THE FIRST INTERVIEW IN SYSTEMIC THERAPY.

FAMILY SYSTEMIC THERAPY

THE FIRST INTERVIEW IN SYSTEMIC THERAPY.

The first interview largely determines the treatment.

2. The family presents itself for therapy:
AT THE VERBAL LEVEL: WANTS CHANGE.
at the analog level: NEGATIVE ATTITUDE TOWARDS CHANGE
The therapist's task is to take charge of the therapy.
4. The family must begin to feel that change is possible.
5. It is not necessary to start the first interview with a lot of information about the family.
6. If the level of distress is high, it may be appropriate to immerse oneself, temporarily, in the history of
some of the members.
7. We must catalyze the present and not seek causes in the past
Observe more the NON-VERBAL process than the VERBAL content.
Diagnosis and treatment intersect
The therapist should imply that they are interested in the group as a whole.
11. Observe the place and position of each member.
12. You can start by asking a general question: What brings you here?
13. Each member must feel that they are participating in the exploration of the problems.
14. If too much discomfort is observed in the family, a step back will be taken, and will be used
support operations.
15. GOLDEN RULE: The family must leave with the desire to return for the next session.

THE FIRST CONTACT.

The first contact with the systemic family therapist will come directly from a family member.
or through a third party who refers it. The FIRST TELEPHONE CONTACT initiates a relationship with the family that
It should be understood as a therapeutic relationship. It goes beyond the mere collection of cold data about the patient.
identified. The family is informed that the way of working is by receiving the whole family, understanding
as such to all the members who live under the same roof and are united by blood ties.
However, at times it may not be necessary to bring in a very small child. One way
it is easy to simply declare that one wishes to get to know the patient's family in order to
better understand the problem. The acceptance or rejection by the family starts to provide data
regarding the family attitude towards the consulted fact. It is highlighted in this phone contact that we want
see the whole family at least once, thus allowing the possibility of dividing the total system into subsystems in
function of what the dynamics of the therapy may suggest as most convenient.

An example of a PHONE CARD is the following:

1) Full name and age of the identified patient (PI)

2) Studies or profession of P.I.
3) Reason for consultation
4) Composition of the nuclear and extended family
Who lives in the house
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Who is calling or requesting the consultation

Who referred them?

8) Address and contact phone number
9) Date of this first call
Members called to the first session
11) Summoned for the day, month, time
Who will take care of the family

GENERAL CONSIDERATIONS

It is important to keep in mind that this initial phase of therapy greatly determines the outcome of the
treatment. The first interview in systemic family therapy is a unique situation.
The fact that the family seeks therapy implies the prior recognition of difficulties or problems.
existing within the family (likely located in a member) and some capacity to integrate a
activity that requires cooperative effort.
Since symptomatology is the means by which 'family homeostasis' is maintained, the family
will present a negative attitude towards change even if they verbally express the opposite. Thus, the
family, in this first encounter directs its efforts towards the annulment of the therapist's activity as
promoter of change.
KEMPLER states: "THE WORK OF THE FAMILY IS TO TRY TO REMOVE US; OUR WORK AS
THERAPISTS ARE TO REJECT BEING DISMISSED.

The new system constituted by the "family group" + the "family therapist" presents different
properties: The family is responsible for initiating the treatment on their own and striving, with the help of the
therapist, for elucidating their own vision of their problems and for defining what they wish to modify, that is,
Define the treatment objectives. The initial task of the therapist is to establish themselves as a therapist, it is
to take charge of the therapeutic process.
Therefore, it is necessary for the first session to be a 'functional' therapeutic encounter; that is,
real meeting of people, in such a way that the family begins to feel that change is possible, without
therefore its current system must be completely destroyed.
Starting the first session with the least amount of information about the family is a very common practice.
useful for the therapist. Therefore, one should not come armed, to the first interview, with an extensive history of the
family derived by another therapist. This allows them to become sensitized to the uniqueness of the new system
of which it is a part. The therapist has before them the verbal and non-verbal interactions of the members of the
family, which reveals the familiar areas of weakness and strength; and this allows them to be able to dispense with a
"history" before being able to offer treatment. However, it may be necessary when the level of distress
from the family is tall, temporarily dive into the history of some family member in order to
reduce the tension of the session. This historical exploration can develop a sense of identity of the
family: for example, a daughter can gain a new perspective on her role in the family by listening to her mother
the experiences she had when she was young.
The 'story' told by any member is always 'for the family' before being for the therapist; its
The purpose is always to catalyze the present and not to seek causes in the past.
Historical exploration should be used with great care to prevent the family or the therapist
huyan of the present.
The keys for the diagnosis that the therapist needs to obtain are found more in the non-verbal process.
that in the verbal content. It must determine the degree of homeostasis that operates within the family system.
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He/she needs to appreciate the communication models, the internal alliances, the coalitions, the roles that
the roles of family members and how the system affects it as a therapist.

The therapist must be able to capture the discrepancies between digital and analog communication.
family members, remembering that they are the non-verbal images that a person gives of themselves and their place
within the family, the ones that remain less censured and inhibited. Nevertheless, the systemic family therapist,
it does not seek to separate diagnosis from treatment; it should not wait until it has discovered and classified
mentally what seems to be happening: he takes each fragment of the picture before him, and
Reflect, together with the family, on it as it is being composed in a new way.

The therapist must convey that he is interested in the group as a whole and that he is not simply
treating an individual 'in the presence of their family'. It must avoid being caught by the secret information that
a member can give about another, either by phone or in any other way. Therefore, it will express to the
family that anything a member shares with it will be considered property of the entire group and,
Consequently, shared. This is so because important private information that cannot be
using it makes it difficult for the therapist to have spontaneity and freedom of movement during the sessions.

The family can present for treatment in two ways:

a) Symptomatic form: based on 'a member' with problems.

b) Interactional form: depending on the difficulties that exist within a relationship, between the
marriage, between parents and children, etc.

Generally, the therapist encounters the first alternative, in which the family considers that the
the source of all their problems is located in one of its members. The family easily feels that their
problems would be solved if the symptomatic individual disappears or magically changes. However, the
family therapist considers that individual symptoms provide clues about dysfunctional areas within the
internal family relationships.

The handling of the 'identified patient' confronts the family therapist with particular problems from the
beginning of treatment. Frequently, the 'identified patient' experiences relief when perceiving that the
the therapist does not share the opinion that their family has about the role they occupy within the family system. It is, by
It is so important for the therapist to be able to convey such a message from the first session.

When asking family members how they see the problem, it is surprising to find that the "patient
"Identified" often presents a radically different opinion from that of others.
members. From the new vision offered by the 'identified patient', the family can start to
consider their problems.

When a family labels one of its members as a 'patient', it is possible to consider the
symptoms of the patient identified as a resource to maintain the system or maintained by the system. The
symptom may constitute an expression of a family disjunction. 0 may have developed in a
individual member due to its particular characteristics, and then, to be supported and maintained by the system
familiar.

The goal of the therapist's intervention is the family. Although it should not ignore the individuals, the
The therapist mainly focuses on enhancing the functioning of the family system. To transform the system.
familiar, the therapist must intervene in such a way that it destabilizes the system. However, every therapist
that does not have the ability to provide the family with a strong sense of respect for each one of them
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 THE FIRST INTERVIEW IN SYSTEMIC THERAPY.

as individuals and show them their strong desire for healing, will lose the family in the process of
transformation. For all these reasons, it is important that by the end of the first interview each member feels that
has participated with the therapist in exploring the issues.

STAGES OF THE FIRST INTERVIEW

An initial session can be divided into four stages:

A) First stage:

The therapist follows the cultural rules of social interaction. At this stage, the therapist's concern is
make the family feel comfortable. He introduces himself and helps the family introduce themselves to him.

When the family takes a seat, the family therapist must pay attention to how they arrange themselves. They
They will say to sit wherever they want, with the chairs arranged in a semicircular shape. Often, their location
Can you provide some information about the existing links in the family.

The therapist can use the first few minutes to chat informally. If any is used
special equipment, such as recorders or cameras, must explain what it is about. It will not allow anyone
I started to comment on the problem until I have received some 'social' response from each member.

B) Second stage:

The individualized view of the problem is obtained. The therapist questions each family member.
about what are, in your opinion, the problems of the family. The therapist's first question is
posed, generally in generic terms, and is not clearly directed to any family member in
particular. It can start in various ways. For example, you can say: 'Well, let's see what is...
has brought here". 0 in a more personal way: "How can I be of help to you?" Another way is to tell them:
I wanted all the family members to come today to see what each of you thinks about the
situation.

The therapist pays special attention to the similarities and differences in the way each
The member presents the problems. Also, they are attentive to the 'content' of the problem presentation.
part of the family, but above all, observe the way the family behaves.

Yes, for example, if the parents were the first to expose the problem, the therapist will question a third party.
member to get your opinion. Generally, it is not advisable for this person to be the identified patient.
since if the parents have focused on one child characterizing him as the problem, he is in a
defensive position. If the therapist establishes contact with this, they may then feel that the therapist is joining
to the coalition that accuses him. Previous contact with another family member may allow it to manifest.
another point of view regarding the problem, thus opening a new area of family issues.

At this stage, the therapist will make no interpretations or comments to help the individual see.
the problem from a different perspective. You must simply accept what they tell you, although you can
ask about a point that seems confusing to you.

You should never ask someone how they feel about something, but rather just collect.
facts and opinions. If someone interrupts the one who is speaking, the therapist will not intervene immediately: it

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 THE FIRST INTERVIEW IN SYSTEMIC THERAPY.

will let you talk a little to briefly observe the nature of the interruption and then will intervene to ask the
I was talking before he continued, saying, kindly, to the one who interrupted that he would get his.
turn. Long dissertations should not be allowed.

The therapist must get in touch with each of the family members present, including the
younger children. It may not be appropriate to question a very young member about their opinion.
about the problem, but the therapist can exchange some effective words or gestures with him, to
make him feel that he is part of the session.

In this second stage, the therapist only wants to hear the opinion of each interviewee. Therefore, all
They must have the opportunity to express themselves.

C) Third stage:

The family structure is explored, favoring interaction among its members. As well as in the stage
Previously, the therapist managed the conversation directly, asking each member for their view of the
problem, in the third stage the therapist must stop being the center and get everyone to talk about
the problem. That is to say, it should ensure that all members 'interweave' more and more in the conversation.

Family members cannot describe their sequences and patterns of behavior to the therapist.
because they are unknown. This information will only be obtained by observing how they conduct themselves with each other;
The conversation among the group members will help the therapist address the sequence class.
existing in that family.

The technique of organizing the family into subsystems also helps to broaden the focus of the problem.
The example that Haley gives is the following: In a family where the father is missing, the mother says that she cannot explain it.
why your daughter does not listen to you and lies to you. The therapist can intervene by saying: 'I want you to choose one of the '
lies and talked about her with her daughter." As mother and daughter begin to converse, the excessively
dedicated to her granddaughter will interfere to interrogate the girl herself or criticize the way she speaks to her
mother. The more difficult it is to prevent grandma from interfering, the more ingrained that pattern will be in the
family. If the therapist manages to stop the intrusion and the mother and daughter can talk to each other, he will have succeeded.
simultaneously two steps: establish a diagnosis and begin a change.

Although the family therapist pays attention to what family members say, their main
concern is to try to understand how the family works. When guiding certain
members to talk among themselves test their 'hypotheses' about how the family functions.
Investigate areas of discrepancy, observe how that discrepancy is handled and how the family resolves it.
a problem. It also gathers information for its later strategy, which may consist of including another
member in the ongoing negotiation or in exploring a different dyad. Examine the degree of "differentiation and
individual autonomy, setting boundaries and flexibility. But at the same time, it explores the configurations.
dysfunctional.

The family attends the first interview with an identified patient. Their goals and those of the therapist do not
they are the same. The family has organized itself focusing on the identified patient and in certain cases it
focuses on maintaining this focus. The family therapist, on the contrary, considers from the beginning that the
the identified patient responds to dysfunctional aspects of family transactions, and what the best way is
Focusing on the identified patient's problems involves clarifying and changing these dysfunctional aspects.
Often, this stage of the session oscillates between these two points: the family therapist extends the focus of

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exploration from the identified patient to different aspects of the family organization; the family centers
again the problem in the identified patient.

The family has attended therapy due to their failure in resolving the problem with the patient.
identified. By broadening the vision of the problem, the therapist brings forth the hope that a different way
Addressing the problem will allow for finding a solution.

The stress points must be explored, but the therapist must be aware of the level of stress that the
family can tolerate. When family members feel too uncomfortable, the therapist must
step back, often using support operations, to the point where the family feels
again comfortable.

Finally, all therapeutic operations must be carried out with a clear awareness of the fact
The first rule of the therapeutic strategy is that the family starts with the desire to return in the
next session.

D) Fourth stage:

The family, along with the therapist, refine the goals. At the end of the first interview, it is important
obtain from the family a formulation that is sufficiently clear about the changes they want to achieve through
therapy:

The problem to be solved by the therapist must be one that the family wishes to resolve, but posed
in a way that makes it solvable. Haley clearly comments that no diagnostic category
traditional is a solvable problem. Thus, for example, if a family defines the 'anguish' as a problem
one of its members, the problem will be the way that anguish manifests itself and the person's reaction
anxious. The same author gives another example: A 'school phobia' is not a problem that we can solve,
but it is indeed an operationalizable problem for the child who does not want to go to school.

One of the reasons why the problem must be clearly specified is that this way we can know if it
he has achieved the goal; if this is confusing, the evaluation of the results will also be.

If by the end of the first interview there is a sufficiently clear idea of the problem, it is possible to
set other elements of the therapeutic contract such as duration, frequency, and number of sessions.

Regarding the duration of the therapy, rather than talking about a time in months, it is advisable to set a
a concrete number of sessions. As a guideline, we can place 5 sessions for mildly severe cases, and between 10
and 12 for the most serious, chronic cases where the family has 'defeated' many previous therapists.
Likewise, they are told that if the problem is resolved before the agreed number of interviews is completed, no
it will be necessary to carry out the remaining ones. However, if by the time of the last agreed session it has not been achieved
The proposed objective will be evaluated together with the family to decide the appropriateness of continuing.
with one more session.

Bibliography:
Minuchin - 'FAMILIES AND FAMILY THERAPY' - Gedisa Publishing
Sue Walrond-Skinner - 'FAMILY THERAPY' - Edit.. Crea (El Ateneo) systemic
Haley.-"THERAPY TO RESOLVE PROBLEMS" Ed. Amorrortu.

Mr. Jorge Morales Terrazas