The development of therapeutic consultations in child-focused family work

This paper outlines the theoretical influences that have led to our use of a consultation approach to work with children and families. Winnicott's notion of therapeutic consultation, the narrative approach in family therapy, the use of letters in therapeutic work and the two-plus-one model of therapeutic contact are discussed. A model of the consultation interview and process is presented together with examples of consultation letters responding to typical client expectations of the process.     

What the family brings: gathering evidence for strengths-based work

Families attending child and adolescent mental health (CAMH) services are often assumed to have problems in key areas such as communication, belonging/acceptance and problem-solving. Family therapy is often directed towards addressing these difficulties. With increasing emphasis in family therapy and human services fields over the last decade on identifying and building from strengths, a different starting point has been advocated. This paper describes a large survey of the self-reported pre-therapy functioning of children and families using a public CAMH service (n=416). Before commencing family therapy parents identified family strengths across a range of key areas, despite the burden of caring for children with moderate to severe mental health problems. This evidence supports theoretical and clinical work that advocates a strengths perspective, and highlights how resilience framed in family (and social) rather than individual terms enables a greater appreciation of how strengths may be harnessed in therapeutic work.     

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.     

School-based social work and family therapy

This paper discusses the importance of family therapy as part of the armamentarium of school-based social work. It provides a rationale for school-based intervention, noting that the school represents for the child the one fixed point (i.e., constant experience) in an endlessly changing world. The author believes that family therapy should be emphasized in school because school social workers are in a strategic position to thoroughly assess family dysfunction. Further, he notes that unless adolescents' problems are understood in the context of improperly functioning families, any help provided will be impermanent at best.     

The Butchers, an eclectic approach to family therapy

The thesis of this paper is that differing theoretical constructs offer a variety of rich approaches when responding to the problems families present. To work exclusively within one theoretical framework is to deny oneself the value latent in other models, and thus restrict one's therapeutic competence. It is suggested that various family therapy models can be worked together without contradiction if they are subsumed in an overriding systems approach. It is also pointed out that the various models have particular capabilities and limitations with differing therapeutic goals. Ten interviews with one family are used to illustrate an eclectic approach in therapy.     

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.     

Reducing work/home conflicts in employed couples: A proposed program to balance job and family demands

Work/home conflict is a dominant stress for workers in industrialized countries, particularly in dual-employment families. Interindividual (husband/wife) and interrole (work/home) conflicts in such families are a unique source of stress and adversely affect family and marital relationships as well as performance at work. Neither family therapy nor the stress literature have reported any interventions directed specifically at reducing work/home conflicts in employed couples or parents, although many workplaces today offer stress prevention programs aimed at individual workers. This paper discusses the underlying theoretical rationale for a marital enhancement intervention currently being developed for prevention of distress associated with work/home conflicts. The program combines marital enrichment and training principles with stress management techniques and aims at reinforcing shared coping resources. It focuses on four main variables associated with interpersonal processes: unrealistic expectations based on irrational beliefs, social undermining, shared decision control, and social support.     

The practice of community family therapy

This paper presents a summary of the basic theories and methods of Community Family Therapy (CFT), a relatively new therapeutic approach developed in response to the need for effective intervention in treating low-income, urban families. CFT operates outside of the traditional therapeutic box, successfully combining family therapy techniques with developmental and motivational theories, community mental health, social work, economic development, and community mobilization strategies. CFT utilizes a dualistic approach in which both client and therapist become involved with the same three levels of engagement. Specifically, the client strives for: (a) personal and family change and growth-level 1, (b) accessing community resources-level 2, and (c) leadership development and civic action-level 3. Also, CFT calls upon therapists to strive for: (a) personal growth and maturation-level 1, (b) collaboration with community resources for professional support-level 2, and (c) operation as a "citizen therapist," through civic action and volunteer services-level 3.     

Assessing the work of a family centre: services offered and referrers' perceptions. A pilot study

A multiple family orientated service was offered by a social services family centre. In order to examine the service, the number and type of presenting problems, services offered and length of contact were recorded for forty-six families. Perceptions of the referring social workers were elicited at the beginning and end of contact with the service, and at follow-up. These suggested that the perceived risk of the referred cases and their complexity decreased. Questions raised by these preliminary findings are discussed.     

Reality construction at the family/society interface: the internalization of family themes and values

An important component of the socialization function of the family continues to be the preparation of the young for integration into society. Empirical data, particularly from therapeutic settings, indicate that some children are notably well prepared for the world outside their families, while others have hardly been prepared at all. Adolescence is typically the time when these coping skills are most obvious. This paper addresses the issue of socialization of the young for participation in society. Building upon the "family theme" motif, the family is viewed as a micro-society. The issue of congruence between family themes and societally shared meanings is considered, utilizing ideas from the social construction of reality theories of Berger and Luckmann (1966). Three ideal-types of family themes are developed relative to their external world meanings. Previous work on family themes typically has failed to deal with the interpretative function of family meanings. How the family "explains" the family-external meanings is addressed.     

Social class and family size as determinants of attributed machismo,femininity, and family planning: A field study in two South American Communities

The major objective of the present investigation was to ascertain how stereotypes of machismo and femininity are related to acquired family size and perceptions of family planning. An indirect measurement approach was employed in which lower-class and upper-middle-class urban adults in Cali, Colombia, responded to photos of Colombian families which varied in size and completeness. The principal findings of the investigation revealed that (1) lower-class subjects described parents in the photos as significantly more macho and feminine because of their children than upper-middle-class subjects; (2) although no overall family size effect on attributions of machismo and femininity to parents emerged, lower-class female subjects described parents of large complete families as significantly more macho and feminine than parents of small complete families; (3) male subjects from both social classes described male spouses in the photos as more dominant and in greater control of the marital relationship as family size in the photos increased; and (4) perceptions of the incidence of family planning behaviors decreased linearly with family size for both social classes, although lower-class females attributed more family planning to spouses of large families than upper-middle-class females. Discussion of these results attempted to account for social class differences in the significance of parenthood as an indicator of sex-role identity and the psychological relevance of male dominance as a factor in fertility.This research was supported by a predoctoral research fellowship from the Council of Intersocietal Studies, Northwestern University, Evanston, Illinois 60201.     

Intensive family intervention in a community consultation framework

This article describes a form of mental health consultation to community workers who have reached a state of crisis in their work with unmotivated, multi-problem families. The central part of the consultation is a therapeutic intervention that draws on principles of time extension and network intervention. The consultant sees the family together with its community workers in a one-time, intensive meeting of up to six hours duration. This meeting is divided into three phases, aimed at achieving respectively (1) structural, (2) emotional, and (3) cognitive imbalancing of the family system. This creates a new situation, which hopefully will enable the community workers and the family to move out of the crisis in which they had become stuck.     

Cause and responsibility: towards an interactional understanding of blaming and 'neutrality' in family therapy

This paper aims to shed light on the ways in which 'neutrality' is both produced and resisted by socially competent actors in family therapy sessions. It draws upon recent and previous papers in this journal ( Stancombe and White, 1997; Stratton, 2003a, 2003b ), which highlight the importance of blame in therapeutic encounters. When families come to therapy, individual members frequently deliver competing accounts about the family troubles and who is to blame for them. This produces particular challenges for the therapist. We examine the practices of therapists in managing accountability in the session and in their own discussions. Family therapists operate with a professional ethic of neutrality, or multi-partiality. This paper is concerned with the linguistic strategies used by therapists to deal with overtly blaming accounts, how these strategies are responded to by family members in talk-in-interaction and how therapists go about crafting accountability-neutral versions. We show that the social and moral context of family work makes the therapist's job of communicating multi-partiality precarious. In producing accountability-neutral versions of families' troubles, therapists are forced to make practical-moral evaluations of competing versions of events. We conclude by arguing for a more explicit engagement with the moral nature of therapeutic practice.     

Family therapists as front line mental health providers in war-affected regions: using reflecting teams, scaling questions, and family members in a hospital in Central Africa

This paper will illustrate the utilization of systemic family therapy services inside a hospital in a war-affected region of the Central African Republic. Through an international non-governmental organization (NGO), the author, a family therapist, provided counselling supervision and services to hospital staff and patients in an area of open conflict in the northern region of the country. In circumstances of chronic insecurity fuelled by both government and rebel forces, families displaced in this region are vulnerable to numerous health conditions and social problems. Family therapy techniques and ideas were used to work with individuals, couples and families presenting with health and social problems resulting from HIV-TB, infections, chronic malnutrition, acute poisoning and beliefs about sorcery. Case examples illustrate the systems consultation model used with the mental health team in order to expand and promote the sustainability of patient mental healthcare in this underserved region.     

Breadwinner and caregiver: A cross‐sectional analysis of children's and emerging adults’ visions of their future family roles

Participants were 150 school‐age boys and girls, 58 high school students, and 145 university students drawn from communities in the Southeastern United States. In this cross‐sectional study, family role attitudes and expectations were examined across development. Parental work traditionality (occupational prestige and traditionality, and employed hours) predicted daughters’ social role attitudes and plans for future family roles, such that daughters’ envisioned families resembled that of their parents. Sons’ and daughters’ own attitudes about adult family roles predicted their plans to work or stay home with their future children; however, mothers’ work traditionality predicted daughters’ future plans over and above daughters’ own attitudes. The only exception to this was in the case of university daughters, where university women's attitudes about social roles fully mediated this relationship. It may be that, as young women approach adulthood and the formation of families, they adjust their vision of their future self to match more closely their own attitudes about the caregiving role.     

Applications of Collaborative Helping Maps: Supporting Professional Development,Supervision and Work Teams in Family‐Centered Practice

Collaborative, family‐centered practice has become an influential approach in helping efforts across a broad spectrum of human services. This article draws from previous work that presented a principle‐based, practice framework of Collaborative Helping and highlighted the use of Collaborative Helping maps as a tool both to help workers think their way through complex situations and to provide a guideline for constructive conversations between families and helpers about challenging issues. It builds on that work to examine ways to utilize Collaborative Helping maps at worker, supervisory, and organizational levels to enhance and sustain collaborative, family‐centered practice and weave its core values and principles into the everyday fabric of organizational cultures in human service agencies and government agencies that serve poor and marginalized families and communities.     

Resolving the trauma organized system of sexual abuse by confronting the abuser: A focal family therapy approach with a woman who was a childhood victim of sexual abuse

The longer-term emotional and interpersonal effects of sexual abuse in childhood are reviewed and approaches to treatment discussed. The notion of a 'trauma organized system' to account for the long-standing effects of abuse is described. A major potential issue in creating therapeutic change is confronting the abuser, and a case is described where a woman brought her family for therapy when it was feared that the father, who had abused her in childhood, might abuse his grandchildren. A focal family therapy approach was used: this takes into account the traumatic nature of abusive events and their long-term organizing effects on individual and family functioning. The process of therapeutic work is described, including the resolution of traumatic effects by confronting the abusive act.     

Job Satisfaction of Child Welfare Workers in an Urban Setting: Status and Predictors

Large urban areas present many challenges to those children and adults who reside in those settings. The social service workers in urban areas have clients with complex, multiple needs. Reliable and consistent workers are essential to successfully working with these families. In the current study, the job satisfaction of 29 social service workers in an urban child welfare agency was assessed using the Job Satisfaction Scale (JSS). The JSS measures satisfaction in 7 areas of one's job (i.e., work, supervision, coworkers, pay and promotion, work environment, training, and position). Data indicated that the staff were relatively satisfied, that satisfaction did not vary by staff position (family worker vs. social worker/supervisor), and that neither demographic factors nor prior experiences were predictors of job satisfaction. Implications for agency management and the provision of social services to urban families are discussed.     

Poverty,state, and the family: A challenge for family therapy

Much family therapy writing has focused on work with discrete presenting problems in circumscribed clinical practice settings. This paper takes a broader focus of poor families which do not fit easily into the one-hour therapy schedule, in the context of the powerful forces of politics and economics. If the prevailing political attitudes and economic realities are ignored, direct practice with families may fail to meet them at their point of experience. Examples of political views, and therapeutic and research thinking which do not pay attention to these aspects, are used to highlight the author's point of view.     

Aging family caregivers: policies and practices

This review examines later life family support for adults with developmental disabilities from a life course perspective that takes into account social trends and changes in service patterns and in attitudes of families. Key issues addressed include: (1) trends affecting family caregiving, (2) health and social outcomes of life-long caregiving, (3) support needs of families, (4) family support policies and practices, and (5) recommendations for a research and policy agenda. Research examining outcomes of life-long caregiving has shown that most families adapt well to having a family member with disabilities. However, some families are at risk for poorer physical and mental health outcomes. These include cultural minorities and families of adults with behavioral challenges. Caregiving does seem to have a negative impact on maternal employment and family income as mothers often give up or cut back on employment to care for a child with developmental disabilities, who is more likely to continue living in the family home throughout adulthood than other adult children. Federal and state initiatives are addressing issues of family support through both the developmental disabilities and aging service systems.