Rebuilding family relationship bridges

This paper describes two techniques that the family therapist can use to help families in emotional crisis change and heal. They require the family therapist to persuade family members to view the therapy sessions as a project in building or rebuilding their family relationship bridges. An essential component of these approaches is the value placed by the family therapist on building rather than destroying family relationship bridges. Four themes are suggested as building blocks for healing dysfunctional family relationships: Love, Anger, Loss and Forgiveness. Vignettes of several family problems are presented accompanied by an intervention demonstrating an aspect of family bridge building.     

Transcending a Differend: Studying Therapeutic Processes Conversationally

Studies of actual conversational behaviours used to generate positive change in family therapy are relatively rare. In this study such conversational details were examined as they occurred in a single session of family therapy. With passages identified by family members as helpful, discursive methods of analysis (conversation analysis and critical discourse analysis) were used to examine an actual conversation between a renowned family therapist (Karl Tomm) and a family formerly at a conversational impasse. Conversational practices and sequences in talk used by the therapist and family members to bridge these differences in their ways of relating are discussed.     

A Family Art Evaluation

A two-hour family art evaluation session has been designed by an art therapist and a clinical child psychologist. It has been used in a child guidance center for the past four years by the authors and other staff. All family members are asked to engage in three tasks: (a) individually developing a scribble into a picture; (b) individually creating a family portrait, and (c) jointly deciding upon and executing a mural. Each task is followed by individual and group discussion of products, associations, and feelings aroused. Occasional “free” art products are collected during the session. The procedure is discussed and illustrated in terms of the rationale for selection of tasks; the sources of data available on individuals, family characteristics, and family interaction patterns; the relationship of the projective and behavioral data to diagnostic conclusions and treatment recommendations; and the implementation and modifications of the technique within the clinic.     

Engagement techniques in family therapy

A number of basic engagement techniques in family therapy are identified and illustrated. These include (1) techniques that enable the therapist to achieve a position of influence with family members or to gain entry into the family system, (2) techniques utilized in teaching the family how to behave in the therapy setting, and (3) the tactics the therapist may use to manage difficult moments in the session. Issues in the relationship between technique and the theory and practice of family intervention are also examined.A videotape (Wells, R.A., & Page, M.H.Engaging the Family in the Helping Process: Basic Techniques. Pittsburgh, PA: UIRC, 1979) is available from the author. Discussion with such colleagues as Patrick McNamee, Larry Pacoe, Mary Page, and Susan Schilling has been invaluable.     

The repertory grid approach to analysing family members' perception of self and others: a pilot study

We report a pilot study involving the administration of a questionnaire to family members, based upon the three key target dimensions of the distance regulation theory of Kan tor and Lehr (1975). The questions, concerning family relationships and personal attributes of family members, were based on constructs derived from the theory, and the responses of family members were in a form consistent with repertory grid analysis procedures. The method allows the family researcher or therapist to explore the organization of the constructs for each family member, showing how each member is construed both by others and by themselves.     

Thinking and Working Relationally: Interviewing and Constructing Hypotheses to Create Compassionate Understanding

In the initial interviews of family therapy sessions, the therapist faces the challenge of obtaining and organizing the information that is most relevant toward understanding the essential concerns that families and couples bring to therapy. This article describes the process of clinical interviewing and case conceptualization used in training family therapists at the Ackerman Institute for the Family. This approach helps the therapist bring forward, and organize, specific information into relational hypotheses, or systemic‐relational conceptualizations, that allow both family members and the therapist to understand presenting problems within their relational contexts. While always provisional, relational hypotheses help anchor the therapist in a systemic‐relational frame and provide a conceptual through‐line to guide the ongoing work of the therapy. The process of interviewing and the construction of clear and complex conceptualizations of presenting problems are illustrated through case examples.     

'But they aren't motivated …' issues concerned with encouraging motivation for change in families

This article is an attempt to provide some frameworks for understanding aspects of the context of families which support or constrain motivation for change. A theme of the entire paper is that ambivalence is normal and that it is therefore useful to regard families both as motivated to change and motivated to maintain stability. Part I focuses particularly upon family–referrer– therapist relationships and Part II upon family–therapist relationships. Part I begins with an exploration of the idea of motivation as a process and outlines the usefulness of the concept of ambivalence. Its main focus however is upon the importance of considering referrers when attempting to assess the motivation of family members for change.
Part II considers the relationship between the family and the therapist and takes account of some important aspects of the contexts of both. It ends with a summary of some experiential exercises which enable one's personal understanding of motivation issues to develop.     

Family members' perceptions of live observation/supervision: An exploratory study

This ex post facto survey examined 75 client family members' perceptions of live observation/supervision of family therapy at a university clinic. The results seem to reflect the subjects' general satisfaction with the process, although this general satisfaction did not significantly predict outcome on either family or therapist goal attainment scores. Family members whose therapists were female reported greater satisfaction with the process than those with male theapists, although no differences by therapist gender were found on either therapist or family goal attainment scale scores. Open-ended responses suggested that some family members were aware of the purposes of certain strategic team interventions. Implications of findings for the practice and research of live supervision and/or observation are discussed.The authors would like to acknowledge the aid of Judith Myers Avis, Marcia Brown Standridge, Cleveland Shields, Linda Stone Fish, and Joseph Wetchler in various aspects of this research project.     

A woman under the influence: An example of multiple victimization within a family

Abstract

The interactional processes depicted in rich detail in A WOMAN UNDER THE INFLUENCE are examined from a family therapist's viewpoint. Rather than portraying the persecution of a single individual by other members of the family, the film's drama demonstrates that the complex interactions within the extended family victimizes all the participants. When events are examined closely, it becomes clear that even the overt victimizers in the family system suffer as a result of the very processes in which they engage. The discussion of the film underscores the need for the therapist to empathize with all members of a dysfunctional system, especially when one member appears to be the victim.     

Perceptions of the therapist in family therapy

Thirty-five families completed ratings describing their perceptions of their therapists. These ratings were then correlated with measures of outcome to assess whether there was a relationship between experiences of the therapist and treatment outcome. Further, the study addresses whether some family members' perceptions are more influential in affecting the course of treatment. The results showed that family members' perception of the therapist does have an impact on treatment outcome, but not all members affect the outcome equally. Further results and their implications are discussed.     

Expanding Uses of the Telephone in Family Therapy

The telephone has been used as an instrument for live supervision. This article describes innovative uses of the telephone by a family therapy training team, including (a) strategic calls to the therapist; (b) calls from the team to family members; and (c) calls between family members. Case examples describing the interventions and their impact are given. Both training and therapeutic benefits are discussed.     

Creating a Secure Family Base: Some Implications of Attachment Theory for Family Therapy

The aim of this article is to make attachment research findings available in a form that family therapists can use. In attachment theory, parents are conceptualized as providing a secure base from which a child can explore. Family therapists, however, need a systemic concept that goes beyond the parent/child dyad. The concept of a secure family base is proposed, in which a network of care is made available for all family members of whatever age so that all family members feel secure enough to explore, in the knowledge that support is available if needed. Factors that contribute to the security or insecurity of the family base are outlined. The overall aim of therapy is to establish a secure family base from which the family can explore new solutions to family problems both during and after therapy. The role of the therapist is to help to resolve conflicts that threaten relationships, and to explore relevant belief systems that may be contributing to a sense of insecurity. The conceptual framework presented allows for an integration of family therapy techniques and ideas into a coherent whole. A new school of family therapy is not proposed.     

A systemic view of family therapy ethics

A critical review of the literature on family therapy ethics is used to develop the proposition that a more systemic analysis is needed, one that includes the levels of therapist and society as well as patient (family). These ideas are discussed through reexamining the issues of family secrets, therapist deceptiveness, and therapist advocacy of personal (feminist) values.     

Brief consultation with headache sufferers

Abstract

This paper describes the author's efforts at involving chronic headache sufferers in brief consultations with individual, family, and group therapy programs in an inpatient medical treatment facility. A variety of difficult issues facing chronic headache sufferers are presented, including the rationale for utilizing each therapeutic modality and the role and strategies that the therapist undertakes in each program. The author provides some case vignettes and discusses the importance of communication between the therapist, the primary physician, and the medical staff members.     

Limited Goals in Short-Term Group Psychotherapy with Institutionalized Delinquent Adolescent Boys

This paper applies a specific view of familylike dynamics to psychoanalytic group psychotherapy. Pathological forms of protectiveness and scapegoating are both involved in which the symptomatic individuals maintain an enmeshment with the group which saves them from anxieties associated with change. As the scapegoat, the problem patient becomes the spokesperson for a group transference involving the therapist(s), group members, and a developmentally internalized family. The primary technical error is the tendency for the therapist, in the guise of appropriate technique, to unconsciously collude with a scapegoating process thereby discouraging differentiation and growth. Viewing the group from the perspective of pathological versus healthy forms of family interaction helps to highlight certain problems in the therapist's interventions.     

Hearing Metaphor: An Approach to Working with Family-Generated Metaphor

This article presents a step-by-step approach to working with family-generated metaphor in family therapy. Although the use of therapist-generated “therapeutic metaphors” has been widely advocated and practiced for many years now, less attention has been paid to the metaphors used by family members. We argue that the family's metaphors are a neglected linguistic resource in family therapy. Highlighting and validating these metaphors produces a therapeutic conversation in which the voices of family members are heard more clearly by the therapist, and the families' own imaginative energies are engaged in defining and pursuing the goals of therapy. Several case examples illustrate the use of this approach with children of various ages.     

Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents’ and youths’ perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.