Running Head: ADLERIAN FAMILY THERAPY AND ASD 1. Adlerian Family Therapy with Families with Children with Autism Spectrum Disorders.

Transcription

1 Running Head: ADLERIAN FAMILY THERAPY AND ASD 1 Adlerian Family Therapy with Families with Children with Autism Spectrum Disorders Jennifer DePrey Seattle University

2 ADLERIAN FAMILY THERAPY AND ASD 2 Abstract This paper will examine the role Adlerian Family Therapy can play in the process of family counseling. The paper begins with an examination of the Adlerian Family Theory, including the theoretical view of mental health and healthy families, the process of counseling, goals of counseling and the role of the counselor. This paper will then examine Autism Spectrum Disorders and families of diagnosed individuals, highlighting the challenges and pressures families of a diagnosed individual commonly experience. Finally, this paper will integrate the application of Adlerian theory with counseling techniques and interventions beneficial to families of individuals with an Autism Spectrum Disorder.

3 ADLERIAN FAMILY THERAPY AND ASD 3 Adlerian Family Therapy with Families with Children with Autism Spectrum Disorders Introduction Autism Spectrum Disorders (ASDs) effect roughly 1% of the American population. ASDs have both individual and systemic impacts, making the participation of the family in therapy ideal. And Adlerian family therapist can contribute significantly to the family s experience in therapy, providing encouragement, reorientation, and education around both the nature of ASDs and concrete skills that will increase functioning and reduce mistaken goals. Adlerian Family Therapy View of Human Nature and the Family The Adlerian view of human nature insists that human beings are essentially social, purposeful, subjective and interpretive in their approach to life (Bitter, 2009, p.101). All behavior is purposeful, oriented towards a goal, and bound by its social context; no act, thought, or feeling can be understood without considering its social context (Abramson, 2007). Starting at birth, the family provides the primary social context for an individual. Children grow into active members of the family quickly; their presence redefines the family constellation many times (Bitter, 2009). Children act in line with their own goals, seeking to grow and find meaning in their family system. The Adlerian view states that parents are the leaders of a family, providing structure and family values. Each member of the family influences each other member. These influences combine with family values and other aspects of the family constellation to create a unique family atmosphere (Bitter, 2009). Model of Mental Health and Healthy Families A healthy family is one in which parents provide the family with leadership and relate to their children in healthy and productive ways. Parents provide a model for their children in how

4 ADLERIAN FAMILY THERAPY AND ASD 4 to participate in the world and get along with others (Bitter, 2009). Ideally, parents will use a democratic child rearing parenting style, helping their children to understand natural and logical consequences, and providing them with emotional and psychological support. Adlerians believe that effective parenting is based on social equality between parents and children (Bitter, 2009). A healthy individual is one that is well connected to others, has a distinct framework for his or her life, and aligns their goals with this lifestyle. From the Adlerian view, disturbances in mental health are created by mistaken goals and a lack of social connectedness. In a family, a lack of connectedness can contribute to breakdowns in understanding and the perpetuation of mistaken goals. Children in a family may present problem behaviors around four common mistaken goals: attention getting, power struggles, revenge, and a demonstration of inadequacy. Bitter (2009) adds to these goals three more, which are particularly common in very young children: getting, self-evaluation, and avoidance. Parents also engage in mistaken goals in relating to their children. Adults tend to try and create a picture of themselves as good parents, often by trying to be in control of their children. Parents may seek power or revenge against a child that is consistently challenging their authority. The may also behave in ways that support the idea that a child is hopeless, not worty of their effort to raise (Bitter, 2009). Parents and children can become locked in repetitive, negative interactions based on mistaken goals (Bitter, 2009, p. 97). The mistaken goals motivate both parties to continue to engage in problematic behavior. Goals of Counseling The Adlerian goals of family counseling focus on modifying the motivations of individuals and the family unit. The therapist must work with the family to make specific process changes, designed to help families develop new goals. These goals must promote functional

5 ADLERIAN FAMILY THERAPY AND ASD 5 interactions within the family in place of previous mistaken goals (Bitter, 2009). In the process of co-creating a therapeutic contract with the family, the therapist often suggests broadening the scope of goals presented by the family (Abramson, 2007, p. 373). These broader goals often provide a way for therapists to include Adlerian educational goals, incorporating parenting skills training (Bitter, 2009). The Adlerian family therapist works to help improve the social relatedness of families, including working to establish parents as leaders of the family and support their development and growth into effective parents. Counseling Process and the Role of the Counselor Adlerian family therapy follows a basic pattern, beginning when the family first enters counseling. Family members often approach therapy expecting that someone else will be treated and consequently altered (Abramson, 2007, p. 373). The therapist must help family members realize the necessity of each family member s willingness to examine their contributions to the challenges facing the family. Adlerians don t necessarily insist that all family members participate in the counseling process, as long as the focus is on family interactions, though Abramson (2007) notes that it is easier to evaluate such interactions when they are present. Throughout the counseling process, the counselor works as a collaborator, joining with the family in a mutual relationship. After intake, Adlerian family therapy is broken into four stages. The first stage focuses on building a mutual respecting and trusting relationship between the counselor and family. This relationship helps individuals to understand the benefits of family therapy (Abramson, 2007), and is necessary before change can occur. It is also important that the family work to establish cooperative, supportive relationships in counseling.

6 ADLERIAN FAMILY THERAPY AND ASD 6 The second stage, investigation, takes place simultaneously with the interpretation phase. In the investigation stage, an Adlerian counselor seeks to understand the lifestyle of the clients, including the view of the world from which they operate. During this phase, the therapist shares their impressions and may offer interpretations. The family judges whether those impressions fit with their lifestyle (Abramson, 2007). In investigation, the therapist is trying to answer the following questions: What is the goal of each family member? What are the costs and benefits of achieving those goals and who pays the price of achieving them? (Abramson, 2007, p. 377). Investigation focuses on the family constellation, the motivations behind interactions that cause problems, and the typical day in the life of the family. By investigating a typical day, the therapist often comes gains insight about repetitive interactions (Bitter & Main, 2011). Investigation should also examine on the marriage contract, the collection implicit and explicit expectations the couple constructed when they entered into a relationship (Abramson, 2007). While an Adlerian counselor is investigating, they are also participating in the interpretation stage of counseling. In family therapy, interpretations can be aimed at individuals or the whole family. The therapist must take care in offering interpretations to individuals in front of other family members, as it is possible others may use this information to undermine the individual member s goals (Bitter, 2009). However, offering interpretations in the presence of other family members can also help others to see the way an individual is thinking, and begin to understand the nature of their motivations (Abramson, 2007). The final stage of Adlerian counseling is reorientation. In this stage, the therapist steps into the role of teacher or guide, educating clients about the general rules of human relations and communication (Abramson, 2007, p. 382). Clients must have an understanding of these rules before they can develop a more functional family life. The counselor works to guide the

7 ADLERIAN FAMILY THERAPY AND ASD 7 family away from a negative atmosphere of criticism or competitiveness and towards an environment of mutual respect, equality, encouragement and cooperation (Abramson, 2007, p. 382). In this stage, counselors pay extra attention to the tasks of helping family members to understand the purposes of their behavior (Bitter & Main, 2011). Family therapy should only end after new goals and new supporting behaviors are in place and the family is operating in a functional, connected way. In addition to acting as an educator, a primary role of the Adlerian counselor throughout counseling is that of encourager. The counselor offers encouragement to individuals and to the family as a whole, placing emphasis on the assets and strengths of the family unit and finding a way to help family members encourage each other (Abramson, 2007). Families with children with Autism Spectrum Disorders Overview of the Population Autism Spectrum Disorders are classified in the DSM-IV as pervasive developmental disorders, including both classic autism and Asperger syndrome, a form of high-functioning autism in which language delays are not present. ASDs are usually characterized by impairments in social interaction and communication, as well as fine motor skills and sometimes, cognitive skills. ASDs occur in approximately 1 of every 150 children in the US, impacting roughly 1% of the population. ASDs are about 4 times more common in males than females (Bradford, 2010). ASDs exist on a spectrum; the manifestation of ASDs will look different in every patient. The majority of individuals with ASD have a milder form, such as Asperger Syndrome. In general, symptoms fall into three overlapping categories: social impairment, communication difficulties, and repetitive behavior. Recent research suggests ASDs may be caused by

8 ADLERIAN FAMILY THERAPY AND ASD 8 structural and functional differences in regions of the brain (Bradford, 2010, p. 162). There is also evidence of genetic markers, suggesting a genetic predisposition. Challenges and Pressures for individuals with an ASD ASDs are characterized by difficulty with social interaction and communication skills. Younger children with ASDs may show little interest in friendships; older children may show an interest, but will lack the necessary skills (Bradford, 2010). Some forms of ASDs also include a lack of language skills; in other forms, such as those recognized as Asperger Syndrome or highfunctioning autism, language develops normally. Individuals with these ASDs have difficulty navigating conversations, because they lack an understanding of the social aspect of language. It is hard for these individuals to understand abstract or figurative language, or read body language or facial expressions (Stichter, Herzog, Viovsky, Schmidt, Randolph, Schultz, & Gage, 2010). Those with ASDs are likely to also suffer from other conditions, most commonly anxiety and depression. Symptoms of hyperactivity are common in those with ASDs; these symptoms can be severe enough to constitute a diagnosis of Attention deficit hyperactivity disorder. (Lozzi- Toscano, 2004; & Ghaziuddin, 2002). Stichter et al. (2010) note that many people with ASD have trouble with theory of mind: the ability to postulate and make assumptions about mental states of others. Children with ASDs experience delayed acquisition of theory of mind, which neurotypical children begin to acquire during the preschool years. The delays are particularly evident in the areas of perspective taking. This difficulty with perspective taking is the root of most social difficulties (Stichter et al., 2010). Challenges and Pressures facing the family of an individual with ASD ASDs considerably impact family life. Families with a child with an ASD face a number of challenges and pressures, including financial hardship, stress, and unpredictability about the

9 ADLERIAN FAMILY THERAPY AND ASD 9 future. They may also face negative reactions of other family members or individuals in society (Ramisch, 2012). Some evidence suggests that the impact of autism on a family is as traumatizing as a major public disaster (Bradford, 2010). There is also pressure politically for families with children with an ASD. In the field of autism research, two competing political ideologies about the causes of autism split the resources available to families into two distinct parties: The autism rights movement, which encourages people to regard ASDs as a diversity status instead of a mental disorder, focusing on social advocacy, while the autism cure movement, which focuses on efforts to cure autism (Baker, 2006). Parents of children with ASD receive less social support than parents of children with other disabilities, and sometimes have more negative views of their own child than parents of neurotypical children (Bradford, 2010). Mothers are more likely to bear the burden of a disabled family member (Bradford, 2010, p. 173) or blame themselves for their child s disability. Relationally, parents are at a greater risk for marital dissatisfaction, depression, and feelings of inadequacy. Parents often report feeling isolated from society (Ramisch, 2012). Parents, siblings, and the diagnosed individual may experience grief responses. These responses are typical at diagnosis, but may also arise as developmental milestones of neurotypical children are missed or altered (Bradford, 2010). The family of a child with an ASD must continually adapt to new changes. As a child with an ASD ages, families may also have to adjust their expectations to include a child that requires life-long care (Ramisch, 2012). Siblings of children with ASDs may foster resentment or guilt towards their family, as typically developing siblings may receive less of their parents attention. When siblings believe they receive different parenting than their disabled sibling, the relationship between siblings is often impaired (Bradford, 2010). Some research suggests having a sibling with autism may

10 ADLERIAN FAMILY THERAPY AND ASD 10 foster greater appreciation of the human condition and of ones own good health (Bradford, 2010, p. 175); other research indicates a sibling is at a higher risk for low social competence. Adlerian Family Therapy with Families with Children with ASD Assessing the Individual and the Family In a recent study, only one in five family therapists correctly diagnosed Asperger syndrome in a child (Bradford, 2010). Evidence indicates early detection can make a significant difference in positive outcomes of therapy and interventions (Ghaziuddin, 2002). Many families enter therapy without a diagnosis or with a diagnosis that isn t accurate, particularly in children with milder forms of ASDs, who may present as quirky or socially awkward without proper assessment (Bradford, 2010, p.164). Accurate diagnoses help families to gain better access to services and understanding of their situation. Counselors in all settings should know the signs of ASDs and be prepared to make the proper referrals for assessment. As Adlerian theory indicates each member of the family has influence over each other member, it is important to consider ASDs contextually; the disorder affects the family, not just the diagnosed individual. The family therapist for a family with a child with an ASD will be part of a team of providers; often their role may be to help parents understand the demands of their child s disorder through education, a role that fits nicely with the Adlerian ideal of reorientation and reeducation. While there is no cure for an ASD, therapists can assist families in learning adaptive coping skills and developing support for long term family care (Bradford, 2010). In beginning therapy, the Adlerian therapist is looking for the repetitive patterns and mistaken goals, just as they would examine relationships in a family of neurotypical individuals. Counselors working with individuals with ASD should keep in mind the need to be explicit with language, avoiding figures of speech or conveying meaning though a specific tone

11 ADLERIAN FAMILY THERAPY AND ASD 11 of speech, and should teach this behavior to family members. While facial expressions, body language, and tone of voice can all contribute to the meaning and connotation of a sentence, those with ASD have difficulty understanding these aspects of language (Lozzi-Toscano, 2004). Short and Long Term Goals of Therapy The primary goal in treating ASDs therapeutically is typically to assist the individual in adapting to social environments (Bradford, 2010). The family, as the primary social environment, plays a key role. Social skills training should be a primary focus of therapy, as a way to alleviate immediate behavioral tensions in the family and as a way to encourage longterm growth in the diagnosed individual. In this form of Adlerian psychoeducation, the counselor should use concrete social skills training and theory of mind instruction with the diagnosed individual ((Feng, Lo, Tsai, & Cartledge, 2008). The therapist should also strive to increase connective and comforting family routines (Bradford, 2010, p. 174). These activities can help to increase connectedness between family members. The family therapist may also play a role in helping the individual with ASD to view his or herself in a more positive light by reframing behavior as wrongly motivated instead of an emotional deficit (Bradford, 2010). This adjusted view can also help family members to gain understanding of the diagnosed individual s view of self, leading to understanding of motivations that are in conflict. Techniques and Interventions Treatments for families facing ASDs should be tailored to the presentation of ASD in that particular family. Treatment should have a predictable schedule; skills should be taught in simple, cumulative steps (Bradford, 2010). Adlerian family therapy focuses on the need of individuals to connect; because those with ASD often have trouble taking perspective of others,

12 ADLERIAN FAMILY THERAPY AND ASD 12 they have a limited ability to connect emotionally with others without concrete social skills instruction. Social skills instruction has shown to be effective in improving overall social skills of those with ASDs (Feng et al., 2008), though it is important to help parents understand their goals for social interaction may not be in line with their child s ability to connect. The family is in the ideal position to provide social skills modeling the opportunity to practice social skills. Family involvement is best practice in treating ASDs (Bradford, 2010). Siblings can serve as peer mentors, helping their sibling learn practice new skills. Social skills training should provide opportunities for the diagnosed child to practice in a variety of environments, including with children of neurotypical development (Feng et al., 2008). Including siblings in the process of social skills training can help them to feel like they are an important part of the intervention process, giving them a new significant role in the family. Theory of mind training can help people with ASD develop their concept of others (Feng et al., 2008). Relationship Development Intervention (RDI) is a relatively new approach to treating ASDs. This approach has the goal of teaching individuals with ASDs how to express friendship and empathy and begin to enjoy connecting with others. This intervention is typically delivered by the parents, after intensive training, and is supervised by an RDI specialist (Bradford, 2010). Psychoeducation will be an important aspect of therapy for all members of the family. Educating the family about ASDs can reduce stress felt by all members, including the diagnosed child. Reframing and normalizing the experiences of families with a child with ASD support the development of hope (Bitter, 2009), and can help to encourage the family. Parents that are able to positively cope with their child s disorder were also likely to face less marital problems. Providing support and helping the family to build their own support system is vital to avoid feelings of isolation (Ramisch, 2012).

13 ADLERIAN FAMILY THERAPY AND ASD 13 Parent education is central to the process of Adlerian family therapy. In this process, counselors work in collaboration with parents to design ways to redirect mistaken goals or actions (Bitter, 2009). Parents must learn to exercise self-control in their interactions with their children. With new, functional goals in mind, parents focus on providing natural and logical consequences, encouragement, and emotional support to their children (Bitter, 2009). The therapist offers the parents plenty of encouragement throughout this process. The family therapist must pay attention to the other needs of the parent, working to strengthen their partnership and position as family leaders. Siblings of children with ASDs also need the attention of the therapist. The counselor should be on the look out for interactions that shortchange neurotypical siblings, and work to help the family recognize the importance of ensuring neurotypical siblings receive adequate attention from and time with their parents. Siblings need help learning to cope with the day-today stress of living with someone who engages in abnormal behavior (Bradford, 2010). As they age, depending on the level of functioning of their sibling, they may also be included in a plan for long term care, which may cause new stress or grief. Conclusion From the point of initial assessment to the continued care and support of all members of the family, a family with a child with an ASD can benefit greatly from the care of competent professionals. A family therapist working from the Adlerian view can encourage the family and offer education and concrete skills. Adlerian therapists can also help the family by reorienting their experience of this disorder and helping them adjust to goals that will increase the overall functioning of their family system.

14 ADLERIAN FAMILY THERAPY AND ASD 14 References Abramson, Z. (2007). Adlerian family and couples therapy. The Journal of Individual Psychology, 63(4), Baker, D. L., (2006). Neurodiversity, neurological disability and the public sector: notes on the autism spectrum. Disability and Society, 21(1), doi: / Bitter, J. R. (2009). Theory and practice of family therapy and counseling. Belmont, CA; Brokes/Cole. Bitter, J. R., & Main, F. O. (2011). Adlerian family therapy: An introduction. The Journal of Individual Psychology, 67(3), Bradford, K. (2010). Brief education about autism spectrum disorders for family therapists. Journal of Family Psychotherapy, 21, doi: / Feng, H., Lo, Y., Tsai, S., & Cartledge, G. (2008) The effects of theory-of-mind and social skill traiing on the social competence of a sixth-grade student with autism. Journal of Positive Behavior Interventions, 10(4), doi: // Ghaziuddin, M. (2002). Asperger syndrome: Associated psychiatric and medical conditions. Focus on Autism and other Developmental Disabilities, 17(3), Lozzi-Toscano, B. (2004). The dance of communication: Counseling families and children with asperger s syndrome. The Family Journal, 12(1), doi: / Nicoll, W. G. (2011). Resilience-focused brief family therapy: An Adlerian approach. Journal of Individual Psychology, 67(3),

15 ADLERIAN FAMILY THERAPY AND ASD 15 NIMH. (2011, October 26). A parent's guide to autism spectrum disorder. Retrieved from Ramisch, J. (2012). Marriage and family therapists working with couples who have children with autism. Journal of Marital and Family Therapy, 38(2), doi: /j x Stichter, J. P., Herzog, M. J., Viovsky, K., Schmidt, C., Randolph, J., Schultz, T., & Gage, N. (2010). Social competence intervention for youth with asperger syndrome and highfunctioning autism: An initial investigation. Journal of Autism and Developmental Disorders, 40, doi: /s