the same grocery store, church, and faith, and working, it’s just like one great big family. And I really don’t want the message to get out that Aaron let’s his wife and daughter party while he’s out of town.

COUNSELOR: So one of the things that happens, is that this means something about you?

AARON: Yeah.

COUNSELOR: Like, if this is happening, people are going to make some judgments about me that I’m not a capable father, that I’m not a good breadwinner, that I can’t keep my own family together.

AARON: Yeah, I never thought about it on that level, but you’re right. A lot of this comes back to me. A lot of this comes back to me.

COUNSELOR: Reputation in the community. I’m wondering what that feels like for you two. It’s interesting when I kind of come back to you, it’s like you two. Like, you are very, very close. I mean, does come up for you, too, do in terms of like, wow, we could really blow this thing wide open?

ROBYN: When he was talking, I was just sitting there thinking he has no idea the pressure he puts on us, and that it’s always–

COUNSELOR: Could I stop you for one second, because I think this is really important. What I’d like to do is begin to kind of separate the us that I see into you each, as individuals. And so when you’re talking about your experience, refer to your experience. And Michelle, I’m going to have you do the same thing, for you to talk about what your experience is like, too. They might be very similar. But I think it’s important for you to talk about what it’s like for you as an individual. So what pressure is on you, mom?

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ROBYN: Well, to be perfect. To always just have everything look like it’s so well put together, and that we don’t have any problems. How much freedom would I feel if we could just live and not worry about what the neighbors think, or what the preacher thinks, or what your parents think? I would just like to not always feel like I’m performing for somebody else, or for you.

COUNSELOR: Yeah. So for you the pressure is, I don’t want to keep playing this game. I don’t want to keep putting this front up.

ROBYN: Exactly.

COUNSELOR: How about for you, Michelle?

MICHELLE: Well, yeah, I get the same thing. It’s like, whoever I want to hang out with might not be good enough, or whatever guy that wants to take me out, he never likes. And like what my grades are, and college I want to get in to. And all I hear about really are my SAT scores, and it’s just a constant pressure. It’s like he’s gone, but then he comes back, and he’s like all these demanding answers, and I’m not ever living up to it and all these things that he wants. Never stop to ask what I want and what I want to do.

COUNSELOR: Yeah. Like, what’s coming up for you is that you see your dad as coming in and talking about all these things, and you never feel like you measure up?

MICHELLE: Oh, right.

COUNSELOR: You never feel like you quite make it. Like, you’re OK with who you are to him. And I think that that’s an important thing, because one of the things that I see dad saying is that I’m making money so that we can have a certain life. And my hunch is, that that’s a way that you show your love for your family.

AARON: That’s the way that my dad did. My dad worked a lot, was away from home an awful lot. His rules, he brought home the money, so we could have a good life. And I don’t want anything bad to happen to my daughter, and I love her, but that’s why I do these things. I work this hard to bring home this kind of money, So that she can go to a good school. And that’s why I want her to do good on her SATs. I don’t want her to hang around with the wrong crowd. I want her to date good kids.

ROBYN: Have you ever asked her what she wants from you?

AARON: I’ve got to be honest with you, honey, I have a hard time asking my child what she wants. I’m in the position to dictate what she wants.

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COUNSELOR: Yeah. Yeah, that’s kind of an interesting thing. I’m in the position to dictate what she wants, so it’s like you have a pretty good idea of what she wants, or in other words, what you want her to want?

AARON: Yeah.

COUNSELOR: And you look like you have a reaction to that, Michelle.

MICHELLE: Yeah, it’s been very clear. I know who he wants me to be, but he has no idea who I am. And I know what school you want me to go to. I understand that you want me to be a lawyer. I understand all this. But you never ask me what I want to do. And like the last thing I want to do, is what you do. Or whatever you want me to do.

NARRATOR: Shawn and Weston are seeing a counselor as they are dealing with feelings of growing apart in their relationship. As you watch this segment, observe the techniques used by the counselor.

COUNSELOR 2: Let’s try something if we might. Weston, just a few moments ago, I asked each of you to name three things that would be different qualities of the relationship if things were going well. What were the three things that you heard Shawn name? Or here, how about this, I’m sorry. Let me re-structure that. What I’d like you to do, is actually tell him what you heard him say.

WESTON: I heard emotional intimacy, that you wanted me to be emotionally intimate with you. I heard being present, so when there’s something going on in your life, being available, and being able to talk about it, and being around you. And I heard spending time together. For example, going out to the bar again, to the dance club. Going out maybe for a date night and having dinner and having that connection on that level as well.

COUNSELOR 2: Was that a representation of what you presented of what you want for the relationship?

SHAWN: Yes.

COUNSELOR 2: So well, what’s clear to me, and I don’t know if it’s clear to you or not, Shawn, that there was something that he heard that you said. And there were the things that were important to you were heard in that. I wonder what’s that like for you?

SHAWN: Well, I mean, like I said before, it is something that I’ve heard that’s important. I just don’t see anything being done. I mean, like for instance, those 30 minutes that he needed after work, all of a sudden, it turned into two hours. And I said, I’m going to bed and now he’s ready to talk. I mean, that’s probably why he used the term, zinger, because I’m pretty good at that, actually. When I don’t feel

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like a person is, Weston is, putting forth the effort or giving me the energies I need. I’m pretty good at kind of attacking him verbally a little bit, just a little bit.

WESTON: A little bit?

SHAWN: Yeah, just a little bit, not much. I mean, that was probably mild. Probably, I don’t know, but I just get so frustrated with I care about you, and I want us to be together. And I’m tired now, and I can’t talk to you so it’s kind of conflict. On the one hand, he says he cares and he loves me, then on the other hand, he doesn’t want to take the time to hear about my days. It doesn’t seem like it’s important to him.

COUNSELOR 2: So where does the zinger fit into that?

SHAWN: Well, I try to give back to him how I’m feeling. And I don’t do it in a very nice way. I know I do that. When I get frustrated, and I don’t feel like he’s trying to hear me, or pay attention to me, or get my needs met, I tend to go on the attack, kind of, sort of. Not physically, but with words. And I feel bad after I do it, but I do it. I would say often, but I do it. Well, maybe I do do it often.

WESTON: It feels like it’s more lately.

COUNSELOR 2: Talk a little bit more, Weston, about being on the receiving end of those zingers.

WESTON: I’m of two minds.

COUNSELOR 2: OK.

WESTON: The first is, it does hurt. And I just had to say, ouch, like I just did, just to say, that hurts. And I appreciate Shawn saying he’s aware that he does it. So one mind, I want it to stop. I don’t like it. It hurts. It’s almost two sides of the same coin, because the other side is, part of what I love about Shawn is his energy. He’s got this energy that just fills up a room.

It was not by accident that I saw him across the room when we first met six years ago, was because he just lit up the room. And I get, he’s lonely, he’s hurt, he doesn’t feel heard, and it’s still that passion coming out in a way that we just don’t seem to be connecting very well. So I get it on one hand. I understand why the zingers are there, but on the other hand, it still hurts.

COUNSELOR 2: Tell me what you’re noticing as this as this is being said, Shawn?

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SHAWN: I didn’t think about the energy, the passion part. I was just trying to get back at him, but I guess that makes less sense. And I know it hurts, and I do apologize for that.

WESTON: Thank you.

SHAWN: I just, I don’t know.

COUNSELOR 2: We’ve talked a lot about the zingers, and the impact of them. And your awareness, Shawn, of yeah, that’s something I do and I know that it’s really not the best thing. I think that’s of value, and I think we do want to go ahead and probably continue with that discussion at some point.

At this point though, I’d like to go ahead and table that if I could, because I do want to go back to an exercise that I introduced earlier. And I’d asked Weston to name three things that he observed that you said about what you’d like to see different in the relationship. What, in fact, would be the qualities of the relationship if, in fact, it was meeting your needs and was growth fostering? And so now, I’ll ask you to share with Weston what you’ve heard him say, as the three things that he identified would be growth fostering elements of the relationship.

SHAWN: Well, I heard you say that you wanted more intimacy, specifically, sexual intimacy. And I heard you say that you want more balance in the relationship. Balance among us. And the third thing I heard you say, is that you want to have more fun, go out more, and go out on dates and things like that. That’s what I heard.

COUNSELOR 2: Does that represent what you said, Weston?

WESTON: I think it’s a good representation. Even just an example, right now, in our session today. I haven’t heard Shawn say, I love you, Weston. and I’ve said it two or three times. And he says those are nice words, but he doesn’t say them back to me. I’d like to hear that sometimes, too.

SHAWN: OK. I love you.

WESTON: Thank you.

COUNSELOR 2: What’s that like for you?

WESTON: I know it’s hard for him to do it, and I get it. And I appreciate it. I really do. What’s it like– hear, let me ask when I say what’s it like– what’s it like first of all to have said it, but then also to here Weston, again, be very genuine and say, I liked it. I know it’s hard, and I heard him say it and I really like it.

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SHAWN: I appreciate that part because it is hard. That’s hard. I appreciate him recognizing that it is hard for me to say. It is nice to hear to know that he’s aware that it is hard for me to verbalize that. I’m such a doing person, that sometimes I forget about the verbal stuff is just as important as doing.

NARRATOR: Billie is coping with the loss of a significant relationship. For six months she has been working with the counselor, which is now concluding today. As you watch this segment, observe the techniques used by the counselor.

COUNSELOR 3: I’m thinking back. I guess it was probably about three months ago, and you gave me a call. And it was during the week, and we weren’t even scheduled for that week. I think we had a week off or something. And you said, I saw him again. Remember that day?

BILLIE: Yeah.

COUNSELOR 3: What was that like?

BILLIE: It was funny. You think you make this progress. I guess I was a little cocky at first. You think you’re making this progress. I can do it, everything’s OK. And then I saw him, and I felt it was like a punch in the stomach. Like I felt all the air just leave. I had to collect myself, and kind of sit with myself a little bit to say, wow, I’m really need to slow this down. I have to work on this a little bit more.

So that was really rough at that time when I called you about that.

COUNSELOR 3: Yeah, I was listening to my voicemail that day, and I was thought, oh, she’s really struggling right now. And I imagine that she’s feeling like that all of the strides that she’s made have probably fallen away.

BILLIE: Right.

COUNSELOR 3: And also feeling like, oh, wow, we’ve got a week and a half before I see you again, wondering what was going to happen. And you came back in and you were still together.

BILLIE: Right.

COUNSELOR 3: So you were able to take what you had learned already, and it didn’t all fall away? It stayed with you. Even though, when you left me the message, you didn’t believe that that was the case.

BILLIE: No, you’re absolutely right. I had to sit back and remember some of the things that we had talked about during our previous sessions. And I was able to, yes, I saw him, yes, he did. He really broke my heart and hurt my feelings. And I was all wrapped up in this person, but I’m a good person. I’m a significant

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person. I need to be significant to myself. And I need to be authentic to who I am. And I have to value myself. And in order to do that, they’re going to be times when seeing him, or seeing his pictures, or maybe run into his family members, that I still might go a little twinge in my stomach.

COUNSELOR 3: Tell me what you mean by twinge.

BILLIE: Twinge. Like butterflies, like nervous, nervousness, like oh my God, here he is. Here’s his mother. I don’t know what to say. I don’t know what to think, but it will pass. And I’ll be OK. I’ll be able to work through that.

COUNSELOR 3: It sounds like you’ve really been practicing that self-talk that we talked about. You said the word, authenticity, a couple of times. I know we’ve talked about it many, many times. But it seems like your understanding of that word has really evolved over time. And so I would like to know on this last day, as you’re leaving, what does authenticity mean for you right now?

BILLIE: For me, it means just really being true and genuine to who Billie is and owning who I am. And appreciating and really, I guess, falling in love with myself first.

COUNSELOR 3: But you’ve acknowledged that there are flaws, right?

BILLIE: Yes, absolutely, absolutely. And I have to embrace those, work on those that I can.

COUNSELOR 3: But we all have flaws, and that’s part of the human condition, I guess. I would like to believe that I don’t have any. I would prefer to believe that every day I’m as good as I would choose to be or want to be. But not always. And I guess, part of being authentic, like you said, is acknowledging those times when that’s not true and then just taking it as information for the future.

BILLIE: And I think I’ve learned, too, that I don’t– even when I fall back, that I’m not falling as hard as I did the first time. I’m not pulling my hair like you said, or crying uncontrollably or anything like that. It’s just that over time, that will lessen.

COUNSELOR 3: Speaking of pulling of your hair. I guess it was what, about a month ago? You said, how will I know when I’m done? And I said, I think you’re going to be feeling it. And it sounds to me like you’ve made a lot of movement already. And then you said I’m scared. And you said I’m going to be right back there in that tornado again. So are you pulling out your hair right now?

BILLIE: No, I’m not pulling out my hair now. I do feel a little nervous about us separating, because you’ve been just wonderful in helping me put this back together and picking up to the debris. And severing this or pulling away from this, is almost like losing another relationship.

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COUNSELOR 3: And just as I’ve always wanted you to know, that really experienced a relationship on a deep and personal level as well. This has been very powerful for me. I’ve learned a lot about you. But I’ve also learned about myself in this process.

We have these boundaries that we have set up as a counseling relationship, and it’s always been about you. But I’m going to also feel good about having learned about myself in this process as well. And it is, I guess, separating is the word that I heard you use just now. But really, for me, it’s about, you’re moving on to something greater. You’re taking what you’ve learned and you are incorporating it in all of those relationships.

And if you need to come back, then come back. Or if you need to see someone else, then we’ll give you names for someone else. But just as you said, you were ready.

BILLIE: Right. And I want to be committed to trying to talk– practicing myself to talk, when I’m having those moments where am I feel like, I’m falling apart. I’m not going to make it. I want to be committed to doing that so that’s something I wanted to tell you, that I will commit to the different changes that I’ve made during this process.

COUNSELOR 3: I’m glad that you said that. I often wrap up these sessions, these counseling relationships, with a personal commitment as well. And that day that you told me that you experienced that as pushy. That time, that disconnection that you discussed. I thought, when she’s made it, I want to go back to that.

And I want to say that I’ve learned from you to even further consider how my feeling compelled to get into the deep end and to really connect can be experienced as pushy. My personal commitment then, is to be very considerate of that. And to check in if I experience that pulling away of someone that I felt that afternoon when you left. To ask about it, and so both, thank you for that. And then I will make the commitment just as you did to check in.

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Psychotherapy with Groups and Families

Psychotherapy with Groups and Families Program Transcript

[MUSIC PLAYING]

NARRATOR: Up to this point, you’ve had the experience of counseling people with a variety of psychiatric and mental health needs, on a one-to-one basis. In this course you’ll take those skills and apply them to groups of people and entire families.

Sometimes called the Third Psychiatric Revolution, the discovery of the effectiveness of treating people in groups has added new approaches to our therapeutic arsenal. The evidence for the efficacy of group and family therapy has become so well documented– and extensive in the literature– that insurance companies not only reimburse, but encourage individuals in treatment to consider group therapy options.

Specific to families, the psychiatric- mental health nurse practitioner uses a wide variety of family therapy approaches, to help individuals in a family improve the way they relate to one another. And in so doing, improve their individual mental health as well. Not only does the deliberate use of psychotherapeutic approaches to family therapy improve the functioning of the current family, but it has the potential to improve family functioning for future generations.

In the group setting, the psychiatric-mental health nurse practitioner works with individuals with a wide range of issues– to improve not only themselves, but their ways of interacting with and relating to others. In group therapy, individuals have the opportunity to try out new communication and coping skills. Not only do group members draw on the strength of the group, but they contribute to the overall mental health of the other group members. As Dr. L. Cody Marsh once noted– by the crowd they have been broken, by the crowd they will be healed.

[MUSIC PLAYING]

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