How to Coach Yourself and Others Coaching Families | Page 61

Chapter 4 - Orchestrating Change
This chapter describes the BSFT approach to orchestrating change in the family. The first section describes
how BSFT counselors establish a therapeutic relationship, including the importance of joining with the
family, the role of tracking family interactions, and what is involved in building a treatment plan. The
second section describes strategies for producing change in the family, including focusing on the present,
reframing negativity in the family, shifting patterns of interaction through reversals of usual behavior,
changing family boundaries and alliances, "detriangulating" family members caught in the middle of others'
conflicts, and opening up closed family systems or subsystems by directing new interactions.
Establishing a Therapeutic Relationship
The counselor's first step in working with a family is to establish a therapeutic relationship with the family,
beginning with the very first contact with family members. The quality of the relationship between the
counselor and the family is a strong predictor of whether families will come to, stay in, and improve in
treatment (Robbins et al. 1998). In general, studies have found that the therapeutic relationship is a strong
predictor of success in many forms of therapy (Rector et al. 1999; Stiles et al. 1998). Validating and
supporting the family as a system and attending to each individual family member's experience are
particularly important aspects of developing and maintaining a good therapeutic relationship (Diamond et
al. 1999; Diamond and Liddle 1996).
Establishing a therapeutic relationship means that the BSFT counselor needs to form a new system--a
therapeutic system--made up of the counselor and the family. In this therapeutic system, the counselor is
both a member and its leader. One challenge for the BSFT counselor is to establish relationships with all
family members, some of whom are likely to be in conflict with each other. For example, drug-abusing
adolescents generally begin treatment in conflict with their parent(s) or guardian(s). Both parties approach
counseling needing support from the counselor. The counselor's job is to find ways to support the
individuals on either side of the conflict. For example, the counselor might say to the adolescent, "I am here
to help you explain to your something he or she would like to achieve, the counselor is able to establish a
therapeutic alliance with the whole family.
The BSFT approach is based on the view that building a good therapeutic relationship is necessary to bring
about change in the family. Several strategies for building a therapeutic relationship, joining, tracking, and
building a treatment plan, are discussed below.
Joining
A number of techniques can be used to establish a therapeutic relationship. Some of these techniques fall
into the category of "joining," or becoming a temporary member of the family.
Definition of Joining
In BSFT, joining has two aspects. Joining it is the steps a counselor takes to prepare the family for change.
Joining also occurs when a therapist gains a position of leadership within the family. Counselors use a
number of techniques to prepare the family to accept therapy and to accept the therapist as a leader of
change. Some techniques that the therapist can use to facilitate the family's readiness for therapy include
presenting oneself as an ally, appealing to family members with the greatest dominance over the family unit,
and attempting to fit in with the family by adopting the family's manner of speaking and behaving. A
counselor has joined a family when he or she has been accepted as a "special temporary member" of the
family for the purpose of treatment. Joining occurs when the therapist has gained the family's trust and has
blended with family members. To prepare the family for change and earn a position of leadership, the
counselor must show respect and support for each family member and, in turn, earn each one's trust.
One of the most useful strategies a counselor can employ in joining is to support the existing family power
structure. The BSFT counselor supports those family members who are in power by showing respect for
them. This is done because they are the ones with the power to accept the counselor into the family; they
have the power to place the counselor in a leadership role, and they have the power to take the family out of
counseling. In most families, the most powerful member needs to agree to a change in the family, including
changing himself or herself. For that reason, the counselor's strongest alliance must initially be with the
most powerful family member. BSFT counselors must be careful not to defy those in power too early in the

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