Safety within the Therapeutic System
Client implies or states that therapy is a safe place.
The client might not necessarily use the word “safe,” but the implication in his/her words is that he/she feels safe. This item requires some kind of verbal indicator; nonverbal indicators are not sufficient for this item to be checked. Implicit examples are when someone says he/she decided to wait until the therapy session to discuss something with a family member or says something like, “It’s okay to cry in here” or “I didn’t know whether I would have the courage to tell you, but...” or “I’m glad we finally made it here.” The point is that the client suggests that the therapeutic environment is valued for its safety, not only as a place to solve problems. At times the indicator may be quite subtle, as “I don’t know quite how to say this, but I’ll just take the plunge,” or “I hope you [other family member] don’t mind my saying this, but....”
Client varies his/her emotional tone during the session.
This item refers to a non-subtle tone variation. Of course, all clients vary their tone over the course of a session, but this item suggests variability with emotions like anger, sadness, fear, happiness, which is signalled by tears, laughing, angry words or tone of voice. This item is not checked if the client is fairly neutral or calm throughout the entire session or if the client is crying or hostile and angry throughout it all. Also, this item is not checked if the tone is simply excitement. In other words, emotion refers to feelings of sadness, anger, happiness, or fear. Note that this item can only be checked once, not every time the tone varies because it refers to the presence of a plasticity of emotions.
Client shows vulnerability (e.g., discusses painful feelings, cries).
For this item to be checked, either the process of the session is a difficult one for the client (shown by crying, for example) or the content of what the client is discussing is difficult and painful (shown by hesitation, anxiety, or verbal expressions of how hard it is to talk about something). Sometimes the content of the client’s messages alone suggest vulnerability, as when one family member asks another if he loves her or when one family member asks another for help or forgiveness (i.e., the client is clearly “going one-down” in interaction with another client or the therapist). Some clinical judgment may be needed with this item. The judgment here is whether the communication seems to be difficult for the client. For some clients, admitting depression or anxiety would be a sign of vulnerability (shown by tone of voice or nonverbal manifestations of unease), whereas for others, such an admission is not a sign of vulnerability.
Client has an open upper body posture.
Although some people naturally sit in an open position, this item is checked when in response to what is occurring in the session the client shifts to an open upper body position. The item is also checked (once) if the client sits that way naturally throughout the session. If the client moves back and forth from open to closed body posture in response to the surrounding interaction, each time he/she opens up, the item should be checked.
Client reveals a secret or something that other family members didn’t know.
For this item to be checked, it must be clear that the client is saying something that is news to other family members. (The “something” needs to be something meaningful, not mundane, such as what the client had for dinner.) The information may or may not be a SECRET that has been deliberately withheld (e.g., the father’s alcoholism, the wife’s affair, the child’s failing grade) but some important piece of information that was not common knowledge, such as the daughter having reached puberty or the fact that the son doesn’t respect his father. For this item to be checked, the revelation of material is significant enough to signal that the speaker feels safe enough to tell others something that was previously hidden or private, i.e., something it did not feel safe to disclose at home.
Client encourages another family member to “open up” or to tell the truth.
Commonly, this item is checked when a parent gently (not harshly) urges a child to speak, but it may also be a statement between adults like, “It’s okay. You can tell [therapist]” or “This is the place to discuss it,” or “We won’t get anywhere if you don’t tell me how you really feel,” and so forth. For this item to be checked, the tone of voice must be one that encourages rather than demands disclosures, i.e., suggesting that it is safe to talk about these things in therapy.
Client directly asks other family member(s) for feedback about his/her behavior or about herself/himself as a person.
It is risky to ask other people for their candid impressions of one-self. This item is checked only when the client explicitly asks for feedback about behavior, as in “Do you think I’m doing better?”, or about how he/she is perceived by others, “Do you think I’m overweight? attractive? a good parent? nice enough to my mother?” Questions could also include how the other person construes the speaker’s behavior, as in, “Why do you think I did that?”
Client expresses anxiety nonverbally (e.g., taps or shakes).
This negative item implies a lack of safety in the therapy environment. Although some people are naturally more anxious than others, this item is to be checked only when there is a clear, overt sign of anxiety, such as fidgetting, shaking, quavering voice, and so forth. If the anxiety persists at the same level throughout the session, it should be checked only once, unless the anxiety is so heightened or disruptive that it warrants additional check marks. If the anxiety is demonstrated in response to something that is said or takes place in the session, the item should be checked each time the overt anxiety is manifest. Note that this item only refers to nonverbally communicated anxiety. If the client talks about how anxious he/she feels in the session, the item “shows vulnerability” should be considered instead.
Client protects self in a nonverbal manner (e.g., crosses arms over chest, doesn’t take off jacket or put down purse, sits far away from group, etc.)
Self-protecting behavior can have many meanings, and this item should only be checked when the context of the session suggests defensiveness. For example, many people cross their arms over their chest for comfort. But the item should be checked when the arms crossing is clearly in relation to what is being said in the session. As an example, the father crosses his arms when the therapist asks the daughter, “How would you describe your relationship with your father?” Another example would be the wife crossing her arms as the husband starts to talk about her lack of sexual interest. At times a client might cross his/her arms on arrival in the therapy room, and this is a defensive pose. Thus, if the arms crossing is not clearly in relation to what is going on, this item should not be checked. If the arms crossing occurs throughout the session and there are other clear, nonverbal signs of defensiveness (hand on forehead while looking down, legs crossed in air as if to create a barrier, looking anywhere but at other family members, coat over lap), this item should be checked. Clinical judgment can be used here; if the behavior seems defensive or self-protective in the context of the session (keeping coat on, purse over chest, umbrella in hands, or moving one’s seat away from the group), this item can be checked.
Client refuses or is reluctant to respond when directly addressed by another family member.
This item is checked when, either verbally or nonverbally, a client fails to respond to a direct request (question or remark) from another client. A lengthy silence in response to a question is one example, if the silence indicates either a negative reaction to the other family member’s request. Silence that occurs because the client is thinking hard about what to say should not be checked. If verbal, the response must clearly indicate a reluctance or refusal to engage when invited to do so. Verbal expressions of reluctance include “I’d rather not talk about it,” or “It’s none of your business” or “That’s personal.” If the client is clearly reluctant but later relents and does respond hesitatingly, the item can be checked if the reluctance is notable. Reluctance can be signalled when a client avoids answering a question by turning to a third person, as in: Husband (to wife): “Tell me why you don’t want to go out with my sister.” Wife (to therapist): “You should just MEET his sister, wow! She is so obnoxious to me!”
Client responds defensively to another family member.
Defensiveness is indicated when, in a non hostile manner, the client uses clearly complaining or criticism in response to other family member who is demanding explanations or justifications for his/her behavior. Often, defensive responses are part of a communication pattern called “cross-complaining”: one family member complains about the behavior of other, and the target of the complaint responds by complaining about any behavior of the first one. If the defensiveness is directed toward the therapist, this item should not be checked. If the client's tone is angry or hostile, the item Family members blame each other should be checked instead, and if the comment is not hostile but is devaluing or disrespecting of the other person, the item Family members devalue each other's opinions or perspectives should be checked. In other words, defensiveness is indicated when the client has been put on the spot by another family member to explain or justify his or her own attitude, behavior, or choices and answers back by complaining defensively about any behaviour of the other (instead of explaining his/her own behaviors). Examples include (without overt hostility): "You are asking me about my behaviour with your son but you do not say anything about your behaviour with YOUR sister” or "You are saying you do not understand my hostility but last week YOU were very aggressive with me too, you yelled me three times”
Client makes an uneasy or anxious reference to the camera, observation, supervisor, or research procedures
This item is indicated if the client spontaneously mentions these extra-therapy procedures in a way that suggests uneasiness. Examples might be, “Do you tell your supervisor everything we say?” or “I wish we could turn the camera off sometimes” or “How do I know that you won’t send the tape to Child Protective Services?” A nonverbal indicator might be looking warily at the camera and then deliberately leaning forward and speaking much more softly