Feeling confident when offering therapy to families is a goal for many therapists and counselors. When we face the limitations of an individual perspective on treatment, we are left to wonder, “What theory, or techniques, can help this client comprehensively?”

Dr. Scott Sells explains two techniques from the Family Systems Trauma Model (FST) that will reframe family problems and help lead to second-order change. FST is applicable to your work whether you see individuals, couples, or families.

Ili: The next question is: "How might these issues present themselves to therapists who mainly work with individuals or couples?"

So, “these issues” meaning the issues of families, the issues of interactional patterns, the issues of trauma. How do you see that these issues present themselves to therapists who mainly do individual work or couple work?

The Stress Chart Technique

Scott: Well, one of the techniques in this model, which is called the Family Systems Trauma Model, that is a technique right out of the gate, for diagnostic and assessment, is the stress chart. And, it's a simple visual thing that you put on a dry eraser board, or a powerpoint slide, which gets that to the family immediately, or individual, or couple.

How stressed out are you on a bad week? Zero percent, you're not at all; 100, you're through the roof.

And so, people start to see their stress. And then, you say—in relationship to whatever percentage you get; let's say it's a hundred percent:

What are your top three stressors?
And then, you do what's called a circular question:
- “You said, I know that your mom, or dad, or significant other is not here, but how much stress do they have in relationship to you and the situation? And, what would their top three stressors be?

So, the client leaves there going, “Oh my gosh! The whole is greater than the sum of the parts.” And so, that's an example.

If you just say, “Go do systems theory,” people are like, “What??” But you use techniques like that.

The Apple Tree Technique

Then, it moves into drawing out an apple tree. So, you put the symptoms, or the stressors, on your stress chart that you just completed with the client, and you put them on apples to represent what you see—like an apple tree doctor would look at the apples and see if they're bruised, or stressed out. And then, what's fascinating, is you say to them:

Will you be my co-detective? Can we go beneath the soil, like an apple doctor, and investigate the toxic seeds and undercurrents that are the drivers of these symptoms?

So, I say, it's just like a doctor doing blood work; they want to look underneath the skin to see.

And people get into this narrative, because then they get to be self-detectives. Like, a parent the other day said, “Yes. I didn't realize that we had unhealed wounds as our toxic seed, and the undercurrent of roots was grief issues. We've never even talked about it.”

And so, you move the narrative from the individual, to expand the symptom out, to let's look at the undercurrent that we have to fix, or cure. People love that, because they come in very much blaming and shaming each other, and that tool: The Stress Chart, to The Seed Tree diagram, to the undercurrent, allows people to become part of a new narrative.

RESOURCES

For more on Family Systems Trauma:

Read an introduction to the model
Grab a copy of the full theory manual
Learn more about Dr. Scott Sells’ course, designed to lead to model mastery, step-by-step

*Affiliate Disclosure: Amazon affiliate links are used in this post to recommended books. If you choose to use our links to purchase a book, Family Therapy Basics will earn a small percentage of your purchase, which goes toward supporting the free resources offered on this site. I appreciate your support, whether by purchasing, reading, or sharing!

*I am a proud affiliate for Dr. Sells’ Advanced Training Course in FST. I only feature clinical experts whose work I believe is valuable and transformational for therapists. Please contact me with any questions.

Let’s Chat

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What questions do you have about the Family Systems Trauma Model?

How To Address Therapy Clients' "Undercurrents" and Stress In Therapy

Treating Traumatized Families: An Introduction to the Family Systems Trauma Model (FST), with Dr. Scott Sells

Dr. Scott Sells, PhD, LCSW, LMFT is my interview guest for this post. He is the founder of the Family Systems Trauma Model, and the Family Trauma Institute, as well as the author of three books on methods for treating families and children, within the context of family therapy.

By watching this video, or reading the transcript, you will learn:

A working definition of the term traumatized family
Three essential steps you may be missing in your clinical work with families.
One thing you can do right now to improve engagement and outcomes with your family clients.
How to learn more techniques that will reinvent your family therapy work.

The Importance of Using Metaphors and Metaphoric Tales as a Therapeutic Intervention

Metaphor is a figure of speech that consists of naming, describing, or qualifying something through its similarity or analogy to something else. It’s not just about songwriting or poetry-- we use metaphors all the time. After all, we all “fall in love” or “get stuck” at some point in our lives.

In the psychoanalytic approach, metaphors have always been very important, since the unconscious mind is

Are Gottman Method and Emotionally Focused Therapy (EFT) Compatible?

Couples counseling today is so much more effective than in decades past. There is almost too much information out there to guide therapists. It can be overwhelming.

I have seen many discussions about two of the main therapeutic models for couple therapy: Sue Johnson’s Emotionally Focused Couple Therapy, and John and Julie Gottman’s Gottman Method. The discussion can be, like so many discussions, very polarized at times. But there is such a richness and joy to learning from both (not to exclude all of the other contributors to the field right now) that the idea of folding together some of what these models offer seems inevitable.

Family Therapy Basics Research RoundUp: Summer 2019

Periodically, I write summaries of the latest research articles that I’ve read (mainly from the AAMFT). This article is a roundup of my recent summaries.

The references listed are from the most current issues of the Journal of Marital and Family Therapy, and I also include a quick summary of a recent book I read in the book club. While MFTs are referenced throughout the summaries, the information is relevant to all psychotherapists, regardless of discipline.

Linear vs. Circular Causality: Systemic Therapy Series

Lately, I’ve been reviewing the history of the marriage and family therapy (MFT) field. Including the stories of MFT pioneers, the shift represented in the field from treating the individual to treating the system, and the core concepts that mark systemic thinking and systemic therapy.

It’s been fun!

I’ve decided to begin a systemic therapy series to review the major concepts of systems theory, as well as how to begin and maintain the systemic perspective.

Steps for Assessing and Fostering Family Resilience in Therapy

Resilience is defined as “The ability to rebound from crisis and overcome life challenges” (Walsh, 2006). It includes a person's sense of hope, support systems, relational encouragement, and emotional endurance.

When families face a crisis, the members' willingness and ability to communicate honestly, tolerate uncertainty, and respect one another's differing needs both define and develop the family unit's resilience during and after the crisis.

In this post, I offer a relational definition of resilience, as well as frameworks for assessing and fostering resilience.

Mindfulness-Infused Therapy: 4 Approaches

You (the readers) have been asking for mindfulness-based interventions to use in your work with groups, networks, or individuals. Today, I am providing a summary of four popular mindfulness-infused approaches, backed by research, that can assist you in enhancing your change-based interventions with clients. These four approaches are: Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, Acceptance and Commitment Therapy, and Dialectical Behavior Therapy.

The Therapist's Battle for Structure and Initiative: A Review

In their now classic family therapy text, The Family Crucible (1978), Napier and Whitaker outline two main “battles” between therapists and clients: The battle for structure and the battle for initiative.

At the time of their writing, concepts of resistance and unconscious processes were accepted within the family therapy field; this may have been due, partly, to the fact that many family therapy pioneers were trained as psychiatrists. While family therapy has moved beyond these views of the therapist-client relationship, there are still ways in which family therapists can use Napier and Whitaker's "battles" to inform and enhance their work.

Appreciative Inquiry: How to Facilitate "Powerfully Positive" Change in Therapy

Appreciative Inquiry (AI) is an approach to change that invites "what gives life" to people and systems to be noticed, discussed, and owned. This specific style of inquiry involves, "the art and practice of asking questions that strengthen a system’s capacity to apprehend, anticipate, and heighten positive potential” (Cooperrider & Whitney, 2005). The goal of AI is to build an appreciation--a positive core--within groups .

Solution Focused Brief Couples Therapy Tips, with Elliott Connie

Elliott Connie is a Solution Focused Brief Therapy (SFBT) practitioner, author, and speaker. He developed an approach to couples work that distills the essence of SFBT into guiding principles for working with couples.

As a therapist who loves working with couples, I am always interested in ways to enhance my couples therapy skills. For this reason, I invited Elliott to explain the reasons why SFBT is his choice for working with clients, as well as how it creates a contrasting experience for couples that have a history in therapy.

Four Systemic Steps for Addressing Anxiety with Therapy Clients

From a systems theory perspective, we, as individuals, exist within a network of relationships and relational interactions. It is within these relationships that problems occur and reside; it is also within these relationships that solutions are generated and maintained (Becvar, 1998).

A systemic approach for guiding clients through addressing, managing, and living well with anxiety takes into consideration not only clients’ relationships with themselves and significant others, but also their relationships with anxiety.

10 Therapist (and Child)-Approved Activities to Support Kids with Anxiety

If you’re a mental health professional working with children, you will probably agree that many of the calls you receive from parents have something to do with anxiety or stress. Child therapists have the amazingly important yet challenging task of educating and supporting kids in a therapeutic setting that is both productive and fun. When working with children as young as preschool age, it can be a very daunting task to keep things fresh and exciting week after week! So, how do we help children develop the coping skills they need while keeping them engaged (and not glancing at their watch)? Here are ten therapist (and child!)-approved, fun activities that address anxiety-based disorders and promote relaxation and stress reduction in children:

The Art and Science of Therapy as Craft, Part 2: Crafting Questions

For this week's video chat, Dr. AnnaLynn Schooley returns to discuss therapy questions as an intentional craft, and she covers four basic question types: single answer, open, closed, relational, and circular.

Therapist Self-Disclosure Simplified

Self-disclosure is a touchy subject among therapists. Some therapists never self-disclose, while others feel stifled by having a rigid boundary around self-disclosure. As I consider self-disclosure in therapy, I ask myself, “When is self-disclosure appropriate?” “How does self-disclosure deepen the therapist-client connection?"

Family of Origin Exploration for the Therapist: How to Create Your Genogram

In article three of the Family of Origin for the Therapist series, you learned 3 simple steps for how to begin family of origin (FOO) exploration: 1) read Bowen’s chapter, 2) observe your FOO experience, and 3) reflect on what you learned. Hopefully, your curiosity has led to significant understanding.

Understanding is the foundation of Bowen Family Systems Theory (BFST). Bowen (1985) believed that if clients could understand themselves as members of their FOOs and as created by their histories, they could begin and continue significant change.

In today’s post, I offer the next step in developing understanding: Creating your genogram. I explain how to create a basic genogram that you can expand as you continue your exploration.

5 Tips for Keeping Up with Therapy Paperwork

In my interaction with therapists as a mentor and supervisor, I’ve learned that one of the main struggles therapists face is having too much work and not enough time. Many therapists find themselves overwhelmed by documentation responsibilities, in particular; this includes completing client notes, referrals, billing, treatment plans, etc.

In today’s post, I offer several strategies for keeping up with paperwork, so that you can stay on track and avoid the stress of falling behind.

Solution-Focused Brief Therapy Client Types, and Their Relevance To Every Session

In her 1989 article, Of Visitors, Complainants, and Customers, Insoo Kim Berg details three types of “client-therapist relationships” (p. 21). Her wording is significant, because she is not labeling clients; she is describing them in terms of their relationship to the therapist, the process of therapy, and the problem. These three relationships have undergirded Solution-Focused Brief Therapy theory and interventions over the years, although they are not consistently discussed in newer works. The client relationship types are widely applicable to therapy, regardless of theoretical orientation, making them one of the most useful concepts in marriage and family therapy.

In this post, I present a review of these client types, and I explain their relevance to and usefulness for all therapeutic sessions.

How to Ethically Offer Coaching as a Licensed Therapist: A Step-By-Step Guide

One of the most common professional goals for my clients is expanding their private practice to include life coaching services. As professionals with a depth of knowledge in personal development and goal achievement strategies, therapists are ideal candidates for the coaching profession. Despite this near perfect fit, there are some important ethical consideration for therapists when offering coaching services alongside therapy, or when choosing to become professional coaches. In this post, I focus on offering solutions for these complications, in an effort to help you ethically practice coaching.

5 Step Plan for De-escalating an In-Session couple Argument

Most of us, therapists, have been there: A simple disagreement turns into an all-out screaming match in the middle of a therapy session. This is, thankfully, not a common scenario for most therapists, but it’s also not rare--especially for therapists who specialize in couple therapy.

In this post, I cover steps for disrupting an argument occurring in a couple therapy session. Intervention on the part of the therapist is necessary during some conflicts, because the arguments can cause further damage in the couple relationship. And, if therapists allow arguments to continue for too long, they can affect the couple’s sense of safety when in therapy.

The main goals of intervention in this case are to: