Toward an integration of child and family therapy

Current forms of treatment for the symptomatic child are reviewed and analyzed. There are four general approaches to treatment: individual child psychotherapy, conjoint parent-child psychotherapy and counseling, parent therapy and counseling, and conjoint family therapy. Each approach has certain strengths, but in-and-of itself is an incomplete treatment mode. An integration of child and family therapy is recommended, and recent attempts at this integration are described. These include approaches which work within the framework of conjoint family therapy and those which provide concurrent child and family therapy.     

Case Report: A Systems Approach to Genetic Counseling for Albinism

A systems approach to family therapy assumes that a person and his/her problems do not operate in a social vacuum but instead are imbedded in a social context. This context includes fairly small social systems such as a nuclear family and larger social systems such as school systems and cultural beliefs. A case of a girl with albinism born to a couple from India will be used to discuss how a systems approach might be useful in a genetic counseling setting.     

A Profile of Chinese Family Therapists

It is helpful for professional organizations, policy makers and regulators, third-party payers, and clients to have access to empirical data about family therapists and the practice of family therapy. Nevertheless, there is no such data available in China. This study attempts to fill this gap by profiling Chinese family therapists. A questionnaire was designed and delivered to family therapists and trainees. A total of 117 questionnaires were collected and analyzed. The findings show that the majority of Chinese family therapists are female, in the age range of 31–40 years, hold master’s degrees, and attend continuous training programs that last 20–40 days over 2–3 years and short-term workshops for family therapy training. They are mainly motivated by the need for personal growth in their career choice. Most of them work in the institutional setting. They have worked in the counseling field for 6.6 years on average, and they have practiced family therapy for an average of 3.4 years. They perform counseling for 9.2 h per week, and 4 h involve working with families. They received an average of 30.6 h of family therapy supervision in the past year. They mainly see individuals and families with adolescents, and their approach is eclectic. This paper compares the findings in China with findings from North America, discusses possible reasons for differences in the findings, and provides suggestions for future development and studies of family therapy in China.     

Practising family therapy in India: how many people are there in a marital subsystem?

Systemic therapy would appear to be a viable form of treatment for people who exist in cultures that contain complex, extended family systems, such as those found in India. The practice of family therapy in India has evolved from Western concepts. These concepts appear to offer Indian therapists relevant and practical ways of working with families. However, some of these concepts need modifying before they can be used in an Indian context. Indian families may have very different worldviews and ideas of 'self' compared to families in the West, leading to different family organization. The situation can be further complicated by the cultural norms of therapists themselves. Therapists in India are often highly educated, come from upper-middle-class families and have been exposed to different cultures. They increasingly share many of the values of their counterparts in the West. At the same time, they retain aspects of their own cultural heritage, which is also the dominant culture for a large number of the families with whom they work. Thus, not only must Indian family therapists seek to work in culturally appropriate ways; they must also tolerate their own internalized conflicts regarding differing cultural norms. With the use of clinical data, this paper describes some of the personal and professional problems experienced by an Indian family therapist working with Western constructs of family organization.     

复杂哀伤丧亲女孩的箱庭疗法个案研究

通过19次个体箱庭和2次家庭箱庭治疗,对一名12岁复杂哀伤的丧亲女孩W进行了个案研究。发现:(1)箱庭治疗能提高丧亲青少年的个体和家庭功能,促进青少年个体和家庭哀伤任务的完成;(2)W的个体箱庭经历了在混乱重复中寻找秩序、重建自我、转化与整合、自我治愈力展现四个阶段;(3)W的哀伤经验经历了在治疗者促进下分享—象征性表达—主动地象征性表达—直接而主动地表达哀伤经验最终获得哀伤任务完成的变化过程。     

The Development of Family Therapy Practice and Training in Taiwan: A Review and Prospects for the Future

This thesis reviews the development of family therapy in Taiwan since its commence in 1969 to today, with two focuses on the status quo in practice and in training. The practice of family therapy in local hospitals, social welfare agencies and community counseling institutes are reviewed respectively, with a discussion of the challenges local family therapists encounter. The status quo of local family therapy trainings is also examined in terms of trainers, programs, professional organizations and licensure. The limitations and possible hindrances to the current professional training system are explored, and finally suggestions for the advance of local family therapy professional development in Taiwan are proposed.     

ABSTRACTS OF LITERATURE

Two case examples are presented in support of the hypothesis that family therapy is useful in situations in which the identified patients are students at a university counseling center. The core dynamic issues focus around separation from parents. It is felt that the family therapy is a useful adjunct to the individual psychotherapy.     

Genetic Counseling: A Transnational Perspective

Although the basic goal and components of genetic counseling appears to be the same across the globe, judged by my experiences there are significant differences in the provision of genetic counseling services in Australasia (Australia and New Zealand) and India. There is poor recognition of the professional status of a genetic counselor in India at present. This may be partly because genetic counseling itself is a relatively new discipline within the medical field in India, although some types of genetic services and research have been conducted since 1960s. In this paper, I aim to provide insight from my personal transnational experiences.     

CF carrier testing: Experience of relatives

Consensus exists that genetic counseling and CF carrier testing should be offered to individuals with a positive family history of CF. To learn more about their experience with genetic counseling and testing we conducted a series of structured telephone interviews and focus group discussions with individuals and couples who had undergone genetic counseling and carrier testing because of a family history of CF. Traditional genetic counseling appears to have been effective for this population. Subjects generally report having a positive counseling experience and few difficulties upon learning their carrier status. Subjects were quite knowledgeable about CF and their carrier risk and were highly motivated to seek testing. They may not be representative of all individuals with a family history of CF however. For carriers, concerns about whether and when to have children tested, and concerns about insurance implications of carrier status may emerge sometime after the initial counseling. Strategies for addressing these concerns and for providing efficient and effective education and genetic counseling for people with a family history of CF need to be developed.     

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.     

Unheard Voices: Experiences of Families Living with HIV/AIDS in India*

This study was aimed at understanding the impact of HIV on the family system in the Indian context. A sample of 20 families caring for a relative living with HIV/AIDS (PLWHAs) was recruited from a HIV counseling clinic at the National Institute for Mental Health and Neuro Sciences and a respite home for PLWHAs in Bangalore City in southern India. Qualitative data were collected from these families using a semi-structured interview guide and recorded in the form of narratives. Analysis of these data revealed the following themes: Stigma and discrimination; disclosure; changes in family functioning; financial difficulties; fears of the family; and helplessness. Each theme was presented in detail and implications for intervention to help these families and their PLWHAs discussed. V.A.S. Krishna, PhD, MPE, Fogarty Funded Post Doctoral Fellow, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63108 (krishnavas@epi.wustl.edu). Ranbir S. Bhatti, PhD, Professor of Family Therapy, Montfort College, Bangalore, Former Professor and Head, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (ranbirbhatti@yahoo.com). Prabha S. Chandra, MD, Additional Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (prabhachandra@rediffmail.com). Srilatha Juvva, PhD, Reader, Department of Family and Child Welfare, Tata Institute of Social Sciences (TISS), Mumbai, India 400088 (juvvas@tiss.edu). *The authors would like to thank all the PLWHAs and their family members for volunteering to be part of this study. Post-doctoral Fellowship support for Dr. V.A.S. Krishna from Fogarty Grant—TW05811 (LB Cottler, PI).     

The Effectiveness of Family History Questionnaires in Cancer Genetic Counseling

The number of individuals receiving genetic counseling for hereditary breast and ovarian cancer syndrome has steadily risen. To triage patients for genetic counseling and to help reduce the amount of time needed by a genetic counselor in direct patient contact, many clinics have implemented the use of family history questionnaires. Although such questionnaires are widely used, scant literature exists evaluating their effectiveness. This article explores the extent to which family history questionnaires are being used in Ontario and addresses the utility of such questionnaires in one familial cancer clinic. By comparing the pedigrees created from questionnaires to those updated during genetic counseling, the accuracy and effectiveness of the questionnaires was explored. Of 121 families recruited into the study, 12% acquired changes to their pedigree that led to a revised probability estimate for having a BRCA1 or BRCA2 mutation and 5% acquired changes that altered their eligibility for genetic testing. No statistically significant difference existed between the eligibility for genetic testing prior to and post counseling. This suggests that family history questionnaires can be effective at obtaining a family history and accurately assessing eligibility for genetic testing. Based on the variables that were significantly associated with a change in probability estimate, we further present recommendations for improving the clarity of such questionnaires and therefore the ease of use by patients.     

Familientherapie

In the field of family therapy besides the emphasis on the autonomy of the different schools (behavioral, psychodynamic, systemic), partly motivated by professional politics, a growing openness for concepts developed in other approaches can be observed. Approaches and results of attachment and affect theory and research find their way into the conceptualization of family processes and family therapy. Processes in the “self” of the therapist are taken into the discussion of therapeutic processes in systemic therapies. Furthermore, new fields of application of family therapy approaches have developed: parents-infant therapy and counseling, therapy of the elder, family medicine and coping with the consequences of the “human genome project”. New research on the empirical validation of relational dynamic concepts and on the evaluation of family therapies show a trend to see the claim for making treatments as short as possible in very relative terms. It is assumed that the family therapeutic approach will become more important in the future.     

Therapist and Family Values in a Cultural Context

In this article the author discusses the nature, complexity, meaning, and function of values, their presence in the family counselor or therapist as well as in the family in treatment, and the consequences for treatment of the interplay between those two value systems. A brief conceptualization of values is offered, followed by (a) a discussion of family language as a key to identifying salient values, (b) where values are experienced, (c) timing as a value in counseling, (d) the relationship between therapy and the ideology of cultural relativism, (e) midwestern American farming family values thai illustrate an ethnographic approach to family assessment and intervention, and if) therapist values and the professional values of family therapy as a social movement. A number of vignettes from the author's work with families and supervision of family medicine residents in family counseling illustrate the theoretical and methodological issues that are raised.     

Assessing and Constructing a Meaningful System: Systemic Perspective in a College Counseling Center

The author describes an application of family systems therapy to treatment in a college counseling center. This approach organizes treatment around the “meaningful system” rather than the family system and includes nonfamily significant others in treatment. Using the Brief Therapy model of the Mental Research Institute, the author addresses special considerations in providing systemic treatment in a college counseling center, assessment and construction of a meaningful system, and specific working procedures. Two case illustrations are provided.     

系统式团体心理辅导改善儿童同伴关系的研究

本研究将系统家庭治疗的思想及技术移植到学校情景中,对实验班人际距离较远的5名嫌弃儿在原班级中开展团体心理辅导活动.实验结果表明:嫌弃儿的人际距离明显改善.辅导中系统思想的引入、积极取向的气氛对同伴关系辅导有特殊的效果.     

A Kinetic Sculpture Intervention for Individuals Grieving the Deaths of Family Members

This article presents a creative intervention called kinetic sculpture for loss adaptation in grief counseling. This intervention is supported by professional literature regarding Bowenian family systems and creativity in counseling. The deaths of family members may generate much uncertainty for clients regarding functioning of their family systems. Kinetic sculpture allows clients to create visual examples of family equilibrium before, in the midst of, and after the deaths of family members. Insight gained from engaging in this intervention can aid clients in making aspirational plans for their own adaptations to loss. In this article, we present step-by-step instructions for creating the kinetic sculpture, make recommendations for process questions to accompany the intervention, and apply the kinetic sculpture in a case example.     

A 40‐Year Review of Multicultural Counseling Outcome Research: Outlining a Future Research Agenda for the Multicultural Counseling Movement

This study represents a 40‐year review of multicultural counseling outcome research that has been done in the mental health professions. Particular attention is directed to the outcomes that ensue from counseling situations that are composed of counselors and clients from different racial/cultural backgrounds and identities in individual, group, and family counseling settings. Recommendations are presented for the next decade of multicultural counseling outcome research.     

Play Therapy in a Natural Setting: A Case Example

Play therapy is commonly used when working with children in counseling. Play therapists work at a developmentally appropriate level to assist children with a variety of mental health and behavioral concerns. Traditionally, play therapy and many counseling methods occur in office settings. We propose that play therapists and other mental health professionals working with children integrate nature and natural settings into their work. The use of nature has been shown to be effective in helping people cope with mental health and physical ailments. In this article, we explore the benefits of the use of nature in mental health and provide a case example of the use of nature and natural settings in counseling.