BLENDED FAMILY

CLIENT PRESENTATION

Angry/Hostile (1)¹
1. Anger and hostility have dominated the client's manner since the parents have blended their two families.
2. The client was extremely angry and hostile about having to be a part of the new blended family.
3. The client's level of anger and hostility has started to diminish as he/she has accepted being a part of the new blended family.
4. The client has dropped his/her anger and hostility and has become a cooperative member of the blended family.
Frustrated/Tense (1)
1. There was a deep sense of frustration and tension present in the client as he/she talked of the blended family situation.
2. The client reported being frustrated and tense about feeling pushed into a new blended family.
3. The client's level of tension has subsided as he/she is feeling more comfortable with the idea of being a part of a stepfamily.
Resistant toward Stepparent (2)
1. The client presented in a defiant manner toward the stepparent.
2. In a defiant way the client reported that he/she will have no part of the new stepparent.
3. The client threatened to make it difficult for the new stepparent.
4. The client has dropped some of his/her resistance and seems to be warming a little to the new stepparent.
Defiant of Stepparent (2)
1. The client showed a pattern of making alliances and causing conflicts in an attempt to have a degree of control over the new stepparent.
2. The client reported no interest in taking direction or accepting limits from the stepparent.
3. Gradually, the client has begun to give up his/her rebellion toward the stepparent and to accept some direction from him/her.
Stepsibling Conflict (3)
1. The siblings have engaged in ongoing conflict with one another.
2. The two sibling groups stated clearly their dislike of and resentment toward one another.
3. The parents indicated their frustration with the siblings' apparent attempt to sabotage their efforts to form a new family group.
4. The two sibling groups have stopped their open conflicts and started to tolerate and show basic respect for each other.
Defiance of Stepparent (4)
1. The client presented a negativistic, defiant attitude toward the stepparent.
2. The client seemed very closed and extremely resistant to the new stepparent.
3. The limited disclosures by the client reflected strong resistance to joining the new blended family.
4. The client has started to warm to and be a little more open to the idea of being a member of the new blended family.
Threats of Moving to Other Parent's House (5)
1. The parents reported feeling like hostages to siblings' threats to move to the other parents' homes whenever the children were crossed or told no.
2. The siblings presented as being ambivalent and manipulative regarding where they would like to live and why.
3. The siblings indicated that they have changed their minds several times regarding where they want to reside and are presently still undecided.
4. The siblings have decreased their threats of going to the other parents' homes and have started to join the new family unit.
Ex-Spouse Interference (6)
1. Both spouses reported frequent incidents of interference in their new family by their ex-spouses.
2. Ex-spouse interference has caused ongoing conflict and upheaval in the new family unit.
3. Efforts to keep ex-spouses out of the new family's business have been unsuccessful and sabotaged by the siblings.
4. Efforts to keep ex-spouses out of the daily life of the new family have started to be effective, and the new family has started to solidify and become connected.
Parental Anxiety (7)
1. The client's parents presented with anxiety about the blending of their two families.
2. The parents seemed unsure about how to respond to issues being raised by the new blended family.
3. The parents looked for reassurance and some sense of security about how best to respond to blended family issues.
4. Parental anxiety has decreased as both parties have become more comfortable with working toward forming a new blended family.
Lack of Responsibility Definitions (8)
1. The family presented as very chaotic, lacking clear boundaries, rules, and responsibility definitions for members.
2. The parents reported that they have struggled in their attempts to establish clear definitions of expectations for responsibility for family members.
3. Siblings indicated that they are not clear about their roles, responsibilities, or expectations in their new family.
4. The family has begun to develop and institute clear areas of responsibility for all members, which has also reduced the chaos and confusion for all.
Internal Loyalty Conflicts (9)
1. The client demonstrated ambivalence and uncertainty about whether to attach himself/herself to the stepparent.
2. The client verbalized loyalty toward the biological, noncustodial parent.
3. The client reported fearing hurting the feelings of the biological, noncustodial parent if he/she made an attachment to the stepparent.
4. Internal conflicts have been resolved, and a sense of loyalty and belonging is beginning to develop between the client and stepparent.

INTERVENTIONS IMPLEMENTED

Build Trust and Express Feelings (1)²
1. Warm acceptance and active listening techniques were utilized to establish the basis for a trust relationship with the client.
2. The client seems to have formed a trust-based relationship with the therapist and has started to share his/her feelings.
3. Despite the use of active listening, warm acceptance, and unconditional positive regard, the client and family appear to be hesitant to trust the therapist and share their feelings and conflicts.
Explore Perceptions, Pain, and Conflict (2)
1. Time was taken with each family member to explore their perceptions of the family unit and the sources of pain and conflict that affect each adversely.
2. The family was assigned to complete the exercise “Assessing the Family: Present and Future” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
3. The family was assigned to complete the exercise “A Few Things about Me” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
4. The family was assisted in identifying diagnosable behavioral, emotional, or cognitive conditions that may be effecting the family functioning.
5. Family members were supported as they described their perceptions of the family, their sources of pain, and the conflicts that affect them adversely.
Evaluate Substance Abuse (3)
1. A substance-abuse evaluation was indicated.
2. A substance-abuse evaluation has been completed and reflects concerns related to substance abuse for one or more family members.
3. A substance-abuse evaluation has been completed, but no concerns related to substance abuse were identified.
Assess Level of Insight (4)
1. The client's level of insight toward the presenting problems was assessed.
2. The client was assessed in regard to the syntonic vs. dystonic nature of his/her insight about the presenting problems.
3. The client was noted to demonstrate good insight into the problematic nature of the behavior and symptoms.
4. The client was noted to be in agreement with others' concerns and is motivated to work on change.
5. The client was noted to be ambivalent regarding the problems described and is reluctant to address the issues as a concern.
6. The client was noted to be resistant regarding acknowledgment of the problem areas, is not concerned about them, and has no motivation to make changes.
Assess for Correlated Disorders (5)
1. The client was assessed for evidence of research-based correlated disorders.
2. The client was assessed in regard to his/her level of vulnerability to suicide.
3. The client was identified as having a comorbid disorder, and treatment was adjusted to account for these concerns.
4. The client has been assessed for any correlated disorders, but none were found.
Assess for Culturally Based Confounding Issues (6)
1. The client was assessed for age-related issues that could help to better understand his/her clinical presentation.
2. The client was assessed for gender-related issues that could help to better understand his/her clinical presentation.
3. The client was assessed for cultural syndromes, cultural idioms of distress, or culturally based perceived causes that could help to better understand his/her clinical presentation.
4. Alternative factors have been identified as contributing to the client's currently defined “problem behavior,” and these were taken into account in regard to his/her treatment.
5. Culturally based factors that could help to account for the client's currently defined “problem behavior” were investigated, but no significant factors were identified.
Assess Severity of Impairment (7)
1. The severity of the client's impairment was assessed to determine the appropriate level of care.
2. The client was assessed in regard to his/her impairment in social, relational, vocational, and occupational endeavors.
3. It was reflected to the client that his/her impairment appears to create mild to moderate effects on the client's functioning.
4. It was reflected to the client that his/her impairment appears to create severe to very severe effects on the client's functioning.
5. The client was continuously assessed for the severity of impairment, as well as the efficacy and appropriateness of treatment.
Assess for Pathogenic Care (8)
1. The home, school, and community of the client were assessed for pathogenic care and concerns.
2. The client's various environments were assessed for the persistent disregard of the child's needs, repeated changes in caregivers, limited opportunities for stable attachment, harsh discipline, or other grossly inept care.
3. Pathogenic care was identified and the treatment plan included strategies for managing or correcting these concerns and protecting the child.
4. No pathogenic care was identified and this was reflected to the client and caregivers.
Address Family and Marital Issues (9)
1. Family sessions were conducted that focused on addressing and facilitating relationship building and joining rituals.
2. Each family member was asked to make a list of his/her recent losses to share with other members in a family session.
3. The parents were educated in the dynamics of stepfamilies and how they work.
4. Conflict negotiation skills were taught to family members and practiced in role-play situations particular to stepfamilies.
5. It was identified that family members have gained information and understanding about stepfamilies, learning to use negotiation skills and building relationships with each other.
6. Despite attempts to address family and marital issues, conflicts continue to occur on a frequent basis.
Assign Cooperative Family Drawing (10)
1. Each family member took part in interpreting and listening to others' interpretations of a drawing that was made through the cooperative effort of all family members.
2. All family members were willing to take part in making the family drawing but were resistant to interpreting it.
3. The family drawing exercise revealed that the family members have a very difficult time cooperating with each other, as there was resistance to the exercise and bickering within the family during the exercise.
List Expectations for New Family (11)
1. Each family member was asked to list his/her expectations for the new family.
2. Family members were assigned the exercise “Stepparent and Sibling Questionnaire” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
3. Each family member's list or expectations regarding the future of the blended family was shared and processed in family session, with common realistic expectations being affirmed and reinforced.
4. Unrealistic expectations of family members were gently confronted and reframed into more realistic and attainable expectations.
Remind Family That Instant Love Is a Myth (12)
1. The family was reminded of the myth of “instant love” between new members.
2. Family members' expectations of instant love and connections between blended family members were confronted with the reality that time is necessary for relationships to grow.
3. All the family members have become more realistic regarding the time necessary for meaningful relationships to develop between them, and this was noted to be a healthy response.
4. Although the family members have been reminded that instant love is a myth, they continue to expect an immediate harmonious relationship.
Reinforce Kindness and Respect (13)
1. The family was reminded that new members need not love or like each other but that they need to treat each other with kindness and respect.
2. Family members were confronted when they failed to treat each other with kindness and respect.
3. The parents were taught ways to model respect and kindness for all members and to confront and give consequences for disrespectful interactions.
4. It was noted that there is a discernible growth of respect and consideration between new family members that is being positively reinforced by the parents.
List Losses and Changes (14)
1. Each sibling was asked to make a list of all the losses and changes he/she had experienced in the last year.
2. Each sibling's list of losses was shared with other family members, and similarities between each list were identified.
3. Reviewing each sibling's list of losses enhanced the degree of understanding and the feeling of similarity between the siblings.
Play Games to Promote Self-Understanding (15)
1. The family was directed to play either The Ungame (Ungame Company) or The Thinking, Feeling, and Doing Game (Gardner) to increase members' awareness of self and their feelings.
2. Expressions of self-awareness and identification of feelings were reinforced in family sessions.
3. The family members were very uncomfortable during the playing of therapeutic games together, and most of them had significant difficulty in identifying and expressing feelings; additional encouragement was provided.
Educate Family Regarding Feelings (16)
1. The family was taught the basic concepts regarding identifying, labeling, and appropriately expressing their feelings.
2. Through the use of role-playing and modeling, each family member was assisted in identifying, labeling, and expressing his/her feelings in family sessions.
3. Family members were prompted when they ignored or skipped over their feelings in dealing with family issues.
Practice Identifying and Expressing Feelings (17)
1. Various feelings exercises were used with the family to help expand their ability to identify and express feelings.
2. Positive affirmation was given to family members when they identified and expressed their feelings appropriately.
3. Each family member was confronted and reminded when he/she was not identifying and expressing his/her feelings.
Read Books on Blended Families (18)
1. It was suggested to the parents and the teen that they read material to expand their knowledge of stepfamilies and their development.
2. The parents and teens were asked to read all or sections of Blended Family Advice: A Step-by-Step Guide to Help Blended Families Become Stronger and Successful (Dudley); Strengthening Your Stepfamily (Einstein and Albert); and Stepchildren Speak: 10 Grown-Up Stepchildren Teach Us How to Build Healthy Stepfamilies (Philips) to expand their knowledge of stepfamily dynamics.
3. The parents and teens were encouraged to talk with other stepfamilies and to gather knowledge of their experience, past and present.
4. Parents and teens were asked to make a list of questions they had about stepfamilies and to process the list with the therapist.
5. Reading books on blended families and talking to other people who have experienced successful blending of families has helped members gather information and develop understanding of the blending process.
6. The parents and teen have not read the assigned books on blended families and were redirected to do so.
Refer to Stepfamily Association (19)
1. The parents were referred to the Stepfamily Association of America in order to gather information on the process of blending families.
2. Information gathered from the Stepfamily Association of America was processed and incorporated into a more realistic view of the reality of stepfamilies.
3. The reality of stepfamilies not being inferior to regular families, just different, was introduced along with the new information the parents received from Stepfamily Association of America.
4. The parents have not followed through on obtaining further information from the Stepfamily Association of America and were again encouraged to do so.
Train in Problem-Solving Skills (20)
1. Family members were trained in developing problem-solving skills.
2. Steps to problem-solving were taught, including problem identification, brainstorming solutions, evaluating pros and cons, compromising, agreeing on a selected solution, making and implementing a plan.
3. Family members were assisted in practicing skills on issues that present within family sessions.
4. The family was assigned the exercise “Problem-Solving Exercise” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
5. Family members were reinforced for their use of problem-solving skills.
6. The family members were redirected when they moved away from structured problem-solving skills.
Assign “Negotiating a Peace Treaty” Exercise (21)
1. The siblings were asked to specify their conflicts and suggest solutions.
2. The siblings were asked to complete and process the “Negotiating a Peace Treaty” exercise from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
3. Through the use of the “Negotiating a Peace Treaty” exercise, the clients were assisted in identifying their conflicts and exploring a variety of solutions.
4. The siblings were asked to select, commit to, and implement one of the solutions they identified in the negotiation exercise.
5. The siblings' completion of the negotiation exercise revealed how far they are from having any common ground, and this was reflected to them.
Use Humor to Decrease Tension (22)
1. Humor was injected into sessions when it was appropriate to decrease tension and to model balance and perspective.
2. Family members were directed to each tell one joke daily to other family members.
3. Positive feedback was given to family members who created appropriate humor during a session.
4. It was reflected to the family members that they have extreme difficulty being light and humorous toward each other, as tension levels are high and teasing is reacted to angrily.
Use “Cloning the Perfect Sibling” Exercise (23)
1. A family sibling session was held in which each child was asked to list and verbalize an appreciation of each sibling's unique traits and abilities.
2. Siblings were asked to complete the “Cloning the Perfect Sibling” exercise from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
3. In processing the cloning exercise, siblings were assisted in identifying and affirming the positive aspects of individual differences.
4. Siblings continued to argue and bicker with each other, complaining about unique traits and characteristics despite the use of the cloning exercise.
Normalize Conflict as a Stage (24)
1. A brief solution-focused intervention was utilized with the family to normalize conflict as a stage.
2. Family members were assisted in identifying the next stage after conflict and determining how they might begin to move in that direction.
3. The intervention of normalizing the conflict as a stage has, according to family reports, reduced the frequency of conflicts.
4. The family was unwilling to embrace any reframing or normalizing interventions.
Emphasize Primary Parenting Role for Biological Parent (25)
1. The parents were educated in the positive aspects of each biological parent taking the main role with the children.
2. The parents were assisted in developing ways to redirect the parenting of the stepchildren.
3. The parents were asked to refrain from all negative references to ex-spouses.
4. Incidents of a parent making negative references to ex-spouses were confronted and processed.
Refer to Parenting Group (26)
1. The parents were referred to a parenting group designed for stepparents.
2. The parents were assisted in implementing new concepts that were learned from the parenting group.
3. The parents were confronted on their poor attendance at the step parenting group.
Institute Family Meeting (27)
1. The parents were assisted in developing a process for and scheduling a weekly family meeting.
2. Family meetings were monitored and the parents were assisted in solving conflictual issues.
3. The parents were given positive verbal support and encouragement for their follow-through on implementing weekly family meetings.
4. The parents have not followed through on implementing regularly scheduled meetings, and a commitment for this scheduling was obtained from them.
Develop Family Rituals (28)
1. The positive aspects of family rituals were taught to the parents.
2. The parents were asked to develop a list of possible rituals for their new family unit.
3. The parents were assisted in selecting family rituals and developing a plan for their implementation.
4. Family rituals were monitored for their implementation and effectiveness.
5. Verbal affirmation and encouragement were given to the parents for their effort to implement and enforce new family rituals.
Select Past Family Rituals (29)
1. Members were asked to make a list of rituals that were followed in their previous family.
2. Rituals from previous families were discussed, and key rituals were chosen to implement in the new family.
3. Plans were developed to implement the chosen rituals from previous families.
4. Family members were assisted in establishing the new rituals and making the necessary adjustments to increase their effectiveness.
Create Birthday Rituals (30)
1. The family was given the assignment of creating new birthday rituals for the new family.
2. The parents were asked to implement the new birthday rituals at the first opportunity.
3. The value of birthday rituals was reinforced with the parents.
4. A new birthday ritual has been implemented, and the family members have responded very favorably to this recognition of their special status.
5. New birthday rituals have not been developed by the family, and they were redirected to complete this task.
Teach Patterns of Family Interactions (31)
1. The parents were taught key aspects and patterns of family interaction.
2. Past family interaction patterns were explored and identified, with a special focus on those involving triangulation.
3. The parents were assisted in blocking patterns of triangulation that are occurring within the family.
4. The episodes of triangulation within the family have diminished significantly.
5. The parents have not identified patterns of triangulation within the family and were provided with tentative examples of how this occurs.
Refer for Marital Therapy (32)
1. The parents were referred to a skills-based marital therapy program.
2. Gains made in marital therapy were affirmed and reinforced with the parents.
3. The parents were asked to identify the gains they achieved in the skills-based therapy program and how they would improve parenting.
4. The parents have not obtained marital therapy and were urged again to do so.
Identify Individual Parental Needs (33)
1. The parents were assisted in exploring and identifying their individual needs within the relationship and family.
2. As the needs of each partner were recognized and affirmed plans were developed for meeting these needs on a consistent basis.
3. The parents were confronted when they failed to take care of their individual needs and did not follow through on the plans developed to do this.
4. The importance of meeting individual needs in a relationship was reinforced with the parents.
Process Sharing of Affection (34)
1. The ways the parents show affection to each other were explored with them in a conjoint session.
2. The negative aspects of blatant displays of parental physical affection were processed with them.
3. The parents were assisted in developing appropriate ways to show affection to each other when in the presence of their children.
4. Blatant displays of affection between the parents were confronted, and they were reminded of the negative impact these displays could have on their children.
Assign Reading Material on Marriage in a Stepfamily (35)
1. The parents were assigned Stepcoupling: Creating and Sustaining a Strong Marriage in Today's Blended Family (Wisdom and Green).
2. The parents have completed the assigned reading and key concepts were reviewed.
3. The parents have not completed the assigned reading and were redirected to do so.
Plan One-on-One Time (36)
1. The parents were encouraged to build time into their schedules for one-on-one contact with each child and stepchild.
2. The parents were asked to complete the exercise “One-on-One” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
3. The parents were reminded of the importance of taking the time to build parent-child relationships.
4. The parents have not developed one-on-one contact with each child and stepchild and were encouraged to coordinate this.
Recommend Initiatives Camp (37)
1. The family was asked to attend an initiatives weekend to build the trust, cooperation, and conflict resolution skills of each family member.
2. The initiatives experience was processed with the family, with each member identifying the positive gains they received from the weekend.
3. The family was assisted in identifying how they could continue to use and expand the gains from the weekend.
Coordinate “Cost-Benefit Analysis” Exercise (38)
1. The family was asked to complete the “Cost-Benefit Analysis” exercise (in Ten Days to Self-Esteem by Burns) to evaluate a plus-and-minus system of becoming a blended family.
2. The “Cost-Benefit Analysis” exercise was processed, with the positives of joining the family being emphasized.
3. Family members' resistance to working together and accepting one another was confronted using the positive items identified in the “Cost-Benefit Analysis.”
Emphasize That Relationships Build Slowly (39)
1. The necessity of allowing relationships to build slowly was emphasized to the family in family sessions.
2. Ways to build trust in relationships were explored with the parents to help them slowly build relationships with stepchildren.
3. The parents' exhibiting patience in allowing relationships to build was verbally reinforced.
Draw Family Genogram (40)
1. A genogram was developed with the family that contained all members and showed how they are connected.
2. From the genogram, the family was asked to identify the ways in which they see themselves being connected.
3. Constructing the family genogram revealed that some family members are virtually unconnected to other family members, and ways to reverse this fact were discussed.
Develop Enjoyable Activities (41)
1. Each family member was requested to suggest an enjoyable activity that the family should engage in to promote connectedness.
2. The family was assigned the exercise “Interaction As a Family” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
3. Family members have identified enjoyable activities in which they wish to engage in order to promote connectedness, and these were processed and reinforced.