Consultations

The purpose of consultation varies. We have the habit of consulting on each others cases when we feel we've run out of ideas or when we think that what we are doing is of no help to the family and there is a need for new and different views.

When you’ve worked for a while in a team, helping clients to construct solutions, and you have become more skillful at this, you will also gradually become more hopeful about the possibilities to find solutions to even apparently impossible situations. You will then soon start asking your colleagues to do consultations in your ‘stuck’ cases and you will be asked to consult your colleagues in theirs.

It is also common that consultations are used in the context of training. The purpose is then two-folded. Besides helping the family a training-group trains working as a team.

When we do supervision it is common that a therapist brings up difficulties he has in relation to some family-member. Most difficulties of this kind can be solved in supervision but occasionally it can be helpful when an "outsider" does the interview with the family and the therapist. This will often give the therapist a completely new understanding of the situation.

Paradoxically consultation-interviews are much easier than most people believe. The expectations on the consultant doing the interview are high both from the therapist and the family. The therapist asking for consultation often does it in a situation, and with families, where there has been therapeutic progress and surprisingly often the family and/ or the client have done much more progress than the therapist is aware of.

We usually want the therapist to be present in the session with the family or the client. The advantage is that we can ask the therapist to comment directly on the progress the family describes and also work with connecting this progress to the work the therapist did. We think this is important so we don’t make it harder for the therapist to continue his work with the family afterwards.

It is often a good start to find out how far the family has come and what the therapist has done that has been useful for the family. Use scaling-questions and ask the family to describe what the therapist has done that has been of help, and also ask the therapist to describe how he sees the family, especially if there has been progress and the family has complimented the therapist a lot. Start as always though by clarifying the context:

"I have been asked by NN to meet with you to help you do an evaluation of your contact/ treatment"

Another way is the consultant asking the therapist, the social worker or whoever is working with the family to tell the reason for the interview.

When it comes to the goal of the interview useful questions are amongst others:

"Imagine this will be a very good meeting, that is useful for you what have we come up with then?"

"On a scale from 0 to 10 where 0 means the worst situation you have ever been in and 10 means the problems are completely solved - where are you today"

You can ask the therapist:

"How far do you think Nisse has come on the same scale?"

"What would be a sign that Nisse is one step higher on the scale?"

"When is the time to end therapy?"

When doing consultation-interviews it is important to remember that the consultant isn’t supposed to take over the therapy. Instead he is supposed to do an interview based on the context and the goal the therapist and the client have defined.

The couple, the therapist & the miracle

Jim has been sentenced to 75 hours of therapy for the second time. The therapist, Mike Weuste, Elmhurst Hospital, Chicago has met him for a couple of sessions alone and has also had some sessions with Jim together with his wife Dora. Mike thinks the couple is very nice and he enjoys meeting them but he wants a consultation. To Mike it seems that Jim just sits the time off and Mike hasn’t got a clue to what to do with the remaining 65 hours or so. Martin Söderquist made the consultation-interview. Harry Korman, Jocelyne Lopez-Korman and Kristina Engman was the team behind the one-way mirror.

MS: My name is Martin

Dora and Jim: Hi

MS: I work as a family therapist in Sweden and we are here doing consultations. I am not alone, we seldom or never work alone meeting couples or families so I have a team behind the screen (MS points and Dora waves her hand). In fact three other therapists and they might buzz the telephone and Mike and I might take a break to discuss with the team. Mike has asked me to do a consultation and in some way evaluate how far you have come in your therapy. Let me ask you the first question. If 0 is the worst situation you ever been in, that is 0. 10 means the day after the miracle, the problems are totally gone and wont come back, that is 10. Where are you today?

Jim: 5

Dora: That is what I was thinking. Probably 5, maybe 6.

MS: Maybe even 6!

Dora: 5,5.

MS: When you started seeing Mike, if I had put you the same question then. . .

Dora: 2.

MS: Then you were on a 2?

Jim: Probably me too.

MS: So you have gone from 2 to 5-6 in how long time? Mike said something about 4 or 5 sessions.

Dora and Jim: A couple of months.

MS: How did you do that?

Jim: Worked I guess.

MS: You worked?

Jim: Working on it.

MS: What did you do?

Jim: We started talking a little bit more about what worried us.

MS: You talked. How did you manage?

Jim: (inaudible - everyone laughs)

MS: If I had asked Dora what do you think she would have answered you had done?

Jim: I donut know.

MS: Guess!

Jim: Talking to her, not being as crabby.

MS: What is crabby?

Jim: Not being upset or yelling at her.

MS: OK.

MS: (to D.) How did you manage to go from 2 to 5,5?

Dora: I don't know . . .. Not being as demanding, trying to be a little, you know and not " Jim, Jim, Jim. "

MS: Not so pushy?

Dora: Yeah, not so pushy.

Mike: How did you decide to do that?

Dora: Not push him to talk, not push him. . sure once in a while I push a bit. I try to think more how I feel about myself and if I have a statement to make to him I’ll do that. But I’m not going at him hysterically, you know. Instead I go to him and say I really don’t like when you do this. Before I was shouting and was upset.

MS: How did you decide not to do it that way?

Dora: My mother gave me some tapes and the tapes were " The dance of anger".

Dora: (to Mike) You are familiar with them?

Mike nods.

Dora: They have a book out and it’s about women controlling their anger. Instead of coming out hysterically talking to their spouse - coming out stating something and just leaving it there. Letting him know about it made me feel better. Before I would still be upset after I would tell him what I want because it would come out all . .

MS: What more did help you to make your decision? The tapes, are there other things too?

Dora: Probably everything, the tapes, realizing we had differences and that we had to go to counseling and being in counseling - knowing we are in counseling together and we are trying.

MS: What is the best help Mike has given you? What is his best advice to you?

Probably not to push Jim about communicating, that’s one good thing. It really made me think - because I’ll always push, push. I want to talk, I want to talk. I always thought about myself, I never thought about him. maybe I should sit down and think why doesn’t he want to talk.

MS: Mike didn’t push Jim either?

Dora: I don’t know.

MS: What do you think Jim, what is the best Mike has done to help you?

Jim: He has given us suggestions. trying to spend some more time together.

Dora: Yeah that’s another one he gave, a real good one.

Jim: It didn’t seem to work all the time.

MS: But it was a good suggestion?

Jim: Yeah.

MS: And it did work out sometime?

Jim: Yeah.

Dora: Just to plan a night together me and him even if it was only an hour a week. Just to talk or something like that.

MS: How much have you done that?

Jim and Dora: To tell you the truth.

Jim: Not too much .

Dora: We’ve done it occasionally but ....

MS: When was the last time?

Dora: A while back.

MS: Do you remember the occasion? What did you do?

Dora: Last time I remember we went out together him and me, we went out shopping. (to Jim.): remember?

Jim: Yeah. A Tupperwareparty too.

Dora: That’s true ( laughs).

MS: I didn’t quite follow?

Dora: He got ( inaudible ) . . taking me to a Tupperwareparty.

MS: A Tupperwareparty!!

Jim: A bunch of women.

MS: That was OK??

Jim: (Nods).

Dora: He would never do stuff like that before. He would never sacrifice. I couldn’t believe it.

MS: He really astonished you?

Dora: O Yeah. In that way - that’s what I’ve seen different, like when you asked me . . I’ve seen him more compassionate, like Jim for instance. I was in an accident so he told our son to move to sit somewhere else and let me sit on the chair because my neck probably hurt. Stuff like that he would never do before.

MS: Has he given you more surprises?

Dora: He has given me flowers.

MS: Is that also a thing he wouldn’t have done some months ago?

Dora: Yeah, he supports me.

MS: How does he support you?

Dora: Just talks to me and tells me a tiny bit of his opinion. He won’t go in to detail in the conversation - I want to talk and talk.

MS: Has she astonished you, given you surprises too?

Jim: Yeah, she doesn’t jump so much as she used to, arguing. . .

MS: Why do you think?

Jim: Why. I don’t know. She wants thing to work out better. She went with me playing cards the other night.

MS: She . .?

Dora: We were supposed to go somewhere.

MS: And?

Jim: She went with me to my friends.

MS: That surprised you?

Jim: Yeah, that was a big surprise (All laugh).

Jim: (inaudible).

MS: Has Mike given you more suggestions that were quite good, the second best suggestion what was that?

Jim and Dora think for a while.

Dora: I kind of liked that circle suggestion. Remember I said I wanted to write things that we liked by each other, things that aggravated us and we try to change. Do more of the things we liked and less of the things that aggravated us. Write them down. And you ( to Mike ) made a suggestion about something I can’t remember . . what was that Jim?

Jim: Role reversal.

Mike: What??

Jim: Role reversal.

Dora: He wants to do that.

MS: Did you do it?

Jim: Not yet . . . but one of these days.

Dora: He wants to do that, it’s OK as long as it is on a day when the house is not too clean - he can do it all.

MS: So you have to do a little more planning?

Dora: Probably yeah.

MS ( to Dora ): What would it take to go from 5,5 to 6,3? What would have to happen?

Dora: I think the compassion has to stay there, I really do. It has to stay, it can’t just stay and go for a week.

MS: More stable?

Dora: Yeah.

MS: How . . .What is the first sign you can see that convinces you that it is a little bit more stable than before? What is the first sign?

Dora: Ah?

MS: That moves you up the scale?

Dora: I don’t know.

MS: What is the first sign you notice that makes you go from 5,5 to 6,3 ?

Dora: That it is constant, that it is not up and down. Not one day compassion and understanding and the other day ... .

MS: How do you notice?

Dora: I can tell, because he criticizes (inaudible).

MS: So he is not doing that, doing other things instead - as for example?

Dora: " Do you want a sandwich, I’ll make you one ". That was great.

MS: He did something for you?

Dora: Yeah. Maybe a suggestion or something. " Do you want?" " Shall we watch this or what do you want to watch ?"

The telephone buzzes.

MS ( to Jim ): What would have to happen for you or what will you notice that make you go from 5 to 5,8? What would be the first sign?

Jim: For me?

MS: Yeah, the first sign you notice.

Jim ( looks at Dora ): More understanding and not being so crabby.

MS: And doing what instead?

Jim: ( inaudible ) . . not jump right away before she thinks about it.

MS: And when she is not doing that and doing other things instead what would be the other things?

Jim: Keep the house all clean I’ve understood lately. We’ve been through a lot. . .

MS: You have ! You have a little kid too!

Dora: Yeah, he is 6 and we have one on the way too.

MS: How far has he come?

Dora: It’ll take some months. He is only 1,5 months.

MS: So it’ll take some months.

Dora: Yeah.

MS: You said ....?

Jim: I’m not a perfectionist wanting everything clean at home.

Dora: He doesn’t like to live in a house that’s gotta be picture-perfect

Dora and Jim: (inaudible).

MS: What do you think Mike needs to see? What will he notice as the first sign of you going higher up to 5,8 and 6,3 ? How do you think Mike will notice?

Dora: If we talk about one subject.

MS: For a whole hour?

Dora and Jim: For a while at least.

Dora: I think he will notice progress in communication.

MS: If it is progress in communication between you - how will Mike notice that ?

Jim: Probably that we will talk about the same thing for a while.

MS: What do you think Mike will tell you then?

Dora: That’s great !

MS: What do you think, Mike, you will notice as the first sign of more progression ? Is it called that ?

Dora and Jim: Yeah.

Mike: Both of you talking about feeling satisfied, with continuing to do these things you say are right. More stability and you are doing what works more.

MS: Suppose, Mike, they won’t tell you - how will you notice "We don’t tell Mike this time and see if he notices". How will you notice if they don’t tell you ?

Mike : I don’t know.

MS: Can you see it?

Mike: I think how they kind of come off being closer to each other.

MS: How?

Mike: The closer they sit. How you guys look at each other. I think you can sense respect towards each other more. I think in terms of how you talk. It’s much more of these things I see you do that are good for you and I appreciate what is going on - I think both of you are feeling more close.

MS: I have another question. Suppose that a miracle . . . You go home, sleep tonight and when you wake up tomorrow a miracle has happened - all your problems, whatever your problems have been or are, they have gone, disappeared. How will you notice that when you wake up tomorrow?

Jim: Winning a Lottoticket. That would help.

MS: I understand. How will you notice that tomorrow morning when you wake up and when will you notice that your problems are gone totally ?

Jim: ( inaudible ).

MS: OK - more or less gone. All the main problems are gone.

Dora: I would notice that we were friends and we talked and how we got up making breakfast, you know -doing things like being nice to each other and a couple of other things, I’m sure.

MS: Like what?

Jim: When we first met.

MS: Like when you first met?

Dora: Just a sense of happiness, being close, being with each other instead of always being unstable knowing that it is stable now. I’m sure we are going to have a little bit of rockiness but at least you have it under control knowing that you have a stable relationship.

MS: Tell me more about when you first met? Then you didn’t have your problems.

Jim: We have been together so long, for so many years too - it would be like getting to know each other again.

MS: How was that getting to know each other?

Dora and Jim look at each other.

MS: What did you appreciate most with Dora?

Jim: I can always find out more about her though I have lived with her and know everything about her.

Dora: You don’t. You think you do.

MS: ( to D.) He doesn’t know you.

Jim: I know her more now - I know her faults now.

Dora: But if I surprise you, it means you don’t know me as much about me as you think.

MS: You have surprised . . .

Dora: Same with me. You have surprised me. It means I don’t know you as well as I thought I did.

Jim: ( inaudible )

MS: You are older now, you have a kid . .

Jim: Sober now too.

MS: And you are sober.

Jim: It’s 10 years of my life using drugs and stuffs. I have to start dealing with things all over again, things I haven’t done before. It’s different.

MS: For how long time have you done it without stuffs?

Jim: 7 or 8 months now.

Dora: It means drinking too.

MS: ( to Dora ) What did you appreciate then ?

Dora: I liked the way he was considerate. The way he were . . If I wanted something - for instance if we were driving and I was hungry, he would stop at a restaurant. Considerate, respecting me, listening to me, not ignoring me, asking me what I wanted to do. You know what I mean?

The compassion was there.

MS: How likely is that to happen again? Are you able to reach 10?

Jim: I think so.

Telephone from the team.

MS: The team are phoning to say I am in a little bit of hurry now. I didn’t ask that question before the telephone call, you haven’t heard that question. They wanted me to ask you: Has it already happened? Have you had a time last week or some weeks ago that was a kind of experience you remember when you were newly engaged?

Dora: Something that was; "Gosh, that was something like it was 10 years ago"?

Jim: I suppose it has been a few times.

MS: It has! Good!

Jim: ( inaudible ) . . Sunday eating breakfast . .

Dora: ( inaudible ).

MS: So you have had some experiences not long ago of this kind ?

Dora: Yes.

MS: How likely is it there are more situations like this coming - more and more often. ? How likely on a scale from 1 to 10? 10 is you are quite sure it is gonna happen?

Dora: I think it would be a 10 as long as we both try. I think, you know what I mean. there is no doubt about it, cause if we try there is no ... reason to even think it would be a 2 or 3. You know what I mean. Because we have come as far and we are still together, we’ve been through a lot.

MS: Yes, you have.

Dora: If the compassion is there and you know it is there - it’s just a matter of yourself, like say for me - it’s a matter for me not jumping like what he said. Stopping myself before I do it and if I know . . . and it would be a matter of me being compassionate knowing, just knowing that’s what I want: I’d rather be nice than being crabby and mean - trying to stop myself.

MS: I’m a fan of scales as you have noticed. If 0 means that you are not going to do a single shit to make anything good and 10 means that you are prepared to do anything to get this going in a smooth and fine way as you want it. Where are you on that scale? Just right now.

Dora: Say 8, cause I try but I’m sure I don’t try hard enough.

MS: Sounds reasonable. Where are you Jim on that scale ?

Jim: About 6. Caring more about myself more than I do for her.

MS: But you are on a 6. It’s between 5 and 10. You have past the middle of the scale.

MS: ( to Mike ) How likely do you think it is that they reach their goals?

Mike: How likely on a scale 0 - 10?

MS: Yes

Mike: I think for these guys about a 9.

MS: So you are pretty confident they are going to make it. Why are you that confident ?

Mike: Because they, sort of the way they are saying. They have been through a lot together, they have a lot of willpower to make this thing work, you are more motivated than a lot of couples I’ve seen. And you really come in here every time I see you saying "We want this to be different" You are not exactly sure all the time how to do, but I see in both of you the same amount of willpower to make this work that it took for both of you to get sober. I mean you guys have made some significant decisions that you want to have a healthy, good family that is pleasing to both of you, that you feel comfortable in and you are very committed to that. You come back here all the time to work at that. You work at it on your own, you are very motivated away from here and you show a lot more motivation than a lot of couples I se. I put you way up on a 9.

Dora: That’s what I meant when I said trying. I couldn’t see . . I didn’t kind of understand what you were saying when you said from 1 to 10. . . . . I don’t know what the question was?

MS: How likely it was - that question?

Dora: For the compassion to continue. That’s what I meant by what you just said. willpower and knowing that you can be compassionate.

MS: You know that you can.

Dora: Or you can be not as snappy at a person. If you think and trying to stop yourself before you are doing it. I think probably try all the time but something you find yourself being crabby but then I just want to apologize and say " I’m really sorry, you know I’m just a crab - let me go to sleep. It’s not anything you said, it’s just me. I’m the crab".

MS: What’s the name of your son?

Dora and Jim: Jim junior.

MS: If he had been here . . .

MS: They wanted me to for a little while go back to the miracle question. You said that if there was a miracle tonight then you would notice you were more talkative and a little bit more compassionate. How would your son notice that tomorrow morning when he woke up ? How will he notice: " A miracle has happened". I don’t know if he knows what a miracle is but suppose he knows that. What will he notice?

Jim: He wouldn’t see us yelling or arguing

MS: What would he notice you doing ?

Dora: I think. Maybe he notice me being more relaxed.

MS: How would he notice that?

Dora: He would notice because, he just . . . When I’m crabby or if I’m aggravated for say I try not to take it out on other people . . . . I don’t really scream . . . . Probably he could ask me something four times and I would still be nice, probably if he asked me the same thing four times - I would probably still have the same nice tone of voice. That’s probably what he would notice.

MS: What would he notice of Jim senior?

Dora: What I think he’d notice ? That if he asked him a question, Jim would turn around and completely give him an explanation.

MS: How would you notice that Jim junior has noticed?

Dora: He was calmer.

MS: Calmer . . .in what way ?

Dora: Some days he can sit like us and he would be calm, he would talk to me, sit there and talk about anything. Then he has his days like what I said. he would ask " Call one, call one, call one " He’d ask me something five times and my answer will be no and he will continue to ask me this. So he has done two days. He will be a little bit more calmer.

MS ( to Jim ): How will you notice Jim junior has noticed ?

Jim: He will calm down a bit and not being so pushy.

MS: And what would he do instead, playing with toys or doing things on his own?

Jim: Probably doing things on his own.

MS: If he did that - what would you think then?

Jim: A miracle has happened.

Dora: Yeah, that sure would be - a whole week of that (all laughs).

MS: What changes have you noticed on Jim junior these last months ?

Dora: Go ahead Jim.

Jim: He has . . . ( inaudible ) and that was a surprise.

MS: So he has surprised you too and you have surprised each other.

Dora and Jim: Yeah.

Dora: Before he was everyday always crabby and just frustrated but then it tended to get . . .some of the days he’d be able to sit like us, we could do a craft and that gave him a sense of family and he likes it a lot.

Jim: He is like that he wants it he wants it now.

Dora: It’s both of us. That’s me too.

MS: He is a little kid, he is 6 . .

Dora: Of course. He wants to stay up to midnight and be outside in the summer. He’d be out there till he falls asleep. I got to expect stuff like that. - Sometimes I forget he is only 6 . .

MS: Do you have any . . . I usually . . .

Telephone call

MS: They have a question. Do you have any question before the break ? . . . . They have one more question. What did you guys do to make this miracle happen? Cause it sounds like some of it already happened.

Jim: Lot of it has to do with quitting drugs and drinking and stuff - that’s the primary thing. The program teaches you to deal with things that pushes you and try to deal with changing yourself instead of changing other people.

MS: That really helped you!

Dora: What was the question?

MS: What did you do to make this miracle happen ? Because some of the miracle has already happened.

Dora: For me it was that I knew I loved him a lot and that we either had to get help or we would probably not be together. I think that is what it was for me.

MS: It was that desperate?

Dora: Yeah. We go out and drink and drink and you know . . . I know that’s a way of relief and you don’t talk about your problems if you drink.

MS: I’ll take a break and discuss with my team. Do you mind sitting out in the waiting room ?

Dora and Jim: Not at all

The break lasts for 20 minutes.

Intervention:

MS: We usually do like this and I have written everything up that I want you to hear from Mike, me and the team. To begin with: We are very impressed by your way of describing the good things that has happened. I said that the miracle has already happened, partly at least. And your way of describing the goals, what you want to achieve. you have been very specific about describing those things, so you have helped us a lot with that to understand you.

We are very impressed by you Jim. You are very mature, you have been through a lot of things, I understand and I think you have learned a lot by what you have come through. You have a lot of wisdom in all these experiences you can use and you are using it. Mike said in our discussion that you seem to be more mature than a 25-year old, you are more like 30 -35 in your way of thinking and doing things.

We are also very impressed by you Dora. One of the team members said that you are a bright lady who knows a lot about marriage and one who works a lot and do much to make it a good marriage. You are very good in observing, articulating and expressing. You are very good at that especially the observing part. We are very impressed by that.

We really think you are on the right track. You have done a lot, you have created your miracle and you are on the way to go on with that. We totally agree with Mike that you are on a 9. We really think you are gonna make it.

We have a suggestion, a kind of homework. A recipe - it’s not a medical thing but this is another kind of recipe, more of a homework-recipe. We suggest that you surprise each other once a week and don’t tell each other that you are going to surprise - which day and with what. Don’t say anything - just surprise each other with small things and don’t tell each other. Keep it a little secret and notice what the other do and how the other react when you surprise him or her. Keep track of it in a notebook or something and discuss it with Mike next time you see him.

Mike: Part of this is that you don’t tell the other person when you did the surprise either

MS: If he or she didn’t notice . . .

Mike: Right - and when you come back here we’re gonna go over the notebooks . . .

Is that right ?

MS: Yeah.

Dora: Thank you.

MS: It was nice meeting you. Good luck !

 

One year later MS calls Mike who tells that Jim and Dora are very well together, have one more child and enjoy being parents to two children. Mike still see them occasionally.