"Enmeshment" and "Fusion"

The paper examines two related concepts utilized by two different schools of family therapy. Any family seen to be "enmeshed" is also seen as "fused," and vice versa. The difference in the level of focus, on the "system containing the individuals" (structural) or the "individual in the system" (fusion), determines the difference in therapeutic approach of these two schools.     

The "psychosomatic family" model: an empirical and theoretical analysis

Evolution of the Family Systems Paradigm has been constrained by the dichotomy between theory building and empirical research. This article integrates these two domains by presenting a theoretical analysis of the "psychosomatic family" model as it informs and is informed by an empirical research project. Forty families of children with Crohn's disease (CD), ulcerative colitis (UC), and functional recurrent abdominal pain syndrome (RAP) were rated during standard, videotaped family interaction tasks, lunch, and interview. Laboratory scores of disease activity were associated with triangulation, marital dysfunction, and total "psychosomatic family" scores. Disease activity was not significantly correlated with enmeshment, overprotection, rigidity, conflict avoidance, or poor conflict resolution. Thus, the marital/triangulation and enmeshment/overprotection/conflict clusters may be subcomplexes of the "psychosomatic family" complex. CD, UC, and RAP groups differed in the relations among particular family patterns and disease activity. A heuristic family-psycho-somatic model is presented to facilitate future research.     

"Don't lock me out": life-story interviews of family business owners facing succession

This qualitative study used a grounded theory methodology to analyze life-story interviews obtained from 10 family business owners regarding their experiences in their businesses with the goal of understanding the complexities of family business succession. The grounded theory that emerged from this study is best understood as a potential web of constraints that can bear on the succession process. Coding of these interviews revealed four key influences, which seem to have the potential to facilitate or constrain the family business owner's approach to succession. Influence 1, "The business within," captures intrapsychic dynamics of differentiation and control. Influence 2, "The marriage," addresses how traditional gender roles shape succession. Influence 3, "The adult children," examines the role of having a natural (accidental, organic, passively groomed) successor. Influence 4, "The vision of retirement," captures the impact of owners' notions of life post-succession. Family therapists frequently encounter family systems in which the family business is facing succession. Even if succession is not the presenting problem, and even if the business owner is in the indirect (rather than direct) system, this research reminds clinicians of the importance of the family's story about the family business. Therefore, clinical implications and recommendations are included.     

When the Woman Presents Herself as "the Patient"

The thesis of this paper is that women are delegated by their families, by sociocultural norms and stereotypes, and by the psychotherapeutic community to perform in the role of patient. In many cases women are diagnosed, labeled and treated for supposed intrapsychic difficulties without adequate consideration of the relationships of the woman's social system to the dysfunction. This acceptance of the notion of intrapsychic causation in the woman, while ignoring the larger family system, grows out of a cultural world view which stresses individual self-determination is economically rewarding for the therapeutic community (two-thirds of the client population is female), it does a disservice to the woman and her family. A societal myth is perpetuated of the women as the "problem-bearer" and the one who is "sicker" or "crazier" than others in her family. The woman's symptoms need to be viewed as having interpersonal reality; symptoms are tactics of communication not mythological internalized driving forces with special attraction to the female psyche. An attempt will be made to outline how therapists may unwittingly collude in perpetuating the myth of individual dysfunction in the woman. Ideas are presented for viewing the woman's request for service as an attempt to solve a systemic problem and how therapists, by recognizing the function of the symptom in the woman's social system, can help the woman better define and solve the problem.     

Detrimental therapist-client relationships--beyond thinking of "dual" or "multiple" roles: reflections on the 2001 AAMFT Code of Ethics

This article presents reflections on and a critique of the recent revision of the AAMFT Code of Ethics on the multiple relationship ethical standard. A brief historical overview of terminology and the debate surrounding "dual" and "multiple" relationship ethical rules in marriage and family therapy is provided. The term "exploitation" is also delimited. Ethical principles and a set of standards addressing "detrimental" versus "potentially beneficial" interactions are introduced, deriving from works in other mental health professions. The article recommends: (a) the terms "dual" and "multiple" relationships should be abandoned; (b) the ethical principles underlying the AAMFT Code of Ethics need to be examined; and (c) the debate on the topic of detrimental therapist-client interactions in marriage and family therapy needs to be revisited, especially in light of a "positive ethics."     

The emergence of "family integrity" in later life

In contrast to the rich and abundant literature on the early stages of the family life cycle, there are relatively few theoretical accounts of family developmental processes in the second half of life. In an effort to address this imbalance, we introduce the concept of "family integrity" to refer to the ultimate, positive outcome of an older adult's developmental striving toward meaning, connection, and continuity within his or her multigenerational family. Subjectively, for the older adult, family integrity may be experienced as a deep and abiding sense of peace and/or satisfaction with his or her multigenerational family relationships, past, present, and future. It is the result of a growing concern for relational closure that typically begins to emerge in mid-life and gains ascendance in later-life. Objectively, at the level of observable relational processes, it is manifest in three interrelated competencies of the family as a system: (a) the transformation of relationships over time in a manner that is dynamic and responsive to the changing life cycle needs of individual family members, (b) the resolution or acceptance of past losses or family conflicts, with the dead as well as the living, and (c) the shared creation of meaning by passing on individual and family legacies within and across generations. As a construct, family integrity involves processes at multiple levels of social organization. At the individual level, it refers to an older adult's inner experience of satisfaction or "completeness" in the context of his or her family relationships. At the family level, it refers to observable relational competencies and transactions that contribute directly to an elder's sense of meaning, purpose, and connection with others. Simultaneously, at the level of culture and society, there are values and rituals that influence whether individuals experience meaning and purpose within the multigenerational family.     

"Worlds apart": truth telling in the case of Mrs. VV

This article discussed how the views of a terminal cancer patient and her family, who were immigrants from Romania, differed from those of her North American caregivers. It presents evidence about truth telling to cancer patients in Eastern Europe and general cultural differences in attitudes to truth telling. Literature on how to span the gap between different cultural worlds is reviewed. Conclusions address ways to minister to patients who come from "different worlds" than their caregivers.     

"Lesbians, gay men, and their parents": a critique of LaSala and the prevailing clinical "wisdom"

This article challenges the popular assumption that coming out to family of origin is important for lesbians and gay men's mental health and couple relationships. First, I present theory emphasizing the unique position of lesbians/gays in families of origin and the significance of "families of choice." Second, I review the quantitative research on social support received by lesbians/gays from family of origin, friends, and other social network sources. Third, I demonstrate how the dominant clinical opinion about coming out to family is based on an unwarranted use of theory developed for heterosexuals and on overgeneralization of findings from studies of white, upper-middle-class, North American lesbians/gays. Fourth, I propose five determinants of lesbian/gay persons' decisions to come out to family-of-origin members. Fifth, I argue that such decisions are constrained by "realistic" costs/benefits in various sociocultural niches rather than being a simple function of individuals' levels of differentiation. Lastly, I offer an expanded contextual stance for the family therapist working with lesbian/gay clients.     

Advancing a family perspective in health research: models and methods

In this essay we review and respond to four problems that have impeded the application of family theory to health research: the difficulty in translating family concepts to empirical health research; the confusion and uncertainty in measuring "wholes" and "parts" of a family in a single health project; the apparent conflict between circular-causal and linear perspectives in model building; and the putative, implicit "violation" of a family perspective by the employment of certain data management and design strategies. We argue that current, complex conceptualizations of the family have to be matched with equally complex research designs and methods, and that techniques are available to reach these goals. We distinguish between theoretical models and research methods, and review several strategies, design issues, and alternatives for data analysis. Throughout, we point to 1) the need to maintain consistency among theory, construct, and indicator, 2) the employment of multidimensional family assessment in health research, and 3) the use of readily available but infrequently used methods and procedures for appreciating the richness of multivariate family data.     

T. S. Eliot's The Family Reunion—"Schizophrenia" Reconsidered

T. S. Eliot's play, The Family Reunion ( 4 ), can be interpreted as a representation of a "schizophrenic" and his family. As such it illustrates some of the clinical insights of both individual psychiatry and family psychiatry. This paper will discuss the play from a clinical vantage point and conclude with a re-consideration of the concept of schizophrenia.     

Barbadian adolescents' views of the "ideal" family

An instrument examining the perceptions of "ideal" family functioning was administered to 536 adolescents aged 12 to 18 yr. in Barbados. Analysis indicated fairly extensive differences between the views of male and female students, somewhat fewer differences in age and type of school attended, and very few differences associated with household composition and religious affiliation.     

Triadic coordination: an observational method for examining whether children are "caught in the middle" of interparental discord.

Triadic coordination refers to how a parent coordinates his or her contributions with the spouse's bids toward their child. This construct provides a basis for studying specifically triadic family interaction processes. In particular, it offers a new approach for examining whether children are "caught in the middle" of marital discord. We conducted an initial, small-scale study of mother-father-child interactions in a structured task in order to pursue the methodological goal of developing an observational procedure for measuring triadic coordination processes. The results suggest that the approach has considerable promise for making a contribution to future research on marital discord and child functioning. We found that processes of triadic coordination can be assessed reliably. Other findings included an interesting pattern of results, which merits further investigation in future studies, concerning relations between whether and how a parent disagreed with or opposed the spouse's bids toward their child, on the one hand, and other measures of family functioning and measures of child functioning, on the other hand.     

Alternative strategies for creating "relational" family data

A major problem facing family clinicians and researchers is creating data that will reflect the family as a unit. To address this problem, we present a framework for family assessment based on three measurement strategies: individual family member assessment, relational family assessment, and transactional family assessment. Within this context, we present several categories of methods for combining individual family member data into "relational" scores that reflect the couple or family as a unit. The problems and benefits of each method are presented, and it is suggested that the choice of method is dependent upon the content of the assessment, the theory underlying the content, and the statistical properties of the individual family member scores.     

The disclosure dilemma for gay men and lesbians: "coming out" at work

This study examined disclosing sexual orientation at work for 220 gay men and 159 lesbians. Self-acceptance, the centrality of one's identity, how "out" one is to friends and family, employer policies, and perceived employer gay-supportiveness were associated with disclosure behaviors at work for gay/lesbian employees. Disclosing at work and working for an organization perceived to be more gay supportive was related to higher job satisfaction and lower job anxiety. Reactions of coworkers to gay or lesbian workers mediated the relationship between disclosure and gay/lesbian workers' job attitudes. Implications and solutions for management are discussed.     

Personal experience in professional narratives: the role of helpers' families in their work with terror victims

This article describes research on the narratives of social workers who help terror victims, focusing on the relationship between the helpers' families and their work. Qualitative analysis of three training groups of social workers who are responsible for helping in the event of terror attacks in different parts of Israel, and of three debriefing groups for social workers after terror attacks, reveals that the helpers' families play a role in the narratives constructed by the helpers. Two main themes were identified. The first centers on the interaction between work and the family, and shows that in the situation of a terror attack, the conflict between the two disappears and the family often serves as a support system for the helpers. The second theme refers to the family dimension alone, and focuses on the dichotomy between vitality and loss. The way that family life events affect helpers'professional intervention is described. The findings are discussed in light of Conservation of Resources Theory, the fight-flight response to threat, and the concept of the family as a source of safety and risk taking.     

Testing clinical hypotheses by means of "falsificationist epistemology"

A family therapist using the "falsificationist epistemology" can, during the first session, test the hypotheses formulated on the telephone intake chart and also gather further information to reexamine and redefine these hypotheses. We shall examine a case treated by Dr. G. Prata, analyzing the most important phases of the first session, and stressing what methodological and tactical choices were designed to test the leading hypothesis of the "game" played by this family.     

Criticism of "brain death" policy in Japan

The 1997 Japanese organ transplantation law is the fruit of a long debate on "brain death" and organ transplantation, which involved the general public and experts in the relevant fields. The aim of this paper is to trace the history of the implementation of the law and to critique the law in terms of its consistency and fairness. The paper argues that the legislation adopts a double standard regarding the role of the family. On the one hand, the legislation over-emphasizes the family's authority by granting the family a veto on the matter of organ transplantation, while, on the other hand, not allowing the family to make surrogate decisions. In addition, the role of law in cases involving minor or incompetent patients is shown to be similarly misguided. The paper argues that accepting a decisive role for the family in current law is compatible with Japanese culture.     

Freud's "bad conscience": The case of Nietzsche's Genealogy

This article develops the argument that Friedrich Nietzsche influenced several aspects of Freud's later writings by illustrating, in particular, the impact of Nietzsche's On the Genealogy of Morals on Freud's Civilization and its Discontents. The theoretical and conceptual schemes represented in Freud's Discontents are found to bear a remarkable similarity to Nietzsche's Genealogy on a number of highly specific points. It is suggested that "DAS ES," "Uber-ich," and "bad conscience," concepts central to Freud's moral theory of mind, are at least partly derived from Nietzsche. Moreover, Freud's phylogenetic theory of guilt is based upon premises found in Nietzsche, as are specific details relating to ideas on human prehistory and the ancestral family. Based on this evidence, a re-examination of the moral and social dimensions of Freud's "structural" model may be in order.     

"Living with" the past: coping and patterns in families of Holocaust survivors

This exploratory study looks at how families of Holocaust survivors work through the traumatic past by considering the coping patterns adapted by family members. Life-story interviews (Rosenthal, 1993) with 57 individuals from 20 families, in which there were two to three generations, were used in order to learn about the significance they attach to the Holocaust past. The interviews were analyzed using Rosenthal's methods and Danieli's (1988) typology of post-war adaptation (victim families, fighter families, those who made it, and numb families). Results showed that in order to differentiate between the coping styles exhibited by the families, two new categories had to be added to Danieli's typology. These were entitled "life goes on" and "split families." It was concluded that survivor families exhibit heterogeneity in the ways in which they cope with the Holocaust past.     

Solving the "human problem": the frontal feedback model

This paper argues that humans possess unique cognitive abilities due to the presence of a functional system that exists in the human brain that is absent in the non-human brain. This system, the frontal feedback system, was born in the hominin brain when the great phylogenetic expansion of the prefrontal cortex relative to posterior sensory regions surpassed a critical threshold. Surpassing that threshold effectively reversed the preferred direction of information flow in the highest association regions of the neocortex, producing the frontal feedback system. This reversal was from the caudo-rostral bias characteristic of non-human, or pre-human, brain dynamics to a rostro-caudal bias characteristic of modern human brain dynamics. The frontal feedback system works through frontal motor routines, or action schemes, manipulating the release and reconstruction of stored sensory memories in posterior sensory areas. As an obligatory feature of frontal feedback, a central character, or self, emerges within this cortical network that manifests itself as agent in these reconstructions as well as in the experience of sensory perceptions. Dynamical-systems modeling of cortical interactions is combined in the paper with recent neuroimaging studies of "resting-state" brain activity to bridge the gap between microscopic and macroscopic levels of cortical behavior. This synthesis is used to support the proposal of an information flow reversal occurring in the hominin brain and also to explain how such a reversal generates the wide variety of cognitive and experiential phenomena that many consider to be uniquely human.