Engaging Adolescents and Caregivers in Family Therapy

“Do I have to do family therapy?”

Yep, that's such a common question I get from my adolescent clients at the start of therapy. Here are some other common questions and statements a therapist may receive in regards to parents and caregivers being a part of an adolescent's therapy process:

"So how much are you going to tell my parents?"

"I hate these family things; i just feel so awkward."

"Do I have to be in the room when you talk to my mom/dad/guardian?"

“I’ll talk to you, but I will not talk to my parents about this!”

“Why try, nothing is going to change!”

“They/she/he just doesn’t understand me.”

Do any of these sound familiar in your therapeutic work?

When reflecting on these common initial responses and questions about family therapy, it has been my professional experience that I see a clear pattern of fear, lack of trust and shame arise as barriers to adolescents getting their needs met by their caregivers. Additionally, many adolescents seem to have a common misunderstanding (and caregivers too) that family therapy is about pointing fingers and being the “problem” of the family. So with this in mind, I’m excited to share some strategies I use to build rapport, connection and trust with adolescents to empower them in engaging with caregivers in family therapy.

1) Be Transparent! In other words, BE REAL with your client. Adolescents are smart, clever and can read through any BS or tip-toeing going on in the room. I give them the direct and transparent version of confidentiality and expectations of what therapy entails. 

“I know you may or may not be wanting to communicate certain things with parents, but I want you to know what I must report immediately. Any safety concern including suicidal ideation/planning, abuse, neglect, witness to violence, and self-injury must be reported to caregivers or appropriate authorities. With that being said, there may be things that come up that you are not open to sharing but would be beneficial to do so in order to get your needs met from your parents/guardians. When this happens, I want you to know I will challenge but not force you, and together we can figure out the best way to schedule a family session around it when you are ready.”

2) Build trust immediately: I know this one is a given, but I start with every first session letting my adolescent client know that I don’t expect them to trust me right away in an effort to ease any tension or pressure someone might feel.

“I want you to know that I don’t expect you to trust me right away. Trust takes time and is earned so that’s exactly what we are going to do. We will take time to get to know each other. You can ask me any questions you need to about myself or the process. I’ll let you know if I can’t answer it for any reason. And I want you to know if I ever ask or discuss something that you are not ready to answer, you say so, and we will use the time for what you are ready for and need. This is your time and space, and I want you to feel safe.”

3) Share the responsibility and “workload”. It’s essential to dispel any myth or belief with the adolescent and caregivers that a) they are the problem child and b)your job is to “fix” them in some way. Again, this is where I use transparency in the first session or parent consult (as well as throughout ongoing treatment) to set clear expectations for all involved.

To caregivers: “I want you to know that if i’m working with your child, I’m working with you also.  In many ways, this work can be equal or more for the parent.  My job is not to “fix”. Rather, i’m here to provide assessment, education, skill-building and a safe space to process and build awareness so that you and your child can more effectively communicate, understand one another and connect in a meaningful way to address the barriers.” I always let adolescents know that I’ve had this conversation with the caregiver(s) as well so they know it’s a joint effort.

4) Empower the adolescent voice. I like to give my adolescent clients as much choice and opportunity to lead as possible when it comes to parent involvement. Here are a few different ways, I frequently go about this in session:

“Would you like me to check in with mom/dad alone or with you it the room?”

“Is there anything you’d like to share with mom/dad/caregiver from our session today?”

“Is it alright if we bring mom/dad in at the end to share any skills we worked on so they can practice it too?”

“Is it ok if I emailed mom/dad about (a specific one or two things from session) so that they can be more aware and better understand what you are going through or how to support you?”

“Is there anything you want to teach mom/dad today?”

“Would you like me to explain (specific pattern or skill) for you to caregiver with you in the room?”

“Would you want to do a family session with mom/dad on this? If so, when do you think you’d like to do it?”

5) Parent Coaching Sessions are a must! Along with letting parents and adolescents know that this is joint work, I let them know that some sessions will be just with the parent(s). I am transparent with the adolescent and parents about the purpose of these sessions from the start.

“These sessions with your mom/dad are NOT to report all that you’ve said or processed in session. Instead, they are an opportunity for you parent to explore their own barriers getting in the way of supporting or connecting with you. I will always let you know when i will be having a session with you parents in case you have any questions or anything you would like me to share or work on with your mom/dad.”

To caregiver: “These are sessions where you can explore challenging emotions, patterns, behaviors that you are struggling with that might be acting as barriers to your relationship with your child. The main goal is to empower you as a caregiver and strengthen your relationship.”

6) Provide Outside Resources to Caregivers and Adolescents from the start.

At the end of an initial session or consult, I provide at least one book and internet-based resource that will help parents get a head start on some of the topics and ideas we will be addressing in therapy. Throughout the process, I continue to provide both the caregivers and the adolescent ongoing supports based on what is coming up in therapy and what the family barriers may be.

Some of my favorite resources are:

Ted Talks: Especially for the adolescent and caregiver to watch together at times.

Wellcast videos: Here is one of my favorites, but they have them on all topics! I often show to adolescent in session and send to both caregiver and adolescent after session. https://www.youtube.com/watch?v=UMIU-Uo8cZU

Phone apps: mood meter, calm.com, Headspace are just some of my favorites.

Books: there are so many; here are a few favorites

The Gifts of Imperfection, Daring Greatly and Rising Strong by Brene Brown (also has great ted talks to introduce the concept of vulnerability and shame)

Whole-Brain Child, Yes Brain and Brainstorm by Dan Siegel and Tina Payne Bryson

Emotion Focused Family Therapy resources: This includes caregiver webinars and in-person workshops, book recs, links to articles, etc. All greatly support parent coaching and family work. http://www.emotionfocusedfamilytherapy.org and http://www.mentalhealthfoundations.org are two helpful websites.

Review/summary emails: These I send with adolescent permission to specifically review a skill, idea or new strategy that would be helpful for the caregiver or adolescent from session. This way, they can refer back to it as needed.

Engagement with adolescents and parents can be difficult at times, but I have found the more i’m able to focus on empowering families and setting clear expectations of what family work is and isn’t, the more willing adolescents and caregivers are to engage in the process. My goal is never to be the one the adolescents trust or “go to” the most, it’s to help them build that with their parent(s) or caregiver to be able manage their challenges and barriers in life in a sustainable and connected way.

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Guest post written by Meaghan Burns Sablich, LCSW

Meaghan Burns Sablich, LCSW is a Licensed Clinical Social Worker, Licensed Colorado State School Service Provider and clinical supervisor with 10+ years experience in the field. Meaghan received her Masters Degree in Social Work from the University of Denver with a concentration in Families and Children. Meaghan has worked in a variety of therapeutic settings including inpatient hospital, residential treatment center, day treatment center, schools, non-for profit organization and private practice. Areas of clinical focus include: depression, anxiety, ADHD, eating disorders, family therapy and parent coaching, grief and loss, school/learning concerns and self worth work.

Community Confidentiality: Supporting Collaboration with Consent

“I cannot confirm or deny.” How do you maintain confidentiality for your client? It may seem easy enough when there is a clearly written, signed release or when your client refuses a release, thus declining collaboration at this time. However, what does it look like in the following situations?

• Your client is involved in an open Child Abuse and Neglect case.

• An attorney calls you saying they represent your client and would like copies of your client record for a disability claim.

• An insurance company calls to report the client listed you as a provider and they want to know your diagnosis to award the client a life insurance policy.

• You outreach an organization about who they serve. They respond by wanting to obtain additional information from you on the client you want to refer.

• A referral source wants to know if their client called to set up an intake and begin services with you.

• A community resource shares that your client scheduled an appointment with them for next week.

• A foster parent wants to know why the parent isn’t engaging in services to reunify with their child.

• A CASA volunteer wants to know if the family is working on their fighting in your sessions because they believe it would be helpful.

• The spouse of your client calls asking you how sessions are going.

• Your client acknowledges that their friend is also your client.

• Their probation officer includes you in a group text or email to schedule a meeting on behalf of the client with several parties you don’t know.

These are just a few of what could be dozens of examples of sticky situations when it comes to maintaining your client’s right to privacy. Let us look at possible responses to the above scenarios to determine what could be best. And as always, seek consultation, supervision, or legal advice if you have needs or concerns.

Signed Release

When a third party reaches out to you by email, text, or voicemail, it can be helpful to notify your client and obtain a release in the next scheduled session. Notifying your client of the outreach you received can support trust and transparency in the therapeutic relationship. It can also help facilitate a discussion on the importance of getting a client’s written permission to respond to an inquiry on their behalf, whether it’s an insurance company, secondary referral, family member, or community partner.

Legal Requirements

Perhaps your client is involved in an open Abuse and Neglect case, diversion, or probation. These entities have been assigned to your client as part of a larger treatment plan to address a legal concern. Whether your client is mandated to complete therapy or the third party referred directly to you, there is a different level of confidentiality implied due to the collaboration needed from you to provide progress reports and updates as appropriate around your client’s engagement in services. If you client is resistant to signing a release, helping them identify the specific pieces of information to share—and thus restricting some information in the effort of privacy—can be helpful to the client’s anxiety about personal information that is disclosed to others. When submitting a progress report to DHS or probation for example, providing your client with a copy can also demonstrate a sign of transparency and trust in encouraging them to review it and provide feedback on their level of comfort with the material shared.

Sense of Urgency

The desired scenario is one of those mentioned above, where we have the client complete a signed release of information highlighting exactly what is released and for what purpose. However, there are times that a sense of urgency may arise in getting permission quickly to collaborate with a community partner in a timely fashion. Depending on the frequency of client contact including regularly scheduled appointments, you may need to get email or verbal permission over the phone from your client as a temporary measure in obtaining consent prior to a written release. Standard practice is to have permission in writing so email can feel slightly more comfortable than verbal permission to us as providers. Either way, documenting your client’s permission with intention to get a full release in the immediate future can be helpful in allowing collaboration and sharing of information under a time restriction.

Curbing Curiosity

Collaboration is a helpful component of therapy, within reason, to support and validate client efforts. It may become apparent that there are other parties involved who may want updates on your client’s progress. This could include caseworkers, probation, child advocates, other mental health providers, foster parents and more. Where it can feel confusing is when third parties know you are actively working with the client and make assumptions that you can share information in the spirit of collaboration. For example, the foster parent is wanting to know how the parent, your client, is doing in services in order to encourage their child of the parent’s hard work. The inquiry may feel innocent enough, however the foster parent is not your client, and is therefore not privy to this information without your client’s consent. Something as innocent as attendance or participation in services can be reported back to other parties and could result in information being misconstrued or shared without permission.

Encompassing Electronics

In an effort to not have information shared unintentionally with third parties, being mindful of how your electronic correspondence is recorded can be helpful. Being aware of emails with additional recipients or group text messages requesting scheduling of a team meeting can feel nebulous regarding confidentiality. Documenting your effort to send correspondence only to approved parties identified on a signed release supports your client’s wishes as well as ethics compliance. Providing disclaimers in your electronic signature in email composed on your computer or phone can also support limiting liability if information is sent to the wrong recipient or forwarded to a third party outside of your control.

Limiting Liability

Documenting each of your efforts to maintain confidentiality as a standard of your practice can limit liability. Obtaining regular releases yearly from your client can keep their record up to date. Utilizing encrypted email and electronic health records for client progress notes can restrict situations where their information could be compromised. When it comes to confidentiality in direct interaction with third parties, identifying a statement of “I cannot confirm or deny they are my client” can feel unhelpful, restrictive but necessary in not admitting unapproved information to family, friends, referral sources, or legal representatives without permission. This feels most challenging by phone when even acknowledging your need to obtain a release is admission of your client’s connection to you. For many, having to share that a release has been revoked can feel even more challenging. You may say something like “permissions have been revoked and we suggest you contact the person of interest directly” can provide enough information for them to understand you won’t be interacting with them further and prevents direct identification of your client by name or circumstance.

Communication with community partners is an intricate dance that can feel challenging when caught off guard by emails, texts, or phone calls asking for updates on your client’s work. Demonstrating your ethical capacity in delaying disclosure of information until a release is obtained can indicate your professionalism in the community and willingness to collaborate under the appropriate circumstance. Be sure to follow up with the community partner once a release is signed to further demonstrate your willingness to collaborate together. Lastly, thinking about the possibly scenarios that put privacy at risk and obtaining signed releases upon introduction to the client can streamline this process by simply asking who else is involved in their treatment or care. Having a scripted response ahead of time for situations where a release is not yet completed can support you in making the best decision to support client confidentiality and community engagement with consent.

Community Confidentiality: Supporting Collaboration with Consent

“I cannot confirm or deny.” How do you maintain confidentiality for your client? It may seem easy enough when there is a clearly written, signed release or when your client refuses a release, thus declining collaboration at this time. However, what does it look like in the following situations?

• Your client is involved in an open Child Abuse and Neglect case.
• An attorney calls you saying they represent your client and would like copies of your client record for a disability claim.
• An insurance company calls to report the client listed you as a provider and they want to know your diagnosis to award the client a life insurance policy.
• You outreach an organization about who they serve. They respond by wanting to obtain additional information from you on the client you want to refer.
• A referral source wants to know if their client called to set up an intake and begin services with you.
• A community resource shares that your client scheduled an appointment with them for next week.
• A foster parent wants to know why the parent isn’t engaging in services to reunify with their child.
• A CASA volunteer wants to know if the family is working on their fighting in your sessions because they believe it would be helpful.
• The spouse of your client calls asking you how sessions are going.
• Your client acknowledges that their friend is also your client.
• Their probation officer includes you in a group text or email to schedule a meeting on behalf of the client with several parties you don’t know.

These are just a few of what could be dozens of examples of sticky situations when it comes to maintaining your client’s right to privacy. Let us look at possible responses to the above scenarios to determine what could be best. And as always, seek consultation, supervision, or legal advice if you have needs or concerns.

Signed Release

When a third party reaches out to you by email, text, or voicemail, it can be helpful to notify your client and obtain a release in the next scheduled session. Notifying your client of the outreach you received can support trust and transparency in the therapeutic relationship. It can also help facilitate a discussion on the importance of getting a client’s written permission to respond to an inquiry on their behalf, whether it’s an insurance company, secondary referral, family member, or community partner.

Legal Requirements

Perhaps your client is involved in an open Abuse and Neglect case, diversion, or probation. These entities have been assigned to your client as part of a larger treatment plan to address a legal concern. Whether your client is mandated to complete therapy or the third party referred directly to you, there is a different level of confidentiality implied due to the collaboration needed from you to provide progress reports and updates as appropriate around your client’s engagement in services. If you client is resistant to signing a release, helping them identify the specific pieces of information to share—and thus restricting some information in the effort of privacy—can be helpful to the client’s anxiety about personal information that is disclosed to others. When submitting a progress report to DHS or probation for example, providing your client with a copy can also demonstrate a sign of transparency and trust in encouraging them to review it and provide feedback on their level of comfort with the material shared.

Sense of Urgency

The desired scenario is one of those mentioned above, where we have the client complete a signed release of information highlighting exactly what is released and for what purpose. However, there are times that a sense of urgency may arise in getting permission quickly to collaborate with a community partner in a timely fashion. Depending on the frequency of client contact including regularly scheduled appointments, you may need to get email or verbal permission over the phone from your client as a temporary measure in obtaining consent prior to a written release. Standard practice is to have permission in writing so email can feel slightly more comfortable than verbal permission to us as providers. Either way, documenting your client’s permission with intention to get a full release in the immediate future can be helpful in allowing collaboration and sharing of information under a time restriction.

Curbing Curiosity

Collaboration is a helpful component of therapy, within reason, to support and validate client efforts. It may become apparent that there are other parties involved who may want updates on your client’s progress. This could include caseworkers, probation, child advocates, other mental health providers, foster parents and more. Where it can feel confusing is when third parties know you are actively working with the client and make assumptions that you can share information in the spirit of collaboration. For example, the foster parent is wanting to know how the parent, your client, is doing in services in order to encourage their child of the parent’s hard work. The inquiry may feel innocent enough, however the foster parent is not your client, and is therefore not privy to this information without your client’s consent. Something as innocent as attendance or participation in services can be reported back to other parties and could result in information being misconstrued or shared without permission.

Encompassing Electronics

In an effort to not have information shared unintentionally with third parties, being mindful of how your electronic correspondence is recorded can be helpful. Being aware of emails with additional recipients or group text messages requesting scheduling of a team meeting can feel nebulous regarding confidentiality. Documenting your effort to send correspondence only to approved parties identified on a signed release supports your client’s wishes as well as ethics compliance. Providing disclaimers in your electronic signature in email composed on your computer or phone can also support limiting liability if information is sent to the wrong recipient or forwarded to a third party outside of your control.

Limiting Liability

Documenting each of your efforts to maintain confidentiality as a standard of your practice can limit liability. Obtaining regular releases yearly from your client can keep their record up to date. Utilizing encrypted email and electronic health records for client progress notes can restrict situations where their information could be compromised. When it comes to confidentiality in direct interaction with third parties, identifying a statement of “I cannot confirm or deny they are my client” can feel unhelpful, restrictive but necessary in not admitting unapproved information to family, friends, referral sources, or legal representatives without permission. This feels most challenging by phone when even acknowledging your need to obtain a release is admission of your client’s connection to you. For many, having to share that a release has been revoked can feel even more challenging. You may say something like “permissions have been revoked and we suggest you contact the person of interest directly” can provide enough information for them to understand you won’t be interacting with them further and prevents direct identification of your client by name or circumstance.

Communication with community partners is an intricate dance that can feel challenging when caught off guard by emails, texts, or phone calls asking for updates on your client’s work. Demonstrating your ethical capacity in delaying disclosure of information until a release is obtained can indicate your professionalism in the community and willingness to collaborate under the appropriate circumstance. Be sure to follow up with the community partner once a release is signed to further demonstrate your willingness to collaborate together. Lastly, thinking about the possibly scenarios that put privacy at risk and obtaining signed releases upon introduction to the client can streamline this process by simply asking who else is involved in their treatment or care. Having a scripted response ahead of time for situations where a release is not yet completed can support you in making the best decision to support client confidentiality and community engagement with consent.

Family Functioning: Low Risk Activities to Improve Relationships

I don’t need therapy, they are the one with the problem! How does talking about it fix things between us? This will just make the fighting worse! You are meeting with a family in your office for the second time. This family is composed of a parent, grandparent, and two preteens and everyone appears on edge. You track body language and energy in the room as you begin to explore what family therapy means to each of them. You notice the crossed arms of the preteens, the angry face of the parent, and the withdrawn quality of the grandparent sitting farthest away in the room. How do you respond? What will engage each of them in this process of healing to strengthen their relationships?

Set Boundaries

When first engaging a family, it can be extremely important to set boundaries as their family therapist so you can begin to engage the family system as a whole. Identifying your role clearly, including your ‘no secrets’ policy, can be helpful for each family member to hear that you aren’t picking sides or aligning in a way that prevents cooperation from all members. Not holding secrets and describing your efforts to remain appropriately transparent with the family can convey neutrality and respect, two elements that can increase willingness to participate and rapport building in your relationship. Reviewing limits of confidentiality can also set the family system up for success in being aware of how you must respond to conflict and needs for safety.

Explore Goals

In conjunction with setting healthy boundaries, engaging each family member in exploring their goals for family therapy can increase their motivation and commitment to the work. What would the preteens like to be different? What would make things better in their home? What would the parent like to see in regards to structure of house rules and parenting? How would the grandparent like things to be between their loved ones? Once you gather information from each family member, you can support the family in identifying how these goals can be measured over time to support positive shifts within their relationships and home.

Slow Down

Positive shifts in functioning are the ideal outcome of therapy and it’s possible that the family is engaging in therapy with a sense of urgency to “fix” their problems. Some members in the family can present with a sense of demand to jump in, unpack the conflict, and tackle change in rapid fashion. However, if the therapist moves too quickly, they run the risk of other family members becoming flooded, feeling attacked, or disengaging due to the pressure they feel by other members of the family or by the pace of the process. Here are some examples of what you might notice if things are moving too fast:

• One or more family members gets quiet and refuses to participate
• Body language conveys discomfort such as crossed arms, slouched posture, clutching a pillow to their chest, or avoidant eye contact
• Responding with “I don’t know” when questions are asked
• Increased agitation including rapid speech, flushed skin, facial grimacing, and fidgeting
• Leaving the room or pulling out their cell phone

Noticing these cues can be important in acknowledging a client’s discomfort and attempting to re-engage them in ways that feel safe. Validating emotion is a powerful tool in family therapy and can ensure everyone has an equal voice in the process.

Structure Sessions

Being mindful of how you engage the family each session in pursuit of their goals can encourage structure, support, and full participation. You may need to explain to one member of the family that jumping right into conflict could deter other members from participating in the future. Addressing immediate concerns with a safety plan can acknowledge the need for structure and safety while still engaging all family members in exploration of coping skills and needs for support.

Creating Commitment

While the safety plan and goals are being established, further rapport and exploration of family functioning can occur through low-risk activities. Low-risk activities, by definition, are presented as and appear to clients as activities that feel safe and don’t require intense participation. Due to the fact that each family member has a different level of comfort in the room, low-risk therapeutic activities can be a great way to explore their communication and build positive experiences between family members to further encourage participation in the therapeutic process.

Some examples of low risk therapeutic activities:

1. Feelings Jenga or Uno with each color or block representing a) things we like, b) things we don’t like, c) things we appreciate about our family, d) things we wish for
2. Feelings chip toss game or bingo to explore emotional vocabulary and awareness including sharing of times they felt that emotion
3. Feelings charades to reach emotions and body language in each family member
4. Cooperative play board games
5. Blindfolded obstacle course, drawing or Lego exercises
6. Recipe for success with colored sand, containers, and cooperation
7. The Ungame
8. Family portrait or family tree art
9. Family playlist with songs representing their experiences
10. And many more

It is important that family therapists consider participating fully in the activities with the family to demonstrate equality, approachability, and cooperation. Many families enjoy the idea of seeing their therapist as a person with their own thoughts and feelings, and engagement in these activities can help a family feel connected. It is, however, encouraged that the family therapist only discloses and engages in activities that support healthy boundaries, and to further evaluate if self-disclosure is relevant and appropriate for their clients.

Introducing creative, low-risk activities can support positive experiences as the foundation for which improvement and repair in the family system can be built. Many activities can encourage new perspective and shifts in thinking by highlighting areas for growth and processing change throughout the activity. Therefore, it is encouraged that we continue to recognize the approachability of therapeutic games and activities in the therapeutic relationship not only as motivators for ongoing participation but insights into the family system as a whole.

Safety Planning with At-Risk Families: Exploring the Benefits

Warning signs, safety measures, plan of action, and supports. These are all vital components of crisis response and safety planning in the field of mental health. Safety planning can be considered a helpful resource to assess safety needs for each family member and develop awareness of individual needs by loved ones when participating in discussion. It can also serve as an empowerment tool to allow advocacy and engagement in positive coping skills when the family is experiencing conflict. Due to family systems becoming more diverse to meet the needs of support and connection, the term family can be defined in non-traditional ways. Not only does it capture the nuclear or biological family, it may also comprise of blended families, extended family, step-parents, foster siblings, or “chosen family.” Chosen family can include but is not limited to, close friends, mentors, and godparents.

Bringing individuals together in their roles in the family system, it has become increasingly important to include all members in safety planning when addressing mental health and safety in order to unify the family and achieve meaningful results. In serving at-risk youth and families in the Denver Metro Area, safety planning has proven to be invaluable in exploring awareness of triggers for disruption and conflict, safety needs; thus engaging the family in exploration to foster empowerment and change. Safety planning allows the whole family to explore their needs rather than isolating one individual as the “identified problem.”

The Benefits

The benefits of safety planning can be demonstrated for one family of seven suffering from neglect, domestic violence, and substance use that lead to Department of Human Services involvement due to ongoing safety concerns. The family system consisted of mom Jenna* (36), boyfriend David (27), daughters Fiona (16), Margot (14), Patricia (6), and sons Julian (9) and Bobbie (2). Jenna and her family were referred to in-home family therapy due to safety concerns with Jenna’s Post-Traumatic Stress Disorder (PTSD) resulting in substance use, domestic violence with her boyfriend David, and neglectful parenting that was negatively impacting each child.

It was the hope of the Department of Human Services to support the family in reuniting and repairing their relationship now that Jenna was sober from substances and ready to actively parent in the household.

Observing and engaging the family in rapport building, it was quickly apparent which role each member played in the family system. Jenna was able to identify her challenges in parenting her children in that they were each struggling with her absence in different ways. Fiona identified her anger that lead to running away from home and engaging in fights at school. Margot reported being a strong student and keeping to herself in her room when not parenting her younger siblings in Jenna’s absence. Patricia was observed to be childlike with attention-seeking behaviors younger than her biological age, whereas her older brother Julian escaped into video games to remain unseen. The youngest, Bobbie, was observed to struggle with meeting developmental milestones and resorted to screaming and hitting himself and others when emotionally dysregulated.

Through engaging Jenna, David, and the kids in a safety planning therapeutic activity, they were able to begin to recognize each of their individual differences regarding warning signs, as well as the coping skills needed to support connection and emotion regulation.  Jenna began to learn more about her children and their needs through identifying warning signs such as isolation, anger, and behavioral changes signifying distress for each child at their developmental level.

Jenna also identified her own triggers and reactions to her children as they related to her trauma and urge to escape.

Connection

When Jenna couldn’t escape her PTSD symptoms through work or substances, she was able to recognize the increased risk of conflict and aggression leading to fights with her boyfriend David. The safety planning served as a tool of discovery for family members and empowered each of them to advocate for their needs through healthy communication. For Jenna and her family, the safety plan served as a means of taking action to support the family in times of conflict and crisis.

Through this process, the children felt heard, Jenna identified goals for ongoing individual therapy work to maintain sobriety, and David and Jenna were able to identify new ways of communicating as a couple in order to bring the entire family closer together. Safety planning can be introduced and implemented early in the therapeutic process to explore family patterns, coping skill needs, and foster trust and safety while empowering families to remain together, connected and aware. A safety plan template is available for professional use along with a suicide risk assessment called the Community Assessment and Coordination of Safety (CACS) at www.cacs-co.com.

*Names have been changed to protect confidentiality