The intervention program itself consists of five major components in addition to pretreatment activities: Engagement in change; Motivation to change; Relational/Interpersonal Assessment and planning for Behavior change; Behavior Change; and Generalization across behavioral domains and multiple systems.
Pretreatment: The goals of this phase involve responsive and timely referrals, a positive “mindset” of referring sources, and immediacy. Activities include establishing collaborative relationships with referring sources, ensuring availability, appraising multidimensional (e.g., medical, educational, justice) systems already in place, and reviewing referral and other formal assessment data.
Engagement Phase: The goals of this phase involve enhancing perception of responsiveness and credibility; demonstrating a desire to listen, help, respect, and “match;” and addressing cultural competence. The main skills required are demonstrating qualities consistent with positive perceptions of clients, persistence, cultural /population sensitivity and matching. Therapist focus is on immediate responsiveness and maintaining a strength-based relational focus. Activities include high availability, telephone outreach, appropriate language and dress, proximal services or adequate transportation, contact with as many family members as possible, “matching” and respectful attitude.
Motivation Phase: The goals of this phase include creating a positive motivational context, minimizing hopelessness and low self-efficacy, and changing the meaning of family relationships to emphasize possible hopeful experience. Required phase skills consist of relationship and interpersonal skills, a nonjudgmental approach, plus acceptance and sensitivity to diversity. Therapist focus is on the relationship process; separating blaming from responsibility while remaining strength-based. Activities include the interruption of highly negative interaction patterns and blaming (e.g. divert and interrupt), changing meaning through a strength-based relational focus, pointing process, sequencing, and reframing of the themes by validating negative impact of behavior, while introducing possible benign / noble (but misguided) motives for behavior. Finally, the introduction of themes and sequences that imply a positive future are important activities of this phase.
Relational Assessment: The goals of relational assessment include eliciting and analyzing information pertaining to relational processes, as well as developing plans for Behavior Change & Generalization. The skills of perceptiveness and understanding relational processes and interpersonal functions are required. The focus is directed to intrafamily and extrafamily context and capacities (e.g., values, attributions, functions, interaction patterns, sources of resistance, resources, and limitations). Therapist activities involve observation, questioning; inferences regarding the functions of negative behaviors, and switching from an individual problem focus to a relational perspective.
Behavior Change Phase: Behavior Change goals consist of skill building, changing habitual problematic interactions and other coping patterns. Skills such as structuring, teaching, organizing, and understanding behavioral assessment are required. Therapists focus on communication training, using technical aids, assigning tasks, and training in conflict resolution. Phase activities are focused on modeling and prompting positive behavior, providing directives and information, developing creative programs to change behavior, all while remaining sensitive to family member abilities and interpersonal needs.
Generalization Phase: The primary goals in the Generalization phase are extending positive family functioning; planning for relapse prevention and incorporating community systems. Skills include a multisystemic/systems understanding and the ability to establish links, maintain energy, and provide outreach. The primary focus is on relationships between family members and multiple community systems. Generalization activities involve knowing the community, developing and maintain contacts, initiating clinical linkages, creating relapse prevention plans, and helping the family develop independence.