Moving towards the consideration and planning of change

This third step represents an attempt to move away from discussing a specific interaction that occurred during the session and to 'widen the lens’ towards:

1. GENERALISING: Capturing more generalised understandings relating to this specific observation.
2. INVITING VISION: Generating possible applications of these understandings, by "inviting vision" of alternative strategies.
3. PLANNING: Planning the implementation of these changes.

N.B. It may take a few "loops" to reach the point of considering and planning for CHANGE

1. GENERALISING

Family members are encouraged to come up with some more general observations and reflections on:

1. How similar interactional patterns tend to evolve spontaneously at home.
2. What feeling states these elicit.

“So we saw that mum feels sad and Johnny feels bad about having triggered this sadness….. maybe this is the only time it ever happened, but maybe it is not…. Can you talk together about whether you recognize this as something that happens at home…or elsewhere”

The effect of this intervention is that what was observed in the ‘here and now’ of the session is ‘looped out’ into life outside the session, in an attempt to identify recurring patterns which are experienced as being ‘dysfunctional’ by family members.

Relating to overarching treatment goals

A major aim of MBFT is to engage in family discussions of problem-relevant situations, to elicit and highlight emerging feeling states and their importance, and to foster within the family experiences of (and confidence in) practicing the kind of "curious interogative stance" that this kind of activity involves.

The therapist may ask people to tentatively speculate about and label hidden feeling states of one of its family member, or may indeed do this at times him or herself. The therapist actively encourages family members to label their own feelings, to reflect on what that must be like for them. Metaphors or wordings like the following can help:

“you may want to find out how feeling leads to doing”
“how a few snowflakes can launch an avalanche”
“how a little feeling can get out of control”

2. INVITING VISION

The therapist requests each family member to identify different ways of overcoming stuck interactions and to think about alternative ways dealing with recurring problematic interactions:

“Given that you think this is not working, how would you like things to be….. what would x need to do differently for you to feel y? What might you need to say or do for your mother not to have these sad feelings – or at least less of them”

In an attempt to elicit solutions from within the family, each person is encouraged to talk about their specific alternative ‘vision’. Once this is achieved, the therapist may ask family members to discuss each other’s ideas:

“Can you talk together about this….about how for example dad’s idea would help mum to feel less sad….”

Note:
At each step it is possible that entrenched interaction patterns re-emerge.

For example, two or three people may talk at the same time. The therapist can loop back to step 1 Noticing and Naming and make an observational statement, asking family members whether they have also noticed this particular interaction, etc. etc...

3. PLANNING FOR ACTION

This phase is designed to ask family members to consider specific and concrete actions that they could apply in the light of their understandings.

This may require them, in the first instance, to negotiate which particular ‘vision’ should be translated into action.

"So we have three ideas... which are you going to opt for...? Please discuss this..."

...followed by:

“you say you’d like things to be this way…what would be the first step you would need to take for you to be on the way to that goal…? Maybe you want to do it right here and now…”

It is important that the first action step is both specific and do-able.

It has to be a relatively a small step – definitely not a leap.

People have a tendency to ask for major changes in a minimum of time and, as this is generally highly unrealistic, the therapist’s task is to slow down individuals jumping into action (the technique of ‘pro and con’ is handy here).

It may be helpful to say:

“What is it that is stopping you…what would you have to say or do to convince them that you mean business…. So, what is the first step you can make now to convince them…?”

or:

“You say you want to talk about all these things you never talked about and how this makes you feel now…and you have all agreed that you might take the risk… how about doing this now? Talk to each other in such a way that allows you not to shut down, but to open up about your feelings”.