Sequences: toward a common denominator of family therapy

This paper presents a conceptual framework that is designed to help clinicians and researchers organize their observations of the complex network of interconnected sequences of behavior and thinking that constitute family interactions. This framework distinguishes four classes of recursive sequences, each of which is defined by its period, i.e., the amount of time it takes for a sequence to complete one cycle. The shortest sequences (S1) are those face-to-face interaction patterns that range in length from seconds to an hour. S2 sequences are played out over one day to one week, often depending on the routines of the family. S3 sequences range from several weeks to a year, and S4 sequences are those patterns of interaction and thought that repeat from generation to generation. In addition to outlining this framework, the paper contends that in many families with a problem, pertinent sequences from each class may be related to the problem and to each other in a cybernetic manner. Suggestions are offered for identifying pertinent sequences from each class and for selecting interventions that best address the targeted sequence. We have found that this conceptual framework has enabled us to use techniques from many different schools of family therapy while avoiding the conceptual contradictions inherent in previous attempts to integrate approaches.     

Priority setting in family change and clinical practice: the Family FIRO Model.

We update a theoretical framework for understanding priority setting for the management of family change, with special emphasis on developmental change. We propose that three core dimensions of family interaction--inclusion, control, and intimacy--constitute an optimal priority sequence for managing major family change stemming from life-cycle transitions and other stressful experiences. In the next section of the article, we compare the Family FIRO Model and other models of family change. Finally, we suggest that therapists can benefit from an explicit, clinical decision-making model for setting priorities in treatment: issues of inclusion take precedence over issues of control, which in turn take precedence over issues of intimacy.     

Multiple family therapy in a residential setting for adolescents*

Treating severely disturbed adolescents in a residential setting without including the family seems impossible. Several ways of letting the family participate in the clinical treatment are discussed. The focus of this article lies in multiple family therapy: groups of family members, adolescents and staff are treating each other. The objects of these meetings are manifold: to modify the stereotyped views that all the participants have of each other, to reduce the isolation of the family which is created by their child's admission, to stimulate interaction and mutual correction between family members, adolescents and staff, and to create a warm-up for and understanding of family system therapy. These multiple family sessions, which take place in a clinic with sixty disturbed adolescents, have a strong influence on the entire therapeutic process. Their impact is felt in the group psychotherapy, psychodrama and other forms of therapy.     

Uncommon strategies for a common problem: addressing racism in family therapy

Race and racism have a profound effect on our daily lives and the practice of family therapy. Whether individual or institutional level, overt or covert, intentional or unintentional, there are a variety of ways in which racism can infiltrate the therapeutic process. Before therapists can take steps to address racism effectively within the context of family therapy, it is important to attend to the development of their racial awareness and racial sensitivity. These provide the critical foundation upon which specific skills and strategies associated with effectively identifying and responding to racism in therapy are based. This article defines racial awareness and sensitivity and provides suggestions for enhancing both. In the section that follows, three major ways in which racism can infiltrate the therapeutic process are described. Skills and strategies for addressing each of these in family therapy are presented.     

Psychological services for children: using family therapy in the setting of a school psychological service

An attempt is made to evaluate the results of using family therapy in the setting of a school psychological service over a period of about two-and-a-half years. Seventy-two children were involved, referred by teachers, with a variety of behavioural difficulties and learning problems. The difficulties of involving parents in regular clinic sessions for problems which they either saw as school-based or did not see at all are discussed. It is suggested that the technique of family therapy has been insufficiently exploited to help children seen to have 'a special educational need'. This includes children who are developmentally immature, as well as those who show more overt signs of emotional disturbance.     

Fear of success: the construction and validation of a measuring instrument

This study constructed an instrument which identifies people who fear success (FOS) in academic areas and conducted a laboratory study which tested the instrument's predictive validity. The theoretical formulation of the FOS phenomenon leads to the expectation that individuals high in the fear of success would demonstrate the following characteristics: low self-esteem, a preoccupation with the evaluative aspects of situations, a competitive orientation, repudiation of competence, and self-sabotage at the approach or attainment of success. The fear of success questionnaire is an 83-item scale with a reliability of .90. In a 2 x 2 factorial design, subjects identified by the FOS questionnaire were given either Success or nonsuccess feedback after completing the first of two equivalent reading tests. The results of the laboratory experiment indicated that there is strong clear evidence of self-sabotage under conditions of success among subjects who scored high on the FOS questionnaire.     

The therapist's inner conversation in family therapy practice: some ideas about the self of the therapist, therapeutic impasse, and the process of reflection.

In this article, a distinction is made between the outer therapeutic conversation and the therapist's inner conversation. The therapeutic conversation is a circle of meaning in which both the therapist and the clients play a part. The therapist's inner conversation is described as a negotiation between the self of the therapist and his role. In this process of negotiation the therapist has to take seriously, not only his observations, but also what is evoked in him by these observations, that is, images, moods, emotions, associations, memories, and so on. Furthermore, therapeutic impasse is conceptualized as a paralysis of the circle of meaning and of the therapist's inner conversation. A process of reflection is proposed as a way out of the impasse. In that process, the inner conversation of the therapist is externalized with the help of an outsider. In the final part of this article, a case study illustrates the importance of these ideas for the family therapy practice.     

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)     

Anti-Semitism in the clinical setting: transference and countertransference dimensions.

Despite the salient presence of Jews in the history of psychoanalysis, literature on the subject of anti-Semitism in the clinical setting is surprisingly sparse. This paper attempts to comprehend the reasons for the dearth of literature on this important topic. A clinical section then breaks the silence surrounding expressions of anti-Semitism in the consulting room. The major focus is on transference and countertransference reactions that arise with regard to anti-Semitism in the clinical setting. Since the first section is concerned with silence in the psychoanalytic community, its focus is primarily on countertransference issues that may hinder the analyst's understanding and use of anti-Semitic material. The second, clinical section focuses on the ways both transference and countertransference reactions combine and influence one another and how they may, when properly attended to, serve as catalytic tools for advancing therapeutic goals.     

Behavioral-systems marital and family therapy: Integration and clinical application

Abstract

This paper describes our integration of two of the more prevalent approaches to marital and family therapy: the behavioral (social learning) and the family systems (communication theory) approaches. A discussion of the development of family rules from a behavioral point of view is presented as an example of conceptual integration. However, the major intent of the paper is to present a rather detailed explication of the authors' multivaried strategies for intervention, which are designed to integrate and innovate upon the major behavioral and family systems treatment techniques.     

Towards a family-centred therapy. Postmodern developments in family therapy and the person-centred contribution

The project for recent developments in family therapy has been to reject scientism and the potential for oppression within the modernist stance, in favour of more respectful collaborative practices. However, scientific certainty is being replaced by philosophical obscurity and there is a risk of missing the obvious in the recognition that, since successful family life is a function of love and respect, these qualities should be modelled in the therapeutic relationship. This paper argues that the humanistic tradition has been neglected and that the person-centred approach has an important contribution to make to the development of a family-centred therapy.     

Attachment and family therapy: clinical utility of adolescent-family attachment research

The divide separating research and clinical work is narrowing. New therapies have been informed by research from specialties such as developmental psychology and developmental psychopathology. In this article, we attempt to illustrate the usefulness of research on attachment relations for family-based therapy with adolescents. We examine the clinical utility of adolescent attachment research within the context of multidimensional family therapy, an empirically supported treatment model that has incorporated developmental research, including basic research on attachment, in its assessment and intervention framework.     

Evidence-based treatment of stuttering: III. Evidence-based practice in a clinical setting

At the heart of evidence-based practice in stuttering treatment are four issues: (1) the collection of data to inform treatment; (2) the long standing concern with maintenance of treatment gains; (3) the need to demonstrate accountability to clients, payers and our profession as service providers; and (4) the desire to advance theoretical knowledge. This article addresses the first three of these issues from a practical point of view, illustrating how data collection for stuttering treatment outcome research in a clinical setting is intimately blended with that required for clinical purposes and providing an example of a process of evaluating data for clinical and research purposes. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to (1) differentiate between treatment outcome and treatment efficacy research, (2) describe models for integrating data collection for treatment outcome and clinical purposes, and (3) utilize guidelines for treatment efficacy that are applicable to outcome research to evaluate data for use in treatment outcome studies and to design outcome studies.     

Client-centred therapy and family therapy: a review and commentary

This article sets out to redress the relative neglect of the client-centred tradition within family therapy. A review of the limited literature emanating from both client-centred therapy and family therapy is provided, supported by a commentary. An argument is made for the relevance of client-centred principles in responding to contemporary concerns about disrespectful practice.     

Graduate trends for one marriage and family therapy program in an interdisciplinary setting

This research compared trends from 1981 to 1993 in several mental health professional training programs at the University of Houston Clear Lake, surveying graduates from three professional mental health master's programs—clinical psychology, school psychology, and family therapy—with the goal of identifying trends in the status of their professional credentialing and current employment. Four mental health groups have attained licensure since a 1981 survey, resulting in graduates now seeking professional licenses and perform psychotherapy more exclusively than other mental health activities. Interdisciplinary training has become increasingly important due to the introduction of managed care and other insurance regulating entities.     

Playingwith fire: art therapy in a prison setting

Art therapy's distinctive approach mediates between verbal and non-verbal, acting and thinking. All behaviour has meaning. As the criminal act is non-verbal, the art therapist has a unique way of engaging patients to find alternative ways of processing difficult feelings and impulses. This paper will focus on work at Holloway Prison and in particular the dynamics of arson to case material.