Co-creating change within a child protection system: integrating art therapy with family therapy practice

This paper considers family art therapy intervention using a partnership developed between an art therapist and a family therapist within a child protection system. The aim of this co-working relationship is to bring together skills that can amplify the child's voice within the family, using art as a means of extending the family story. The use of metaphor adds to the repertoire of skills available when working with families, and offers a particular form of communication in which children can more easily engage. By co-working, we also bring together our personal and professional stories, creating multiple ideas and ways of seeing and taking account of differences in the life experiences of individual families.     

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.     

A training program for family psychology: Evaluation,prevention and therapy

Abstract

Family psychology differs from family therapy on a variety of dimensions. Philosophically, family psychology emphasizes the relationship of the individual to the family rather than considering the family as a system, deemphasizing the individual, as in systems family therapy. In addition, family psychology is interested in the whole spectrum of functionality-dysfunctionality, while family therapy is interested mainly in dysfunctional families. Substantively, in terms of differences in training, family psychology stresses the importance of theory testing, evaluation of process and outcome of interventions, and prevention with functional or at-risk families. An academic curriculum in family psychology, which has been operational at Georgia State University for the last 10 years, is presented. Clinical training follows a gradual approach, starting with relatively simple Structured Enrichment, progressing to more complex training in Covenant Contracting and Systematic Homework Assignments, and finally family therapy.     

The crucial roles of attachment in family therapy

This paper's aim is to enable family therapists from whatever approach to address family attachments during their work. It explores the role of attachment in the family, and how to enable therapists to increase security in the family so that family members can solve their own problems during and after therapy. The article gives a brief overview of the nature of family attachment relationships and the influence of secure and insecure attachments within the family and their narrative styles. This is described in language that a therapist might readily hold in mind and share the ideas in dialogue with families. The paper discusses the interplay between insecure attachments and other family problems, such as parental conflict and disagreements over authority. It also discusses ways of establishing a secure therapeutic base and the influence of the therapist's own attachment style. The implications for family therapy practice are described and illustrated by work with a specific family.     

Family Therapy in India: A New Profession in an Ancient Land?

This paper examines the need for family therapy in India and its evolution as an integrated academic discipline and widespread form of clinical practice. Included is a discussion of the numerous factors placing Indian families at risk today, both common and more serious child, marital, and family difficulties, the current status of mental health services and minimal emphasis on family-based treatment, and the potential benefits of family therapy to such a radically diverse and rapidly changing society. Targets of and settings for family therapy training are highlighted, and a brief outline of a training-the-trainer approach is provided.     

Enlisting family support in drug treatment

Drug abuse programs often experience difficulties involving clients' families in treatment. This article describes general principles and specific techniques for recruiting family members in drug abuse programs and in other treatment settings. Stanton and Todd's principles of recruiting for family therapy in drug programs generally apply, adapted to a project that involves only one family member in multifamily groups and provides psychoeducational training rather than therapy. Additional principles include: focusing on family members who live with the client, tailoring recruitment to the needs of individual families, emphasizing how the family member will benefit, addressing resistance directly, helping families to build a support network, and informing family members of what is expected of them. The psychoeducational approach shows promise as a beneficial adjunct to client-focused treatment and as a gateway to more extensive family treatment.     

"If I Don''t Get Simple, I Cry"

Poor families have taught us special lessons that are applicable to all families. They have instructed us about the problems, within families, of developing relationships adequate to the tasks of family life. One consequence is that therapists are attending more to the evolution of the structure of family relationships, particularly, the phenomenon of underorganization. Poor families have also provided insight into the dynamic relationship between families and their social context. As a result, a therapeutic perspective is emerging that focuses on the influence of the community on the individual and the family, a perspective that may be called an eco-structural approach to therapy.     

Family therapy for older adults: a survey of professionals' attitudes

Faced with a limited number of referrals to a newly established family therapy team for older adults we conducted a survey of doctors', nurses' and social workers' views concerning the value and limitations of a family therapy approach to the problems of later life. The results suggested that, despite generally positive attitudes towards the idea of family therapy with older adults, there was a mixture of ignorance about the service in particular and the approach in general, as well as some reservation concerning the potential for change in the families of older adults. We describe some of the actions we took in the light of these findings.     

A Review of Family Therapy in Residential Settings

This article provides an overview of the history of family involvement in residential treatment as well as a synthesis of the research showing family-centered interventions and outcomes for youth in residential settings. There are many methods for engaging families in residential treatment that are discussed in the literature; however, there is a significant gap as the field has not yet identified specific family therapy approaches that demonstrate efficacy in working with youth and their families in this particular setting. A review of the literature over the past 10 years will highlight the emerging family therapy models being utilized in this setting, which include multiple-family group intervention, family-directed structural therapy, and narrative family therapy. The article will also include a discussion of three major, well-established theoretical approaches that have been found to be effective in working with youth with conduct issues and show promise in treating youth and families in the complex setting of residential treatment: brief strategic family therapy, multi systemic therapy, and functional family therapy.     

On the Reclaiming of Denied Affects in Family therapy

A central developmental task of the family is to help its members develop the capacity to cope with the grief attendant on separation and loss. In order to work through such feelings, each member must first be able to acknowledge the affect as present, internal, and belonging to the self. Depending on the degree of intrapsychic differentiation, and the dread of abandonment, family members may seek to avoid awareness of such feelings within themselves. The disclaimed emotions remain powerful unconscious motivators of behavior, exerting their influence despite their denial. Some typical clinical illustrations of this are provided. Excerpts from conjoint family therapy are then presented to illustrate the therapeutic interventions made in assisting a family to acknowledge denied grief over the separation of one of its members along with unspoken tender feelings within the family. This paper affirms the continued relevance of a psychodynamic, interpretative approach for families struggling with unresolved grief.     

Systemic-motivational therapy for substance abuse disorders: an integrative model

Although recent reviews of the literature on families and substance misuse offer compelling evidence that inclusion of families significantly improves treatment engagement, retention and outcome, family therapy remains peripheral in most substance abuse treatment programmes. Furthermore, many of the treatment approaches that have been included under the term 'family therapy' continue to focus on the substance abuser as the sole target of treatment. Still conspicuously absent are treatment models based on family systems approaches, with outcomes targeted at non-abusing family members as well. This article presents an overview of one such family-focused substance abuse treatment model – systemic-motivational therapy – that combines a family systems approach with techniques derived from motivational interviewing, but this time is applied to work with the family as a unit. The background for the development of the model will be described, as well as the assessment/consultation, family-level action plan, and aftercare/relapse prevention phases of the treatment approach.     

A supervision approach for teaching structural/strategic therapy in a limited setting

Many counselors are currently undergoing a Kuhnian paradigm shift from linear models of behavioral problem conceptualization to systemic conceptual models. As a result, it has become incumbent on counselor-educators to introduce the systems concept of family therapy to their students within a framework that renders it meaningful not only intellectually but also practically. This paper presents one way of doing this successfully with master's level counselors-in-training who have no live families on which to practice. An overview of systems approaches to family therapy is presented along with a seven-stage supervision approach for teaching structural/strategic therapy in limited situations where the supervision of live families is not practical or possible.     

Chronic Eating Disorders in Therapy: Clinical Stories Using Family Systems and Psychoanalytic Approaches

This paper presents three pieces of work, all focused around a person presenting with a long history of disordered eating patterns. One treatment was a couple therapy, one a family plus individual therapy and the third a purely individual therapy. The three different psychotherapies demonstrate an approach which uses psychoanalytic as well as family therapy thinking and techniques. The material is offered to show examples of the clinical practice within which individual and couple or family therapy constitute a range of psychotherapeutic responses to people and, in particular, to people with eating disorders. The context of the therapy is described in some detail as it accounts for many features of the treatments, for example, that they are justified within the institution by having been subject to empirical investigation. A metaphor, that of the medieval castle, is offered as an evocation of the experience of the person that is relevant in the practice of both individual and family therapy.     

Cross-Cultural Family Therapy — A Malaysian Experience

This case report illustrates the possibilities and difficulties of family therapy in a non-Western culture. Malaysia is a truly multiracial society with diverse ethnic groups having different religions, languages, and cutural patterns of relationships. In addition, the nation as a whole, and each ethnic group in particular, is in the process of cultural change, which produces stress on the traditional family's style of relationships. The therapists working in this culture are often crossing religious, linguistic, and socioeconomic barriers, as well as encountering the cultural pressures placed upon families. We will formulate some general problems in cross-cultural psychotherapy, discuss some aspects of this specific culture and family with a case report, and offer some suggestions for handling problems in family therapy under these circumstances.     

Power and influence in the environment of family therapy*

This paper explores some of the ways in which family therapy theory and practice limits an appreciation of the contexts of families and family therapists. It focuses particularly upon how the rules which underlie patterns of relationships in social systems are made and maintained more by one part of a system than by another, and considers this (a) within families, (b) within various aspects of the social environment of families, and (c) within the organizational contexts of family therapists. It then proposes that the systemic thinking which family therapists apply to families is potentially applicable to wider contexts including international relationships.     

The Inclusion of Fathers In Family Therapy: A Research Based Perspective

This paper summarizes the results of research on the role of fathers in families and family therapy with particular reference to preparation for fatherhood, father involvement in family life as a protective factor, fathers' deviant behaviour as a risk factor, fathers' communication and coping styles, fatherhood and different types of marriages, and the effects of the workplace on fathers' behaviour within the family. Available research suggests that, with respect to problem formation, the behaviour of fathers may serve as either a risk factor or as a protective factor. With respect to problem resolution, fathers may be a powerful therapeutic resource or seriously compromise effectiveness of family therapy. The implications of research for clinical practice are discussed.     

Power and influence in the environment of family therapy

This paper explores some of the ways in which family therapy theory and practice limits an appreciation of the contexts of families and family therapists. It focuses particularly upon how the rules which underline patterns of relationships in social systems are made and maintained more by one part of a system than by another, and considers this (a) within families, (b) within various aspects of the social environment of families, and (c) within the organizational contexts of family therapists. It then proposes that the systemic thinking which family therapists apply to families is potentially applicable to wider contexts including international relationships.     

Treatment of the disturbed adolescent: A family system approach

Adolescence is a period of turbulence for the young person as well as his family. This particular transition phase requires changes of adaptation for all family members to facilitate the unique needs of growth of the adolescent. This article will discuss certain characteristics and factors which make some families more vulnerable in this period: e.g., a family's structure, catastrophic or unusual events within or outside the family, regardless of whether they occur in the present or have taken place in the past. Case examples are given to illustrate how a systemically oriented family therapy approach can enable these families to become unstuck, resulting in the adolescent's ability to enter the next life phase, and the family's achieving once again a new equilibrium.Gerda L. Schulman, LL.D., M.S., is Associated Professor of Family Therapy in the advanced clinical program at Hunter College; School of Social Work, and teaches in the doctoral program at Adelphi University SSW.This paper is adapted from a presentation on November, 18, 1983, at the Long Island Jewish Hillside Medical Center.     

A Supervision Approach for Teaching Structural/Strategic Therapy in a Limited Setting

Many counselors are currently undergoing a Kuhnian paradigm shift from linear models of behavioral problem conceptualization to systemic conceptual models. As a result, it has become incumbent on counselor-educators to introduce the systems concept of family therapy to their students within a framework that renders it meaningful not only intellectually but also practically. This paper presents one way of doing this successfully with master's level counselors-in-training who have no live families on which to practice. An overview of systems approaches to family therapy is presented along with a seven-stage supervision approach for teaching structural/strategic therapy in limited situations where the supervision of live families is not practical or possible.