Family sculpting: II. Some practical examples

This paper reviews a number of practical examples of family sculpting to illustrate possibilities for its use described in a general way in an earlier companion article (Journal of Family Therapy (1981) 3: 341–352). Examples are considered first in relation to generic practical possibilities for sculpting: structural analysis and diagnosis, the inescapability of the concrete, the portrayal of ambiguity. A second set of examples is considered in relation to major practical contexts of sculpting: with children, with students, with workers. The paper concludes with a discussion of the complexity of family sculpting and a comparison of the structural interpretation of sculpting offered here with Papp et al. 's notion of choreography.     

Reflections on Family Therapy in Australia

Family therapy in Australia has been influenced by ideas mostly from North America and Europe. However Australian family therapists have also made their own significant contributions to theory and practice. The vastness of the continent combined with a relatively small population has presented challenges with respect to the formation of a national association and for many years, the Australian Journal of Family Therapy (later the Australian and New Zealand Journal of Family Therapy Board acted as de facto national voice for the discipline. The Australian Association of Family Therapy was formed as recently as 2011. It has a total of over 1,000 members and is the sole organisation representing family therapy and family therapists in Australia. Clinical membership is achieved via successful completion of a 2-year sequence of study in family therapy followed by 50 hours of supervision (or its equivalent). Family Therapy training is mostly delivered in the four most populated states in Australia at both University level and through private organisations registered to provide training at government approved levels. La Trobe University (through the Bouverie Centre), Swinburne University (through the Williams Road Family Therapy Centre) and the University of New South Wales currently provide training leading to specialist qualification in family therapy. A number of other private institutions also provide recognised family therapy training. To date, family therapists and couple therapists in Australia have not in the main shared common platforms such as conferences, training and professional journals. Narrative therapy has also remained somewhat detached from “mainstream” family therapy. Family therapy qualifications are often valued by prospective employers even when duty statements are focused on the more traditional skills of professionals such as psychologists or social workers. Researching family therapy outcomes remains challenging. But although there is increasing practiced-based evidence of the efficacy of family therapy, Australian family therapists as a group are yet to concentrate their efforts on convincing funding bodies of its usefulness. At the same time, via the teaching and promotion of family sensitive practices, systemic ideas are being increasingly incorporated within areas of mental health, disability, alcohol and drug dependency, and within a range of health and welfare areas that impact not just on the individuals but on those close to them.     

The use of structured experiences in family therapy

Structured experiences such as sculpting, psychodrama, rôle-play and growth games are frequently used in family therapy. This article puts forward a framework for the use of structured experiences which can be used in the context of a family session to ensure that the family will gain the maximum learning and change. Use of the framework is illustrated with examples from practice.     

ABSTRACTS

This is an essay on the history of family diagnosis and therapy. The role of the family in the etiology of psychopathology was a longstanding "blind spot." Family psychotherapy is gradually developing as a form of psychotherapy with indications and contraindications of its own. Comparison studies with other forms of psychotherapy should be done.     

Family and Systems Therapy and Training in Portugal

The history of systemic family therapy in Portugal since its appearance until the present is discussed. Some data on systemic family therapists’ training is provided in the context of the Portuguese Society of Family Therapy and Academic Institutions. In Portugal, family therapy has been extended to various contexts, including medical and community services. Finally, future directions for family and systems therapy practice and training in Portugal are provided emphasizing the importance of family interventions as an important resource to empower families living with health chronic conditions. The Portuguese Family Therapy Society, every 2 years, organizes a scientific Iberian conference with Portuguese and Spanish speakers. This allows the exchange of clinical experience and research about family and systems theory.     

Gender, Power, and Relationship Ethics In Family Therapy Education

Awareness and sensitivity about gender issues have central positions in family therapy education. Traditionally gender relationships have been treated as either a reflection of cultural values and norms or as a dynamic of the way that men and women deal with the other sex. This paper presents the findings of a qualitative study that examines the meaning and enactment of gender issues in the supervisory process in family therapy. Based on that study, the authors developed a strategy for raising issues of gender equity in clinical training and describe the effects of that strategy on one practicum.Professor of Family and Child Sciences and the director of the Interdivisional Program in Marriage and Family Therapy at Florida State UniversityAn associate professor of Family and Child Sciences and the co-director of the Family Policy and Research Unit in the Family Institute at Florida State University     

The evolution of family interventions for schizophrenia. A tribute to Gianfranco Cecchin

Family intervention for schizophrenia has informed the whole history of family therapy, although in different fashions. This presentation will deal with the main phases of such intervention, outlining the characteristic features of each one. We can roughly divide the history of family intervention for schizophrenia into four phases: Phase 1 – Conjoint family therapy (1955–1965). Family interventions were aimed at modifying family communication patterns, implying the possibility of a definitive resolution of psychopathology. Phase 2 – Antipsychiatry (1965–1975). This, rather than a treatment model, was a philosophy of psychiatry, which considered schizophrenia as an epiphenomenon of the distortions of Western society. Family treatment was aimed at promoting the awareness of such a dynamic. Phase 3 – Milan systemic therapy (1975–1985). The systemic model was aimed at helping people with schizophrenia to recognize their position within their families (and other significant systems), giving all family members a new sense of their relationships to each other. Phase 4 – Psychoeducation (1985–2005). In most psychoeducational models, schizophrenia was conceived of as a biologically determined disorder. Psychoeducation was a way of helping the not diagnosed family members to cope with problems brought about by the illness, eliciting consensus towards psychiatric treatments such as medication and rehabilitation. A fifth phase of family intervention for schizophrenia is probably developing right now. If this is happening it should probably be an integrative phase, in which different approaches to family dynamics might be bridged and blended, in order to give more effective help to all members of families with schizophrenia.     

The growing pains of family therapy in Singapore

Family therapy in Singapore is both short on history and overdue for development. Through in‐depth interviews with six experienced local family therapists and trainers, this article explores the challenges of family therapy development in Singapore, giving particular attention to practice, supervision, training, and research. Over time, family therapy practitioners in Singapore have gained insights in applying systemic ideas in this pluralistic society where there is a rich mix of race and ethnicity. This article highlights the contribution Singapore's experience of family therapy can make to a more global picture, in view of its rich multicultural context despite significant challenges.     

Family therapy and the politics of evidence

This article situates family therapy in the politics of evidence-based practice. While there is a wealth of outcome research showing that family therapy works, it remains on the margin of mainstream therapy and mental health practice. Until recently it has been difficult to satisfy 'gold standards' of randomized control research which require manualization and controlled replication by independent investigators. This is because systemic family therapy is language-based, client-directed and focused on relational process rather than step-by-step operational techniques.
As a consequence family therapy is an empirically supported treatment unable to join the evidence-based club. The politics here concerns what is 'evidence', who defines it and the limitations of a scientist-practitioner model. Therapy is art and science and its research needs to be grounded in real-life clinical practice. Common factors such as personal hope and resourcefulness and the therapeutic relationship contribute more to change than technique or model.
While arguing for a wider definition of science and evidence it is politic to seek evidence-based status for family therapy. Family therapy is a best practice approach for all therapists where systemic wisdom helps to decide what to do with whom when . A systemic-practitioner model is informed by quantitative and qualitative research and holds modern and postmodern perspectives in tension, a stance I call paramodern . Family therapy is both scientific and systemic; it is a science of context, narrative and relationship.     

Abstracts edited by Neil Frude

F riedman , S. (1987) Technical considerations in the behaviour-marital treatment of agoraphobia. American Journal of Family Therapy,
P arker , T., H ill , J. W. and M iller , G. (1987) Multiple family therapy: evaluating a group experience for mentally retarded adolescents and their families. Family Therapy
B erger , M. and J urkovic , G. J. (1987) Family context in therapy. Journal of Family Psychology
L ebow , J. L. (1987) Training psychologists in family therapy in family institute settings. Journal of Family Pgcholosy
S loman , L., P erry , A. and F rankenburg , F. (1987) Family therapy with deaf member families. American Journal of Family Therapy
H oopes , M. H. (1987) Multigenerational systems: basic assumptions. American Journal of Family Therapy
M unton , A. G. and A ntaki , C. (1988) Causal beliefs amongst families in therapy: attributions at the group level. British Journal of Clinical Psychology     

Development of Family Therapy in Ireland

In Ireland family therapy is a small profession, with under 200 registered therapists. The Irish family therapy movement began in the mid-1970s. By 1980 the Family Therapy Network of Ireland in the Republic of Ireland and the Northern Ireland Branch of the UK Association Family therapy had been founded. At present there are three main family therapy training centers in Ireland: two in the south (the Mater University Hospital, affiliated to University College Dublin and Clanwilliam Institute) and one in the north (at Queen’s University Belfast). There is no statutory registration and licensing of family therapists in Ireland. Accredited professional family therapy programs in Ireland are 4-year part-time courses culminating in masters level qualifications. A primary degree in medicine, nursing, psychology, social science or education is a prerequisite for entry. Family therapists in Ireland work in both private practice and the public health service. Most family therapists in the public sector are employed as social workers, psychologists, psychiatrists or nurses, and conduct family therapy as part of their broader professional roles. Couple therapy in Ireland is provided by family therapists, and also by voluntary couple counselors based in networks of local centers, some of which were originally religiously affiliated, without a formal connection to national family therapy associations. The three major future challenges for Irish family therapy are creating a research infrastructure, developing a career structure in the public health service, and introducing statutory registration.     

Family psychology and family therapy in Japan

The development of family psychology and family therapy in Japan has occurred mostly since the 1980s. This development was originally activated by the major social issue in contemporary Japan of school refusal, in which more than 127,000 children either overtly refuse to or claim that they cannot go to school. From a family perspective, this problem is analyzed as it relates to the confusion that children experience from unbalanced and unclear boundaries in family relations or "membranes." An approach to family therapy that adapts systems theory and integrates a clay sculpting medium has been developed to work with Japanese families confronting this problem. The design and implementation of preventative family psychology programs applied at the community level are also an important part of the future development in these fields.     

Family Drawings as a Diagnostic and Therapeutic Technique

This article concerns a family whose son was treated for two years by chemotherapy, the parents participating for part of that time in a parents' group, without any significant changes in behavior. Family therapy was initiated, with the inclusion of family art therapy, which immediately provided highly significant diagnostic data not otherwise observable. It also served as a dramatic catalytic agent for constructive change as evidenced by other family sessions.     

Psychoanalysis and systems in family therapy

This paper describes three frames of reference for understanding family function. The three frames are (1) The Life-cycle of the Family, (2) The Intergenerational, Historical Aspects of the Family, (3) The Interactional Structure of the Family. It is suggested that these three frames can provide a detailed formulation of family functioning and disturbance in order to plan rational foci, strategies, techniques and aims of family therapy.     

Outcome studies of family therapy in child and adolescent depression

There is surprisingly little good-quality evidence for the effectiveness of family systemic interventions with child and adolescent depression given the prevalence of depression and the demonstrated association with a range of family factors. What studies there are suggest the possibility of family therapy being an effective intervention but more research is needed before firm conclusions may be drawn. Family interventions may be more effective in children than in adolescents and where other family members are depressed. It is possible that family interventions continue to bring about improvement in symptoms after cessation of treatment. What research there is evaluates older structural models of therapy: there is a real need for more evaluation of newer models of practice.     

The cost of treating substance use disorders: individual versus family therapy

This study examined the cost of substance use disorders treatment in a large healthcare organization. A survival analysis demonstrated that family therapy utilised the least number of sessions (M = 2.41) when treating substance use disorders followed by individual therapy (M = 3.38) and mixed therapy (M = 6.40). Family therapy was the least costly of the three types, at $124.55 per episode of care for a client, with individual therapy costing $170.22 and mixed therapy $319.55. The ratio of family therapists utilising family therapy was more than three to one compared to other licensed professionals. The percentages of clients coming back for more than one episode of care are fewest for family therapy (8.9%) followed by mixed therapy (9.5%) and individual therapy (12.0%).     

Family criticism and self-starvation: a study of expressed emotion

The measure Expressed Emotion (EE) has been established as an exceptionally useful indicator of relapse in people with schizophrenia and depression. EE is now also being applied more broadly for the investigation of other disorders. EE is usually rated by conducting the Camberwell Family Interview, i.e. in the course of separate individual interviews with the relatives of the symptomatic individuals. This paper reports the rating of EE in adolescents with eating disorders within a semi-structured family schedule - the Standardized Clinical Family Interview. Consecutive referrals for eating disorders were assessed prior to family therapy and again at regular intervals during therapy. EE ratings for this sample, the prognostic value of EE, and the changes in EE that took place during the course of therapy are presented and their clinical implications discussed. The findings suggest that even low levels of Critical Comments from the parents to the anorexic adolescent are associated with continuing symptoms.     

RAE WEINER

Rae Weiner, a pioneer of the concept of family therapy with the Philadelphia Child Guidance Clinic and the Family Institute of Philadelphia, died Monday, August 13th at the age of 46. Mrs. Weiner received a bachelor's degree from the University of Pennsylvania and a master of social studies from Bryn Mawr College. Mrs. Weiner joined the Philadelphia Child Guidance Clinic in 1968 where she was instrumental in creating and overseeing family counseling programs. She was also closely affiliated with the Family Institute of Philadelphia, an organization of family therapists and social workers. Mrs. Weiner was president-elect of the Family Institute and served on its executive council. She is survived by her husband, Oscar R. Weiner, M.D., two sons and a daughter.     

Family therapy in Macau: development,challenges and opportunities

Family therapy in Macau is in its early stages of development. The Satir model and structural family therapy were the first two therapies introduced. Later on, solution‐focused brief therapy and narrative therapy were also introduced. Macau has been undergoing dramatic socioeconomic changes since the relaxation of the gambling licenses. In sociocultural terms this has led to significant changes: the so‐called ‘dealer's complex’, gambling, drug abuse and youth deviance have become more prevalent. To address complicated family problems, various counselling institutes and training centres were established to conduct family therapy. However, there are still some limitations and challenges that must be addressed in order to have a thriving family therapy profession in Macau.     

Normal crises: Stage theory and family therapy

Abstract

The theme of the Twenty-Third Georgetown University Symposium on Family Theory and Family Psychotherapy, held November 8 and 9,1986, in Washington, DC, was Toward a Science of Human Behavior. The program included famed sociobiologist Edward O. Wilson as the Distinguished Guest Lecturer; a special panel discussion about what is involved in moving toward a science of human behavior; a presentation by Murray Bowen, Director of the Georgetown University Family Center; a presentation by Walter Toman, who is well-known for his research on sibling position; and 10 other presentations related to various aspects of family systems theory and therapy.