The autistic moment in psychotherapy

This is a report on the author's experience in treating four autistic children and their families. The importance of making available the therapist's own autism is stressed. The difficulty in doing this and reverting defensively to an administrative approach is described. A previous paper discussed the corrective autistic experience with a focus on the autistic person. This follow-up describes the autistic moment which is a relational experience between the therapist and both the autistic person and the autistic family. The family needs to have an experience of its own autism as a continuum of normal before it can relate to an autistic child. To the extent that the therapist can bring his own autism into the therapy can the family experience its own. The patients are the person, the relationships, the family, and the therapist.The author would like to thank Richard B. Anderson, MD, Lindy T. Barnett, MSW, David V. Keith, MD, JoEllen Barnett Smith, MA, and Orion Smith for their participation as cotherapists. The comments made on an earlier draft of this paper by the members of the Atlantic Psychiatric Clinic are warmly acknowledged. Valuable editorial assistance has been extended by Robert Garfield, MD, and Stuart Sugarman, MD. Lastly, the author would like to extend his appreciation to Robert R. Haubrich, PhD, for stimulating his interest in the field of comparative ethology.Presented at the Conference Honoring the Retirement of Carl A. Whitaker, MD, in Madison, Wisconsin, June 25, 1982.     

The Jerusalem TeleRehabilitation System, a new low-cost, haptic rehabilitation approach.

Survivors of brain injury or stroke can improve movement ability with intensive, supervised practice. Since the hours of supervised therapy with a physical or occupational therapist are limited, telerehabilitation will enable patients to greatly expand the hours that they practice therapeutic exercises. The Jerusalem TeleRehabilitation System (JTRS) consists of patient and therapist systems plus a central server and database connected via the internet. The system can work in two modes: (1) a cooperative mode in which the therapist and patient are online at the same time, and (2) a stand-alone mode in which the patient uses the system on his own. In both cases, the system will monitor the status and progress of the patient and various parameters of his movement abilities, and prepare reports for the patient and for the therapist. From the clinic, the therapist will be able to change the screen seen by the patient and change the level and types of tasks, as needed. Compared to existing systems, our system will have the following advantages: (1) inexpensive and easy to use; (2) remote monitoring and control of the patient's computer by the therapist in the clinic; (3) more detailed analysis of patient status and progress; (4) a "smart" system which self-adapts to the patient's capabilities in real time, increasing or decreasing the difficulty of the exercise as needed; and (5) a central, international database which, by gathering data on many patients over time, will provide the basis for "smart" therapy and will also facilitate coordinated multicenter research studies.     

The Effects of Religiosity on Preferences and Expectations for Marital Therapy Among Married Christians

Highly religious couples constitute a substantial portion of marital therapy clients in the U.S. Married Christian individuals ( N = 211) completed a survey of demographics and religiosity (religious values and Christian beliefs). They rated preferences and expectations for one of four marital therapy situations: Christian therapist using Christian practices (e.g., prayer or reference to Scripture), Christian therapist using psychological practices only, non-Christian therapist willing to use Christian practices, and non-Christian therapist using psychological practices only. High religious values and high Christian beliefs predicted ratings of marital therapy situations, where high was defined as one standard deviation above the mean of standardized norm groups. Low to moderate religious values or Christian beliefs did not predict ratings of marital therapy. It was concluded that highly religious couples present a special situation where the marketing, assessment, and practice of marital therapy might differ from therapy with other types of couples.     

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.     

Warriors,authors and baseball coaches: the meaning of metaphor in theories of family therapy

This article examines the metaphors family therapists use in their theories to reveal aspects of the theories which are not explicitly stated, using Whitaker's symbolic experiential therapy, Minuchin's structural therapy and White's narrative therapy as examples. Such examination, drawing on social constructivist understandings of metaphor and meaning making, reveals that Minuchin's metaphors of family as organism and therapist as artist and warrior emphasize the family as relatively holistic and the therapist as relatively interventionist. In contrast, Whitaker's metaphor of family as ecological system or team and therapist as coach emphasizes the interdependence and context sensitivity of the family and relative powerlessness of the therapist to impose change. Finally, White, reflecting his explicitly post‐structural commitment, uses the metaphor of therapy as a journey undertaken with a map and as therapy as an act of re‐narrating a story.     

Ibsen's truth, family secrets, and family therapy

In certain Ibsen plays a character (would-be family therapist) enters during a crisis revolving around family secrets. Taking two such plays as models, this paper examines family processes and clinical issues surrounding secrets and myths. In Ghosts, Ibsen demonstrates the tragic foreclosure visited upon the Alvings' lives by a generation of secrecy. For contrast, in The Wild Duck the would-be reformer Gregers brings out the truth, to expose and correct consequences of his father's past machinations. The biographical roots of Ibsen's obsession with truth and illusion are explored. Lastly, the notion that Ibsen and early family therapist were reformers is viewed in historical perspective.     

TIME FOR LOVE: The Place of Marriage and Children in the Thought of Stanley Hauerwas

In essays written throughout his career, Stanley Hauerwas has unfolded a Christian vision of the marriage bond and the presence of children that seeks insistently to place these seemingly natural bonds within the new family of God that is the church. I examine his understanding, aiming to appreciate the Christian vision displayed while also suggesting that his emphasis on the new thing God does in the church is sometimes allowed to absorb and thereby lose the distinctive significance of the created bonds of marriage and family.     

Death,Myth and Reality in C.S. Lewis

C.S. Lewis's life and writings were profoundly shaped by his childhood experience of his mother's death. It is significant that the young hero's dying mother is mentioned at the very beginning of the first book of the Narnia sequence (seeThe Magician's Nephew.)., which in more general terms offers a mythopoeic version of the Christian interpretation of death. Lewis had a keen awareness of the power of myth (he would not have denied that the Christian gospel is myth). However, it was in the experience of the death of his wife (recounted inA Grief Observed) that he felt confronted by reality in a way that shook his faith to its foundations. This article will explore the tension between myth and reality in Lewis's attempts to write, as a Christian, of the experience of death.     

Becoming verbal: autism,trauma and playfulness

This paper will describe work in progress with a boy who was 3.4 years old at the time of referral. At this time he had no speech and there were a number of marked autistic features in his presentation, although no formal diagnosis had been made. He had suffered the trauma of a life-threatening illness requiring major medical interventions at the age of 5 months and again at 18 months, which may have been the precipitating factor for his disturbance. He is from an intact family with an older sister and a younger brother and no apparent significant family pathology. During the course of his treatment - which has now been on-going for nearly three years - he has acquired a capacity for play and has become very talkative. Using extensive clinical material, the paper will explore the factors which may have contributed to his improvement, especially the modifications in technique introduced by the therapist in order to make contact with this little boy. Special attention will be given to the role of playfulness, as introduced by the therapist, with particular reference to the way in which this may facilitate the emergence and expression of aggressive feelings and phantasies. The links with the development of the capacity for speech will be explored.     

Use of Self: A Brief Report

One of the effects of crisis in a family is that the members become fixed in rigid attitudes with strong, narrow limits imposed on the free flow of feelings. A way for the family therapist to free up the members of such a system is to introduce his own affect into the structure. A child may be required to help the therapist gain entry.     

Does Therapist–Rater Religious Match Predict Higher Therapist Ratings?

This study investigated whether therapist–rater religious match predicts better therapist ratings. Christian and Muslim Lebanese students (N = 187) were randomized into 3 conditions. A written vignette of the therapist was constant across conditions, but her picture was manipulated to include a veil, a cross pendant, or neither. Participants filled out a therapist rating form afterward. There were no significant differences in overall therapist ratings between groups.     

King Tiger and the roaring tummies: a novel way of helping young children and their families change*

Therapy with young children and their families poses special challenges for the therapist. In particular, it is important for the therapist to meet the child at his or her ‘view’ of the world. King Tiger is a special helper who can assist the therapist in this task. Once the idea or existence of King Tiger has been introduced to the child and family in therapy, the therapist can commence writing letters and stories to the child on King Tiger's behalf. These written interventions can affect the entire family. The paper will examine some of the useful and creative techniques that can be incorporated into King Tiger therapy. A case example will illustrate how King Tiger can work as a co-therapist.     

Ethical contexts of healing: Character and ritual

Conclusion Jesus was asked by what authority did he heal. I suggest that the authority of the healing ministry of Jesus occurred because his work was a part of the inbreaking of God's Reign, was consistent with call to covenantal obedience within the Jewish community and because his life was the incarnation of God's righteousnes. The authority of the contemporary Christian therapist is different in degree not in kind. Our authority emerges when healing occurs that is consistent with the Sermon on the Mount, when the people of God have blessed our service and when our lives approximate the ethic of the Reign of God. It is my hope that an ethic of God's Reign, a normative people and our personal character as disciples of Christ might more significantly shape the therapeutic process.This is the third article in a series published in Pastoral Psychology. The first two appeared in the previous two issues.     

J.L. Moreno: An Unrecognized Pioneer of Family Therapy

J.L. Moreno's fundamental and pioneering contributions to the development of group therapy, encounter, transactional analysis, and especially psychodrama are well known. However, most family therapists seem unacquainted with the fact that from his earliest writings in 1923 J.L. Moreno developed an interactional view of psychotherapy that in 1973 already resulted in formulations of a true systems orientation and very concrete ideas about marital therapy, family therapy, and network therapy. He probably is the first (1937!) therapist that actually involved a husband's lover in conjoint marital therapy. His general theoretical formulations about the pathology of interpersonal relations as well as his practical suggestions for the therapy of the interpersonal relations seem to be insufficiently known to workers and researchers in the field of family therapy.     

Ethnocentrism and beyond: Letters between a family therapist and an advocate of alcoholics anonymous

Both family therapists and advocates of 12-step programs are vulnerable to ethnocentrism, a one-way zeal that can inhibit collaboration and make it difficult to appreciate other ways to help individuals with drug and alcohol problems. Included is a series of letters between a family therapist and an advocate of Alcoholics Anonymous which illustrates the problems inherent in such ethnocentrism. An alternative position is also discussed which involves professional collaboration and an appreciation of the strengths of both traditions.Fred P. Piercy, PhD, is professor of family therapy and director of training and research in the family therapy doctoral program, Department of Child Development and Family Studies, at Purdue University.The letter writer's name and identifying information have been changed to protect his identity. This paper is not about Jim but about certain issues his letters raise for all of us.     

On the witness stand:

Abstract

The family therapist is frequently called upon to testify as an expert witness. For many family therapists, the courtroom is an unfamiliar environment with different ground rules and basic assumptions. Testifying can be a difficult experience as the mental health professional faces different situational role demands than those encountered in usual therapeutic settings. If the family therapist can transfer to the court context the art of influencing interpersonal situations, the effectiveness of his/her testimony will be enhanced. This paper describes predictable legal behaviors and suggests to the family therapist strategic responses to improve skills as an expert witness.