箱庭疗法应用于家庭治疗的理论背景与临床实践

心理咨询与治疗领域出现了整合的趋势,将箱庭疗法应用于家庭治疗是这一趋势下的成功尝试。箱庭疗法应用于家庭治疗的理论背景是家庭治疗与游戏治疗的整合以及箱庭疗法在团体治疗中的应用。箱庭疗法应用于家庭治疗的临床实践包括家庭评估、家庭治疗、夫妻治疗、家庭治疗师督导,这些临床实践的开展为儿童青少年心理咨询与治疗方法的发展提供了有益的启示。     

Psychoanalytic Models of the Mind for Couple and Family Therapy

This paper describes an object relations theory of mind that highlights the interactive origin of psychic function and the beginnings of mental structure in the infant's relationships within the family group. Based on this model, psychoanalytic family and couple therapy employs the interactions between family and therapist to detect and work with developmental failures in holding and containment, skewed family projective identification, and attacks on linking, which characterize pathological and traumatized families. The coming together of transference generated by the family as a group and the therapist's countertransference are the fulcrum on which such therapy turns. An extended vignette of a session is used to illustrate the application of object relations theory to the therapeutic process of family therapy.     

Collaboration and a Self-Help Orientation in Therapy with Suicidal Clients

Working with suicidal clients historically has placed a heavy burden of responsibility on the therapist for a successful outcome. This orientation generally has left clinicians feeling stressed and in need of controlling their clients' behavior; clients, in turn, often have developed unrealistic expectations of therapy or resistance of the therapist's interventions. In this context, the chance for a potentially valuable collaboration between client and therapist is often lost. This paper builds on previous work that has introduced the notion of a collaborative working relationship with suicidal clients. It is argued that the therapeutic process ideally should not only utilize the therapist's knowledge and skills in treating suicidal clients, but also cultivate self-efficacy by encouraging the client to adopt a self-help orientation to therapy. Several general principles of a collaborative/self-help orientation to working with suicidal clients are discussed and a variety of specific therapeutic strategies consistent with this orientation are described.     

Towards a common ground in psychoanalysis and family therapy: on knowing not to know

In this paper a common ground between psychoanalysis and family therapy is discussed in terms of postmodern theorizing in both disciplines. Recent systemic, narrative or social constructionist thinking in psychoanalysis and a psychoanalytic turn in family therapy offers the possibility of a shared epistemology. This is described in terms of a critical not-knowing stance which allows for the therapist's/analyst's contribution of meaning, interpretation and knowledge in therapeutic conversation. Here the holding of not knowing and knowing together provides a narrative container for personal meaning and thinking to develop. This 'knowing not to know' is what a postmodern psychoanalysis has in common with family therapy: both are ways of being with persons to help them develop and hold their own knowing. This therapeutic process is illustrated in a clinical vignette of narrative child family therapy.
For what one knows does not belong to oneself.
(Marcel Proust, Remembrance of Things Past , p. 898)     

Family Therapy With Irish-Americans

This paper presents a paradigm for understanding the cultural values and family patterns of Irish-American families and offers suggestions for clinical intervention. Families' correspondence to the model described will depend upon their level of acculturation, socioeconomic status, and other contextual factors. The paradigm suggests a number of issues that may create difficulties for the therapist and for the family in therapy. In general, behavioral techniques, Bowen systems therapy, and strategic interventions may be more useful than techniques emphasizing expression of emotions in therapy or direct attempts to alter communication or family behavior in therapy sessions, as used in structural therapy.     

Child Participation in Family Therapy

The full involvement of children, particularly those of younger ages, in family therapy presents a personal and professional challenge to the therapist. Out of his own needs he may favor involvement with one or another generation rather than with the complete three generation family. This issue is discussed and suggestions for therapeutic use of younger children are presented.     

The therapist's self in dialogical family therapy: some ideas about not-knowing and the therapist's inner conversation

In this article, the focus is on the therapist's self, which will be in line with Bakhtin's thinking, viewed as a dialogical self. First, the dialogical view of the self is situated in the context of psychology's traditional focus on the individual self. Then, leaning on Bakhtin and Volosinov, the self is described as a dialogue of multiple inner voices. Some of the implications of this concept for family therapy practice are examined, focusing especially on the therapist's participation in the therapeutic process and on the therapist's inner conversation. The author argues that not-knowing does not only refer to the therapist's receptivity and respect but also implies that the therapist is aware of his or her experience and reflects on how his or her inner conversation might inform and enrich the therapeutic conversation. Finally, these ideas are illustrated with a brief clinical vignette.     

Reciprocal inhibition or extinction?

Since reciprocal inhibition therapy techniques involve the procedure for classical extinction, it is reasonable to consider the possibility that it is extinction, rather than counterconditioning, that is responsible for their efficacy. Certain experiments increase the plausibility of this possibility by suggesting that a certain feature of the extinction procedure involved in the reciprocal inhibition techniques makes it more effective than free response avoidance extinction. This feature is the fact that the subject's escape from the anxiety stimuli is delayed by the therapist's instructions. Only one experiment clearly indicates any feature of any reciprocal inhibition technique which could not be attributed to extinction, this characteristic being a superiority of a reciprocal inhibition procedure to extinction in eliminating fear in rats. Thus for explaining reciprocal inhibition therapy, it is still essentially an open question as to whether the concept of reciprocal inhibition is better than extinction.     

The unraveling of a treatment paradigm: a followup study of the Milan approach to family therapy

A 2-year followup study was conducted to determine the efficacy and degree of satisfaction with Milan-style family therapy with families refractory to other treatment interventions. Fourteen families and 5 couples who received Milan-style family therapy participated in the study. Family outcome was found to be improved in 56% of parents and 89% of identified child-patients at followup. Improved self-outcome at followup was reported by 56% of fathers, 67% of mothers, and 78% of identified child-patients. A substantial percentage of fathers (68%) and mothers (59%) reported that at least one family member sought further therapy posttreatment. Factors associated with either parent's positive perception of the treatment in general included the time interval between sessions, experiencing the treatment as brief rather than long, and positive feelings for the group behind the mirror. Mothers who reported liking the treatment reported better family outcome. For mothers, disliking the treatment was related to family members seeking further treatment. The more negative the mothers' and fathers' spontaneous comments about therapy were, the more likely that a family member would seek further alternative psychotherapy. The outcome results are explained in terms of the treatment families' negative reactions to some aspects of the therapist's stance and to the group behind the one-way mirror, as in Milan-style therapy. The importance of modifying Milan-type therapy to foster a positive attitude toward the treatment procedures and the therapist's interventions is discussed.     

Stages in the Family Therapy of Adolescents

Family therapy is considered from the systems point of view as a process with a series of stages including definitive beginning and end points. The stages are identified as crisis points in family therapy - i.e., moments in the therapy process when the equilibrium of the family is upset and when stress reactions among family members are most likely to be intense. Since times of crisis also provide special opportunities for growth and change, they can be utilized therapeutically provided the therapist is knowledgeable about the kinds of upheavals that a family may experience and the time sequence in which they may occur. Eight such crisis points and their relation to therapeutic intervention are presented. The purpose of this paper is to outline the role of the crisis as therapeutic opportunity in the course of family therapy.     

Professional Politics and the Concepts of Family Therapy, Family Consultation, and Systems Consultation

At a time when an increasing number of professionals are calling themselves "family therapists," many teachers and theorists in this field are troubled that the term "family therapy" no longer adequately characterizes the concepts or activities of the field. Recently, clinical, political, and economic circumstances have emerged that suggest the need for alternatives to the role of "family therapist." By adding the roles of family consultant and systems consultant, we can open up new options for ourselves and our clients. During initial contacts with families, agencies, and other professionals, we can heighten our therapeutic potential by proceeding with consultative stocktaking, not starting with therapy. Family consultation also can assist in redirecting therapy when a new problem or an impasse develops, in focusing on competency rather than on pathology, and in engaging constructively with families that have a physically or mentally ill member.     

Using psychodramatic techniques in structural family therapy

This article describes how psychodramatic techniques can be used in structural family therapy sessions. After a preliminary discussion of the therapist's spontaneity and role functions in both psychodrama and family therapy, specific action techniques are then discussed using case examples. Auxiliary Ego, Role Reversal, Double, Use of Space, Physicalization, Warm-up, Soliloquy, Surplus Reality, and Future Projection are illustrated.     

The Greek Chorus and Other Techniques of Paradoxical Therapy

This paper has described some of the interventions developed at the Ackerman Brief Therapy Project in treating the families of symptomatic children. The interventions are based upon a differential diagnosis of the family system and upon an evaluation of that system's resistance to change. They are classified as compliance-based or defiance-based, depending upon the family's degree of anxiety, motivation, and resistance. Paradoxical interventions, which are defiance-based, are used as a clinical tool in dealing with resistance and circumventing the power struggle between therapist and family. A consultation group acting as a Greek chorus underlines the therapist's interventions and comments on the consequences of systemic change. This group is also sometimes used to form a therapeutic triangle among the family, therapist and group, with the therapist and group debating over the family's ability to change.     

Employing the God-Family Relationship in Therapy with Religious Families

In many religious families, God functions as a crucial family member, stabilizing interpersonal relationships and engaging in daily family transactions. In the psychological role of a transitional object, God can be usefully employed by the family therapist in therapeutic interventions, when the therapist keeps the focus upon the interpersonal relationship with God rather than the specific content of religious beliefs. This approach can access a vital resource in the family, particularly when conditions for therapy are otherwise difficult, such as an isolated, enmeshed dyad presenting alone for therapy. Four case examples illustrate how one may use this approach in family therapy.     

A Feminist Approach to Family Therapy

Although family therapy recognizes the importance of the social context as a determiner of behavior, family therapists have not examined the consequences of traditional socialization practices that primarily disadvantage women. The unquestioned reinforcement of stereotyped sex roles takes place in much of family therapy. A feminist therapy orientation that considers the consequences of stereotyped sex roles and the statuses prescribed by society for females and males should be part of family therapy practice. This paper describes the ways in which family therapists who are aware of their own biases and those of the family can change sexist patterns through applying feminist principles to such areas as the contract, shifting tasks in the family, communication, generational boundaries, relabeling deviance, modeling, and therapeutic alliances.     

‘Why should we talk to you? You'll only tell the Court!’ On being an informer and a family therapist

The family therapy literature recognizes the constraints imposed on a therapist's freedom and impartiality in a statutory agency. This paper shows that clinical settings that are apparently independent are not free of such constraints. The wider professional welfare system has confused expectations of a clinical agency that it should provide simultaneously both therapy and a measure of social control. An account is given of one hospital-based family therapy team's struggles to find manoeuvrability in child-focused statutory cases, so as to be helpful both to families and referrers. One method of working is illustrated with a case example.     

Case Report: Smuggling Family Therapy Through

Therapists with a family systems orientation are, on occasion, called upon to work in settings where political constraint, cultural patterns or the unchangeable expectations of the clinical population make it impossible to identify the treatment as being directed at the family. Under these circumstances, family therapy concepts and techniques may be employed by smuggling them in under another label. This article describes a setting in which such a strategy was necessary.     

Children's and Adolescent's Views on Family Therapy

Family therapy has made a considerable contribution to our understanding of the experiences of children and families and especially how various symptoms can be understood as their response to distressing family dynamics. Though family therapy has found ways of alleviating children's distress we still know relatively little about how children experience the process of family therapy. Such knowledge is important for ethical as well as pragmatic reasons – to be able to offer a more sensitive and effective experience. This paper reports a study employing qualitative methods whereby children were interviewed about their experience of family therapy. Semi-structured interviews were conducted after family therapy sessions, and children were invited to recall what they perceived to be helpful and unhelpful. Helpful events or moments were then identified and replayed on the videotape of the sessions to assist children's memory. The results suggest a diversity of experiences according to the children's ages, gender and role in the family. Some common assumptions were challenged by the findings, for example, that some children preferred more directive and focused aspects of the therapy, rather than systemic questions which could inspire feelings of confusion and inadequacy.