SHARED SENSE OF PURPOSE WITHIN THE FAMILY

Family members offer to compromise.
The offer may or may not be in response to the therapist’s request for a compromise. Sometimes the client’s offer to another is clear, as in “Well, if I do [this], will you do [that]?” A client might only make one part of the offer, such as “I could [do this]” or “I’m willing to....” Typically people compromise on something behavioral, but the compromise could also be cognitive, such as “I’ll try to stop looking for the negative in everything, if you do.” The therapist might ask each member of the family to think of something positive to do in relation to other family members, and if the client comes up with something, that could be considered a compromise, such as, “I’ll help Mom with the dishes.” These statements need to be considered in a context of quid pro quo. That is, if a client merely offers to do something different without an implicit or explicit expectation that another family member will also do something in return, the item “Client offers a plan for improving the situation” (Engagement) should be considered instead.

Family members share a joke or a lighthearted moment with each other.
This item is checked only if the humor is evoked during the session, not before it gets started or as people are leaving. The humorous moment may or may not involve the therapist, but for this item to be checked, there needs to be some connection among the family members, i.e., joking with each other, or making eye contact while laughing together. One exception is when a joke reflects negatively on another member, or when family members joke together at another’s expense (see the item “client makes hostile or sarcastic comments to family members”).

Family members ask each other for their perspective.
This item is often a precursor to an offer to compromise. For the item to be checked, family members must explicitly speak with one another, and one person needs to ask another what he/she thinks, feels, or wants to do. Examples include “How do you see it?” or “What do you think is causing this problem?” or “How would you suggest we solve it?” However, simple questions about agreement regarding information or something prosaic(“Was it Wednesday or Thursday that you...?” or “Who said that, Mom?”), this item should not be checked. Also, if spoken sarcastically, however, this item should not be checked. This behavior is also not checked when it was prompted by the therapist, asking, for example, “Why don’t you ask your dad and mom how they see your plan?” (see “complies with therapist’s requests for enactment”).

Family members validate each other’s perspective.
Although validation tends to be thought of as positive (e.g., “I can see where you’re coming from” or “That makes a lot of sense”), positive content is not required for this item to be checked. A couple might agree in the session with each other, for example, that their marriage is over and that they need to separate. The validation might be mixed with other messages, such as, “Although as your mother, I’m hurt by this decision, I recognize your right to do what you want.” This item requires some verbalization, not merely head nods or “mhmm.”

Family members mirror each other’s body posture.
Doing so is generally unconscious rather than deliberate. For this item to be checked, at least two family members must be positioned similarly with respect to both arms and legs. It is important to pay attention to specific moments in which somebody changes his/her body position in response to what is being discussed and another family member mirrors that shift.

Family members avoid eye contact with each other.
Eye contact is a personal and cultural experience. Some people maintain good eye contact with everyone, so that doing so does not necessarily mean there’s a connection. However, the avoidance of eye contact with other family members throughout the session, such as when everyone looks at the therapist and never at each other, is notable. Thus, for this item to be checked, the avoidance needs to be notable, consistent, or prolonged. Avoidance of eye contact among family members is particularly notable when one family members is speaking and others do not look at him/her.

Family members blame each other.
In determining whether or not blame is present, a distinction needs to be made between expressing blame vs. simple responsibility for an action or problem. Blame is usually carried in tone of voice and implies fault. Further, blame tends to be indicated when the client describes a specific event or problem as clearly avoidable, intentionally caused, or due to another client’s negative attitude. Terms like “blame,” “fault,” “if only you had[n’t]...” may or may not be present. Blame may also be expressed through a highly negative, accusatory, or pejorative manner. For this item to be distinguished from the items “devalue each other’s point of view” and “makes hostile or sarcastic comments,” the client must be blaming another client for something, typically for the problem under discussion, or for having done or not done something, for having made a poor decision, and so forth. Examples include, “Your drinking caused all our problems!” or “My son lost his job because he seems to think he can come in late and the boss won’t mind!” or “You screwed up as much as I did when it came to parenting.”

Family members devalue each other’s opinions or perspectives.
This item is checked if the client verbally says something to contradict another client’s point of view in a way that suggests disrespect. The item can be checked if the statement is made angrily, but not if it is made sarcastically or in a mean-spirited way (see item “makes hostile or sarcastic comments”). Examples include, “You don’t have the right to ask me that!” or “That may be your point of view, but that’s just because you don’t give a damn!” or “Who gives you the right to talk to me that way?” The essential point of this item is that clients are not listening to each other in an accepting way. The key feature is disrespect rather than hostility. Note that if blame (i.e., ascribing fault for having done or said something) is expressed, consider the item “family members blame each other.” Note that devaluing is different from simple disagreement (“That may be your point of view, but I think you’re wrong!”).

Family members try to align with the therapist against each other.
Verbal expressions of this item include a client asking the therapist for an opinion in the midst of an argument with another family member or directly asking the therapist to choose sides, to decide who is right, or to intervene in a specific way with someone else, or joking with the therapist at another client’s expense. The meaning of “against” is not necessarily a disagreement, however. It may simply be that one family member accentuates a controversy by including the therapist on his/her side. Examples of these less overt behaviors include saying to the therapist, “Can you tell him again what you told him last week?” or “My father needs to be told that he has to see a doctor for his heart.” As another example, one adolescent may tell another in his mother’s presence, “You need to listen to [therapist], not to mom!”

Client makes hostile or sarcastic comments to family members.
For this item to be checked, there needs to be a mean-spirited exchange, not merely an argument. Name calling, cursing, or threats are examples. The interchange must suggest not only disrespect (see item “devalue each other’s opinions”) but also rage, condescension, contempt, or disgust. If blame (i.e., fault for having done or said something) is expressed, consider the item “family members blame each other.” Joking with one family member at another’s expense could be also an example of this behavior when the joke implies hostility.

Family members disagree with each other about the value, purpose, goals, or tasks of therapy, or about who should be included in the sessions.
The argument or disagreement needs to be clear, not implicit or simply nonverbal. Further, this item is only checked if the disagreement or argument is among the clients, not between one client and the therapist (see item “questions the value of therapy” under Engagement). This item should be checked rather than the item “family members try to align with the therapist” when the disagreement or argument is about the goals, tasks, or value of therapy, as in, “You heard what [therapist] said! We need to be here!” Other common examples include, “If you don’t take this seriously, it doesn’t make sense to come here” and “Why is HE coming? He NEVER does his part in anything!”