The family interview

Much information will have been garnered by the time the family is seen. The clinician should consider any biases that may have crept into his or her thinking about the family, and how best to avoid being drawn into alliances, a possibility when conflict prevails. A non-judgemental stance is paramount.

Introductions are made in the initial phase. Names and preferred modes of address are clarified. The clinician then explains the meeting's purpose, details of which may crucially influence future family participation. The clinician invites everyone to share their views about the nature and effects of problems they have encountered.

The clinician may have an idea about how the identified patient's problems relate to family function, and can test it out by asking probing questions and observing interactions. This idea is characteristically kept private since it is unhelpful for a hypothesis to be put forward prematurely. Instead, details about everyday events should be sought and inferences drawn later. For example, rather than focusing on 'closeness', questions can be asked about time spent together by members, whether intimate experiences are shared, who helps with family tasks, and so on.

Triadic relationships can be scrutinized both through questioning (what does A do when B says this to C?) and observation (what does A do when B and C reveal tensions?). The scope for circular questioning is enhanced if several members participate. A third person may be asked to comment on what two others convey to each other when a particular event occurs. This approach of not asking predictable questions, to which the family may by now have stereotypical responses, often challenges them to think about their relationships in a fresh way.

Information is elicited that elaborates the family tree. Observations may be made concerning family structure and functioning; for example, who makes decisions, who controls others and in what areas, the quality of specific dyadic relationships, conflict, alliances, how clearly people communicate and how they solve problems. The discussion then extends to all spheres of family life: beliefs, traditions, rules, and values.

Throughout the interview the clinician affirms the experiences of all family members. Concerns are attended to and the members strengths and efforts acknowledged.

The interview concludes with a summary of what has emerged. The clinician may wish to continue the assessment or may recommend family therapy at this point. If the latter, an explanation of its aim and rationale is then given. Arrangements are made for a follow-up session, purportedly the launch of the family therapy perse, but in essence a continuation of the 'work' already in progress.

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