Essay: Adolescence

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[. . .] 12). Based on Bateson's (1935) original classification, three interactional patterns can be identified: complementary, symmetrical, and transitory (Rogers & Escudero, 2004). In complementary interactions, the definition of the relationship offered by one participant is accepted by the other and is reflected in communication exchanges such as closed question-answer or command-compliance (Friedlander et al., 1991). In contrast, competitive-symmetrical exchanges show participants' discrepant views of who is in control in a social relationship, evidenced by sequences of challenges and counter challenges, such as when one person changes the topic of conversation and the other person does not follow along, or when one person asks a question and there is no response (Ericson & Rogers, 1973). Transitory exchanges, the third transactional style, are neutral, non-control-defining communication patterns where, for example, a speaker responds by extending the previous speaker's topic.

A number of psychotherapy studies using these concepts have found that, overall, the predominant relational control pattern shown by therapists in individual and family therapy tends to be complementarily (Friedlander et al., 1991; Friedlander & Heatherington, 1989; Raymond et al., 1993). In other words, therapists tend to take a dominant ("one-up" or ?) position with clients who, in turn, tend to assume a submissive ("one-down" or ?) position (Friedlander & Hetherington, 1990). In contrast, relational control patterns characterized by question-answer and symmetrical exchanges (i.e., interruptions, no supportive responses, etc.) are more frequently observed in the initial sessions of clients who subsequently drop out of treatment (Beyebach & Escudero, 1997; Heatherington & Friedlander, 2004). Eyebath and11Escudero (1997), for example, compared the relational communication patterns of 16 dropout versus 16 continuation cases of solution-focused therapy. More conflictive therapeutic interactions and more domineering behaviours were observed in the dropout group than in the continuation group. Moreover, clients in the dropout group were more likely to adopt a one-up position and their therapists were less likely to respond with a one-down complementary message. However, clients in this study were largely adults seen in individual therapy, not adolescents in family therapy.

There is some evidence that relational control patterns reflect differences in therapeutic orientations. Friedlander et al. (1991) compared six family therapy interviews by expert therapists, three from the structural approach and three from the Milan systemic approach. Results supported theoretically predictable differences in relational control patterns between the two approaches consistent with the therapist distinct styles. Specifically, the structural sessions were characterized by more overtcontrollingness and competition whereas the systemic sessions evidenced greater complementarity (Friedlander et al., 1991). Relatedly, Heatherington (1990) compared a number of family and individual therapies with respect to four different indicators of domineeringness. Results revealed substantive differences between family therapy approaches themselves and illustrated that, in contrast with popular beliefs, some individual therapy approaches are more controlling than some family approaches. It was argued that differences in therapist controllingness arise from the theory of change rather than from the nature of the client system (i.e., family vs. individual)(Heatherington, 1990).

Few studies have examined relational control patterns in the context of family therapy, and even fewer when the focus is families with adolescents. A review of the sparse literature reveals that patterns of relational control in successful family therapy do not seem to be ubiquitous or constant (Lichtenberg et al., 1998; Raymond et al.,1993). Rather, relational control seems to evolve and change over the course of the therapy process (Heatherington & Friedlander, 2004; Raymond et al., 1993). In one notable single-case study, Raymond et al. (1993) examined the relational control dynamics in a family with an adolescent daughter who suffered from anorexia. The family was seen on an inpatient for 15 sessions. John Sargent, a prominent family therapist who is well-known for his work with families of this sort, worked intensively with the family over a period of three weeks. Sessions were examined separately interims of their relational control patterns, and changes in these patterns were explored over time by comparing the beginning, middle, and final phases of treatment. Consistent with the aim of structural therapy to alter patterns of dysfunctional interactions (e.g., enmeshment and rigidity), it was expected that changes in relational control would reflect processes consistent with the theory.

Raymond et al.'s (1993) findings provided some evidence consistent with previous research. First, therapist ?/client ? complementarity predominated throughout the treatment. Higher complementarity during the early and late phases of treatment was more prominent between the therapist and the adolescent daughter, and increased symmetry was more prominent between the therapist and the father. These relational patterns seemed to reflect the therapist's attempts to join with the adolescent early in therapy (Raymond, 1993). The authors also noted that the lower occurrence of complementary interactions in the middle sessions of therapy may have been due to the greater depth of work during this time, when therapist and clients were most likely to challenge each other and take risks (Raymond et al., 1993).

Only one other study was located that involved examination of relational communication in the context of family therapy with adolescent clients. Cabero (2004) examined relational control patterns in a single therapist's initial sessions with adolescents and one or both parents. Results showed that more frequent competitive symmetry was associated with less adolescent engagement. In other words, less relational conflict occurred between adolescent and therapist when the former was more involved in the therapeutic process. In addition, results suggested that complementarity (with the therapist in a submissive position) occurred significantly more often when the adolescents demonstrated greater engagement, emotional connection, and safety.

Cabero's (2004) findings support the widely held conclusion in the literature about the importance of joining with the adolescent in a cooperative rather than a competitive manner. However, the lack of studies examining specific relational communication patterns between adolescent clients and their therapists makes it difficult to develop strong conclusions about the nature of effective therapist-client interaction in the context of conjoint treatment

References

Green, A. (2005). Medical encyclopedia: Adolescent development. Retrieved April 10, 2011 from www.nim.nih.gov/medline/ency/article/002003.htm.

Beyebach, M. & Escudero, V. (1997). Therapeutic interaction and dropout: Measuring relational communication in solution-focused therapy. Journal of Family Therapy, 19, 173-212.

Bolton Oetzel, K.B., & Scherer, D.G. (2003). Therapeutic engagement with adolescents in psychotherapy. Psychotherapy: Theory, Research, Practice, and Training, 40, 215-225.

Cabero Alvarez, A. (2004). Patrones de interaccion y relacion terapeutica: control de la relacion y clima afectivo en la interaccion terapeuta-paciente. Unpublished doctoral dissertation, University of Salamanca, Spain.

Diamond, G.M., Diamond, G.S. & Liddle, H.A. (2000). The Therapist -- parent alliance in family-based therapy for adolescents. JCLP/In Session: Psychotherapy in Practice, 56, 1037 -- 1050.

Ericson, P.M., & Rogers, L.E. (1973). New procedures for analysing relational communication. Family Process, 12, 245-267.

Friedlander, M.L., Escudero, V., & Heatherington, L. (2006). Therapeutic alliances with couples and families. Washington, DC: American Psychological Association.

Friedlander, M.L., Wildman, J., & Heatherington, L. (1991). Interpersonal control in structural and Milan systemic family therapy. Journal of Marital and Family Therapy, 17, 395-408.

Heatherington, L., & Friedlander, M.L. (2004). From dyads to triads, and beyond: Relational control in individual and family therapy. In L.E. Rogers and V. Escudero (Eds), Relational communication: An interactional perspective to the study of process and form. London: Lawrence Erlbaum Associates, pp.103-130.

Hogue, A., Dauber, S., Stambaugh, L.F., Cecero, J.J., & Liddle, H.A. (2006). Early therapeutic alliance and treatment outcome in individual and family therapy for adolescent behavior problems. Journal of Consulting and Clinical Psychology, 74, 121 -- 129.

Liddle, H.A. (1995). Conceptual and clinical dimensions of a multidimensional, multisystems engagement strategy in family-based adolescent treatment. Psychotherapy: Theory, Research, and Practice, 32, 39 -- 58.

Orvaschel, H., Beeferman, D., Kabacoff, R. (1997). Depression, self-esteem, sex, and age in a child clinical sample. Journal of Clinical Child Psychology, 26, 285-289.

Rogers, L.E., & Escudero, V. (2004). Theoretical foundations. In L.E. Rogers and V. Escudero (Eds), Relational communication: An interactional perspective to the study of process and form. London: Lawrence Erlbaum Associates, pp.3-22.

Rogers, L.E., & Escudero, V. (2004). Theoretical… [END OF PREVIEW]

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