PERSEDIAAN DALAM AMALAN

– PROSES DALAM TERAPI

KELUARGA

(Fauziah Hanim Jalal, PhD)

Jabatan Psikologi dan Kaunseling , FPPM, UPSI
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WHAT IS FAMILY THERAPY ?

Family therapy – an interactional and perceptual process.

 One- therapist – one or more persons : clients

Specialized form
of dialogue 2
3
 TERAPI KELUARGA/ KAUNSELING
KELUARGA

Satu proses psikoteraputik dijalankan

oleh professional kepada klien untuk
mengubah cara keluarga berinteraksi,
memperbaiki kefungsian keluarga
sebagai satu unit dan memperbaiki
individual dalam keluarga.

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KETRAMPILAN SEORANG TERAPIS
KELUARGA
 Keterampilan (personhood ) seorang terapis
keluarga sgt penting (Aponte, 1992)
 Terdapat kebaikan dan keburukan terapi keluarga
ke atas diri terapis .
 Mempunyai proses pelbagai- personal dan
professional growth
 Umumnya: seorang penyemboh (healer).

 - dedikasi, kesedaran, stabil, kualiti seni/artistik (

intuitive dlm hubungan interpesonal)
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BEBERAPA KESILAPAN YANG SERING
DILAKUKAN OLEH TERAPI BARU
 TERLEBIH PENEKANAN – terlalu details, what
(kandungan) dan proses
 X SESUAI – tanya berapa kali suami memarahi

 / SESUAI – tanya kesan suami marah

 Terlalu berkehendakan semua gembira

- Elok juga kita biarkan keluarga dalam keadaan tekanan

Lebih memfokus expressi verbal
 -bole juga non- verbal komunikasi yang berkesan
 -elakkan dari hanya guna expressi verbal semata .

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BEBERAPA KESILAPAN YANG SERING DILAKUKAN OLEH TERAPI BARU

 terlalu cepat nak mencari penyelesaian

 -terlalu lebih masa pada seseorang ahli keluarga

 SANGAT KURANG PENEKANAN

 Kurang tunjuk penyayang, mesra dan empati

 Kurang terlibat dalam proses teraputik

 Tidak membantu keluarga melakukan perubahan

 Tidak kisah dengan tanda-tanda dari non verbal comm.

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PROSES YANG SESUAI
 It the therapist not plan properly , they are likely to fail.

 “ that is because conceptualizing, planning, and

implementing effective interventions with couple
and families can be more complex given that
family dynamics are intertwined with individual
dynamics” (Sperry, 2005, p.71)

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KEYSTONE OF PROPER PLANNING IN
WORKING WITH FAMILIES.
 Ways to conduct sessions based:-

on one’s impression of a
family,
one’s theoretical position,
one’s clinical skills

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SESI PROSES

A. Pra sesi ( pre-session )

B. Sesi-sesi awal (initial session(s))
C. Fasa pertengahan Rawatan
D. Penamatan ( termination_

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A. PRA SESI
 Perancangan dan Tugas
 Family therapy “begins the moment of the
first interaction” Olkin, (1993. p.32 )
 Initial contact – telephone
 The first person who initiate the phone
calls are usually “ the most interested to
change and may be the most open to
engaging in therapy” (Weber & Levine,
1995, p.54) 11
TUGAS TERAPIS
a. Menjawab telefon ( agar rapport terbina dan
kerjasama wujud dengan ahli keluarga ( Weber,
McKeever, & McDaniel, 1992) serta pamerkan
kompetensi dan kredibiliti.
----
b.Dapatkan siapa yang menelefon, (nama,
alamat, no telefon dan permasalahan, sumber
rujukan, sejarah mendapatkan rawatan, cara
bayaran)
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1. THE REFERRAL PROCESS
 Referral – is a process by which clients enters family
therapy.
 Someone decide that a problem exists and initiates the
idea that a therapy is possible resource.
 Eg questions should be ask:

-Who first thought that there was a problem?

-Whose idea was it for you to seek therapy?
-When you began to think about seeking help, who or
what gave you the thought that therapy might help?

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 why need to explore from the clients?
- who take the initiative
- family level of motivation
- Influential external relationship or
- whether therapy is appropriate in such circumstances
- gains information for subsequent use in developing
mutually satisfying goal for to individual needs

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 Motivation may be addressed during early stages of
the therapeutic process.
 The intake interview conducted by telephone and
includes categories of info as in the tables,
 Ambil maklumat penting mengenai keluarga

 Buat arrangement untuk jumpa dalam masa 48 jam

 ****

 Peringkat ini penting : guna penstrukturan dan

tingkahlaku yang mesra. Kembalinya klien juga
bergantung bagaimana kaunselor berperanan
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TUGAS TERAPIS
c. Bina persekitaran (suasana yang
professional tetapi mesra, Synder, 1992)).
d. Nada suara – caring, supportive, hormat,
receptivity ( menerima)
 e. Appointment perlu di buat dalam masa 48
jam ( melambatkan appointment akan
merenjatkan perjumpaan)
 d. Mengadakan latihan hipotesis mengenai
dinamika keluarga. Contoh buat andaian tentang
family cycle. Cth: budaya keluarga . 16
TUGAS TERAPIS
 e. Buat dignosis awal – contoh anak lelaki lari
dari rumah –
 Andaian
 Ialah berlaku disengaged anak dan bapa.
Anak tak mahu sekolah- enmeshed anak dan
ibu
Andaian ini membantu terapis berfikir tentang
keluarga ini dan perkembangan individu dan
sistem-sistem .
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RUMUSAN
 Dalam pre-sesi ini 3 soalan ini perlu di jawab.
 A. Apa yang berlaku? ( diagnosis awal )

 B. Kenapa perkara ini berlaku? ( guna untuk

formulate a clinical explanation of household
explanation)
 C. Apakah yang boleh di lakukan terhadap
perkara ini dan bagaimana ? ( ttg rancang
rawatan yang sesuai)
 ( ini adalah case conceptualization)
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Steps of the intake interview
1. Referral a. names, address an phones numbers
information b. identify referral sources and the relationship

2. Clinical information a. Get brief description of the problems and any recent changes in the family
b. Ask how the problem is affecting other family members.

3. Previous therapy a. Ask if any family members have been involved in previous therapy
b. Are there other informal helpers who have positive or negative effects on
the family?

4. Family information a. Identify family members and others who are related to the problem.
b. Are there additional extended family members who have strong feelings
about the problem?

5. Scheduling a. Ask for other relevant parties ( e.g. spouses, additional children, referral
information source, extended family, sig friends) to attend the first session. 19
b. Specify date, time of appointment, and location of facility.
B. SESI AWAL (INITIAL
SESSIONS)
A. Fasa ini kritikal dalam menentukan kejayaan
terapi ( Odell& Ouinn, 1998).
 i. penstrukturan (cth, mengajar, mengarah)
 ii. tingkah laku menyokong ( mesra, ambil
erat)
 iii. Sebelum sesi bermula pastikan perkara ini.

 a. siapa yang akan datang? Anak?

 b. beberapa matlamat perlu dicapai dalam
sesi seterusnya. 20
TUGAS TERAPIS
a) Join the family : bina rappo
b) Peroleh pandangan ahli tentang keluarga
c) Pengamatan tentang corak keluarga (family pattern)
d) Taksir apa yang perlu dilakukan
e) Beri harapan (engender hope) untuk berubah dan atasi
resistance.
f) Membuat appointment semula dan beri tugasan
g) Rekod gambaran tentang sesi keluarga dengan segera

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a. Join The Family : Establishing Rapport

- bina kepercayaan
 Peringkat ini dikenali sebagai JOINING (Haley, 1976;
Minuchin, 1974)
 - therapeutic alliance dengan keluarga

 - komponen sangat penting

 Meet, greet dan bina kemesraan dengan ahli-ahli

keluarga secara ikhlas dan pantas.
 Pastikan keluarga rasa selesa melalui social exchange
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a. Join The Family : Establishing Rapport

 Universal or most borrowed .. Used by Minuchin

 Joining is more an attitude than a technique.

 Letting the family know that the therapist understand

them and working with and for them. Protection and
security to explore alternatives.
 Glue that holds the therapeutic system together.

 Interaction pattern that is repeated throughout the

session.

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 Eg Many therapist use metaphoric comparisons from the
client‘s world.
- young couple who likes to go boating was asked for an
assessment .
Wujud rasa kepercayaan dalam diri keluarga.
 The above eg show the couple stage in life. If the couple had
been married for 20 years, different metaphors will be used.
 Joining – closely related to therapist flexibility.

a good chemistry – the ability of the therapist and family to

become comfortable with wide variety of people. 24
STEPS IN JOINING
 1. Greet each member of the family by name

 2. Make friendly contact with each member. Ask each member what he does or she
does, where they live, to share information about the children, so on.

 3. Respect the family hierarchy. Begin with the parents first.

 4. Acknowledge each members’ experience, position, and actions (“so ms. Alia, you
think your son ran away because he was angry with you”)

 5. Normalize experience, views, and actions, ( its is common for people in your
situation to feel the way you do’)

 6. Validate positive things you can say about a family member whenever possible
( Puan Alia, I know you have tried your best to help your son. Its show how much you 25
care about him.)
 STEPS IN JOINING
 Identify family strengths is another way of joining or having a good
relationships with family
 Eg
 1. Emphasize positive statements reported by family members
 (my father listens to me when I have a problem”)
 2. Encourage family members to share their stories about themselves.
 3. Note family interaction that reflects strength and competence
 ( I like the way you help your daughter find her own answers to the problem)
 4. Emphasize times that family member enjoys together.
 (what are they doing, what makes it enjoyable?)
 5. Reframe problems or negative statements in a more positive
 (Your anger shows how much you care about him? )
 6. Emphasize what families do wells.
 (Patients, skills, and coping behaviors . Asking questions: “what works best with 26
your child”)
Theories concerned on: Joining

1. Importance of ethnicity Appreciation of family language, customs,

heritage and beliefs.

2. Development Identification of clients’ age, empathy with

their stages of life.

3. Intergenerational Recognition of significant family members

who may not presents, nicknames,
circumstances, impact on present family
members.

4. Structural and strategic Assessing the family’s hierarchy and

those in authority are truly engaged

5. Erickson and social construction Encourage humor and playfulness. Accept

resistance as a helpful message about the client
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‘s uniqueness
WHY ?
 To be balanced and versatile. Exposed with a
variety of people , culture , language and
metaphors
 Metaphors
 - Farmer: compared to county extension agents.
 - Physician: compared to medical specialist
 - Cares more about physical appearance: – a hair
stylist
 Reasons: easier to joins clients in their world rather
than expecting them to fit the prescribed world of 28
the therapist .
RUMUSAN JOINING
 Summary :
 1. what common ground can I share with the family ?

 2. What family strength can I identify and validate?

 3. How can I address issues of race, gender, culture ?

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b. Peroleh pandangan ahli tentang
keluarga

Apabila mendapatkan maklumat tentang ahli keluarga,

terapis mesti cabar persepsi lama.
Setiap individu dalam keluarga biasanya ada masalah,
individu, atau situasi yang di frame dalam keadaan
tertentu.
Konsep frame ( Baterson, 1955) – satu pandangan
/persepsi yang terbentuk dalam interaksi supaya “ at any
given time certain events are more likely to occur and
certain interpretation of what is going on are more likely
to be made (Coyne, 1985, p.338)
Dengan mencabar terapis mengajak klien berfikir jln 30
penyelesaian yang berbeza.
 . c. Pengamatan corak keluarga

 Formal and informal ways.

 - observation on micro and macro levels of experience.

 - therapist decide : data form past, present of future

 - content vs process

 Family Dance – setiap keluarga mempunyai keunikan

tersendiri. Bagaimana personaliti di pamerkan. (Napeir
& whitaker, 1978)

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 Resnikoff (1981) menyarankan terapis menyoal diri mereka
tentang bagaimana keluarga itu berfungsi :

 - bagaiman penampilan keluarga ini? Cth cara duduk – dekat atau jauh
 Corak komunikasi – cth tolak ansur atau rigid

 ulangan dan nonproductive sequences yang di lihat . Cth bagaimana

cara marah atau puji selepas melakukan tingkah laku tertentu
 Perasaan asas dalam keluarga ini dan siapa yang yang menunjukkan
perasaan itu. Cth anak yang murung memberi kesan kepada keluarga
yang murung
 Peranan individu yang menekan family resistance and apakah most
prevalent family defense . Cth marah atau menafikan
 Subsistem yang berperanan dalam keluarga ini? - siapakah yang jadi
kambing hitam. triangulation
 Siapa yang mempunyai kuasa dalam keluarga ini. 32
 Bagaimana ahli keluarga ini differentiated sesama
mereka? cth – enmeshed atau distancing
 Bahagian kitaran perkembangan keluarga yang dialami
dan adakah penyelesaian yang diambil sesuai?
 Apakah penilaian terapi terhadap keluarga ini ? Kadang-
kadang terapis keliru dan mengaitkan dengan keluarga
asalnya.

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d. Mentaksir keperluan

Terapis perlu menaksir perubahan yang perlu

dilakukan bagi memastikan keluarga tersebut
berfungsi.( L’Abate & Baqarozzi, 1993)
Cth: guna alat ukur diagnostik (West, 1988).

Atau tidak formal – pemerhatian (cara ini selalu

di lakukan).
Perhatikan juga bias kaunselor terutama
berkaitan SES, budaya, tabiat

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HYPOTHESIZING
 Mentaksir apa yang patut dilakukan.
 Perlu taksir agar dapat kenalpasti perubahan yang patut
dilakukan
 -guna beberap instrumen diagnostik , biasanya guna
pemerhatian
 -semasa buat pemerhatian elak prasangka buruk.

 Instrumen – contoh : Family Assesment Device

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e. Memberi harapan untuk berubah
dan atasi keengganan

 Bagi kata motivasi:

 Keadaan keluarga En. Telah melalui masa yang lama,
maka perubahan tidak akan berubah sekelip mata.
Tetapi, jika En. sekeluarga bekerja keras masalah ini
boleh diatasi.
 Boleh juga kenalpasti kekuatan dan asset yang ada
– jiran yang baik, sifat peramah.
 Isu keengganan- cth – menguasai sesi, senyap,
tidak hadir, tak mau bercakap dengan ahli lain, 36
dan membuat kerja rumah.
 BGM hendak atasi masalah keengganan?

 i. Buat sempadan untuk keluarga ( Jaffe, 1991) –

peraturan ttg kehadiran atau panggilan kurang disenangi
 ii. Reframing – different meaning to the behaviors or
interpret positively the behavior.
 Ahli yang enggan= mungkin dia sgt berhati-hati --

 iii. Paradox – strategi dimana keluarga diberi keizinan

untuk ikut cara yang mereka yang mereka hendak.

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f. mengadakan sesi perjumpaan dan memberi tugasan

 - setengah
terapis membuat kesilapan di akhir sesi pertama, dengan menunggu keluarga membuat appointment. Terapis juga boleh mengesyorkan dengan
menerangkan apa yang akan dilakukan pada sesi akan datang.
 Sekirannya sesi sterusnya dipersetujui, langkah seterusnya ialah memberi tugasan keluarga – homework ( diluar sesi terapi)

 Kebaikan tugasan/homework:
 i. bantu keluarga bertingkah laku dan rasa berlainan – keluarga perlu rasa selesa dengan cara yang baru
 ii. Peluang untuk melihat bagaimana mereka berinteraksi

 iii. Bantu terapis untuk menentukan tindakan yang akan dibuat pada masa akan datang.

 Pastikan tugasan itu jelas apa yang perlu dilakukan, bila, bagaimana , a “trial run” perlu dilakukan dahulu,

 Contoh, homework, latihan mendengar dan memprasa

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 G. MEREKODPADANGAN KELUARGA
DENGAN SEGERA

 Buat nota klinikal ; 3 perkara perlu dibuat:-

 a. paper trail – corak atau proses yang dilalui interaksi,
guna masa depan
 b. reflektif dan objektif

 c. mengingatkan terapis tentang percakapan dan tindakan

yang dtelah dilakukan.
 e. catatatn demografik

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 Gather information about clients, their:
 Perceptions,

 Behaviors related to problem

 Relationships

Therapist thus can making hypotheses

about which area of change is the most
appropriate to target
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RUMUSAN SESI AWAL
 Rappo
 Struktur

 Initiatif

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C. SESI PERTENGAHAN UNTUK
RAWATAN
 Sesi ini terapis meminta seluruh ahli keluarga membuat
perubahan . Langkah yang perlu dibuat
 Langkah 1 – penglibatan semua ahli keluarga

 - libatkan juga ahli keluarga yang kurang berminat

( uninvolved)- sebagai pemerhati/reporter/maklumbalas
 Guna circular questioning – cth : bagaimana ayah awak
buat apabila dia menerima jawapan awak?bagaimana
pula emak awak.
 - soalan mampu trigger teraputik change

 Juga, guna kuasa seluruh keluarga- masukkan terus ahli

yang kurang terlibat dalam sesi 42
 Langkah 2 ; jalinkan hubungan dengan ahli keluarga
 - individu ( adik beradik)

 - putuskan sebarang coaliton atau gabungan

 - menyokong sebarang bentuk kemesraan, kerapatan dan

pertumbuhan ( a must ( milstein &Baldwin, 1997)
 Langkah 3 : mengujudkan kontrak dan galak quid pro
quo relations.
 -foster ‘payoff’ in relationship dalam bentuk tingkah
laku baru
 Iaitu konstrak – quid pro quo (something for
something) .. Contoh Siap cuci rumah dapat makan pizza

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 Langkah 4: menekankan perubahan dalam sistem
keluarga
 - proses untuk berubah adalah sukar bagi kebanyakkan
individu.
 -kemahiran baru yang perlu di pelajari

 - mula dengan sedikit atau kecil cth : bangun awal untuk

sediakan sarapan jika masalah rushing setiap pagi, setiap
hari berbuat selama 15 minit utk pasangan yang sibok.
 - tidak mengancam

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 Langkah 5: melakukan penenguhan terhadap tingkah
laku baru.
 Peneguhan positif bagi mengekalkan tingak laku baru
..good job, nice work , Pelaziman tingkah laku baru
 -Melazimkan tingkah laku baru perlu diberi “Token”

 Langkah 6: Terapis perlu aktif

 - seorang terapis perlu aktif dari segi mental, komunikasi
dan tingkah laku
 - gagal jika pasif

 - galakkan celik akal ( ramai yang tahu merokok itu

salah, tetapi mereka tak mampu ubah)

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

 Langkah 7: hubungkan keluarga danga sistem luar

 Dapatkan beberapa agensi untuk dihubungi

 - seperti Pengasih , alcoholics anonymous (AA)

 Langkah 8: Fokus terhadap proses

 Must keep unbalancing

 Continuous in therapeutics alliance of collaboration.

46
 Langkah 9 : Kecindan yang sesuai
 - kebanyakkan keluarga mempunyai persepsi yang
negatif kehidupan mereka, - tragedi, satu hukuman,
 Kesannya – self esteem rendah, rasa bersalah,

 - bantu keluarga rasa enjoy

 -- cautions – not make fun of families.

 Langkah 10 : Bukti perubahan

 -jika terapi lancar , iannya adalah satu bukti.

 -closely observe the family system the new experience

 Cth – lebih banyak bercakap di antara sat sama lain,

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3. THE THERAPEUTIC CONTRACTS (TC)
 Some therapy never mention an explicit agreement
between therapist and clients –however, all therapeutic
interactions are part of a spoken and unspoken TC.
 Therapeutics: a. expectations and b. goals through two
levels of communication-
 Content – verbal information transmitted

 Process – nonverbal manifestation ( some

may clear
and some not, therapist: as neutral negotiator
, hw, clients: defined therapist as a referee.
48
 A. expectation -Intention – must be clear and understood.
Important that expectations of the client be fully known.
 More of personal needs

 - families come with unrealistic hopes, hope of miracles or

some hidden agendas that they not able to say.

Eg. Unfaithful Husband: simply lessen his guilt having

decided to leave the marriage, client hope therapist can
become someone his wife can lean on. ( client unable to
disclose his intention). Can become great influence to the
process if it remains unknown to therapist. 49
HOW TO MAKE EXPECTATIONS
KNOWN?
 1. Provide comfortable atmosphere for sharing all
possible responses.
 2. Make tentative guesses about what the clients may be
expecting
 3. Get multiple points of view.

 3. Some questions may be asked eg

 - who is defining a problem? The present one is priority.

 - involving significant others strongly considered

 - attending fears is important for preliminary goal

50
 B. Goal – more to actual problems defined and mutually
understood.
 - continue a struggle, eg . Early years

Clients – asking for help with child’s behavior

Therapist – anxious to convert their client- families to
systemic thinking. Meaning that too quick to persuade
families to think that their child’s behavior as a family
problem. Communication blame to other family members.
Actually the intent of the therapist was to develop a shared
goal

51
 Settings goals :
 A. Exploration (creative discovery or cognitive change)

 B. Clarification ( reframing or cognitive change)

 C. Experimentation ( behavioral Change)

52
SUMMARY
 A. address client expectations
 1.what are you hoping a therapist can do to help?

 2.what did you think would happen in counseling?

 B. Negotiate the role of the therapist

 C. Provide a rationale for the goal and roles

 D. explore each person's motivation/commitment

 1. is there anything that doesn’t fit for anyone?

 2. what would have to happen for the process to be more

beneficial
 E. address issues of informed consent (confidentiality etc
53
)
 Today ---
 Many social constructionists speak of co-creating the definition
of the problem =
 - asking family to clarify what they would like to see happen in
family therapy ( respect family and some already come with
co-created by others in the system)
 Therapeutic lies on where therapist help to influence clients
away from pathologized view
 therapist : accept the family definitions of the problem while
implicitly exploring possibilities for future change. Flexible
and trusting enough to grant the clients wisdom for further
understating.

54
 DATA : Content vs process

 Content eg
 - family (focus of their concerns) eg . Runaway or hyperactive.

 - a couple – describe their relationship as empty

 Role of therapist :

 listens to what each member says about each other (content)

 Interested in how members interact with each other (process).

Give clue about the intra-family relationships as well as family
and therapist relationship.

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 DATA : PAST, PRESENT , FUTURE
 Therapist decision- to focus past or present of future??

 Fleuridas, Nelson and Rosenthal (1986) suggest to examine

these categories :

1. Differences or changes within the family between

relationships, between beliefs or behaviors or
between their family and other families,
2. Agreements or disagreements between members
3. Explanations of why relationships and interactions
proceed as they do and the intended or perceived
meanings of certain behaviors” (p.119)
56
 Historical approach – focus primarily on client’s
experience of the past.
 Now they have expanded integration of systemic
thinking – eg:
 Framo’s approach seeks information about past
interactions and perception to understand the
development of current relationships
 Milan team: tracking the past life and intervention
focused on the client’s ability to impact the future .

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 Integrated model of change :
 Connections between the original problem and future
solutions.
 The balance must also include guiding families into
“forward thinking”(White, 1986)
 Eg: “ what would you imagine your life to be like when
you no longer have this problem”
 “what things would you like to be doing when this is no
longer a problem?”

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D. TERMINATION (PENAMATAN)
 “progress” dalam terapi keluarga bergerak dalam
circular.
 -ada pertumbuhan

 -rancang dengan keluarga untuk persetujuan bersama

untuk penamatan.
 Fikirkan untuk open ended penamatan

 Kurangkan kekerapan sesi

 Ikut 4 step proses penamatan :

 i. oreintasi ii. Summarization iii. Discussion of long-

term goal iv. Follow –up.
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 i. orientasi – elok di maklumkan sebelum masa nak
tamatkan . Apabila telah mencapai matlamat
 ii. Summarization- review sessions .

 Terapis dan keluarga membuat rumusan sessi yang telah

dibuat
 iii. Discussion of long term goals. –

 Terapis tanya tentang peluang sumber ( resources ) yang

boleh membantu dalam keluarga dan luar .
 iv. Follow-up and relapse prevention

 - tujuan nya ialah terapi keluarga

 tidak pernah tamat. –open –ended maksudnya keluarga

mungkin akan datang semula untuk boost atau elak
regression.
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RUMUSAN
Proses kaunseling keluarga adalah unik kerana ia
melibatkan pelbagai individu dalam keluarga dan teknik
dari beberapa model melalui proses awal, pertengahan dan
penamatan. Setiap peringkat harus dilalui agar maklumat
yang diperolehi lengkap dan betul serta menepati
kehendak keluarga. Peribadi kaunselor sangat penting bagi
kejayaan proses kaunseling.

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DI MANA ADA USAHA DI SITU ADA
KEJAYAAN ~ HAPPY FAMILY ~

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