Family Therapy Learning Session - Teresa McDowell - July 26, 2018 - Oregon Problem Gambling Services

1. C
FIRST, SECOND AND THIRD ORDER CHANGE
IN PROBLEM GAMBLING TREATMENT WITH
FAMILIES:
FORUM VII
Teresa McDowell, Ed.D., LMFT

2. This learning session focuses on levels of
thinking and change in family therapy in
relationship to gambling treatment. We
emphasize the importance of taking a meta-
view and recognizing self as part of the
therapeutic system.

3. LEARNING GOALS
At the end of Family Therapy Learning Session and Forum
VII, participants will be better able to:
1. Recognize their role in therapeutic processes,
2. Identify the differences between 1st, 2nd and
3rd order thinking and change, and
3. Apply these concepts to the treatment of
families struggling with problem gambling.

4. 1st order change
•Tends to be direct, “common sense” solutions
much like family is already attempting (set a limit, walk
away with a win, don’t gamble, take me with you)
•Non-solutions as future problems
•First order change is change within a set of
alternatives

5. 1st order change…
•Common sense tends to be dominant
cultural sense (reflect values of self-control,
autonomy/independence, individualistic definition of “self,”
expectations about productivity)
•Psychoeducation v common sense
solutions

6. 1st Order Change in Problem Gambling
Treatment
Important in crisis and early recovery
money barriers, legal issues, budgeting
Tends to follow second order change. When change
in relationships and repetitive patterns occur, many
more practical changes follow disclosing debt –
budgeting – working as a team – sharing bank account information
-

7. A focus on first order change as
primary tends to limit the
therapeutic process
https://www.youtube.com/
watch?v=wHfGES7zT4M

8. Most clients are thinking 1st order
and therapists may at times be
talking first order while thinking
second order
(clip of first phone call)

9. Taking a Meta Perspective
Thinking about thinking
Talking about talking
Taking a multi-ocular view
Observing self in relation
to others in action

10. 2nd Order Change
•Facilitating second order change requires the
ability to look at the bigger picture, to identify
repetitive patterns and schemas
•2nd order change focuses on changes in sets of
alternatives

11. Second order change is said to have occurred
when system rules and shared meaning change
along with interactions.

12. Most problem gambling treatment is
focused on 2nd order change
• Becoming aware of gambling patterns
• Identifying triggers to interrupt gambling,
• Restructuring family relationships
• Changing gambling schemas/world view
• Overcoming experiential avoidance

13. Therapist as Part of the System
The term “2nd order cybernetics” refers to the ability
to see the therapist as participating in patterns and
making meaning with clients/families
https://www.youtube.com/watch?v=bwpHXtwjP-8

14. Mimetic Isomorphism
Tendency to
engage in
parallel processes
across levels of systems
Therapists and
supervisor
Therapist and
family
Family

15. 3rd Order Change
(McDowell, 2015; McDowell, Knudson-Martin & Bermudez, 2018)
Third order thinking requires considering systems of systems,
e.g., relationship between capitalism, patriarchy and
race/racism and how family relationships reflect these
broader systems; how gambling is situated amidst societal
systems

16. 3rd order thinking
Therapists considers social location/interconnected
identities of clients and therapist within broader
social context in which problems and treatment
occurs
The aim of 3rd order thinking and change is to
expand alternatives and possibilities for change

17. Examples of 3rd order thinking and 3rd order
change in problem gambling treatment:
•Meaning of money in societal context
•Gendered relationships, power and escape
•Definition of success in capitalist societies
•Relationships between fathers, sons & patriarchy
•Social construction of values

18. Process v Content
A focus on content tends to lead therapists to:
1. Common sense “non-solutions”
2. Limited 1st order change
3. Getting “stuck” where clients are stuck
4. The sense of jumping from one problem to another
5. Feeling “lost” in sessions and treatment planning
6. Abandon theory as guiding interventions
(Clip of family session)
Ameliia attunes to
and accomodates
Jane
Jane responds in a
power-over move
David supports
Jane's position
Amelia shuts down
or futher
accomodates
Jane's position and
voice is further
legitimizaed

19. 1. Do I base interventions on a model of treatment? Can I articulate the model I
am using?
2. Do I know where the session is going? Do I have a plan that can be flexibly
applied to where clients’ are/what is going on in their lives?
3. Do I use common problem gambling treatment interventions without placing
them in a theoretical framework (e.g., using the white board)?
4. Do I avoid interrupting or redirecting? Do I think it is rude or controlling to do
so? Do I not interrupt sometimes because I don’t know where I am going?
5. Do I ask questions without considering the message implied in the question?
Every question also sends a message about what the counselor thinks is
important or how they are thinking about a situation.

20. 6. Do I feel stuck sometimes? Relieved when the session is over or willing to
allow clients to ramble because I am not sure where we should go
therapeutically?
7. Do I rely on a limited number of interventions based on my assumptions
about change? E.g, do I repeatedly focus on feelings and showing empathy? If
so do I have specific rationales at specific times for these interventions and do
they support problem gambling recovery?
8. Would I be uncomfortable if someone were watching a video of my session?
9. Do I rely on common sense solutions with a tendency to direct clients in
what to do rather than facilitating a process?
10. Do I have an idea by the end of each session what might be helpful to
continue change between sessions? Do I tailor between session
interventions?

21. Facilitating Change
 Experts in therapeutic process
 Experts in problem gambling
& Problem Gambling Recovery
 Identifying what guides treatment
– model of change

22. Facilitating Change…
Determining goals/treatment plan
collaboratively – informed by therapist
knowledge
Interventions purposefully designed and
delivered to fit clients/family, model, and
problem gambling

23. DISCUSSION