Setting the Stage for Change: An Eco-Systemic Approach to in-Home Family-Based Treatment

In this second edition of Setting the Stage for Change , a detailed road map is presented for applying a strength-based, eco-systemic family therapy approach (ESFT) to helping children and adolescents with severe emotional problems (SED) and their multi-stressed, fragile families. ESFT has proven highly effective in helping children with SED break the cycle of repeated out-of-home placements. This easy-to-read book distills the clinical wisdom gleaned from ESFT s 30-year large-scale implementation in Pennsylvania s intensive in-home family-based programs.

The book addresses not only the nuts and bolts and the how of an eco-systemic approach to treatment, but also its theoretical foundations, or the why of treatment. One full unit is devoted to methods for engaging and keeping these children and their parents in treatment a major challenge for this population given their histories of trauma, high levels of distrust, and frequent experience of failure in the behavioral health system. A second unit is devoted to the use of methods, such as systemic interviewing, enactments, relational time-lines, and genograms for contextualizing and reframing problems as relational. A third unit describes four of the most common maladaptive family structures associated with SED. These include the enmeshed family, the under-organized family, the embattled family, and the authoritarian family. A fourth unit presents an integrative framework and tools for developing a systemic case conceptualization that is child-centered and family focused which can be easily translated into a relational treatment plan.

The book is replete with case studies reflecting the realities of day-to-day clinical practice and includes reproducible clinical tools useful for both therapists and supervisors. These include a systemic case conceptualization worksheet, relational treatment plan and family safety plan templates, treatment fidelity measures, clinical skills assessments, and a glossary of concepts and terms used in family treatment.