Objective A new condition, “child affected by parental relationship distress” (CAPRD), was introduced in the DSM-5. A relational problem, CAPRD is defined in the chapter of the DSM-5 under “Other Conditions That May Be a Focus of Clinical Attention.” The purpose of this article is to explain the usefulness of this new terminology. Method A brief review of the literature establishing that children are affected by parental relationship distress is presented. To elaborate on the clinical presentations of CAPRD, four common scenarios are described in more detail: children may react to parental intimate partner distress; to parental intimate partner violence; to acrimonious divorce; and to unfair disparagement of one parent by another. Reactions of the child may include the onset or exacerbation of psychological symptoms, somatic complaints, an internal loyalty conflict, and, in the extreme, parental alienation, leading to loss of a parent–child relationship. Results Since the definition of CAPRD in the DSM-5 consists of only one sentence, the authors propose an expanded explanation, clarifying that children may develop behavioral, cognitive, affective, and physical symptoms when they experience varying degrees of parental relationship distress, that is, intimate partner distress and intimate partner violence, which are defined with more specificity and reliability in the DSM-5. Conclusion CAPRD, like other relational problems, provides a way to define key relationship patterns that appear to lead to or exacerbate adverse mental health outcomes. It deserves the attention of clinicians who work with youth, as well as researchers assessing environmental inputs to common mental health problems. Continue reading “CAPRD”
The therapist models many of the skills and validates the valid thoughts, wants, and emotional responses of each family member along the way or coaches family members to do this, thus demonstrating or facilitating skillful responses and alternatives for the clients and cheerleading their new steps (Fruzzetti & Ruork, 2018).
Much like the process of individual chain analysis (e.g., Rizvi & Ritschel, 2014), a double chain analysis is an opportunity for both assessment and intervention. The goal is to understand the antecedents and consequences of a problematic behavior in order to facilitate the generation of possible solutions. Typically, in individual chain analysis the therapist and client will discuss the client’s behavioral chain (vulnerabilities, thoughts/judgments, emotions, sensations, actions) and then identify and practice possible solutions to “break the chain.” All events are understood primarily from the perspective of the client. In a double chain analysis, each individual’s chain is described, including points in which their chains intersect and affect each other. These “public” links are shaded in Fig. 1, and only one occurs at any given moment, highlighting actions or verbal behaviors that are relevant to both people. In contrast, the “open” links are drawn for each person simultaneously. A double chain thus can illuminate a great deal about the transaction between one individual’s overt behavior and the other’s dysregulated emotion (and vice-versa), allowing for the selection of specific targets to treat, ultimately replacing problematic reactions and other behaviors with new emotional or relationship skills, as well as mutual understanding.
To begin a double chain analysis, the therapist (with input from the individual client and the family) selects a specific instance (specific day, time, and place) of a problem or conflict. Each family member then goes though the links on the chain, including vulnerabilities, thoughts, urges, emotions, and actions (verbal or other). As shown in Fig. 1, the shaded links represent the public events and the nonshaded links represent private experiences (thoughts, emotions, desires, etc.), that can only be understood once described in an accurate way. Each individual has the opportunity to disclose his or her experiences and validate the other’s experiences. With this greater knowledge of the chain of events, each person can discuss and practice skillful alternatives to “break the chain” and end the interaction in a completely different manner.
In the session, one or more people may be dysregulated, and conducting a double chain analysis (or any meaningful exchange) may be difficult. DBT couple and family therapists may need to utilize various session-management strategies in order to run the session effectively. These include blocking dysfunction early, inviting accurate expression, providing at least minimal validation to soothe negative emotional arousal, making sure not to show up parents or partners (instead, try to make them look good and build competence), real-time skill coaching in the session, and the therapist may even employ a “revolving door” in which more regulated and collaborative family members spend short periods of time in the waiting area while the therapist tries to understand, block, and teach or coach relevant skills to the more dysregulated family member to allow for meaningful discourse in the session together (see Fruzzetti & Payne, 2015, for more details about these strategies).
Because opportunities for family assessment and intervention are often limited, it is important to employ efficient procedures and to have clarity about who conducts the assessment.
Who Is the Family Therapist?
DBT teams typically include three or more people, often with multiple roles on the team: skill trainer, individual therapist, peer supervisor, skills coach. We will assume that the family therapist also conducts the family assessment, and simply refer to that person as the family therapist, because family assessment and family therapy are so interwoven. This is another role that needs to be incorporated into the team.
Obviously, in this DBT team context, there are two options: the individual therapist can also be the family therapist; or, a different team member can serve as the family therapist. Although people often have strong opinions about the need to do it one way or the other, there are no data to support one structure versus the other. It is important for all participating members to agree to open discussion in sessions about all relevant issues. Ethically, of course, any adult can terminate permission to disclose or discuss private information, so it is important to get a clear agreement keeping communication open. We believe that there are no inherent “dual role” problems when the therapist and team opt for the individual therapist also to provide couple or family interventions. Of course, the therapist needs to be clear about treatment targets (below), and that the therapist is working to improve both the couple/family relationship and the well-being of all individuals in those relationships, in typical dialectical (DBT) fashion (see Thorp & Fruzzetti, 2003, for a fuller discussion of ethical issues and practices in couple/family therapy).
In practice there are pros and cons for both options (individual therapist also providing couple/family interventions vs. having a separate couple/family therapist; Fruzzetti, 2018). For example, some of the pros of having the individual therapist also be the couple/family therapist include: (a) the therapist will have more awareness of the individual client’s problems and prior chains (and solutions), and may be able more effectively to intervene earlier on the chain if problematic transactions emerge in-session; and (b) the therapist will likely be more facile in motivating the individual client in couple/family sessions (e.g., may be able to push harder for change, and/or more efficiently validate). On the other hand, some of the pros of having a different DBT team member take the role of the family therapist include: (a) it may seem more balanced (or simply preferable) to partners or parents that the couple/family therapist be dedicated to this role only, and (b) having an additional person participate directly with the family may provide more helpful perspectives for the DBT consultation team to consider. (Note: some teams choose to have the individual therapist also provide family therapy, but have a different therapist provide parent or partner skill coaching.)
Family intervention in Dialectical Behavior Therapy (DBT) is a core part of multiple required functions of DBT, providing opportunities for skill training (including relationship-specific skills that are not covered in individual DBT), skill generalization, and direct intervention into the social and family environment. In order to intervene with parents, partners and other family members efficiently and effectively, therapists must first conduct a careful assessment. The core relationship transaction of emotion vulnerability/dysregulation and inaccurate expression leading to invalidating responses (and vice versa) is highlighted, as are the treatment targets in DBT with families, which inform assessment targets. Then, two core assessment procedures are explored, with clinical examples: (a) conducting “double chain” analyses, demonstrating how one person’s social or relationship responses affect the other’s emotional arousal (and vice versa); and (b) direct behavior observation of family interactions, which allow treatment targets to be identified efficiently. These two assessment strategies may also be combined. Implications for family interventions are discussed.
Despite our current zeitgeist of “brain” disorders and “individual psychopathology,” research tells us clearly that individual psychological problems and disorders are multiply-determined, and primarily occur in a relational context, affected in no small way by those relationships (Brown & Harris, 1978; Fruzzetti, 1996). People with borderline personality disorder (BPD) and related problems often struggle in relationships that significantly affect their lives and can either promote or interfere with treatment progress. And, of course, people with BPD and/or severe problems managing their emotion have a big influence on their own relationships and on others.
Consistent with this view, most modern models of developmental psychopathology are transactional, highlighting the bidirectional (or reciprocal) relation between parent behaviors and children’s behavior problems. Similarly, partner involvement, or couple interactions, have been shown to be relevant in the development or exacerbation of many forms of psychopathology (Fruzzetti, 1996; Fruzzetti & Worrall, 2010), and partner involvement and/or couple interventions can aid in the prevention, treatment, or prevention of relapse in a variety of problems (cf. Baucom, Whisman, & Paprocki, 2012). Of course, different models consider different transactional factors, but the focus on mutual influence of factors over time is consistent across models (e.g., Leve & Cicchetti, 2016; Serbin, Kingdon, Ruttle, & Stack, 2015). Indeed, a specific bio-social or transactional model is utilized in Dialectical Behavior Therapy (DBT) to understand the development of borderline personality and related disorders of emotion dysregulation. This framework maintains that BPD specifically and emotion dysregulation in general are the product of (and are maintained by) an emotionally vulnerable individual transacting with, and within, an invalidating social environment (Crowell, Beauchaine, & Linehan, 2009; Fruzzetti, Shenk, & Hoffman, 2005; Fruzzetti & Worrall, 2010; Grove & Crowell, 2017). Of course, in the present model the specific parent behaviors (and other caregivers, and later peer and partner behaviors) are invalidating responses, and the child’s (and later adolescent’s and adult’s) behaviors are inaccurate expression, vulnerability to becoming emotionally dysregulated, and pervasive emotion dysregulation.
DBT affords multiple pathways to help patients not only improve their relationship skills and employ those skills unilaterally (Linehan, 2015; Rathus & Miller, 2014), but also to intervene directly in their close relationships to help improve them via parent, partner, and family skill training (Fruzzetti, 2006; Fruzzetti, in press; Hoffman, Fruzzetti, & Swenson, 1999) or DBT family therapy (Fruzzetti, 2018; Fruzzetti & Payne, 2015; Fruzzetti, Payne, and Hoffman, in press). Thus, there may be a variety of reasons why a DBT therapist may want to assess directly (and likely intervene with) the client’s family and client-family member transactions. Continue reading “DBT”
The following are some of the defining traits of dysfunctional family dynamics:
Poor communication: Communication is one of the most important building blocks of good relationships. Dysfunctional families are unable to listen to one another, so individual members often feel misunderstood or like their voices aren’t heard. In addition, communication in dysfunctional families is DISJOINTED RATHER THAN DIRECT: “Family members talk about each other to other members of the family, but don’t confront each other directly. This creates passive-aggressive behavior, tension, and mistrust,” Psychology Today says. äó
Drug or alcohol abuse: When drug or alcohol abuse exists in a family, “family rules, roles and relationships are established and organized around the alcohol and/or other substances, in an effort to äó_ MAINTAIN THE FAMILY’S HOMEOSTASIS AND BALANCE,” according to subject matter expert Marni Low. Family members also tend to fall into certain well-defined roles, such as enabler and scapegoat. Enablers do whatever they can to ensure the household runs smoothly in spite of the substance abuse, while the scapegoat is usually a child in the family who acts out to deflect the negative experiences happening at home.
Perfectionism: In a dysfunctional family, one or more adults may be perfectionists. They have very high expectations for children or other family members and don’t accept failure. This has a lasting negative effect, reducing playfulness and assimilation of knowledge in children. Perfectionism creates a “steady source of negative emotions” that causes individuals to constantly feel inadequate, according to Psychology Today.
Lack of empathy: One of the hallmarks of a dysfunctional family is lack of empathy. Parents do not show unconditional love, instead becoming judgmental. Rather than attempting to understand a child’s feelings and point of view, a dysfunctional parent might rely on anger or derision, making the child feel guilty or demeaned. Parents “lack the ability to emotionally tune in to their kids,” according to Psychology Today, causing children to internalize negative feelings.
Control: In a dysfunctional family structure, one or more parents often focus on controlling their children. They might pit children against one another and make them compete for affection, or constantly compare them. Other important elements of control are dependence and LACK OF PRIVACY. “Researchers found that people who reported their parents had intruded on their privacy in childhood or encouraged dependence were more likely to have low scores in surveys of happiness and general wellbeing,” The Independent reports. When children aren’t allowed to make their own decisions, they grow up without the confidence to excel in the classroom or workplace.
Excessive criticism: Criticism and other verbal abuse are particularly difficult for children to overcome. Parents in dysfunctional families often criticize a child’s looks, intelligence, value, or abilities. Some criticism might be direct, while other forms are more subtle and relayed in the form of teasing or put-downs. Regardless of delivery, consistent criticism from parents has a negative impact on self-image and development. Continue reading “Defining traits of dysfunctional family”
A genogram is a picture of a person’s family relationships and history. It goes beyond a traditional family tree allowing the creators to visualize patterns and psychological factors that affect relationships.
Genograms were first developed in clinical psychology and family therapy settings by Monica McGoldrick and Randy Gerson and popularized through the publication of a book titled Genograms: Assessment and Intervention in 1985. This new system visualized the client in the context of other relatives including parents, grandparents, spouses, siblings, children, nephews, and nieces.
Genograms are now used by various groups of people in a variety of fields such as medicine, psychology, social work, genetic research, education, and youth work to name but a few.
Most social work practitioners in personal and family therapy use genograms alongside sociograms for personal records and/or to explain family dynamics to their client.
Dependence-The internal, psychologically felt wish or yearning for emotional (vs. instrumental or task oriented) support, care, comfort, attention, nurturance, and similar responses from significant others.
Dependence in PARTheory also refers to the actual behavioral bids individuals make for such responsiveness. For young children these bids may include clinging to parents, whining or crying when parents unexpectedly depart, and seeking physical proximity with them when they return. Older children and adults may express their need for positive response more symbolically especially in times of distress by seeking reassurance, approval, or support, as well as comfort, affection, or solace from people who are important to them particularly from parents for youths, and from on parental significant others for adults.
Dependence in PARTheory is construed as a continuum, with independence defining one end of the continuum and dependence the other.
taken from Concepts In Parental Acceptance-Rejection Theory (PARTheory)
Defensive independence– The commonplace tendency for seriously rejected persons to make fewer and fewer bids over time for positive response because of their growing anger and increasing emotional unresponsiveness. Many defensively independent persons say, in effect, “To hell with you! I don’t need you. I don’t need anybody!” Defensive independence is one way many rejected persons attempt to defend themselves against further hurt of rejection in situations over which they feel they have little control. Defensive independence is like healthy independence in that individuals make relatively few behavioral bids for positive response. But it is unlike healthy independence in that defensively independent people continue to emotionally crave positive response, though they sometimes do not recognize it. Indeed, because of the overlay of anger, distrust, and other negative emotions generated by chronic rejection, defensively independent individuals often actively deny their need for support, encouragement, sympathy, love, and other forms of positive response.
taken from Concepts In Parental Acceptance-Rejection Theory (PARTheory)
Beliefs and values are not fixed for life.
You can change them along the way using the skills of NLP.
CBT can help you overcome those errors in reasoning that can lead to catastrophic thinking, which can lead to even more negative automatic thoughts.
Three-Step Process for Identifying Cognitive Distortions
Step 1 – Identifying Thoughts, Feelings and Behaviours
Step 2 – Understanding the Links Between Thoughts, Feelings and Behaviours
Step 3 – Making Behavioural Changes