Healing traumatized children: creating illustrated storybooks in family therapy

In this article we describe the therapeutic practice of creating illustrated storybooks in family therapy with traumatized children. Illustrated stories offer a predictable structure to sessions and facilitate engagement and participation of children in therapy. The therapeutic emphasis of storybooks can be adjusted to take into account a child's life story, verbal capacity, level of anxiety, and traumatic hyperarousal. The creation of storybooks is an active process that embraces important aspects of trauma-specific interventions, including expression of trauma-related feelings; clarification of erroneous beliefs about the self, others, or the traumatic event; and externalization of traumatic stimuli into artwork, allowing for exposure and habituation of the arousal response. A focus on visual images together with narrative takes advantage of children's developmental capacities and spontaneous pleasure in the creation of art, thus minimizing anxiety and enhancing feelings of mastery, competence, and hope. The creation of storybooks is compatible with family interventions that foster a safe family context, strengthen attachment relationships, insure appropriate structure and boundaries, and enhance parenting capacity as well as those interactions that facilitate understanding and dialogue between family members.     

Drawing a family map: an experiential tool for engaging children in family therapy

Inclusion of children in the treatment process is a central aspect of the discipline of family therapy. Young children's verbal skill and level of abstraction may not be suited to ‘talking therapy’, but they have an intuitive grasp of family life which is invaluable, and their views and needs should be considered when effecting change in the family system. A method is offered to engage young children, adolescents and adults of divergent verbal skills into a shared process. It requires no special set‐up or tools, only paper and markers. Distance and proximity are represented in a simple map of the family, adding symbols for affection and conflict. A spatial representation of the family system is created, and may be referred to in the course of the therapy.     

One articulation of the structural family therapy model: a biobehavioral family model of chronic illness in children

This article presents the Biobehavioral Family Model (BBFM), which, as a general systems model, has the advantage of being conceptually neutral with respect to health versus pathology, and promotes integration of individual, family and social levels of theory. The BBFM provides a heuristic theory of pathways by which family patterns of interaction and individual family member physiological function influence one another. The BBFM also can be extrapolated to the clinical domain, providing a developmental biopsychosocial approach to assessment and intervention in childhood chronic illness or disability. A case illustration demonstrates clinical application.     

Selective mutism in children: A structural family therapy approach to treatment

When children refuse to speak in some social settings, but can understand and speak in other settings, the diagnosis of selective mutism must be considered. A review of the literature describes the disorder, the various types of mutism, and related family dynamics. A family systems approach to treatment using structural family therapy is suggested. The case history presented illustrates one type of mutism as well as the family rules and hierarchy which appeared to be maintaining it. Structural and strategic family systems theory techniques that were used to move the family toward resolution of this problem are discussed.Diane Wolf Tatem, MA, MS, completed graduate work in marriage and family therapy at New Mexico State University, Las Cruces, NM. She is employed at Life Management Center of El Paso's Child Development Services and also has a private practice in marriage and family therapy in El Paso, Texas. Robert L. DelCampo, PhD is a professor of family science at New Mexico State University and maintains a private practice with Associates for Marriage and Family Therapy in Las Cruces, NM. Please address all correspondence to Dr. DelCampo at Box 3470, New Mexico State University, Las Cruces, NM, 88003-3470.Appreciation is expressed to Dr. Charles Huber, New Mexico State University in Las Cruces, for his insightful critique of the final draft of this paper. This paper was presented at the Texas Association for Marriage and Family Therapy Annual Conference, January 25–29, 1995 in Dallas, TX.     

Art therapy in transcultural family therapy

The increased existence of foreign culture patterns in the child population calls for transcultural comprehension in child psychiatry. This case report describes transcultural aspects in the therapy of an 11 year-old Moslem girl admitted to a child psychiatric department. Her symptoms were abdominal pain, headache, anxiety, and pretended fever. A family therapeutic approach was used together with elements of art therapy and individual therapy in a successful treatment. The family therapeutic approach was based on art therapy as a part of the communication where cultural symbols were an important part. An interpreter was not used. The cultural context where it is acceptable to overstep the borderline between reality and fantasy is seen as an important healing capacity.I would like to acknowledge my debt and my appreciation to Ebba Ernst, psychologist of the department and supervisor in the therapy of the S. family. I would also like to thank professor Kai Tolstrup and child psychiatrist Torben Marner for stimulating support in the process of writing the article. A grant from Enkefrue Hermansens Mindelegat made the participation in the Krakow Congress possible.     

Talking to children about family therapy: a qualitative research study

In an exploratory study a number of children were interviewed some time after family therapy. Their responses were analysed using grounded theory methodology. Outcomes indicate that for children, family therapy is potentially a complex arena in which ambiguities and ambivalences are present. The children's position in the therapeutic session is discussed in terms of their role in the 'therapeutic circle'.     

Siblings in family therapy

The participation of siblings in family therapy was studied from case records in 76 consecutive cases attending a child and adolescent psychiatric outpatient clinic. Siblings took part in family therapy in two thirds of the cases. Of these, 76 per cent attended only one or two sessions. A sub-sample of nine families with children below 13 years of age was interviewed. Seven out of 10 evaluated siblings had psychiatric symptoms of some severity at the onset of therapy compared to two after, and all had fewer symptoms after therapy compared to before (p<0.01). Most families thought it relevant for both parents and siblings to take discussing their children's behaviour in front of them and wanted the opportunity of also talking to the therapist without the children being present.     

Consultation in family therapy

Abstract

This paper addresses the issue of the use of consultants by experienced family therapists. The authors discuss the need for consultation under different circumstances and review a number of models currently being utilized. Emphasis is placed on preparing the clients for the consultation, providing background information to and preparing with the consultant for the session(s), and transferring “power” to the consultant and back again to the primary therapist.     

Children in family therapy

The distinctive skills of child psychotherapy can be utilized in the development of a form of conjoint family therapy especially applicable to the field of child psychiatry. It is suggested that the engagement of children in the process particularly enhances the specific characteristics and potentialities of this form of treatment.     

Mystery in family therapy

Existential approaches to family psychotherapy are considerably different from the problem centered approaches to treatment which are currently so popular in the field. Gabriel Marcel's distinction between a problem centered and a mystery centered understanding of life is utilized to overview the basic and deep differences between existential and problem centered approaches to family treatment.     

Countertransference in family therapy

The intent of this article is to describe the importance of one psychoanalytic concept, countertransference, in family treatment by a review of the literature on the subject. Case illustrations will then be used to show how the supervisor of a family treatment case elicited the countertransference in order to move the therapy forward. Some thoughts with regard to training will be offered.     

Redefinition in family therapy

Abstract

In the wider context of an epistemological renewal, the author describes the possibility of a redefinition of therapy from that of an intervention focused on the patient to one of an opportunity for participation and growth of a group which shares a common history. The author speaks of the necessity of giving alternative meanings to the presenting symptoms, citing examples from his work with families.     

Psychological services for children: using family therapy in the setting of a school psychological service

An attempt is made to evaluate the results of using family therapy in the setting of a school psychological service over a period of about two-and-a-half years. Seventy-two children were involved, referred by teachers, with a variety of behavioural difficulties and learning problems. The difficulties of involving parents in regular clinic sessions for problems which they either saw as school-based or did not see at all are discussed. It is suggested that the technique of family therapy has been insufficiently exploited to help children seen to have 'a special educational need'. This includes children who are developmentally immature, as well as those who show more overt signs of emotional disturbance.     

Contemporary family therapy in the United States

Major issues in contemporary family therapy in the United States are described. Issues from outside the field impacting family therapy include health care reform, family 'values', multiple forms of 'family', and the growing aging population. Issues within the field include the challenge of social construction theory, the decline of the expert, the feminist critique, sensitivity to culture, rediscovering individuals within families, focus on strengths and resources, a both–and attitude toward collaboration with other professionals, emphasis upon the person of the therapist, and convergence of 'schools' of family therapy. Therapists in the United States are also opening up the private process of therapy through reflecting teams, including clients in therapist thinking, multi-family groups, and through psychoeducational groups. Finally, attempts to bridge the gap between research and practice are analyzed.     

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.