Mixed Methods Research on Clinical Consultation Within the REStArT Model in Residential Treatment

Abstract

The Relational Re-enactment Systems Approach to Treatment model is a treatment approach that informs a residential treatment family intervention called clinical consultation . Clinical consultation is a system-oriented intervention that embodies the model’s principles regarding therapeutic alliance and working through ambivalence . This chapter highlights the process and benefits of mixed methods research on family interventions by describing the results of a mixed methods study on clinical consultation . First, the study empirically analyzed youth characteristics related to outcomes and then used a qualitative approach to examine the treatment process, as it may have impacted outcomes. The quantitative part of the investigation included comparisons between youth with and without the involvement of the Department of Children and Family Services, specifically in terms of length of stay , involvement in consultation, and sustained outcomes. The qualitative component involved therapists who work with youth and their families discussing their understanding of what differentiated successful and unsuccessful cases.

Appendix: Principles: The Relational Re-enactment Systems Approach to Treatment (REStArT)

• I. Developing a Working Therapeutic Alliance : Client, family, and service providers agree on the goals and tasks of treatment. These goals and tasks need to be youth and family driven.

• II. Relational Re-Enactment: Identify youth’s attachment style through the ways in which the youth re-enacts it in their behavior with others (i.e., identify the conflict cycle) .

• III. Managing Counter-Response: Identify the adult counter-response (feelings and subsequent behavior) within that youth’s particular conflict cycle ; identify the adult’s unpleasant reality (related to the youth’s conflict cycle) that is being avoided by the adult; face the adult’s unpleasant reality and the adult’s feelings so that they are not driving the adult’s behavior (counter-response).

• IV. System-Oriented: Identify all the adults involved with the youth and have them come together to develop a shared understanding of and way of approaching the youth.

• V. Finding the Imbalance in the System : Identify polarities in youth’s behavior and subsequent polarities in adults’ counter-response (i.e., splits/divisions within the system).

• VI. Seeing the Whole Youth: Identify ways in which our view of the youth has been compartmentalized (i.e., sees the youth in a particular way). Work together and dialogue so that all parties see both sides of the youth—the adaptive side and the maladaptive side.

• VII. Restoring the Balance : Use dialogue and consensus to restore balance in developing a plan to interrupt the youth’s conflict cycle (integrate both extremes of the adults’ counter-response reactions in order to arrive at a more balanced response).

• VIII. Interrupting the Conflict Cycle: Implement a plan that interrupts the way the youth typically responds to stressors which provides an opportunity for the youth to respond in a new more adaptive way.

• IX. Working with Ambivalence : Be aware of and identify examples of ambivalence toward the current circumstance in the family and the youth so that this can be verbalized instead of expressed through behavior.

• X. Expecting Health: Trust the youth’s ability to determine their own goals, tolerate disappointments , and repair relational disruptions.

• XI. Ownership at Every Part of the System: Create investment in the model across the entire system and support each part’s contribution to the plan, which promotes responsibility and accountability .

• XII. Evidence-Based: Use concrete data about the youth to determine conflict cycle and plan development and to evaluate effectiveness and outcomes.

• XIII. Dynamic and Reflexive Process: Establish a continuous process of looking at our own responses/reactions and evaluating whether the plan is effective.