Session Guidelines
OBJECTIVES Couples will:
• begin to understand the impact of substance use on their own relationship and their families of origin • begin to identify patterns of use and related problems in their own relationship
• further identify and develop their treatment goals.
Group cohesion and commitment will continue to develop.
CHECKLIST
Guidelines for the Counsellor Tips on What to Do with or Say to the Client
1. Check-in Ask about questions or issues arising from the last session.
“Name a thought, word or feeling that describes how you are right now.”
2. Stating the Format and Purpose “Through the presentation of the family trees to the of This Session group, you will begin to understand the impact of
substance use in your own relationship and in your families of origin. This will help you to focus on areas for change and relationship goals. We will begin this process tonight with a review of your family trees, and we will continue to explore goals and areas for change in later sessions.”
3. Reviewing Family Trees Each couple will present their family tree, which will be taped to the wall. All of the family trees will be explored with the group in terms of patterns of family relationships, and positive and negative aspects of these relationships. Group leaders will record common themes and issues on a flipchart, keeping in mind potential areas for change and treatment goals.
To the extent that it is comfortable for the client who is sharing, explore relationship patterns, substance use, and similarities and differences across generations that may be influencing the current couple relationship.
Ask couples to “identify two things of interest that helped you to do this — one pleasant surprise and one not-so-pleasant surprise.”
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4. Homework (Miracle Question) Couples are instructed to complete the Miracle Question handout for discussion in the next session. Note that the purpose of the Miracle Question is to instil a sense of hope and agency in each individual. It is not to encourage one partner to try to change the other partner.
“This exercise will help you to create a future vision of your relationship. Please read each question, think about an answer and then write down your response. Each partner can have a different miracle. You will share your miracle with the group in our next meeting.”
5. Check-out Ask each group member to state one positive word that he or she is thinking or a feeling that he or she is experiencing. The therapist can begin with an example such as “I’m feeling hopeful.”
SESSION 2 | GENOGRAM/FAMILY TREE
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Session Resources
MATERIALS
• tape for taping family trees to the wall or a stand to put up family tree flipcharts
(Note: two stands would make it possible to put up flipcharts for both partners, side by side, for further comparison of patterns and themes.)
• Miracle Question homework sheet
(Note: if a client is unable to write, or if English is not his or her first language, the client may use other methods to answer the Miracle Question, such as drawing symbols, writing in his or her first language or making brief notes to jog memory.)
SUMMARY
1. Check-in
Discuss comments or issues arising from the last session.
2. Stating the Format and Purpose of This Session
3. Reviewing Family Trees
Focus on areas of change and treatment goals.
Review family trees.
Allot sufficient time — approximately 10 minutes per person.
Group leader(s) record common themes and issues on a flipchart — note potential
treatment topics and goals.
Explore patterns and themes with couples.
Identify one pleasant surprise and one not-so-pleasant surprise.
4. Homework (Miracle Question)
Describe the purpose of the Miracle Question.
Explain how to do it — give examples of concrete miracles.
Remind couples they will be sharing their miracles with the group.
Hand out packages.
5. Check-out
T I P S F O R I N D I V I D U A L C O U P L E S E S S I O N
• Check-in: Ask the couple to talk about anything that came up for them as a result of the previous session and then ask them about their week.
• Family Trees: Discussion about the couple’s family trees is briefer in the individual sessions. Extra time can be used to explore more fully and concretely the impact of past family patterns on the substance use and on the present couple relationship. As well, extra time can be used to begin to look at possible changes that the couple might want to make in their relationship.
• Use the extra time to explore what pieces of the family history were known to the couple.
• Ask them if they learned anything new or surprising about their own family or about their partners. SESSION 2 | GENOGRAM/FAMILY TREE
THE MIRACLE QUESTION
After thinking about your relationship, please take a few moments to answer the following
questions:
Suppose one night, while you were asleep, there was a miracle and your relationship issues
were resolved. When you woke up:
• how would you know a miracle had occurred?
• what sorts of things would be different?
• how would you be thinking differently?
• what would you be doing differently?
• how would your family/friends know that a miracle had occurred?
You can provide as much detail as you need to describe what your life would be like after this
miracle. Try to think about your miracle in concrete terms (e.g., “we will go for long walks
together” or “after we put the children to bed, we will spend time cuddling on the couch and
talking”) as opposed to abstract wishes (e.g., “we will be happy”).
Also, be sure to focus on changes in your own behaviour when you are describing changes in
the relationship.
____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________SESSION 2 | GENOGRAM/FAMILY TREE
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SESSION 2 | GENOGRAM/FAMILY TREE
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Progress Note: Genogram/Family Tree
Session date ____________________
Patient/Client Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Health Record # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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■ Patient/Client cancelled Specify action plan ______________________________
■
■ No show ______________________________
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■ Therapist cancelled
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■ Attended Session #2 of the BCTProgram
This session was conducted in the following format ■■ Individual ■■ Group This session covered the following (check one box)
NOT COVERED COVERED
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■ ■■ Patient/Client homework of genograms was reviewed
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■ ■■ Patient/Client discussed preliminary short- and long-term treatment goals
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■ ■■ Homework assigned: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
■
■ ■■ Check-out completed
Drug Use Goal(s): ■■ Abstinent ■■ Reduction ■■ Undecided ■■ No change ■■ N/A Substance Use Since Last Session: ■■ Abstinent ■■ Non-abstinent ■■ Don’t know ■■ N/A
Therapists (print name & credentials): (for group only)
1. ________________________________________________________________________________________________________________________________________________________ 2.__________________________________________________________________________________________________________________________________________________________
Outcome of Session:
■
■ Next Session Scheduled for: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
■
■ Treatment Terminated (patient/client initiated)
■
■ Treatment Terminated (therapist initiated) Additional Notes:
FORM COMPLETED BY
NAME (PRINT) SIGNATURE AND CREDENTIALS DATE
Session Guidelines
OBJECTIVES
. . . .37
CHECKLIST
. . . .37
Session Resources
MATERIALS
. . . .39
SUMMARY
. . . .39
TIPS
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Client Handouts
GOAL ASSIGNMENT 1
. . . .40
Progress Note
. . . .41
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MIRACLE QUESTION
Session Guidelines
OBJECTIVES
Couples will begin to:
• identify any positive small changes within their relationship
• focus on the future and form a vision of how they would like the relationship to be • focus on reasonable and achievable goals that will bring them closer to their vision.
CHECKLIST
Guidelines for the Counsellor Tips on What to Do with or Say to the Client
1. Check-in Ask about issues arising from the last session.
“Name a thought, word or feeling that describes how you are right now.”
2. Stating the Format and Purpose of “By reviewing the miracles that you’ve written down, we This Session hope to help you formulate a vision of how you would like your relationship to be, and communicate this to your partner and the group.”
3. Reviewing Miracle Question Homework Ask couples to discuss their miracles. They may need help keeping the focus of the discussion on themselves, rather than their partners, and on concrete changes.
Encourage concrete, specific and behavioural answers; specifically, ask them what would they be doing differ- ently and not how they would be feeling different. Therapists should listen for small, concrete expressions (e.g., we would kiss each other goodbye when we leave for work).
Ask people if any part of their miracle is already happening, and if so, what is that like?
4. Homework (Goal Assignment 1) Couples are instructed to complete the Goal
Assignment 1 sheet for discussion in the next session.
Couples will individually select a personal goal and a couple goal from their miracle, and write down the steps needed to achieve that goal.
Therapists should encourage positive, action-oriented goals (e.g., “talk twice a week” versus “argue less”) and give clients examples of individual goals (e.g., “I want