EurJPsycholEducStudies_2014_1_1_2_150262.pdf

Original Article The challenge for the person of the therapist in the work with disadvantaged families Harry J. Aponte, Nina Anne Méndez Department of Couple and Family Therapy, Drexel University, Philadelphia, USA ABSTRACT Socially disadvantaged families present special challenges to therapists. Within the families themselves the family relationships are often underorganized, that is lacking in irm structure and functional coherence. They also live in social circumstances that are not only unsupportive, but also actively destructive. The families struggle to cope with life’s challenges, and may be guarded and untrusting of professionals who, while wanting to help, may appear to the families as intrusive and insensitive to a family’s plight. This article identiies six basic therapeutic tasks that the authors believe essential to work with socially disadvantaged families. It also introduces a particular approach, The Person-of-the- Therapist Model, to therapists’ use of themselves in the work with these families. It emphasizes therapists relating and working through their own life experiences, especially their personal vulnerabilities, as a medium through their own life experiences, especially their personal vulnerabilities, as a medium through to relate to the pain and brokenness of these emotionally and socially vulnerable families. Key words: Disadvantaged families, person-of-the-Therapist Model, use of self Background Therapy with disadvantaged families calls for particular approaches that take into consideration client families’ social circumstances and the effects of those circumstances on their psychology and family relationships. While these circumstances have prompted the development of a number of therapeutic approaches from various schools, particularly in family therapy, we do not find in the literature a systematic treatment of how therapists need to actively use themselves—their own emotional makeup, their own social circumstances, and worldviews—in their implementation of these various aspects of the therapeutic process with disadvantaged clients. Aims This paper aims to identify and describe from selected Access this article online Quick Response Code: authorities in the field core therapeutic tasks that need special attention in the treatment of disadvantaged families. The paper goes on to propose approaches to the use of self by therapists in the implementation of these tasks in ways that may be most effective with disadvantaged families. Materials and Methods For the identification and description of the therapeutic tasks, the paper will resource the work and experience of experts in the field who have contributed to the literature and research on therapy with disadvantaged families. For the proposed perspectives on therapists’ use of self in the implementation of these tasks, the paper looks to the Person-of-the-Therapist Model on the use of self, a systematic method of thinking about the active and purposeful use of self by therapists in the therapeutic process. The theory and methodology behind the model is described, and an example of its use with a disadvantaged family is offered. Website: www.ejpes.org DOI: *** Disadvantaged families call for a particular kind of therapeutic attention. The very designation “disadvantaged” adds a distinct dimension to the therapy that calls for therapists to take into account the Address for correspondence: Dr. Harry J. Aponte, 1420 Walnut Street, Suite 920, Philadelphia, PA 19102, USA. E-mail: harryjaponte@verizon.net. 2 European Journal of Psychology & Educational Studies, Vol 1 / Issue 1 / Oct-Dec-2014 Aponte and Mendez: The challenge for the person of the therapist in the work with disadvantaged families social conditions that have had and are having harmful effects on the families’ personal lives.[1-6] These families’ personal difficulties are amplified and complicated by their vulnerability to the social and economic stressors impacting them.[7] For therapists, the work with resource-scarce families contending with persistently destructive personal and societal factors can be demoralizing. The work demands the technical skills to address simultaneously deeply personal emotional wounds and overwhelming social forces. It also pleads for a personal sensitivity and emotional strength that allows therapists to feel the pain and challenge the social odds their clients face. We contend this calls for a distinctive training in the use of self that speaks to the therapist’s emotional resources and social consciousness. This article does not pretend to address the full complexity of this subject. However, it hopes to distill some key factors that we believe need to be considered in any approach to working with disadvantaged families. These tasks are aspects of the therapeutic process that are common to most therapies[8,9] but require “strategies” adapted to “different structural arrangements, developmental phases, and sociocultural contexts.”[10] When working with families that are suffering from damaging social legacies and adverse socioeconomic conditions, and are likely of ethnic, racial, or cultural minorities, therapists need to attend to complex array of dynamic factors. In general, these tasks fall into two broad categories—the technical and the personal.[11] The technical refers to the “external” interventions and strategies drawn from therapeutic models necessary to the work of therapy. The personal speaks to the use of self within and through the therapeutic relationship in carrying out those interventions and strategies. We have identified six therapeutic tasks of particular importance when working with disadvantaged families: • Gain the Client’s Trust and Partnership • Connect to Today’s Issue • Assess its Source and Dynamics • Make the Session a Real Experience for Clients • Build on the Client’s Strengths • Mobilize the Client’s Eco-systemic Resources. These are tasks that we found in the literature highlighted by representatives of a broad spectrum of schools of therapy as basic to the work of therapy such as: (1) The emphasis on a collaborative therapeutic relationship exemplified, for example, by Feminist Family Therapy,[12] (2) The practical focus on here-and-now issues of Structural Family Therapy,[13] (3) The intent to make constructive sense of past antecedents noted by Resiliency Therapy,[14] (4) The goal of creating an active experience for these families in the session of Structural Family Therapy[7] and of some Social/Cultural/Political Approaches,[3] (5) The building of the therapeutic work upon client strengths that characterizes[15] Narrative Therapy,[16] and (6) The effort to broaden the venue of therapy to include the family’s social context advocated especially by the Social/Cultural/Political Approaches.[17-20] Virtually every school of therapy when speaking of work with disadvantaged families has touched one or more of the therapeutic tasks cited above. The Person of the Therapist In this paper, we want to spotlight the personal dimension of the therapeutic process, meaning the use of self in all these tasks as therapists look to relate, assess, and intervene with disadvantaged families.[21] We are approaching here the concept of the use of self from the perspective of The Person-of-the-Therapist Model, POTT. [22] This model, while accepting the traditional notion of emotional healers needing to work on healing themselves [23,24] pivots on the therapist’s ability to consciously and purposefully make therapeutic use of the self-as-is in the present moment of engagement with the client family. A critical and distinctive implication of this approach is that therapists aim for the self-insight, self-acceptance, and self-mastery to be able to make positive and purposeful therapeutic use of all of who they are, and in particular of their own personal struggles, wounds, and vulnerabilities, which the model calls their signature themes.[25] The wounded healer helps heal through his/her own personal wounds.[26] The idea is that therapists’ own life experiences and personal struggles can enable them to better empathize with their clients’ pain, better intuit what their clients’ experience in their struggles, and better sense how best to personally approach clients when intervening. The central premise of this paper is that in working with disadvantaged families, therapists need to have a particular competence in meeting the particular personal challenges to relate, understand, and intervene with their clients because of the distance between them and their clients’ life experiences. First of all, unique clinical issues that result from poverty sometimes can be overlooked by therapists who are more accustomed to working with clients who share their own middle-class values and beliefs. As a result, low-income families, European Journal of Psychology & Educational Studies, Vol 1 / Issue 1 / Oct-Dec-2014 3 Aponte and Mendez: The challenge for the person of the therapist in the work with disadvantaged families whom many would consider the neediest of all families, are often served ineffectively by this profession.[27] Therapists may encounter difficulty relating to these clients and their issues because the families may be so battered from generations of deprivation, marginalization, and overt or covert social hostility that they may not be readily accessible emotionally. Therapists who work with them may witness such despair and painful wounds to the human spirit that they themselves may have trouble recognizing the strength and resiliency in the families. The therapists, themselves, may experience a helplessness in the face of the scarcity in the lives of these families of the most vital resources for civilized living. Therapists may need to be able to deal with their own preconceptions and biases that blind them to the vulnerable and sensitive humanity of the people they are dealing with. They may find themselves contending with thoughts and feelings about their own emotional vulnerabilities awakened by the depth of the raw emotional wounds they are touching in their clients. They may react by withdrawing emotionally from the intensity of a family’s pain, and/or attempt to control and contain the family’s spontaneous expressions of its distress. If therapists cannot empathize with their client families and be fully present with them in their distress, they will not be able to get close enough to the families to feel with them, understand them, and connect to them. We will break down into the six categories of the therapeutic tasks that we believe present some of the therapists’ personal challenges that are especially salient to carrying out these tasks when working with disadvantaged families. We will subsequently illustrate an application of this perspective with a presentation and analysis of a therapeutic encounter with a family considered disadvantaged, with a boy at risk of drifting into the world of gangs. The use of self in the six basic tasks with disadvantaged families I Gain the Client’s Trust and Partnership • Put yourself in the mindset of wanting to care about them • Get in the mindset of wanting to know them in their life context • Look to join them personally in the full story of their life’s journey. The clients who come from distressed and deprived life circumstances often have suffered so much marginalization, neglect, and abuse in their lives that 4 they do not trust easily. They feel estranged from people who are outsiders—people who are not of their world. It becomes the therapist’s job to bridge that gap, and this begins at a personal level - personal trust founded on the belief that someone really cares, understands, and is really with you. What then does it take for the therapist to inspire this trust in the family? It begins with the therapeutic relationship that has at its core a personal connection at the level of our common humanity.[28] Key to the POTT perspective is the belief that therapists have the ability to consciously choose to dispose themselves mentally and emotionally within personal relationships. In their role as therapists, they can choose to want to care about a client. They can open themselves at a personal level to their clients, as people who like themselves struggle with life. However, different their life circumstances, therapists can choose to look into their clients’ personal experiences, at the root of the human element, for something that touches on their own life experience. They can choose to look to identify personally with their clients so as to be able to genuinely care, and want to join with them in their efforts to overcome. The case we will use as an illustration is a single encounter of a therapist with a Latino family whose focus of attention is a 14-year-old boy who has been kicked out of school for bullying, and is flirting with the gang culture. In this case, the therapist’s effort to identify with the clients is not a great stretch since he also is Latino and comes from a similar socioeconomic background. For a therapist of a different social location, he/she would want to relate to common human elements that allow for a personal identification while being curious and open to taking in what is alien to the therapist of the family’s life experience. The therapist in this case put himself mentally and emotionally in the family’s world. Because of his own cultural background, he treated the boy’s mother with the culturally fitting “respeto,” which he anticipated would help him gain the boy’s trust. Any therapist could have observed that the boy was sitting next to and close to his mother, attentive to her every word and emotional expression, as if to protect her. II Connect to Today’s Issue • Let yourself personally enter into their experience of their issue today • Look to resonate with their pain and distress from your own life • Stay connected to your own journey and sense of self. Families, who live under chronically distressed circumstances, most often come into therapy European Journal of Psychology & Educational Studies, Vol 1 / Issue 1 / Oct-Dec-2014 Aponte and Mendez: The challenge for the person of the therapist in the work with disadvantaged families presenting an issue of acute concern to them today. This challenges therapists not only to relate immediately to today’s pressing issue, but also to understand the story behind it, and responding to the family in a way that the family perceives the therapist really gets it. This entails therapists opening themselves to experience a family’s emotional state as the family relates its story. Then if the therapists can dig deep enough into their own stories to connect with their own personal struggles and/or life experiences that are at least in some way analogous to their clients’, the empathic response will carry with it elements that can convince the families that the therapists are connecting for real, something more than empathic sounding words. However, therapists cannot lose their differentiated sense of self even as they enter into their clients’ experiences. This will be particularly challenging in work with disadvantaged families where therapists can lose the clarity of their personal and professional boundaries as they plunge into the personal and social crises and chaos their clients may be living. Therapists’ ability to remain in touch with their own distinct personal legacies and ongoing personal struggles will enable them to remain grounded in their own sense of self even as they risk ever deeper empathy and resonance with their clients. The mother talked about her worry for the safety of her son who was hanging around gang members, and her concern that he was not attending school. He was also keeping within himself at home, not talking and staying in his room. The mother knew he was concerned about what she was going through, with their father in prison and his younger brother drifting into contact with some of the older brother’s friends who lived at the fringes of the local gangs. The therapist elicited from the family details about the realities of their life circumstances—about the boy’s worries for his mother and brother, and the mother’s worries about the boy’s schooling and association with gang elements in the neighborhood. The therapist had the mother relate her story in a way that allowed him to walk with her emotionally through her journey of worry and anxiety. When the therapist responded sympathetically to the mother’s concerns, he could see the boy was keying in on the mother’s tearful assent. III As You Assess its Source and Dynamics • Search for circumstances in their story that contextualize today’s issues • • Look to have them relive their story as they share it Allow yourself to resonate emotionally to it as you try to grasp it. You do not really know what the family’s current troubles are about unless you also know the story behind them. The history that led to today’s troubles makes sense of today’s issues so that therapists can get a handle on the forces driving what they are now witnessing. For families coming from these difficult life circumstances the story is always complex, with multiple subplots, sensitive, and embarrassing details that families are often reluctant to get into with too many specifics. The families need to sense that the therapist not only understands, but also cares. Therapists need to be so present and connected to the people, but also to their own vulnerabilities that they may gain a feeling for where they can enter into a family’s story through their own story. They are looking to explore a family’s history, but delicately so that they can sense where the line is, knowing when to stop asking or push a little further and deeper. Therapists’ own histories must be accessible to them with all their failures and hurts so that they can be feeling and reading their clients through their internal reactions, and not just their analytical heads. This means internally walking the journey of their own struggles as they simultaneously try to track their clients’ stories as they relate and relive them. So when the mother made reference to the father’s imprisonment, the therapist remembered that the counselor had said the family did not want the charges revealed. The therapist asked nothing at this point about any of the circumstances surrounding the father’s imprisonment. He just spoke to how hard it was for them to have their father and husband so far away in jail in another city. When he went on to ask about the mother’s worry for the boy’s “safety,” he learned that the oldest brother had been killed a few years back in a gang related incident. He heard that the parents began fighting after that, that the father was never the same again, and that the boy’s school problems had their beginning at that time. This news immediately connected the therapist with a tragic loss in his own life, the stressful impact on his family, but what it meant to have family support that fortunately did not come apart as it did in this family’s case. So he could speak to the sadness of each individual in the family, and to the pain and guilt that precipitated European Journal of Psychology & Educational Studies, Vol 1 / Issue 1 / Oct-Dec-2014 5 Aponte and Mendez: The challenge for the person of the therapist in the work with disadvantaged families the conflict within the family, while also standing apart in his own distinct personal experience. Knowing the Latin culture of the family,[29] he also went immediately to what he instinctively knew was the weight of the boy’s awareness that he was now the “man of the house.” The boy would feel and be expected to look after his mother and brother, a responsibility, the therapist learned, his father from prison had explicitly put on this fourteen-year-old son. The therapist recognized and spoke to the burden of the boy’s worry about his family, a worry made heavier by a sense of his own helplessness to relieve his mother of her fears. The therapist could identify, but also differentiate from the family as he recalled his own growing up experience, not assuming responsibility for his family, but of forging for himself in what felt to him an unforgiving world outside his family and neighborhood. The differences proffered him a certain distance from the client family that allowed him to see them in their own uniqueness even as he identified with them. IV Make the Session a Real Experience for the Family • Use your presence with them to draw their presence into the room • Attend to your experience of them in their interactions with you • Draw them into interacting with each other around their issues. A family so overwhelmed and so unsupported needs to feel they can bring all their distress and sorrow into the room as they relate their story. They are remembering and reliving it. The therapist needs to be present with them in the experience of the moment. This is not just a conversation. It is life as they are experiencing it right then. The therapist needs to enter that living moment with them—with not only the meaning, but also the emotional valence of their words. Something is taking place in that room for the family. The therapist needs to draw “the family members to interact with each other,”[30] and then to also allow him/herself to be drawn into the plot and drama of their issues as they emerge right in his/her presence. This personal experience of the family makes it possible for a therapist to see and know them viscerally. To the extent they feel known and cared about, the more will they open themselves to the therapist. To the extent they feel the therapist’s presence with them, the more they can risk new responses to old problems. There was a sadness in the room. There was also love in the room along with an aloneness, person from person. What was happening at home for the family was being 6 relived in the session. The therapist made space for them not only to tell their stories, but also to recall and feel, look, and touch. The mother talked with anxiety and pain about her son’s seclusion in his room, and spoke of the younger son’s bemoaning the absence of his brother from his everyday life in words that the mother described as identical to what the older boy had said after the loss of his older brother. As she relived all this, you could also feel that the mother, along with her sons, missed her husband, the boys’ father, who had lived all of this with them, but now was in touch only by phone. The therapist was already personally in their sadness and in their aloneness, and reached out to the mother and the boys about what each was feeling at that moment. Having connected with each about her and their heartaches, he could use his connection to each as the base from which to begin to knit one to the other right there through the care and concern that bonded them to one another. He could ask the mother to speak of her love for the older boy, and him about his worry about his mother and concern for his younger brother, activating in the immediacy of the moment the caring bonds he knew existed among them. V Build on the Client’s Strengths • Find and ride the momentum of their efforts to “overcome” • Grasp the significance of the values driving their motivation • Within your relationship enable their power vis-à-vis you. However disadvantaged a family is, if there is life, there is some strand of the drive to overcome.[31] It is for the therapist not to be blinded by the disadvantaged family’s dark and dispiriting histories, but to search for the strength and determination in their stories, reach to touch it, and then build upon it.[32,33] Connecting with them in their pain will leave them vulnerable but also open to the therapist’s intervention. To some degree or another, there will always be within each story an instance of triumph, and a relationship that made the difference. This moment of openness is the time for the therapist to search out that power of the will to stretch beyond old limits. As Viktor Frankl[34] asserts, that in face of the most daunting adversity, “there is always a certain residue of freedom left to [a person’s] decisions.” p. 67 For therapists working with these families, it is presumed that they bring with them into the therapeutic encounter not only their personal woundedness, but also their own triumphs with their hopes, which feed off of their belief systems. It does imply that therapists are in touch European Journal of Psychology & Educational Studies, Vol 1 / Issue 1 / Oct-Dec-2014 Aponte and Mendez: The challenge for the person of the therapist in the work with disadvantaged families with the sense of possibility in their own lives, journeys toward growth and change to which they themselves are actively committed. They will draw from their own strength and life-outlook to seek out and relate to whatever determination, faith, and hopefulness live in their clients. The younger brother was attending school, and doing well. Although the older brother was forced out of school, he wanted back in, reportedly wanting to prove to people that he could make it. He was hanging with gang members, but had not become an active member. He was vigilantly shepherding his brother away from his gang-associated friends. Their mother, although originally feeling overwhelmed and helpless, was open to seeking out and accepting whatever help her caseworker and the therapeutic team could offer. She had agreed to enter individual counseling, and had engaged in job training. She was bolstered by her faith, which was important to her. She was a fighter. The father, from his own principles and values, was coaching his wife and sons from his jail cell. There was hope and a will to make it in this family. The therapist allowed himself to be inspired and energized by the depth of caring and determination he felt from within the family. He was open to that positive belief system and energy of theirs as he had been to their pain and sorrow. He knew from his own journey’s ups and downs what it meant to keep striving in face of what felt like unknowable and impossible obstacles. He could relate to the older boy’s barely clinging to the will not to give up, and to the mother’s resolve to find a solution in the face of the fear-filled unknown. There were varying degrees of will in each to risk that next step. The therapist reached for that will in each, referring one to other as they spoke, using the resolve of one to bolster the resolve of the other. VI Mobilize the Client’s Eco-systemic Resources • Join the family members in the milieu of their issue’s social context • Open yourself to the family’s cultural and spiritual world • See yourself as an active member of their social network. The deadliest condition for families living in depressed circumstances is the quarantine of social isolation. This cut-off from support and resources can come from outside or from within—from poverty, marginalized minority status, or most devastatingly from family disintegration.[35] In any case, especially for families that are already disadvantaged, trying to go it alone in the face of a life crisis is to be up against the seemingly impossible. Just as in the case of the strength of the individual’s will to overcome, however attenuated by life’s reversals, there are sources of support and help for every family, whatever their situation.[36-38] It is the job of therapists working with these families to facilitate the connection to these resources. Moreover, for many a family, especially ethnic and racial minorities, their spirituality is a potential source of strength and hope in the most despairing of situations.[2,39-42] Therapists working with disadvantaged families have the task of being alert to and actively connected to resources in the social context of these families.[43,44,1,45] Moreover, they themselves are part of those families’ community environment, and must recognize that they may be a family’s single lifeline at any particular moment in time, and, yes, that may mean the investment of extra time and personal energy not only with the family, but in reaching out into their community. That is why agencies and clinics with dedicated teams are best suited to serve these families with their multiple needs and scarcity of resources. The older boy’s family had the extraordinary good fortune of being connected to a program that had multiple resources from personal counseling to family counseling to group and community activities, as well as a network of connections within their city’s official assets. The boy’s mother had available to her individual counseling that helped transform her from the despairing sole support of her family to an empowered advocate for them in the counseling center’s rich network. The boy’s younger brother was taking advantage of a group activity that drew him away from the gang community, and the older boy had a caseworker persistently seeking him out. The therapist used himself to make a personal connection with the older boy in the session. He related and built on the concept of the boy’s being the “man of the house,” lending him a sense of pride in trying to carry out his father’s expectations of him. The therapist kept alive the boy’s sense of responsibility for his younger brother, and his readiness to be a support to his mother. However, he also brought the boy’s father into the session by treating his role in the family as alive and present even from his jail cell so that the boy could feel his dad’s presence and support. When the therapist learned that the mother was finding her church to be a source of consolation and strength, he encouraged her personal participation in it, and her determination that her boys attend services with her on Sundays. At the end of the session the therapist used his connection to the boy to gain from him a willing commitment to accept a supportive relationship from a male who would come European Journal of Psychology & Educational Studies, Vol 1 / Issue 1 / Oct-Dec-2014 7 Aponte and Mendez: The challenge for the person of the therapist in the work with disadvantaged families from the center’s program or the church. He was not to go it alone. The therapist spent time with the team after the session to share about how they would be incorporating what just happened in the session into their plans as a community resource working with this family. Some part of him would remain with the family and with the team, and they with him. 8. Conclusion 13. The various therapeutic tasks here described and demonstrated, and taken together, represent a coordinated effort tailored to the particular needs of disadvantaged families. These are tasks that strive to bring personal caring, professional skills, and social resources to families in an integrated approach that is intended to engender a trust in the families that they are not alone in their endeavor to find the potential of their own personal strengths, the resources in their communities, and what their therapists have to offer of their selves. In this light, we have attempted to identify and explicate through a case example how therapists can make use of their personal selves and their life experience in purposeful ways to bring insight, energy, and possibility to their therapeutic relationships, exploratory assessments, and technical interventions. The goal of the Person-of-the-Therapist approach is to maximize the impact and effectiveness of the professional process through the conscious and purposeful use of the therapist’s personal journey and living presence in the present moment’s encounter with the client family. Through the therapist’s own woundedness, the therapist connects to the family’s woundedness. Through the therapist’s own belief in possibility, the therapist searches for the family’s sense of hope. Through the therapist’s own strivings and triumphs, the therapist seeks to discover the family’s strength and determination. 14. 9. 10. 11. 12. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 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