For years family therapists have been engaged in the process of family assessment of one form or another. Whether the clinician specifically starts with a critical period of family evaluation and diagnosis or the process is continuous and ongoing throughout treatment, family practitioners implicitly utilize a series of underlying dimensions. Some may focus their evaluation on terms of family conflict, some aim toward an understanding of family needs or roles played by different members, and some deal more with issues of boundaries, culture, and social context. Yet, each therapist must employ a conceptual schema, a model, a personal point of view of family functioning, which is useful in understanding the family and in facilitating therapeutic work.

This presentation will review a two-part assessment format. The biopsychosocial history is completed by the family members outside the session. In the session, the therapist administers assessment of the step-family. The clinician’s emphasis is on the particular aspects of step-family life that plays a crucial role in the adjustment of the remarried family including the resolution of the previous relationships, the influence of the outside parent(s) on the household, the mobility of the children between households, the integration of the new spouse/partner and the different family cultures, values, and norms in a step-family landscape.

Presentation will focus on the part of assessment that is conducted by the practitioner in session, while the copy of the biopsychosocial history completed by the family members will be provided as a guide to show how gathered information helps the therapist to conceptualize the problems and strengths of each family in an effort to develop the treatment plan for amelioration of the complaints.  After assessment is completed, the strengths, needs, and preferences factors contributing to the step-family’s adjustment should be identified separately from the presented problems areas. It is important also to recognize the support system of the step-family as being a crucial predictor of family strength and success.

Learning Objectives:

      Participants will:

      1. increase knowledge about step-family assessment that is based on four fundamental principles (identify, respect; educate; empathize)

      2. review administration of two-part step-family assessment format (use of biopsychosocial history questionnaire outside the session; performing assessment in the session)

      3. Increase knowledge on how to use assessment data to formulate plan for treatment by using case material.

Presenter’s Background:

Cecile Dillon, Ph.D., is licensed both as a clinical psychologist and a marriage and family therapist, and has been practicing in Huntington Beach, Orange County for over thirty years. Her special interests include work with families in transition, such as divorce and remarriage, as well as serious mental and emotional disorders in children and adults.

Dr. Dillon, a team member in a Clinical Care Management division of IBH, Inc., is also an AAMFT Approved Supervisor and a core adjunct faculty member at the National University, who recently completed her six-year appointment as a volunteer member of the Orange County Mental Health Board. Eighteen years ago, Dr. Dillon co-founded the Living Success Center, a non–profit community counseling center in Costa Mesa. Currently her affiliation with the LSC is in the capacity of Advisory Board member.

In addition to making presentation at national and international conferences and professional meetings, Dr. Dillon maintains professional relationship with colleagues at the Nis Philosophy University, Psychology department, in Serbia where she visits and lectures on various topics related to her areas of expertise. Her last professional international trip in December of 2012, co-sponsored by The International Family Therapy Association, took her to the Republic of Gambia in Africa where she became acquainted with members of the Family Association of Gambia.

Stepfamilies Presentation Summary by Janell Gagnon

At our January IE CAMFT meeting, we had the pleasure of learning how to properly assess step-families in treatment from Cecile Dillon, Ph.D., a licensed clinical psychologist and marriage and family therapist, practicing in Huntington Beach and Orange County for over 30 years. The following article is a brief summation of the useful information in Dr. Dillon’s great presentation, from which we gained a comprehensive understanding of how to assess stepfamilies by utilizing the assessment tools she provided.

Since divorce, separation and re-partnering are the norm for many of the families with which we work as MFT’s, it is important to understand how to properly assess them to better guide our treatment with these families. In fact, Cecile informed us that:

• More than 50% of divorced parents form stepfamilies.
• More than 50% of remarriages end in divorce.
• More than 25% of all stepfamilies break down in the 1^st year.
  

            When assessing stepfamilies, there are 2 major questions to first ask yourself to guide your assessment. The first question is who to assess. This can range from individual family members, to all household members. Second, you need to ask yourself what factors to consider. Cecile did a great job of breaking this question down into five major categories: 1) stages of the stepfamily integration,2) locus of major difficulties and problems, 3) psychopathology of individual members, 4) ages of the children, and 5) comfort of the therapist.

            There are 3 Stages of Integration: early, middle and later. The early stages of integration are characterized by initial contact of 2 family systems. The middle stages of integration are characterized by structuring of the new family system.   And the later stages of integration are characterized by solidifying the new system. It’s important to figure out in what stage of integration the family is in order to figure out how to treat them and which members need to be treated.

Assessing the psychopathology of individual family members is important because when there is a member of the family who is suffering from a serious mental illness, the usual difficulties can be magnified due to the added structural and emotional complexity this causes. It may be necessary to refer an individual family member out to deal with the specific problems caused by the mental illness while working with the rest of the family.

            The ages of the children in the family are important because age generally dictates whether or not they need to be involved in treatment. In general, Cecile makes the point that younger children do not necessarily need to be involved in the treatment process because they are more dependent upon the parents, so changes made by the parents tends to influence the children more. Thus, working only with the parents can bring about the changes in the children without their participating in treatment. Children in the latency age (about 6-12 years old), have more of an idea and opinion about how the family should operate, and for this reason may need to be included in treatment, depending on the specific situation. In general, adolescent family members should be involved in treatment if the situation directly involves them because they tend to have more of an influence on how things operate in the family.

            Identifying the locus of major difficulties and problems is crucial to guiding treatment. It is important to distinguish which problems result from the “step” family vs. problems which existed prior to the formation of the step-family. Some of the following questions will probably need to be asked in order to identify the locus of major difficulties: What are the stepfamily structural and relational processes? Are there any changes and what are the changes for the children? Are there any unrealistic beliefs/expectations, and what are they? Are there any life cycle discrepancies? What are the loyalty conflicts?  Are there any boundary problems and if so, what are they? What are the household roles and where does the power lie? The answers to these questions will guide who needs to be involved in treatment and what interventions need to be utilized in treatment.