CSS Guide

Engagement and Motivation

Initial Family Presentations- Your observations of family. How family presented the problem. (e.g.

What did you need to work on to change the negative momentum in this session, the rest of the note

flows from this)

e.g. low degree of neg. & blame in session, both asked therapist questions, mom seemed sad (put head

down and grimaced).

e.g. Mom- Johnny is always coming home late and yelling at me. Johnny- Mom just nags when I get

home

Relationship Building- Don’t confuse w/matching.

e.g. Made small talk w/family, asked about their daily routines, asked about their goals, validated

youth’s perspective, used reflective listening. Noticed dad likes baseball and talked about last night’s

game…

Matching- How you matched w/each person.

e.g. Used youth vernacular, humor, tone of voice, voice intensity, mood. In later session, matching to

Relational Assessment

e.g. Writer was conversational, laid back. Family seemed to respond well.

e.g. Mom is one-up, so let her take the lead on the conversation

INTERVENTIONS

*remember these are all things you DID in session, not things you thought of later (that goes under Next

Session Plan). Write exactly what you said and family’s responses.

Change Focus Interventions

Interrupting/Diverting- How you interrupted negativity & blame. (if none needed, write in n/a or

―none needed.‖)

e.g. interrupted yelling when it began to escalate, stated, ―I know there are many examples you can give

me about what is frustrating you, but I don’t want to get caught up in examples, let’s figure out what we

do from here.‖

Sequencing- Behavior pattern that the family TELLS you about (not that you necessarily observe).

Asking ―and then what happened?‖ questions. Can add twist (feelings, etc) to sequence/pattern. WRITE

THE FULL SEQUENCE!!!

e.g. mom feels disrespected when…mom yells, kid rolls eyes, ignores her, goes in his room and slams

door. (you can copy and paste this in Behavioral Patterns later)

Point Processing- Behavior pattern you OBSERVE during session, and point out to the family.

e.g. This writer stated, ―I notice, Johnny, that you stare at the ceiling when mom talks and you roll your

eyes like you’ve heard this before.‖ Mom and Johnny laugh and agree.

Strength-Based Relational Statements – Does NOT have to note noble intent. State the

linkage/commonality between family members.

e.g. both get frustrated but both also don’t give up easily. Or you both get frustrated, but express it in

different ways (mom- emotionally, kid- physically), both are Taurus’, you both are creative but express

it differently.

Change Meaning Interventions

Reframing-Changing meaning to what was said in session, acknowledging the negative, then offering

noble intent. Check for impact. Remember:

Reframe = Pointing out negative behavior + relational “noble” intent + listen for response

e.g. This writer acknowledged mom’s yelling, and offered that she cares for her son’s safety and well-

being and is scared. ―Wow, mom, I really hear you. I notice that you are yelling and coming across as

very angry, and I can’t help but think that under all that yelling is being really scared about Johnny

getting hurt when he’s out late. Does that fit?‖

-- you may want to go back to the negative behavior (e.g. second time you bring up the reframe) after

the noble intent to point out that the negative behavior is a problem: ―Wow, mom, I really hear you. I

notice that you are yelling and coming across as very angry, and I can’t help but think that under all that

yelling is being really scared about Johnny getting hurt when he’s out late. And I also know that when

you yell like that, he just shuts down and doesn’t hear that you are scared.‖

Theme Hints- One or a few words/phrases. The words that come to your mind when you think of this

family.

e.g. Faith, strength, trauma, survival, fighters, determination, hurt behind anger, respect, trust,

frustration.

Relational Themes- Strength-based relational statements WITH noble intent. A general, over-arching

theme linking them together.

e.g. Mom is expressing her worry and concern, but it comes across as nagging. They both want to have

calm conversations instead of yelling so it doesn’t blow up and turn ―nasty.‖

Behavioral Themes Developed- Sequences WITH noble intent added in. or Stringing together

reframes to put the behaviors and noble intents altogether into a cohesive theme.

e.g. mom feels disrespected when…mom yells, kid rolls eyes, ignores, goes in room and slams door.

Mom is trying to express her worry and concern for kid by yelling, however, kid feels like mom is

nagging, and but both are left feeling hurt and angry.

ASSESSMENT

*You should pretty much always click ―Family relationships‖ as a risk factor since they are in FFT.

Additional Protective and Risk Factors- add in Protective factors here since there is no other place for

them.

e.g. Protective factors- grandma’s support, mom’s job, kid has goals, etc.

Behavioral Pattern- Literally copy and paste the box you wrote under ―Sequence‖ and write the date

before it. This will continuously populate. **This is the best way to get information on Relational

Assessment, so this box should NEVER be empty or have minimal info!! Because this always populates,

you can add sibling relational functions in here.

NEXT SESSION PLAN

Assessment Focused Questions- These questions are asking for relational assessment focused

questions- your assessment of their relational functions and hierarchies. This is more filled in EM

sessions.

e.g. Not sure if mom is more connecting to son or vice versa… get another example of sequence to

clarify connectedness. What do they do for fun as a family? What is a typical day like for your family?

When things get bad, who brings it up first? What happens after you have an argument? I need to find

out where grandma fits in this picture. (remember that all these ―questions‖ are to help you understand

the relational assessment)

Goal Focused Questions- Questions you have about the Goals of the Phase (E/M, BC, Gen) you are in.

Use the FSR and the session outcome boxes to guide responses. (alliance, hope, reduce

blame/negativity, relational focus in EM)

e.g. I am afraid I lost mom at the end of session, I need to check-in with her to check for alliance. Need

to build alliance with grandma. Still need to work on building a relational focus. Little need to work on

negativity and blame.

Specific Session Plan- What goal/target do you want to focus on for next session? How will you do it?

This should include ways you are going to answer Assessment/Goal questions from the previous two

boxes!!

e.g. build relationship with grandma using strength based relational statements when kid constantly says

to her, ―I don’t care.‖

Between Session Intervention Plan- State what you will do between sessions for family. If nothing,

then write ―none needed.‖ Especially useful in Behavior Change to ―check in‖ as a reminder for them to

do their homework

e.g. will call to check-in, will talk to probation

Agency Related Information- Depends on what agency wants here. Billing, etc.

CSS Guide

Behavior Change

Behavior Change Phase Plan (BCPP)- What your plan is for the entire Behavior Change phase. You

can look at session by session, but remember you may have to be responsive and deviate from a strict

session by session plan. CSS prompts: “This section is an opportunity for you to plan for the full phase

and the desired phase outcomes as much as possible. In doing so, describe anticipated specific family

core skills (the family's targeted behavioral risk factors) for each family member and how these skills

will match relational functions. Consider the protective factors to be enhanced. In the Behavior Change

progress notes, you will be discussing the progress you have made in this plan session-by-session.”

Thus there are three parts to BCPP:

1. Target = specific and individualized skills. Write this out for each family member and be clear about

how this is going to impact Risk Factors (such as going over their sequence/patterns and where to insert

skill to change the negative pattern)

2. Matching Relational Assessment—how are you matching the specific skill to relational assessment. If

mom is connecting and child is more autonomous, how are you matching to those?

3. Risk and Protective factors—how are you using protective factors to help support the changes

(―grandma is a good listener so mom can talk to her during mom’s time away to cool down‖). Be sure

you are addressing risk factors including the REFERRAL problem!

e.g. Target – better communication

Johnny’s role- acknowledging mom with active listening skills

This matches Johnny’s greater autonomy because he only has to listen and acknowledge that he

heard.

Mom’s role- brevity and impact statements with Johnny

This matches mom’s higher connection by allowing her to still talk about what is bothering her,

but it doesn’t overwhelm Johnny’s higher autonomy.

You can write session by session:

Session 1- review theme, review sequence/pattern, present active listening, practice skills in session,

give homework

Session 2-Ask how the skill went at home/did they practice skill at home, review skills, practice skills in

session. Present second skill (KISS- Keep It Simple Sweetie), practice, give homework.

Session 3- …

Session 4-...

SESSION INTERVENTIONS

Introduced New Skills- Describe the skill introduced. You will be very directive during Behavior

Change. You are educating, teaching, coaching, modeling, using worksheet, ANYTHING that will

match the family’s style and help them learn the skills.

e.g. use words like, ―This writer taught/coached/directed the family…‖

Practiced New Skills- Describe how the family practiced skill in session. This is an excellent

opportunity to use the ―content‖ they bring to session. If they had a fight the week before you can say

―Great! Because I have this thing I want to talk about today and this is a great example to work with!‖

Then you continue with introducing your skill for the week, and then have them practice the skill using

the fight they brought up earlier. (e.g. use active listening while discussing sequence)

Matched New Skills to Relational Functions- How your skills are matching their relational

assessment. E.g. Both are autonomous. This skill maintains their autonomy in a more positive way and

still allows mom to express her concerns.

Reviewed Skill Progress in Session- In 1st session of BC, you will likely write ―n/a.‖ 2

nd session on,

state whether the family is practicing skill at home, if it is working, etc.

Assigned HW- If family is not at a place to assign homework right away, write ―n/a‖ and just practice

the skill in session first. If you assign homework, state what it is. Be sure the first time you assign

homework it is something they will be successful doing! We want them to feel success, not failure.

Even if it is simply ―practice this skill tonight by saying ―goodnight‖ to each other nicely and I’ll call

tomorrow and see how it went!‖

RELATIONAL ASSESSMENT

Behavioral Pattern- You will likely write nothing more here after Engagement/Motivation is done.

Prior ones from EM will continue to populate.

All information here is populated from previous EM session. If you think your assessment may have

been off you can just change it (it will change all past session notes in CSS).

Next Session Plan

Assessment Focused Questions- You may not write anything here after Engagement/Motivation as

your relationship hierarchies/fxns have been established. However, if you notice that things don’t feel

―quite right‖ or the family is losing motivation or not following through on practice in session or

homework, consider looking at Relational Assessment again. (i.e. ―mom didn’t follow through with

homework, is she really as connecting as I think? Get an example sequence from the week to re-check

my assessment of mom being a 4‖)

Goal Focused Questions- Think in terms of Goals of the Phase (practicing skill, making positive

changes, maintaining change)

Ask questions of yourself like: How did they do with their homework? Are the skills working? Should I

add more skills?

e.g. ―family seems to be practicing skill, but they are still having difficulty staying positive all week.

Should I do a call in half way through the week or add in an additional skill? Perhaps the ―active

listening‖ needs…‖

Specific Session Plan- What skill you are going to present next session based on your BCPP (at top) If

you wrote out specific session by session plans, you can copy and paste here.

Between Session Interventions- Will likely call-in to check to see if family is doing homework and if it

is working. Calls to ―check in‖ halfway through the week are good reminders for the family to practice.

Remember, we want them to feel successful so any way that you can help them be successful is useful.

You may even call them and have them practice while you are on the phone! This will help them follow

through and feel success.

CSS Guide

Generalization

GENERALIZATION PHASE PLAN

Describe Generalization Phase Plan.

(CSS says: This section is an opportunity for you to plan for the full phase and the desired phase

outcomes as much as possible. In doing so, describe how you anticipate to 1) generalize skills by

identifying specific within family and outside family areas for application of new skills; 2) maintain

family changes by identifying specific areas for relapse prevention practice; 3) maintain family changes

by identifying potential family and community resources that reduce family risk factors and/or enhance

family protective factors. In the Generalization progress notes, you will be discussing the progress you

have made in this plan session-by-session)

Example:

(1) Continue to use communication skills within the family by providing clear expectations for residing

in the home in the future. (1)External to the family, individuals will progress through the use of the

behavior change skills by being able to communicate more clearly with employers

(2) Develop Relapse prevention plan that looks at each person’s triggers, cues, behaviors, and how to get

back on track. Complete Relapse Prevention Worksheet

(3)To maintain these changes Dad’s networking in order to remain employed will be critical. (3)

Johnny’s contact with probation provides some minimal structure as his parents often differ in their

parenting approaches and D often takes advantage of these differences. (3) Mom’s contact with her

physician’s for her physical ailments will help her cope with her work schedule.

(In this box you want to have a pretty clear plan of what you are going to do to address 1, 2, & 3 above.

For 1—how can you generalize the skill you taught them within and outside family. For example,

practicing on a new problem, or practicing with employers. For 2—what do YOU think relapse will look

like for this family, what do you think their triggers will be, and how can they address this? For 3—what

outside resources will help maintain the changes by either addressing risk factors (ie keeping kid busy

out of gang) or using protective factors (ie working at grandpa’s house)

SESSION INTERVENTIONS

Generalization of Skills -- discuss internal and external family application of skills

Example:

D was present for the session. During the course of the session T applied skills that were successful in

her relationship with K, such as clearly stating limits and providing space for replies, to her relationship

with D. (Perfect example!) K asked his mother to assist him choose some college classes after having

considered the need to pay rent during the upcoming year. (Perfect, adding what skill they used) D lived

with his mother this week and has been clean from marijuana during the past seven days and appeared

significantly more alert during the session. (did they use a skill to achieve this?)

(This box is specifically how they generalized a skill learned in BC to either a new problem within the

family, or externally)

Maintenance of Change (Relapse Prevention)

Example:

Completed Relapse Prevention Worksheet with family (see copy in file). This included mom’s ―old

behavior‖ of nagging, what triggers her to nag, what cues she notices before she nags (tense stomach,

chewing on her cheeks, someone else pointing out she is tense), and how she can get back to her new

behavior of brevity and active listening. Johnny’s old behavior ―screaming at mom then leaving‖ is

triggered by mom’s nagging, fight with girlfriend, bad day at school, being bored. His cues are feeling

bored, being tense, and mom asking him ―what’s wrong, you look upset?‖. The way he can get back to

his new behavior of taking a deep breath, counting back from 10, and saying ―I need a break‖ and going

to his room to listen to music‖ is a key phrase from mom that is very positive ―I hope we have a good

conversation, do you want a snack or some time?‖

(I don’t know why this says ―maintenance of change‖ and not just ―relapse prevention‖(RP)!! This is

where you write how the family worked on RP—recognizing triggers, recognizing old behavior, having

a relapse and discussing it, how to get back on track when relapse happens (and it will!!!) and how to

avoid relapse)

Resource Links that Decrease Risk and Enhance Protective Factors

Example:

D will begin individual therapy with CL this week. I referred K to craigslist, the newspaper, and mall for

beginning his search for additional employment. T made several suggestions for businesses that have

recently had help wanted signs. Probation will set up community service.

(self explanatory. Referrals you make. Importantly, think of this in terms of risk and protective factors—

are you reducing a risk? Using or increasing protective factors? Think of natural resources that the

family is more likely to use. Will the family be able to continue the referral after you leave (ie match to

family’s level of functioning, don’t get them ―systematized‖))

ASSESSMENT

Match of Generalization Interventions with Family Relational Functions

External Family Risk Factors that may impede family’s maintenance of change. For example: school,

juvenile justice system, neighborhood, job loss, homelessness, etc.

The family’s communication pattern and ability to function within limits is critical to their maintenance

of change. Employment is a major factor for T and K. The degree to which T and C conflict and argue

over their parenting styles will continue to raise the risk that D’s acting out behaviors and ability to

function within limits will go unsupported.

(pretty self explanatory. These are multisystemic issues (ie poverty) that may keep family stuck or

sabotage change)

External Family Protective Factors that may enhance family’s maintenance of change. For example:

school, juvenile justice system, neighborhood, extended family, new job, church, etc.

D’s involvement with the probation office and T’s use of clear communication to explain her vision of

parenting and co-parenting to D, C, and the P.O. may well prove to be very protective. T’s network of

friends and her own experience of working in many different positions is protective to herself and

through her assistance to K. K’s friendships are protective as they provide and outlet for him to express

his frustrations as well as possible future independent living partners.

NEXT SESSION PLAN

Assessment Focused Questions

How does K feel his commitment to work additional hours affect his relationship with his mother?

(Does it match to his relational functions) Has T and D's relationship continued to improve while D

resides at her home and remain clean?

(Basically, how does the relational assessment affect generalization.)

Goal Focused Questions

What hurdles has K encountered in his search for employment? Has D been drug free and what factors

influenced his success or relapse?

(Basically, goals of generalization that you feel you still need to address: (generalize skills

internally/externally, relapse prevention, external supports)

Specific Session Plan: Describe plans (areas of practice, how you will match-to relational functions) for

relapse prevention and generalization of skills in your next session. Indicate if you plan to help family

connect to any resources.

Review behavior pattern and successes using skills. Discuss possible areas of risk that the family can

apply skills to and complete Relapse Prevention Worksheet.

(If you had any questions above, how you will address them)

Between Session Intervention Plans: Describe what interventions (phone calls, learning about

family/community resources, etc) you plan before next session.

Contact family regarding employment search, drug usage, and parental response.