The Use of Teaching Stories in Conjoint Family Therapy

Two general factors have been singled out as being held in common by all types of psychotherapy: an educational, rational factor (often called "content") and a factor operative in the relationship between the therapist and his patient (often called "process"). In the field of family therapy, the non-educational aspects of intervention are sometimes presented in the form of "therapeutic, paradoxical communications" (Haley, Bateson, Jackson, Weakland) or the 'therapy of the absurd" (Whitaker, Malone). In the present paper, I wish to present a form of therapeutic communication, the teaching story, that embodies a unique mixture of both the educational and the paradox, or absurd.     

The Conjoint Family Drawing

A new technique, the Conjoint Family Drawing, is described as a means of assessing family functioning. The method is projective as well as interactive, reflecting individual feelings and group interaction. Fourteen randomly chosen families, whose children had been referred to a Child Psychiatry Clinic, were studied. They were observed in a structured, performance-task-oriented session where they collaborated on drawing a picture of their family, which was discussed with them on its completion. Analyzing the data on all of the family portraits, six relevant dimensions were identified: 1) organizing role, 2) sequence, 3) size, 4) choice of person, 5) isolation, and 6) content. Clinical material is presented to demonstrate the value of the Conjoint Family Drawing as a potential research instrument, a diagnostic tool and a therapeutic device.     

Sexual Attraction in Conjoint Therapy

Considering the magnitude of the potential repercussions concerning sexual attraction between mental health professionals and their clients, relatively little research exists in the field of marriage and family therapy (MFT). Although the topic of sexual attraction and various ethical dilemmas accompanying the issue have raised awareness of the increasing need to address sexual attraction dynamics in therapist training programs (Harris, 2001 Harris, S. M. 2001. Teaching family therapists about sexual attraction in therapy. Journal of Marriage and Family Therapy, 28(1): 123–128.  [Google Scholar]), the inherent gray nature of the topic often makes it difficult to address. Research shows that that a majority of therapists encounter feelings of sexual attraction either toward or from their clients during their careers. In light of the MFT research addressing sexual attraction in therapy, to date few studies address the phenomenon in the context of conjoint therapeutic sessions, a significant component of our profession. This paper presents the results of a study designed to assess how therapists in training think about how they would handle attraction in the context of a conjoint couple session and discusses the inherent difficulty in managing sexual attraction in such a context.     

Therapist-Parent Interaction Patterns in Home-Based Treatments: Exploring Family Therapy Process

At the current stage of development in the family therapy field, exploratory, small-scale process studies are necessary in order to understand through what interpersonal processes child and family change occur. The goal of this article is to show how relevant therapist-parent interactions within family-based approaches can be explored and linked to the reduction in childrearing and behavior problems. Sequential analyses on 13 treatments using the Family Project Approach revealed that, within the most successful treatments, therapist and parent interact in a collaborative way in the phase of Direct Influence. In the beginning of this treatment phase, the therapist must activate the parents to tackle the problems actively. Further explorations indicated that a collaborative interaction pattern between therapist and mother during the first three sessions of therapy contributes to a better outcome.     

The Conjoint Family Diagnostic Interview and the Family Index of Tension

The present paper is written in response to the, as yet, unmet need for a broadly applicable, clinical rubric for assessing the psychiatric patient's situation in his family. It describes a conjoint family diagnostic interview procedure (CFDI) which enables a clinical interviewer, within a single ninety-minute, problem-focused, conjoint interview, to describe or rate the verbal and nonverbal behavior of a Ten family unit along dimensions relevant to clinical decision-making for the psychiatric patient. A rating instrument, the Family Index of Tension (FIT) will also be described. It provides a convenient format for quantifying the information obtained at the CFDI, facilitating comparisons within and across family systems. Though initially developed and protested on 350 families of hospitalized psychiatric patients, the procedure described appears applicable to all clinical situations in which families, regardless of their composition and background, are seen together with an “identified patient” for purposes of evaluation and treatment planning.     

Within-session Response Patterns On Conjoint Variable-interval Variable-time Schedules

Operant responding often changes within sessions, even when factors such as rate of reinforcement remain constant. The present study was designed to determine whether within-session response patterns are determined by the total number of reinforcers delivered during the session or only by the reinforcers earned by the operant response. Four rats pressed a lever and 3 pigeons pecked a key for food reinforcers delivered by a conjoint variable-interval variable-time schedule. The overall rate of reinforcement of the conjoint schedule varied across conditions from 15 to 480 reinforcers per hour. When fewer than 120 reinforcers were delivered per hour, the within-session patterns of responding on conjoint schedules were similar to those previously observed when subjects received the same total number of reinforcers by responding on simple variable-interval schedules. Response patterns were less similar to those observed on simple variable-interval schedules when the overall rate of reinforcement exceeded 120 reinforcers per hour. These results suggest that response-independent reinforcers can affect the within-session pattern of responding on a response-dependent schedule. The results are incompatible with a response-based explanation of within-session changes in responding (e.g., fatigue), but are consistent with both reinforcer-based (e.g., satiation) and stimulus-based (e.g., habituation) explanations.