How Do We Get Therapy Progress to Really Stick?

This episode of Family Trauma Step-by-Step Tools covers how to get therapy progress to really stick.

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Today’s technique is called the FST mini scale. Are your clients at a new normal of change? This is a really interesting strategy because most of us or all of us want to see second order change in our clients. This means permanent change after treatment has been terminated so your clients don’t return to status quo. But what often happens is what’s called first order change. For the clients that we work with, the traumatized families, the individuals, couples change is temporary while they’re in treatment but then as soon as treatment is over like I said before they return to first order change.

So, this strategy I believe will really help increase the odds dramatically towards moving to second order change with our clients and preventing relapse.

So, the FST mini scale like I said it was developed to really increase the odds of second order change. Let me describe what those are. So, first order change of course is the client change is temporary. Let me give you two quick examples to make this definition just come alive and then I want to give you a short case study to show you this technique.

So let’s say you have a teenager who’s on probation. They say to you, and I’ve had this happen before actually, “I’m on probation but as soon as I get off I’m going back to the same way I used to be.” That’s first order change. Or you could have a client that says, a mom, “Yeah, thanks therapist you’re helping me learn how to stop criticizing but I’m not really taking credit for these changes, I don’t really believe they’re going to work.” And so, after treatment’s over the mom starts criticizing again or as well I’ve had counselors say, “They keep calling me up every time there’s a crisis and it’s just a revolving door.”

A second order change means that what you do in treatment is lasting long after treatment’s over. So for those same two examples let’s take the adolescent on probation he turns to you and says something or she, “Yeah, since I’ve been on probation my parents have changed, they’re much more fair, they’re much more level headed. I don’t know if it’s probation or whatever but long after the probation is over I think I’m going to maintain this change, more respect, less aggression, et cetera.” That same parent also says in a different setting, “Yeah counselor, you really helped me learn how to not criticize my child. I see a higher calling. I’m taking credit for these changes and so I’m going to stick with these.”

That’s what we’re after.

So, let’s go to this technique so you can see how this works.

So, the FST mini scale, now here is what it looks like. I’m a very visual learner hopefully you are as well. So as you can see these are called mini scales and in the FST model there’s something called undercurrents. These are unseen to the naked eye. I’ll tell you later how you can find out more about these in a very easy way but for now undercurrents are what we’re trying to get after because that will bring about second order change. You’ll see this in a moment.

Let’s take a case that I worked with so you can see this. So, Lisa’s story is she’s 15 years old. She comes to me.  She’s in foster care.  The goal is to reunify with her biological mom, but before she was removed from the home there was extreme mental abuse and neglect from mom which both left Lisa feeling betrayed and very unforgiving.  There’s a lot of unforgiveness.

So, the FST model looks for these undercurrents as like the KFC 11 herbs and spices, the Coke formula or the secret sauce. What you see here that you’ve got these undercurrents that are typical that fill what’s called a wound or a trauma seed.

So in this case we see betrayal and abandonment with Lisa and her mom which the healthy undercurrent is forgiveness and attachment to counteract the unhealthy undercurrent. No family secrets in this family but there is some mental abuse. As we go on we see that a tremendous amount of criticism, put downs from the mom. She was traumatized with generational trauma. She was doing the best she could but didn’t have the tools. And so, there needs to be some accountability because the daughter wants to say, “I need forgiveness but I need you to be accountable for your hurt and pain.” And then of course we have the forgiveness around the betrayal or abandonment.

So this is a good place to start. So in treatment I’m able to work with what’s called a trauma playbook to give the family the tools so when mom and a daughter come together there is accountability, there is forgiveness, there is attachment. But what I’m worried about is the stickiness factor. Is this going to stay or as soon as stress hits are we going to go back to first order change? So to help take out an insurance policy, this technique was developed.

So, before FST treatment I ask them on a scale of one to five where they were, five being there’s a lot of forgiveness, one not even being close and the first answer they give is two before treatment starts. Accountability, the daughter’s a one and attachment a one. So my goal is to utilize these skills towards the end of treatment and say, “Okay, now where are we?” Clients love to have measurable impact and see it and also you’re going to see that there are co owners of the story and when people are co-owners of the story, then the changes that they make they take credit for. Again, my goal is to get fired from my job. I want them to say, “I did this.” Because if they said, “Dr. Sells you did this,” guess what? I may win the battle but lose the war, the war being that they’re not going to stay changed after treatment’s over.

So let me go through this step by step.

So I say to the mom and the daughter, “Hey, I want to take things a step further. I want to take the next 20 to 30 minutes and ask you a question around what we call mini scales. These are used to see how much progress you made on each of the healthy undercurrents that we targeted at the beginning of treatment to help your child.

So here’s the question. On a scale of one to five one meaning there’s been little improvements since we started family systems trauma counseling to five meaning a hundred percent positive change since FST counseling, where do you think you started and where are you today?” Families love this question because they’re like, “Yeah, I like this let’s keep going.”

And so here I say, I’ll just give one example because of time.  Let’s take forgiveness. They start two out of five but then when I ask the question they’re at a four out of five. Now if you just did that that’s helpful but again it’s not going to be enough.  Let’s watch what you do here next.

“After this answer I’m going to ask you how do you account for this improvement.” Or, “What’s been happening in your feeling now or since treatment to account for this improvement?” You probably know where I’m going with this question. I want them to take credit for the changes because the odds will increase that they take ownership of that and when they take ownership of it, it sticks.

Watch what happens here.

So I say, “Remember the healthy undercurrents, they’re really important to look at.” And every client wants to know what’s in it for me. “If we heal them and we help heal your child’s wound long after counseling ends, they stay healed.  So, I’m going to ask you, “How do you account for this improvement?”

So in this family you write them up on a flip chart and big, broad, bold so they can see them like skywriting.  Mom says, “I think I’ve improved in forgiveness and we’re at a four out of five or just at a two because I’ve taken your suggestions on special outings and no matter what the week is I’m consistent and I have not been consistent before and I think that that has made the change.”

So I say to mom, “Would you ask your daughter?” And the daughter turns to mom and says, “Yep, your consistency has helped me forgive you.”  I’ve also learned both of us,” both daughter and the mother say, “We don’t sweat the small stuff anymore.” And again, I ask them, “What does that look like?” And I’m fanning the flames of hope talk.

We don’t grudges. The daughter raises her hand and says, “That’s a big one. My mom used to just hold grudges and it was just like she kept saying, ‘I got to do all the change,’ and mom knows that she’s got to do some changing too and we have family game night. We connect and have fun. It’s playful. And again, if you hadn’t given us a clear direction with your trauma playbooks that outlined these, it wouldn’t have happened.”

So here’s what you see, they take credit for these changes.

So, let me summarize today’s talk. So there’s three points here I want to make. The FST mini scale was developed to increase the odds dramatically for second order change by helping the family connect the dots. They learn what’s the healthy undercurrent that we contended for at the beginning of treatment and what and where are we today so they can take ownership of all the things that is allowing us to move up the scale. And what we’ve got to do to hold these new undercurrents in place even when the stress or as I say the crap hits the fan.

Also what happens is it gives clients to do something psychologically, a psychological term called consolidate the gains. Again the gains that they’ve made are consolidated with this tool where they can put almost driveway sealant on it so that they can actually say, “I did this and I give words to this.” And these are real safeguards number three to prevent relapse.

If I can be a guide to help with that it’s a blessing for me and I enjoy helping from a servant’s heart. So until next time have a great week everyone. Bye now.

 

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