PEER/SIBLING CONFLICT

CLIENT PRESENTATION

Angry/Tense (1)¹
1. The client described a pattern of frequent, intense conflict with peers and siblings.
2. The client appeared angry at everything and everybody and was not willing to be very cooperative in the counseling process.
3. The client denied responsibility for the frequent, overt verbal and physical fighting with both peers and siblings.
4. The level of anger and fighting between the client and siblings has decreased as they have actively worked with the therapist in session.
Projecting/Blaming (2)
1. The client displayed a propensity for blaming others for his/her problems.
2. The client refused to take any responsibility for the ongoing verbal and physical conflicts he/she has with peers and siblings.
3. All problems or conflicts were viewed by the client as the responsibility of others, not his/hers.
4. Slowly, the client has started to take responsibility for some of the conflicts in which he/she is involved.
Parents' Unfairness/Favoritism (3)
1. The client reported that the parents always treat his/her siblings more favorably than they do him/her.
2. The client cited incidences of his/her perception of parents' unfairness toward him/her.
3. The parents acknowledged that they find the other siblings easier to like than the client.
4. The client's complaints about unfairness and favoritism have started to decrease, and the parents are beginning to be seen in a more favorable light.
Defiant/Vengeful (4)
1. The client presented in a vengeful, defiant manner.
2. The client reported a long list of people who have wronged or slighted him/her in some way and how he/she has gotten back at them.
3. The client's level of bullying has caused him/her to be constantly at odds with peers and siblings.
4. The client has gradually let go of some of his/her intimidation and vengeance and has started to have less conflict with peers and siblings.
Isolated/Intense (5)
1. The client presented as a lonely, isolated individual.
2. The client reported a history of aggressive relationships with peers, which he/she resolved by keeping to himself/herself.
3. The client stated that he/she cannot get along with either peers or siblings without trouble, so he/she chooses to keep to himself/herself.
4. Since taking part in the counseling process, the client has gradually started to relate at least superficially with others.
Impulsive/Intimidating (6)
1. The client showed a pattern of impulsiveness and intimidation within the session by not considering the consequences of his/her actions and by challenging the therapist.
2. The client described a pattern of relating with peers and siblings in an impulsive, intimidating manner.
3. The client reported a history of impulsive, intimidating actions toward peers that have caused him/her repeated social problems.
4. The client has gradually accepted that he/she is intimidating and that this has been the reason for his/her conflicts with peers and siblings.
Aggressive/Mean (7)
1. The client seems to have an aggressive, mean manner of relating to others.
2. The client indicated that he/she has been involved in encounters that resulted in physical injuries to others.
3. No remorse appeared evident on the client's part for the painful way he/she treats others.
4. All his/her aggressive, mean acts are blamed on others or given great justification.
5. As treatment has progressed, the client has displayed less aggressive and mean behavior.
Insensitivity (7)
1. The client did not appear to be bothered by the ongoing conflicts he/she has with peers and siblings.
2. The hurtful impact on others of the client's verbally hostile, aggressive behavior does not appear to have an effect on the client.
3. The client has started to understand the effect of his/her conflictual behaviors on others and his/her need to be more sensitive to them.
Parents' Hostility (8)
1. The client described instances from his/her childhood in which severe and abusive punishment resulted whenever he/she was blamed for negative behavior.
2. The client described how parents always unfavorably compared him/her with peers and siblings, which led to feelings of anger, inadequacy, and resentment.
3. The parents' style of relating to the client was rude and hostile.
4. The parents' home environment appears to be highly competitive, with one sibling often pitted against the other to outdo him/her in a given area and thus win the parents' praise.
5. The client has begun to understand how his/her attitude and behavior toward others are connected to parents' treatment of him/her in childhood.
6. The parents have begun to treat the client in a more respectful and less hostile manner.

INTERVENTIONS IMPLEMENTED

Build Trust (1)²
1. Initial trust level was established with the client through the use of unconditional positive regard.
2. Warm acceptance and active-listening techniques were utilized to establish the basis for a trust relationship with the client.
3. The client seems to have formed a trust relationship with the therapist and has started to share his/her feelings about conflictual relationships.
4. Despite the use of active listening, warm acceptance, and unconditional positive regard, the client appears to be hesitant to trust and to share his/her feelings and conflicts.
Explore Relationships and Assess Denial (2)
1. The client's perception of how he/she relates to siblings and peers was explored.
2. The client's degree of denial was found to be high regarding conflict and acceptance of responsibility for any part in it.
3. The client was open in acknowledging the high degree of conflict between the siblings and was supported as he/she accepted responsibility for his/her part in the conflict.
Assess Level of Insight (3)
1. The client's level of insight toward the presenting problems was assessed.
2. The client was assessed in regard to the syntonic versus 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 (4)
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 (5)
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 (6)
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 (7)
1. The home, school, and community of the client was 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.
Teach Social Learning Techniques (8)
1. The parents and teachers were asked to identify all nonaggressive, cooperative, and peaceful behaviors of the client that they could praise and positively reinforce.
2. The parents were assigned the exercise “Clear Rules, Positive Reinforcement, Appropriate Consequences” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
3. The parents were assigned the exercise “How Parents Respond to Sibling Rivalry” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
4. Role-play and modeling techniques were used to show the parents and teachers how to ignore the client's nonharmful aggressive behaviors and how to praise prosocial behaviors.
5. The parents have shown an increase in the use of positive reinforcement of prosocial behavior by the client.
Play The Anger Control Game (9)
1. The Anger Control Game (Berg) was played with the client to expose him/her to new ways of handling aggressive feelings.
2. The client was asked to make a commitment to handle aggressive feelings by trying one of the new ways learned through playing The Anger Control Game.
3. The client has reported that he/she has successfully implemented new anger control techniques, and his/her successes were reviewed.
4. The client reported that he/she continues to have problems managing anger and was urged to continue to use the techniques to handle these aggressive feelings.
Play The Helping, Sharing, and Caring Game (10)
1. The Helping, Sharing, and Caring Game (Gardner) was played with the client to expose him/her to feelings of respect for self and others.
2. The client was assisted in identifying how people feel when they show respect to and receive respect from others.
3. The client was reminded of how others feel when they are treated in a rude, disrespectful manner.
4. The client has consistently shown more respect for the feelings of others.
Play The Social Conflict Game (11)
1. The Social Conflict Game (Berg) was played with the client to introduce prosocial behavioral skills.
2. The client was asked to list all the negative consequences that have resulted from his/her antisocial behaviors.
3. The client was reminded of the emotional and physical pain his/her actions have caused others.
4. The client was assisted in identifying two positive consequences of showing respect and concern for others.
Introduce Negotiation (12)
1. The client was urged to stipulate the problems that exist with his/her siblings and suggest concrete solutions.
2. The client and the parents were asked to complete the “Negotiating a Peace Treaty” exercise from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis) to introduce the concept of negotiation.
3. The client was asked to complete the “Why I Fight With My Peers” exercise from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
4. The parents were asked to start negotiating key areas of conflict with the client.
5. Role-play sessions involving negotiation were used with the client and the parents to build their negotiating skills.
6. The positive aspects of negotiation versus winning and losing were identified and reinforced with the client.
Teach Understanding of Feelings (13)
1. The client was taught to identify basic feelings using a feelings chart.
2. Aggressive actions were focused on to assist the client in identifying how others might feel when they were the object of such actions.
3. The idea of how the client would like to be treated by others was explored, along with what he/she would need to do to make this possible.
Refer for Group Therapy (14)
1. The client was referred to a peer therapy group to expand his/her social sensitivity and behavioral flexibility.
2. The client accepted the referral to group therapy and has been attending regularly.
3. The client reported that the group therapy experience has taught him/her to be more sensitive to the feelings of others.
4. The client has been resistive to group therapy and has not attended on a regular basis; he/she was encouraged to attend the group.
Play The Talking, Feeling, and Doing Game (15)
1. The Talking, Feeling, and Doing Game (Gardner) was played with the client to build and reinforce his/her awareness of self and others.
2. After playing The Talking, Feeling, and Doing Game, the client began sharing more about himself/herself and showing some sensitivity to others.
Refer to Behavioral Group (16)
1. The client was asked to attend a behavioral contracting group that works to develop positive peer interactions.
2. The client's group goals for positive peer interaction were set and reviewed each week.
3. The client reported positive verbal feedback from peers within the group on his/her interaction goals.
4. The client's positive gains in peer interaction were verbally reinforced and rewarded.
Encourage Involvement in Cooperative Activities (17)
1. The benefits of involving the client in cooperative activities were discussed with the parents.
2. Options for cooperative activities were presented to the parents, and they were asked to make a commitment to get the client involved.
3. The client was assisted in identifying positive gains he/she could make through participating in cooperative activities such as sports, music, scouts.
4. It was noted that the client's involvement in cooperative activities with peers has increased significantly since the parents have encouraged this activity.
Refer to Camp (18)
1. The client was referred to a summer camp that focuses on building self-esteem and positive peer relationships.
2. The client was helped to identify a list of specific things he/she could do at camp to increase his/her self-esteem.
3. Gains in self-esteem and in peer relationships reported by the client as having been gained through the camp experience were affirmed and reinforced.
4. The client and his/her parents have not followed through on enrolling the client in a summer camp experience focused on building self-esteem and peer cooperation, and they were encouraged to use this resource.
Work through Favoritism (19)
1. The client was assisted in identifying his/her perception that his/her parents have more affection and feelings for a sibling, rather than him/her.
2. The client was assisted in identifying his/her motions related to perceived favoritism.
3. The client was assisted in identifying alternative explanations for his/her perceived favoritism.
Promote Acceptance of Praise and Encouragement (20)
1. The client was assisted in identifying how he/she responds to praise and encouragement from others.
2. The client's barriers to being open to positive feedback were identified.
3. New ways to respond positively to praise and encouragement were taught to the client.
4. Role-play, modeling, and behavioral rehearsal were used to provide the client the opportunity to practice new, accepting responses to praise and encouragement.
Teach Parents to Praise (21)
1. The parents were asked to list all the possible ways they might give verbal affection and appropriate praise to the client.
2. The parents' resistance to giving affection and praise to the client for expected behavior was addressed and resolved.
3. The parents were asked to choose three ways to give verbal affection and appropriate praise and to implement each with the client when appropriate.
4. Affirmation and reinforcement was given to the parents for their reported use of verbal affection and praise with the client.
Reduce Parental Aggression, Rejection, and Quarreling (22)
1. Parental patterns of aggression and rejection were identified in family sessions.
2. The parents were assisted in removing acts of aggression and messages of rejection from their parenting.
3. Various methods were modeled for the parents to respond to the client in a warm, firm, yet caring way.
4. Parent messages of rejection were blocked and confronted in family sessions.
Assign Reading on Peers and Siblings (23)
1. The client was assigned to read material on resolving relationship conflict.
2. The client was directed to read excerpts of Siblings: You're Stuck with Each Other, So Stick Together (Christe and Verdick).
3. The client was directed to read excerpts from Teen Relationship Workbook (Moles).
4. The client was assisted in processing the reading material, identifying key changes in personal attractions that will need to occur to decrease the level of rivalry.
5. The client has not read the assigned material and was redirected to do so.
Assign Reading on Siblings and Rivalry (24)
1. The parents were assigned to read books about siblings and rivalry.
2. The book Siblings without Rivalry (Faber and Mazish) was assigned to the parents to read and process with the therapist.
3. Based on their reading of Siblings without Rivalry, the parents identified two new ways to reduce rivalry and began implementing them in their family.
4. The parents reported positive results from the new methods that they have implemented to decrease the level of rivalry in the family.
5. The parents gave numerous excuses for their inconsistent use of new parenting methods and for the mixed results they experienced.
6. The parents have not read the material on siblings and rivalry and were redirected to do so.
Explore Rejection Experiences (25)
1. The client's rejection experiences with family and friends were probed.
2. Active listening was provided as the client expressed numerous causes for his/her anger, which were based on rejection by family and friends.
3. The client denied any rejection experiences as being the basis for his/her anger, and this was accepted at face value.
Reframe Rivalry as Stage (26)
1. Rivalry within the family was reframed as a normal stage and something the siblings will successfully resolve.
2. Reframing of the family's rivalry experiences as normal seems to have relieved concern over this issue and even reduced the rivalry experience itself.
Identify Past Success at Decreasing Rivalry (27)
1. Times without sibling conflict problems were identified with the family and probed.
2. A solution was developed for rivalry by analyzing times identified by the family as rivalry free.
3. Encouragement was given to the family to keep implementing the solutions from successful experiences.
4. The family struggled to implement the solutions from the past because they were unclear on the directions and timing; these solutions were fine-tuned.
Refer to Parenting Class (28)
1. The parents were referred to and encouraged to attend a support group.
2. The parents reported attending a support group and receiving helpful feedback and encouragement.
3. The parents offered several reasons for not yet attending a support group; they were redirected to do so.
Develop Behavior Modification Plan (29)
1. A behavior modification plan targeting cooperative sibling interaction was developed by the parents and the therapist for the client.
2. The parents were taught how to effectively implement and sustain a behavior modification program focused on reinforcing positive sibling interaction.
3. The parents' administration of the behavior modification plan was monitored and encouragement given to the parents to continue their work.
4. The parents were confronted when they failed to immediately reinforce positive interactions by the client.
5. The behavior modification plan to reinforce positive sibling interaction has been successful in increasing such behaviors and reducing the sibling conflicts.
Evaluate Behavior Modification Contract (30)
1. The effectiveness of the behavior modification plan was reviewed with the client, and the parents were given positive feedback for implementing the contract.
2. Aspects of the behavior modification contract that focused on reinforcing positive sibling interaction were modified with the client and the parents because expectations were set unrealistically high.
3. The parents and the client were confronted on their lack of follow-through on the behavior modification contract, and resistance issues were addressed and resolved.
Teach Use of Positive Consequences (31)
1. The parents were taught to use positive consequences when the client's behavior is unacceptable or disrespectful.
2. The parents were assisted in constructing a list of possible positive consequences to use when the client exhibits unacceptable behavior, along with a plan for implementation of them.
3. The parents reported a reduction in the client's arguments with siblings due to the parents' use of positive consequences, and they were encouraged to continue their use.
4. The parents indicated that they found it difficult to use positive consequences and slipped back into using natural consequences, which were easier.
Teach Problem-Solving Skills (32)
1. The family members were taught problem-solving skills, including precisely pinpointing the problem, brainstorming alternative solutions, listing the pros and cons of each solution, selecting one solution for implementation, enacting the solution, and evaluating satisfaction.
2. The family was assisted in applying problem-solving skills to current problems.
3. The client was assigned the “Problem-Solving Exercise” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
Confront Disrespect and Teach Conflict Resolution Skills (33)
1. Family members' disrespectful interactions were highlighted and confronted in family session.
2. Conflict resolution skills were taught to the parents and siblings.
3. Role-play, behavioral rehearsal, and modeling were utilized to teach the family effective conflict resolution skills and to give each of them opportunities to practice these new skills.
4. The family has struggled to implement conflict resolution techniques, as they give up easily and fall back on old patterns of arguing and verbal abuse.
Identify Environmental Changes (34)
1. The parents were assisted in identifying specific things they could do in their physical environment to reduce conflicts between siblings.
2. The parents implemented the plan to move siblings into separate bedrooms and to stop leaving the older child in charge of the younger; the benefits of this practice were reviewed.
3. Physical changes made by the parents in the home environment were monitored for their effectiveness, and the parents were given support and encouragement for their actions.
Assign Reading on Interventions for Sibling Conflict (35)
1. The parents were assigned to read material on interventions for sibling conflict.
2. The parents were asked to read How to End the Sibling Wars (Bienick) and select from the reading several interventions to implement with their child.
3. The parents were assisted in implementing chosen techniques from the assigned book, and role-play was utilized to help the parents increase their skills and confidence in the new techniques.
4. The parents' resistance to trying new techniques was addressed, and the advantage of using new approaches was seeded with them.
5. The parents have not read the material on interventions for sibling conflict and were redirected to do so.
Assess Dynamics of Underlying Conflicts (36)
1. The dynamics and alliances present in the family were assessed in a family session.
2. A structural intervention was implemented with the family to create new and healthier alliances between the members.
3. Key dynamics that create and promote sibling conflict were confronted.
Develop a Sibling Alliance (37)
1. The siblings were assisted in identifying a common issue to negotiate with the parents.
2. The parents and siblings were taught basic negotiation skills and practiced them in role-play situations.
3. In a family session, siblings negotiated with the parents to expand their freedom and were able to convince the parents to expand their freedom under the condition that the siblings decrease their conflicts.
4. Despite coaching and encouragement, negotiations broke down when siblings started arguing again.
Unite Siblings in Common Cause (38)
1. The siblings were assisted in identifying a common point that they would like to change within the family.
2. The family session was held in which the siblings worked together to negotiate the issue with the parents.
3. Both sides were coached in negotiating.
4. Parents were prompted to accept the point on a specific condition of decreased conflict between the siblings.
Develop Appreciation of Sibling (39)
1. The siblings were asked to list and verbalize an appreciation of each other's unique traits and abilities.
2. The client was asked to complete the “Cloning the Perfect Sibling” exercise from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
3. The client processed the completed cloning exercise and identified key positive points about differences between siblings.
4. The client processed the completed cloning exercise but refused to see the positive points of individual differences.
Refer for Psychiatric/Psychological Evaluation (40)
1. Options for a psychiatric or psychological evaluation were explained to the client and family.
2. The client was referred for a psychiatric evaluation.
3. The client was referred for a psychological evaluation.
4. The parents were asked to make a verbal commitment to follow through with the evaluation and report the results to the therapist.
Monitor Implementation of Assessment Recommendations (41)
1. The parents and the client were assisted in implementing the psychological/psychiatric evaluation's recommendations.
2. The importance of follow-through on the assessment recommendations for the client was emphasized with the parents.
3. The parents and the client were confronted for their inconsistent follow-through on the assessment recommendations.
4. The client and the parents reported following through on each of the recommendations of the evaluation and were given positive verbal affirmation for their efforts.