The Voices of Therapists and Children Regarding the Inclusion of Children in Family Therapy: A Systematic Research Synthesis

In 1970, Nathan Ackerman challenged the field of marriage and family therapy to actively involve young children in the family therapy process. How has the field of marriage and family therapy responded to his challenge? Using a systematic research synthesis to review and critique the non-empirical and empirical literature in the area of children in family therapy, the author discovered that the field of marriage and family therapy has not responded to Ackerman's challenge in the way he may have hoped for nearly three decades ago. A summary of the literature's findings is provided and recommendations for future research, as well as implications, for the field of marriage and family therapy are discussed.     

The complaining client and the troubled therapist: a discursive investigation of family therapy

In this paper I examine two important issues for family therapy research. I attend to the concept of complaints, highlighting the conversational structure they take in a family therapy setting. I do this by outlining how clients construct their complaints and examining how the family therapist receives them. Data is taken from a corpus containing four different families and two different therapists, and is subjected to discursive analysis in order to provide a rich analysis of not just what is happening in the talk but how it is happening. I conclude that complaints are not received as useful to the therapeutic process, despite their constructed importance to the client, and therefore there are wider implications for therapy and professionals more generally, particularly implications for multi-agency communication.     

Families-at-risk and home-based intervention: A therapist training model

Home-based family therapy programs are designed to provide intensive family intervention for at-risk children and adolescents. However, examination of the literature reveals limited publications about training therapists for this difficult task. The purpose of this paper is to describe a therapist training model based upon a family-as-context approach to crisis intervention. Specific units covered during the course include: family-as-a-system, structural family therapy, family crisis intervention, family assessment and simulation. It is concluded that the effective prevention of placement for at-risk children and adolescents requires both a home-based family treatment program and a specific therapist training model for family intervention.John J. Zarski, PhD, is a professor in the marriage and family therapy training program at the University of Akron. Carol A. Pastore is program coordinator for the T.I.E.S. program in Canton, OH. A. Lynette Way and Richard N. Shepler are home-based therapists with T.I.E.S. The authors would like to express their appreciation to Professor John West for his helpful comments on drafts of this article.     

New branches on the Tree of Knowledge. Challenges for systemic family therapists

Faced with today's challenges, I question whether the framework for family therapy provided by systemic thinking is sufficient when working with children and teenagers. The aim of this paper is not to argue for an eclectic model for therapy, but rather to encourage a critical dialogue between various bodies of knowledge. The paper raises the discussion of how family therapists relate to knowledge external to the therapy field. Contemporary developmental psychology, neurobiology, behavioural genetics and group socialization theory are highlighted as useful bodies of knowledge for family therapists. Examples from clinical practice are used to illustrate this.     

Eliciting children's thinking in families and family therapy.

In this article, I introduce a way of talking between a therapist and children, which aims to be more adaptive to the family therapy context than the modes of communication with children often reported by individual psychotherapists. Although the recent increase in articles concerned with the role of children in family therapy is welcomed, I suggest that the common recommendation of the use of "play" and nonverbal methods of communication with young children can at times introduce its own constraints on a child's thinking. A method of engagement in "dialectical" conversations with children is described, and illustrated with verbatim case examples. It is argued that this offers one route to a discourse commonly used between children, and one that acknowledges their capacity to think.     

Are family therapists listening to the young? A psychological perspective*

This paper sets out to examine the family therapist's relationship to young children from a psychological perspective. Earlier contributions to the literature regarding the involvement of children in family sessions are reviewed briefly. Aspects of attachment theory and Piaget's theory of cognitive development are considered in terms of their implications for family therapy. It is argued that family therapists should be mindful of parents’ responsibilities for meeting their children's needs, particularly their need to experience predictability and to have a coherent story about their lives. The importance of exploring the effects of adult choices on the children is also emphasized.     

Family treatment of an obsessive-compulsive child: a case report

This paper presents a family therapy approach to the treatment of an obsessive-compulsive child. Psychodynamic, behavioral and family therapy approaches to the etiology and treatment of this dysfunction are described briefly, and a detailed case report of a 15-session treatment utilizing behavioral interventions designed to change the family context is presented. Various procedures for dealing with the obsessive-compulsive behavior have been reported in the literature, including eliminating it directly by interruption or ordeal and modifying it. In this case, the author proceeded by ignoring the compulsive behaviors and concentrating on more functional ones using a paradoxical charting intervention. At one-year follow-up, the child was symptom free. Relationship factors, technical interventions, and stylistic aspects of the therapy are discussed, and the importance of rapid symptom alleviation in these children is underscored.     

Marital Conflict by Proxy After Father Kills Mother: The Family Therapist As an Expert Witness in Court

The father killing the mother leaves the children effectively without parents. The extended family from both sides will often intervene to offer a home for the children, or at least to have a say in what arrangements are made for the children and how they are to be brought up. Intensely competitive and hostile feelings between the opposing sets of relatives are commonly aroused, and the children may be caught up in a battle reminiscent of the conflict between their parents, which culminated in the death of their mother. I and my colleagues have, as a team, seen more than 300 children who have lost one parent at the hands of the other, and we have been involved in subsequent custody battles as expert witnesses. Based on this experience and using this context as an example, the issues for the family therapist as expert witness in adversarial Court proceedings are presented. A case is described that illustrates the theoretical exposition — including the effectiveness of family therapy from the witness box.     

Youth Depression in the Family Context: Familial Risk Factors and Models of Treatment

Research on parent risk factors, family environment, and familial involvement in the treatment of depression in children and adolescents is integrated, providing an update to prior reviews on the topic. First, the psychosocial parent and family factors associated with youth depression are examined. The literature indicates that a broad array of parent and family factors is associated with youth risk for depression, ranging from parental pathology to parental cognitive style to family emotional climate. Next, treatment approaches for youth depression that have been empirically tested are described and then summarized in terms of their level of parent inclusion, including cognitive–behavioral therapy, interpersonal therapy, and family systems approaches. Families have mostly not been incorporated into clinical treatment research with depressed adolescents, with only 32% of treatments including parents in treatment in any capacity. Nonetheless, the overall effectiveness of treatments that involve children and adolescents exclusively is very similar to that of treatments that include parents as agents or facilitators of change. The article concludes with a discussion of the implications of these findings and directions for further research.     

Treating Parents and Children Together

SUMMARY

In this paper I look at two traditions of psychotherapy with children: family therapy {here considered in its common paradigm of systems theory and not in its diversity of approaches) and individual psychodynamically oriented child therapy. The author examines how, in these two modalities of treatment, the real world of the parent-child relationship, which remains mostly a world of women and children, tends to be left out in practice. Many family therapists “exclude” children from their sessions and concentrate on the marital relationship while child therapists “exclude” parents from the core of the therapeutic process. The issues for therapists and the consequences for adults and children in families in this com-partmentalization of services are examined within a feminist framework. The development which is advocated is for therapists to expose themselves fully to the world of the parent-child relationship as a fust step in reexamining their stereotypical views of motherhood and fatherhood which trap women in conflicted and potentially exploitative situations and do not consider that children actively construct their own relationships.     

Rationale and directions for an increased emphasis on the therapeutic relationship in family therapy

This paper argues the need for an increased emphasis on the therapeutic relationship in family therapy. The ways in which the field of family therapy has eschewed the importance of the therapeutic relationship are discussed. Therapeutic alliance research from the field of individual psychotherapy and research on the importance of relationship factors to family therapy are reviewed. Suggestions for family therapy theory, practice, and research are presented.An earlier version of this article was presented at the 1992 Western Canadian Conference on Family Practice.     

On the Origins of Children's Compliance and Opposition: Family Context, Reinforcement, and Rules

Interactional synchrony and context dependent reinforcement are presented as similar phenomena in this discussion of children's dispositions to comply with or to oppose parental instructions. I argue that consistent and appropriate parental reactions to the full range of a child's response repertoire will establish a family context conducive to positive reinforcement of child compliance. In contrast, inconsistent parental reactions appear to create a chaotic family context conducive to the negative reinforcement of child opposition. Depending on these two forms of context, the parents and children seem to generate distinctive personal rules which outline the functional arrangements of context, behavior and reinforcement. The importance of these personal rules in helping parents and children to improve the lawfulness of family context is highlighted.     

Attachment relationships within a family system

Insecurity in attachment relationships may promote family interactions that involve (1) “capturing” an attachment figure, (2) turning to an inappropriate attachment figure, (3) inappropriate responding to attachment behavior, and/or (4) anticipating loss, similar to past loss. In a family with two small children, family therapy over all the sessions involved reducing the need to “capture” (point l), with the therapist acting as a secure base for each family member (point 2) and exploring the anticipation of past losses (point 4), so that the parents could become a secure base for each other and their children (point 3). Coding from videotapes focused on a few minutes of intervention concerning the problem child. The interactions formed a pattern suggestive of a pattern of attachment with each parent. How the family contributed to the origins and maintenance of each pattern was illuminated by the above four influences of insecurity.     

As the Twig Is Bent? The Myth of Child-Rearing Influences on Personality Development

Social scientists and laypersons alike believe that child-rearing styles and family environments are formative of personality traits such as shyness and activity level, intellectual traits such as IQ, and psychopathology. After 100 years of behavioral genetic research, however, including new studies of twins raised apart and together, little factual support for this “common sense” proposition can be found. Nonintellectual traits seem to be determined instead by genetic influences and by relatively specific environmental influences, most of which are not particularly tied to the family or parental treatments. Intellectual traits show modest family environmental influence, but that influence may diminish in importance after childhood. I conclude that parents should be given less credit for children who turn out well and should take less blame for children who turn out poorly. Counselors who blame parents less for children's behavioral outcomes—especially extreme traits and psychopathology—may find those parents to be more willing helpers in those intervention processes that have been shown to work.     

Rebuilding security: group therapy with children affected by September 11

This article examines group therapy with children and adolescents impacted by the September 11 terrorist attacks on the World Trade Center, with a focus on the role of metaphor, enactment, and the creative arts therapies in trauma treatment. Attention is given to the importance of fantasies, family structure, and culture in determining how the child constructs and processes the events. Examples are derived from ongoing, trauma-focused groups with traumatically bereaved children who lost parents, as well as from ongoing drama therapy groups in which traumatic themes emerged.     

The phenomenology of children's influence on parents

Starting from the core systemic premise that humans influence each other, this paper focuses on child influences in the bidirectional parent–child relationship. Following a co‐constructionist approach on bidirectionality, meaning constructions of children and their parents concerning child influences are explored. The authors used in‐depth interviews separately with children and their parents. Phenomenological analysis shows similarities and differences in children's and parents' thinking. Both stress the difficulty and existential dimension of the subject and refer to this influence as mainly unintentional. In particular, children disentangle influence from power. Children focus on the responsiveness of their parents. Parents emphasize the overwhelming effects on their personal development. The importance of making room for constructive child influences in family therapy is acknowledged.