SUPPORTING BEHAVIORAL CONCERNS

Chapter 7: Students with Severe Acting-Out Behavior: A Family Intervention Approach

KEITH M. DAVIS

Appalachian State University

Highly disruptive behavior is a challenging problem to deal with effectively in a school setting. Of course, professional school counselors will attempt to use the systems approach (e.g., Hawe, Shiell, & Riley, 2009), where they work within multiple contexts in an attempt to support the troubled student. Perhaps due to time constraints or a lack of training, the family system is often neglected in this approach. It is, however, important for the school counselor who is operating out of a comprehensive school counseling program to use strengths-based, time-limited family interventions (American School Counselor Association, 2005). Most school counselors agree that involving families in their children’s educations has a significant positive impact on the academic, personal/social, and career aspirations of students. When families are actively engaged in their children’s academic, personal/social, and career activities, there is a higher likelihood that the educational experience will have a positive outcome (Amatea, Daniels, Bringman, & Vandiver, 2004; Amatea, Smith-Adcock, & Villares, 2006; Davis, 2001; Davis & Lambie, 2005; Duhon & Manson; 2000; Galassi & Akos, 2007; Ravthvon, 2008; Reink, Splett, Robeson, & Offutt, 2008; Thomas & Ray, 2006).

This chapter is intended to supplement the earlier chapter on externalizing behavior problems by first providing a real-life school-based case study of how a high school counselor intervened with a youth who was severely acting out (disruptive behavior) in the school by assisting the family. Then the essential characteristics of acting-out behaviors, often classified as a “behavior disorder (BD)” in the school setting, are overviewed. Third, key research-based family interventions employed by the professional school counselor are discussed. Finally, the chapter provides additional resources that can be used by practicing professional school counselors and counselors-in-training to assist students and families with behavioral challenges.

David’s case may sound familiar to many professional school counselors, who often work with children and adolescents who present with severe acting-out behaviors. A brief overview of the essential characteristics of acting-out behaviors in children and adolescents will help professional school counselors in their work.

David: A School-Based Case Study

David was a 15-year-old white male freshman in high school who was referred to his high school counselor as a result of frequent physical fights (resulting in suspensions from school), school attendance and truancy issues, and using foul language to teachers. Despite having no identified learning disabilities and a record of successful academic achievement in elementary and middle school, David was failing several classes. David’s grades and conduct began to come into question during Grade 7, and continued until his current referral.

David was identified by others, including the high school counselor, as an angry and aggressive teenager. He was clearly not pleased to be speaking with the school counselor. As a result it took several meetings for the counselor to establish a positive rapport with David and help him realize that the meetings were not punishment, but a genuine attempt to understand him and his worldview. When asked his thoughts on why things began to turn for the worse during middle school, David could offer no answer other than: “Everybody is against me and I don’t take no crap from anyone.” When asked about his family, David reported that he was an only child, his mother worked part-time, and his father was a truck driver, who was gone several days a week on long hauls. David seemed indifferent when the counselor asked if it was all right with him to have his parents to come in for a meeting.

When phoned, David’s mother agreed to come in for a meeting with the school counselor, but said it might not be possible for David’s father as he was frequently gone for his job. Meeting with David’s mother only at first, the counselor confirmed that David had not been in any trouble before seventh grade. When asked what had changed during that time, David’s mother noted that it seemed to have begun when David’s father was laid off from his factory job, was out of work for a couple of months until he took the truck driving job, and was then gone most of the time. David had become less manageable during this time, and was frequently left alone while his mother worked part time.

ESSENTIAL CHARACTERISTICS OF ACTING-OUT BEHAVIORS

This section briefly discusses several characteristics of acting-out behaviors as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, also known as the DSM–IV–TR (American Psychiatric Association [APA], 2000). For a comprehensive understanding of the complete diagnostic criteria for acting-out behaviors most commonly experienced in childhood and adolescence (e.g., Attention-Deficit/Hyperactivity Disorder; Conduct Disorder; and Oppositional Defiant Disorder), a reading of pages 85–102 in the DSM–IV–TR is recommended (see also Chapter 2).

Common Diagnostic Features and Associated Factors

The prevalence of acting-out behaviors has increased over the years and is often diagnosed more in urban settings than rural. Although behavioral symptoms vary with age, behaviors tend to escalate in severity as the individual develops “increased physical strength, cognitive abilities, and sexual maturity” (APA, 2000, p. 97). Males outnumber females in the diagnosis, and differences between the genders demonstrate that males tend to exhibit more acting-out behaviors associated with physical confrontations and property vandalism, while females tend to exhibit more behaviors associated with lying, truancy, running away, substance abuse, and prostitution. Children and adolescents who act out may also experience “low frustration tolerance, temper outbursts, bossiness, stubbornness, excessive and frequent insistence that requests be met, mood swings, demoralization, dysphoria, rejection by peers, and poor self-esteem” (APA, p.88). Finally, thereare often” conflicts with parents, teachers, and peers” (APA, p. 100) that develop as a result of the behaviors.

Caution should be taken when assuming acting-out behavior diagnoses for children or adolescents who immigrate to the United States from war-ravaged countries, or areas of the United States where crime or poverty are widespread. Adverse behaviors in these children and adolescents may be outgrowths of protective behaviors developed in their sociocultural context.

In David’s case, his acting-out behavior diagnosis was made based on information from his teachers and school administrators, his former middle school counselor, by meeting with his mother, and the school counselor’s observations of and discussions with David himself. Specifically in David’s case, he exhibited repetitive and persistent acting-out behaviors, such as fighting, intimidation and bullying, breaking in and destruction of personal property, stealing, staying out at night, running away from home, and truancy/attendance issues at school. These behaviors had caused significant impairment to David’s social and academic functioning. For David, there was no documentation that any of these behaviors existed before the age of 10. His troubled behavior began in seventh grade when he was 13 years old, and interestingly enough, shortly after his father lost his factory job and began working as a long-haul truck driver. This led the school counselor to think systemically about David and his family, and conclude that a family intervention was warranted.

EFFECTIVE FAMILY INTERVENTIONS

The fact that David’s behavior began to deteriorate at about the same time his father lost his job and subsequently took on work truck driving, requiring him to be away from the home several days at a time, was too coincidental. Immediately, the school counselor began forming a systems perspective for understanding David and his behavior.

A family systems perspective attempts to understand individual human behavior within an interrelated social and familial context (Amatea et al., 2006; Davis, 2001; Duhon & Manson; 2000; Fine, 1992; Fine & Carlson, 1992; Hawe et al., 2009; Hinkle, 1993; Hinkle & Wells, 1995; Reink et al., 2008). School-age children and adolescents belong to several systems (e.g., family, school, community, and cultural), all of which combine and interrelate to form a series of subsystems within one larger system. Thus, when professional school counselors consider problem behaviors in school-age children and adolescents, the outlook from a family systems perspective is that these problem behaviors may result from dysfunctional family interactions, rather than placing blame for the problem behaviors on the child alone (Hinkle & Wells, 1995). In these cases school counselors should want to switch from a deficits approach to a strengths-based, family resiliency perspective (Amatea et al.; Galassi & Akos, 2007).

Specific Family Interventions

Examples of positive family interventions employed by professional school counselors within the school have received increasing attention in the school-counseling literature. Briefly described below are several examples of family interventions that can be employed in a school setting by professional school counselors, concluding with a more comprehensive description of the case study presented earlier in the chapter.

Collaborative and Systemic Consultation

Mirroring in several ways Dinkmeyer and Carlson’s (2006) processes, Amatea et al. (2004) discussed a four-step collaborative consultation process that could be employed as a way to facilitate stronger home-school relations and encourage family engagement in their children’s education.

•  Step 1. Assessment. The first step involves school counselors assessing the initial attitudes and practices of all school personnel relative to all family-school communications.

•  Step 2. Education. This phase involves the education of school personnel, with school counselors modeling the collaborative process for all school personnel. School counselors accomplish this by seeking input from all school personnel in a such a way that hinders “the blaming that undermines many family-school problem-solving routines and engages in joint problem solving” (Amatea et al., pp. 50–51). This step also includes opportunities for school counselors to arrange meetings with teachers, families, and students in an effort for all parties to become active participants in school-based decisions, with emphasis placed on a no-fault, co–decision-making model for educational success.

•  Step 3. Restructuring. This step examines family-school interaction patterns, revising the manner in which family-school meetings are traditionally conducted. By collaborating with teachers, school counselors are able to establish biweekly grade-level meetings in which families are invited to join with their children in non-problematic and student/family-led conferences for educational decision-making.

•  Step 4. Evaluation and accommodation. Finally, this step allows school counselors to elicit feedback from students, families, and school personnel regarding the overall effectiveness of the collaborative and systemic approach.

Imaginative-Constructivist Model

This strengths-based approach for family intervention integrates concepts from narrative and solution-focused therapies (de Shazer, 1985; Eppler, Olsen, & Hidano, 2009; Freeman, Epston, & Lobovits, 1997) with school counseling activities and services (Galassi & Akos, 2007). Narrative approaches help families change how they view their current circumstances by restructuring how they tell their personal stories. Solution-focused strategies help families focus on current strengths (i.e., what is already working for the family), exceptions to the problem (i.e., times when the problem is not happening), and what the family would want ideally to happen (Eppler et al.). Thomas and Ray (2006) provide excellent examples of this intervention approach in their work with the families of gifted children, children with learning disabilities, and children with behavior problems. Their two-phase intervention is comprised of an assessment phase followed by a phase during which intervention techniques are implemented.

•  Phase 1. Assessment. An informal assessment by the school counselor is conducted, using information gathered from family interviews and from listening to “the stories each family member brings to the session” (Thomas & Ray, 2006, p. 62).

•  Phase 2. Implementation. The school counselor uses a narrative approach to help the family restructure their personal stories. Having families restructure their stories facilitates the change process “because changing the stories people tell about themselves and others changes their situation” (Thomas & Ray, 2006, p. 62). A tool for facilitating the restructuring of family stories involves moving from “thin descriptions” of family lives, which tend to be more stereotypical and rigid, to more complex “thick descriptions,” which encompass multiple perspectives (Geertz, 2000; White & Epston, 1990).

In describing their work with families of gifted children, Thomas and Ray (2006) stated, “A typical thin description of giftedness primarily presents the benefits of being gifted. A thick description also would talk about the drawbacks of being gifted” (p. 62). Some specific questions put forth by these authors for school counselors were “How does the giftedness of one person affect the family and the school? Who has a vested interest in the giftedness of this person? What does giftedness do for the family?” (p. 62).

To support a family with a child who is acting out, sample questions based within a solution-focused orientation might include “How is the trouble your child is getting in to working for this family? Was there a time when your child’s behavior was not a concern (i.e., exceptions to the problem; times when the problem was not happening)? What would the family ideally like to see happen with this acting-out behavior?” With solution-focused family interventions, the main goal of the school counselor is to focus the family on times when the family was already successful and encourage them to reproduce those times, re-enacting what exactly had to happen to pave the way the for those successes.

Time-Limited Structural-Strategic Family Counseling Interventions

The landmark book written by Hinkle and Wells (1995) detailed how professional school counselors can employ a family systems perspective in schools, what training school counselors can receive in family counseling and interventions, and specific techniques that have been proven in a school environment. The book also contains a variety of case studies looking at the ways in which practicing professional school counselors were able to successfully employ time-limited family counseling and interventions in their individual schools. As a further example, Davis (2001) described a family counseling intervention he employed while working as an elementary school counselor. This family intervention used a structural and strategic approach to reestablish a shared parental subsystem between the grandmother and mother of an elementary-school-age child who was exhibiting increasingly aggressive behavior at school as a result of a conflicted parental subsystem.

Structural-Strategic Family Intervention

Both structural and strategic interventions help families see how their patterns of interacting with one another might contribute to dysfunction within the family, which often might be expressed in behavioral and learning challenges suffered at school by children and adolescents (Davis, 2001; Hinkle & Wells, 1995; Thomas & Ray, 2006). Developed by Minuchin (1974), structural family interventions are directed at changing the organization of a family by altering familial interaction patterns. Family structure refers to the organized ways in which families interact, behavior patterns being typically influenced by a set of rules for each behavior. Within each family there is a structure, with adults and children having differing degrees of authority and influence. In most families, the parents, parent, or guardian typically has authority, responsibility, and influence over the children. A fundamental goal of structural family intervention is to aid the family in solving its own problems by reorganizing the family structure. For example, the school counselor might help the family create a more effective structure, one that typically expects the parent(s) or guardian(s) to be in charge of the whole family, including the children, not the other way around, with children controlling the family through their behaviors.

In strategic family intervention (Haley, 1980; Madanes, 1981, 1984, 1990), a school counselor might employ techniques (e.g., strategies and/or directives) to help families change their thinking, behaviors, and interactions with one another. Strategies and directives are designed to aid the reorganization of family structure. Strategic interventions introduce new behaviors into familial interactions, allowing families to practice these new behaviors between family meetings. Through the practice of the new behaviors, the family can change the existing behavior patterns and interactions that have maintained the dysfunctional behaviors within the family.

In the case study of David and his parents, the school counselor decided to test, through a series of family meetings, a modified structural and strategic intervention. The goal was to help David’s parents learn a common parenting strategy in order to support their child.

David’s deterioration in academic achievement and social behavior first began in middle school, shortly after his father changed jobs and became “absent” from the family. David’s mother was left the task of being “the parent” on her own. When David’s father was at home, he was “too tired” from his work to be involved with the family and became disengaged as both a husband and a father (a dysfunctional family interaction pattern). As David’s behavior began to deteriorate, his father became even more disengaged. From a family systems perspective, and specifically from a structural family perspective, David no longer felt his parents were on the same page in parenting him. The task for the school counselor was to find a way for David’s parents to begin parenting him together again. To facilitate this process, a strategic intervention (i.e., a directive) was offered as a way to bring David’s parents together.

Meeting with the parents first, without David, helped begin the process of establishing the parents as “in charge” (i.e., a strategic intervention). The school counselor learned, in talking with the parents, how difficult the transition had been when David’s father lost his job and was out of work for two months, and how David’s mother, who previously had not worked outside the home, had to begin working in order to support the family. According to David’s father, this was difficult in the sense that he himself had been raised with the belief that men were supposed to be the provider for the family. When the job for a long-haul truck driver became available, he immediately took it in order to once again be a provider. David’s mother continued to work, as bills had accumulated during the period of David’s father’s unemployment. Before the job transition took place, the family had been spending a lot of time together, going to the movies together, having backyard barbeques, being involved in Little League baseball, and taking family vacations. With the father often on the road and away from home for long periods, the family was spending less quality family time together. When David’s father was on the road, he rarely called home, and when he did, he spoke only to David’s mother, and not to David himself. As David’s behavior began to deteriorate, phone calls from the road effectively ceased, as conversations between the parents led only to arguments about David and his behavior (i.e., a dysfunctional interaction pattern).

In parallel conversations with David only, the school counselor learned that he felt his father did not care about him anymore, that his father was always gone, and when his father was home, “he didn’t give a damn about me.” In David’s eyes, he did not have a father anymore. In fact, he felt like he did not have a family anymore. David became angry, and this anger resulted in numerous fights at school, school suspensions, staying out late, and eventually legal troubles from breaking and entering and vandalizing homes and property. David also demonstrated contempt for authority figures, mainly his mother and teachers at school, through his use of profanity and defying any direction.

Conceptualizing David and his family, the school counselor did not see David’s behavior problems as resting with him alone, but rather the whole family having not successfully adjusted to the father’s new work schedule. David’s father was disengaged from the rest of the family, the mother exasperated by circumstances, and David feeling like he had no father or family, or authority figure to provide structure. Thus, David’s acting-out behavior was a result of dysfunctional family interaction patterns.

Meeting with the parents began the process of reestablishing the parents as parental figures. The strategic directive that was first given in a meeting with the parents was for the father to call home each night when he was on the road. Conversations between the parents during these calls were not to be about David’s behavior, with the idea that no arguments about the behavior could therefore take place. Equally important, these phone calls each night would also include a conversation between David and his father as well, to see how David’s day went at school and see how he was doing, something that had not previously taken place. This strategic directive would begin a change process in the family’s behavior and interactions and divert them from the current dysfunctional pattern.

A second strategic directive given was to not only affirm that the parents for each working hard to provide for David and the family, but that they also deserved quality time together with David, as well as quality time together as husband and wife. By affirming David’s father for being a hard worker and provider and acknowledging his being tired when he was home, and acknowledging David’s mother as enduring the hardships of having the father absent part of the week, the counselor was able to have them agree to try to spend a little more quality time together as a family and separately as a couple when the father was home.

After speaking with David’s parents together, and then David separately, it was time to bring the entire family together to discuss the plan. This served the purpose of bringing the family together as a total family unit. The school counselor was able to obtain agreement from the whole family as a unit that they would try this new pattern of behavior. It was also agreed that as David’s academic and social behavior improved, his father would allow David to accompany him on the road with the truck when David did not have school (the third strategic directive). This prospect excited David, as he had expressed an interest in truck driving as part of his future. Subsequent meetings resulted in an agreement that David’s father would accompany the family to court to help resolve David’s legal troubles for breaking and entering. To further bolster and reinforce the family in change, a family meeting was scheduled at the school with David’s teachers and the school principal to help provide support and consistency.

The school counselor met with David’s parents together twice monthly after school for about four months to check on progress and provide support, bringing David in to join them at the end of the meetings. The counselor met with David individually on a weekly basis to check up on his academic progress, work on his anger, and reinforce the changes that were taking place. This family had made a commitment with continued support from the counselor, as well as support and understanding from teachers and the school administration. As David’s family slowly began to spend more quality together, the father became more engaged in the family and David’s behavior began to slowly change for the better. There were a few relapses with continued fights at school; however, all were able to process those relapses in follow-up meetings with the idea that change is a process. The counselor was able to secure from David and his teachers that when he felt like a fight was going to happen, he could immediately come to the counselor’s office, or the counseling suite, to sit and “cool off” without question. By the end of the year, David had not been in a fight for the last two months of the school year.

For this case study, it would have been easy to place all the responsibility for his acting-out behavior on David. However, from a family systems perspective, the case can be seen as the family’s inability to adjust to changing family circumstance, warranting an intervention at the family level. It is critically important in such cases to not place blame on the parents for their child’s misfortune. David certainly had individual responsibility in his behavior choices. At the same time, professional school counselors need to be cognizant and sensitive to changing family circumstances and how these circumstances affect the family and the child, as well as the academic, personal/social, and career aspirations of the child.

RESOURCES FOR PROFESSIONAL SCHOOL COUNSELORS

For many professional school counselors, the thought of providing family interventions within a school context seems daunting. Many school counselors feel ill prepared or have not received any training to provide such services. With so many demands and responsibilities already placed on professional school counselors, many may not feel they have the additional time to provide such services. In this section there are some suggestions to address these legitimate concerns.

For professional school counselors who may have an interest in providing time-limited family counseling and interventions with the families of school-age children, but feel unprepared to do so, several options are available. Many state, regional, and national school counseling associations provide training in family counseling and interventions, typically at school counseling conferences. Being a member of professional organizations and associations can keep practicing school counselors abreast of presentations, trainings, and opportunities to further their knowledge and skills on a variety of topics germane to the development of the profession. Furthermore, as members of professional organizations and associations, professional school counselors typically receive professional journals and newsletters (both paper and electronic) that share the latest research and proven techniques in the counseling field. At the time of this writing, as a result of being a member of the American School Counselor Association (ASCA), the author received an electronic invitation from ASCA to attend a local training on solution-focused brief counseling and parent consultation.

Another professional association for school counselors to consider, as it relates to increasing knowledge of family counseling and interventions, is the International Association of Marriage and Family Counselors (IAMFC), a subdivision of the American Counseling Association. By being members of IAMFC, professional school counselors to receive The Family Journal, a professional journal that publishes the latest research, techniques, and interventions in marriage and family counseling. More information on IAMFC can be found at their Web site: http://www.iamfc.com/index.html.

Another way for professional school counselors to receive training and/or supervision in family counseling and intervention knowledge and skills is through in-service training at the school or school system level. Professional school counselors acting as counselor educators visit several school-system-wide school counselor meetings to provide training and supervision in family counseling and interventions. Many school systems are located near universities that house counselor training programs. Contacting a university counseling program to inquire about providing training and supervision to school counselors in the area is often well received, and an opportunity for the counselor educator to provide a valuable service. Equally, many counseling programs allow already trained school counselors to take courses in marriage and family counseling as a way to stay updated on changes in the profession with further training in knowledge, skills, and supervision. Finally, there is already a strong literature base of professionally published articles and books regarding family interventions employed by professional school counselors. Some are listed in the references here, and are strongly recommended readings.

Some professional school counselors may wonder how in the world they are going to find the time to incorporate family counseling and interventions within the school into already demanding schedules and responsibilities. What works for some is to first realize that any such intervention would be time-limited. Secondly, given all the counselor’s other responsibilities, they have to pick and choose which families to work with based on the probability of a successful outcome given the time limitations. For families that need long-term, in-depth psychotherapy, referrals were given to local mental health professionals, with school support coordinated by the school counselor. For families that a school counselor feels could benefit from time-limited counseling and interventions, it can be helpful to work with them at the school, typically after school hours. The school counselor may also be able to negotiate with the school principal for one day a week of flex-time, when the counselor can come into the school at noon and stay well into the evening, seeing up to four families in the afternoon and evening. This also speaks to the importance of having administrative support, so the school counselor can have every opportunity to help students and their families.

SUMMARY

School-age children and adolescents belong to several subsystems, including their school community and family. It is a natural fit to bring these two systems together in the form of time-limited family counseling and interventions within the school. Bringing the family into the school setting and asking them to be part of solution may seem to be just another thing to do on the counselor’s agenda, but neglecting this potential source of resiliency and support may in the long run increase the amount of time the counselor spends on students with difficult problems. Research suggests that for some learners who exhibit acting-out behaviors and externalizing disorders in school, supporting them from a family systems perspective increases the likelihood that these students’ long-range developmental academic, personal/social, and career goals will be achieved.

REFERENCES

Amatea, E. S., Daniels, H., Bringman, N., & Vandiver, F. M. (2004). Strengthening counselor-teacher-family connections: The family-school collaborative consultation project. Professional School Counseling, 8, 47–55.

Amatea, Smith-Adcock, & Villares, (2006). From family deficit to family strength: Viewing families’ contributions to children’s learning from a family resilience perspective. Professional School Counseling, 9, 177–189.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington DC: American Psychiatric Association.

American School Counselor Association. (2005). The professional school counselor and comprehensive school counseling programs. Retrieved June 6, 2009, from http://asca2.timberlakepublishing.com//files/PS_Comprehensive.pdf

Davis, K. M. (2001). Structural-strategic family counseling: A case study in elementary school counseling. Professional School Counseling, 3, 180–186.

Davis, K. M., & Lambie, G. W. (2005). Family engagement: A collaborative, systemic approach for middle school counselors. Professional School Counseling, 9, 144–151.

de Shazer, S. (1985). Keys to solution in brief therapy. New York: W.W. Norton.

Dinkmeyer, D. Jr., & Carlson, J. (2006). Consultation: Creating school-based interventions (3rd ed.). New York: Routledge/Taylor & Francis.

Duhon, G. M., & Manson, T. J. (2000). Preparation, collaboration, and emphasis on the family in school counseling for the new millennium. New York: Mellen Press.

Eppler, C., Olsen, J. A., & Hidano, L. (2009). Using stories in elementary school counseling: brief, narrative techniques. Professional School Counseling, 12, 387–391.

Fine, M. J. (1992). A systems-ecological perspective on home-school intervention. In M.J. Fine & C. Carlson (Eds.), The handbook of family-school interventions: A systemic perspective (pp. 1–17). Needham Heights, MA: Allyn & Bacon.

Fine, M. J., & Carlson, C. (Eds.) (1992). The handbook of family-school interventions: A systemic perspective. Needham Heights, MA: Allyn & Bacon.

Freeman, J., Epston, D., & Lobovits, D. (1997). Playful approaches to serious problems: Narrative therapy with children and their families. New York: W.W. Norton.

Galassi, J. P., & Akos, P. (2007). Strengths-based school counseling: Promoting student development and achievement. New York: Lawrence Erlbaum.

Geertz, C. (2000). Thick description: Toward an interpretive theory of cultures. In C. Geertz (Ed.), The interpretation of cultures (pp. 3–32). New York: Harper Collins.

Haley, J. (1980). Leaving home. New York: McGraw-Hill.

Hawe, P., Shiell, A., & Riley, T. (2009). Theorising interventions as events in systems. American Journal of Community Psychology, 43, 267–276.

Hinkle, J. S. (1993). Training school counselors to do family counseling. Elementary School Guidance and Counseling, 27, 252–257.

Hinkle, J. S., & Wells, M. E. (1995). Family counseling in the schools: Effective strategies and interventions for counselors, psychologists, and therapists. Greensboro, NC: ERIC/CASS.

Madanes, C. (1981). Strategic family therapy. San Francisco, CA: Jossey-Bass.

Madanes, C. (1984). Behind the one-way mirror: Advances in the practice of strategic therapy. San Francisco, CA: Jossey-Bass.

Madanes, C. (1990). Sex, love, and violence. New York: W. W. Norton.

Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University.

Rathvon, N. (2008). Effective school interventions: Evidence-based strategies for improving student outcomes (2nd ed.). New York: Guilford Press.

Reink, W., Splett, J., Robeson, E., & Offutt, C. (2008). Combining school and family interventions for the prevention and early intervention of disruptive behavior problems in children: A public health perspective, Psychology in the Schools, 46, 33–43.

Thomas, V., & Ray, K. E. (2006). Counseling exceptional individuals and their families: A systems perspective. Professional School Counseling, 10, 58–65.

White, D., & Epston, D. (1990). Narrative means to therapeutic ends. New York: W.W. Norton.