"Detoxification" of Vietnam War Trauma: A Combined Family-Individual Approach

Treatment with families of veterans suffering from the aftereffects of combat trauma in the Vietnam War often requires a preliminary phase of disjoint treatment, in which family members are seen separately, before conjoint treatment can proceed. In this disjoint phase of treatment, wives and children are introduced to the brutal realities of Vietnam combat experience and to an understanding of its sequelae. This disjoint phase of family therapy detoxifies combat experience so that it can be approached in subsequent conjoint sessions along with more traditional family therapy issues.     

Revenge of the fathers Incest and the male therapist

Abstract

This paper argues that the socio-psychological foundation of incestuous relations between father and daughter resides in the primordial rivalry between father and son and is a manifestation of the property relations existing between them throughout the period of patriarchy. After an attempt to trace this rivalry along a path through Western civilization by summarizing evidence from both religious and mythological sources, I introduce it into our own times by using two case illustrations from my own clinical work. Here I claim that when a male counsellor/therapist engages a sexually abused female patient he, at the same time, encounters the incestuous father in a potentially rivalrous struggle over the patient. For genuine healing to take place in the patient, the counsellor/therapist must form an alliance with the father and utilize his hidden value in enhancing his own therapeutic capability.

I began by stating that particular clinical complexities exist when male therapists engage with female clients who have been the victims of paternal incest. I then postulated the idea that the socio-psychological foundation of such relationships is the primordial rivalry between father and son and is in fact a particular manifestation of the property relations existing between them. I then traced this father/son rivalry along its path down through Western civilization via Jerusalem and the Judaic/Christian religions, and Athens with its early creation myth, and the somewhat later myth of Oedipus. I then pursued the course of its influence to our own times, to the incestuous father/daughter relationship, and, using examples from my own clinical work, I attempted to show how this father/son rivalry survives as a powerfully pervasive influence in the clinical relationship between the female patient who has experienced paternal incest and her male therapist.     

Counseling Japanese Men on Fathering

The authors review an article (J. Yamamoto & F. Tagami, 2004) published in the Japanese Journal of Counseling Science that described changes in contemporary Japanese family structures and illustrated a therapy process with a father to enhance the father‐son relationship. Implications for the counseling profession in working with men on fathering, including single fatherhood, are shared based on the literature from both the United States and Japan.     

Observers' reaction to parent-child intimacy

A study was carried out to examine how people react to acts of intimacy between parent and child. Based on an extensive series of studies reported in 1998 by Reis who found less intimate interactions between two men who are friends than between men or women or between two women who are friends, it was reasoned that intimacy between two males may violate norms of our culture, so it was predicted that people would react less favorably to intimacy between father and son than to intimacy between father and daughter, mother and daughter, or mother and son. Men (n = 19) and women (n=26), most of whom were 18-24 years of age, read versions of a mother or father having an intimate interaction (lap-sit, hair-stroke, hug/kiss) with an 11-yr.-old daughter or son and then rated the act on a 7-point scale from good to bad. As predicted, the undergraduates rated intimate interactions between father and son less favorably than those between father and daughter, mother and daughter, and mother and son.     

Proximal and distal effects of play on child compliance with a brain-injured parent.

Individuals with brain injury may experience severe cognitive and other impairments. For brain‐injured parents, such deficits may be associated with child behavior problems, including noncompliance. We assessed the effects of a play period conducted by a brain‐injured father on the compliance of his son, who had become uncooperative with his father after the injury. The child consistently demonstrated improved compliance during proximal and distal compliance sessions that followed father‐son play periods.     

The ghost in the group room: countertransferential pressures associated with conjoint individual and group psychotherapy

Conjoint individual and group therapy is a commonly used, effective psychotherapeutic treatment. The relationship between the conjoint therapists significantly influences the treatment. This article examines countertransference dilemmas of the group and individual therapists arising from the real and fantasied conjoint relationship. Case examples illustrate specific countertransference dilemmas. Therapists are encouraged to consider the possibility of difficulties with each potential conjoint treatment. Consultation and supervision are recommended to help the conjoint therapists identify and manage countertransference pressures.     

Toward an integration of child and family therapy

Current forms of treatment for the symptomatic child are reviewed and analyzed. There are four general approaches to treatment: individual child psychotherapy, conjoint parent-child psychotherapy and counseling, parent therapy and counseling, and conjoint family therapy. Each approach has certain strengths, but in-and-of itself is an incomplete treatment mode. An integration of child and family therapy is recommended, and recent attempts at this integration are described. These include approaches which work within the framework of conjoint family therapy and those which provide concurrent child and family therapy.     

Short- and long-term effectiveness of two communication training modalities with distressed couples

Abstract

Communication training is a widely practiced therapeutic approach for the treatment of marital discord. Although there is some empirical support for the theoretical assumptions underlying constructive communication patterns, it has not yet been ascertained whether changing these behaviors is sufficient in bringing about stable changes in distressed marriages. The present study was designed to investigate the efficacy of this treatment approach in a conjoint and conjoint group modality. Following therapy, conjoint couples (n = 16) when compared with a waiting list control group (n = 17) showed improvement on five of the seven outcome variables. Couples in the conjoint group modality (n = 13) improved on only two of the seven variables. Follow-up assessments one year after treatment showed that initial gains had been substantially reduced. On the basis of these results it is now open to question whether conjoint group treatments are an appropriate treatment modality for even moderately distressed couples.     

Spatiality of the family's inner structure: choice of seat in family therapy

Many family therapists have observed that the family's choice of seat in the family therapy session provides information concerning the inner structure of the family. The purpose of this study was to study certain aspects of this observation. The selection of seats in family therapy sessions and the mutual distances between family members were investigated for 13 families. The inner structure of the family is described in terms of the existence of problematic relationships and the distribution and quality of power as assessed by the family therapists. The family members' selection of seats in the family therapy session was compared to the sitting order at meals, watching TV at home, and family drawings. It was found that the distance between the father and the patient (a son or daughter) and the location of the father and the mother in relation to each other in the family therapy are more related to the inner structure of the family than to situational factors.     

Clinical Commentary

Abstract

This paper is the narrative of a first-time father with a son born seven weeks early by Caesarean section. Against the anxiety and trauma of his infant's birth and his wife's illness, another inner darker drama is being relived. Michael shows all the wounds of a battered child. He asks two awesome questions - Will I be to my son as my father was to me? Will my son be to me as I was to my father? Fearful and at first unvoiced questions, the developing interviews gave them a voice. We respected Michael's sharing of the early and fearful days and nights when his infant first came home. We sometimes found it hard to empathize with his running away to hide in work, until we understood what he was hiding from. Most poignant was his struggle with his anger and hurt with his father and his desire to understand, ‘Why?’, so that he would not be like this to his son. We saw a sensitive revelation of life being born inside him anew, as he made contact with his real infant and his psychic infant within. Of particular interest was the therapeutic use of the research interview space and the interviewer.     

Dominance and Dialogue in Couple Therapy for Psychological Intimate Partner Violence

Although there is controversy concerning indications for conjoint therapy in Intimate Partner Violence (IPV), both research and practice have come to recognize that it has some important benefits. This study analyzes issues of dominance and dialogue in a conjoint therapy for psychological IPV within a naturalistic setting, in which the spouses sought couple therapy on a voluntary basis. The method used to analyze the therapy was Dialogical Investigations of Happenings of Change (DIHC). Results on dominance indicated that the male client showed more quantitative dominance, whereas semantic dominance was more present in the female client, and therapists used more interactional dominance. Results on dialogue analysis showed that dialogical dialogue might help to construct a new-shared meaning of the issue of violence. In the Discussion section some research and clinical implications of the results are derived.     

“That man’s father is my father’s son”: The roles of structure,strategy, and working memory in solving convoluted verbal problems

Normative data (N=896) collected on solutions to the traditional reasoning problem “Brothers and sisters have I none,/That man’s father is my father’s son” was the platform for a set of experiments to investigate the roles of problem structure, subject strategy, and working memory in error making in a class of verbal problems. The normative data revealed that the modal, but incorrect response to the brothers and sisters problem was “himself,” whereas the correct response of “son” was given by only 17% of subjects for the traditional version above, rising to 40% for a reordered novel version. This problem’s structure, identified as adouble-modifier structure, was found to produce similar response patterns across a range of verbal problems. Results from (1) syntactical structure manipulations (e.g., “My father’s son is the father of that man”), and (2) efforts to teach subjects to use a linear strategy (a sequence of steps), interpreted within a framework of Just and Carpenter’s (1992) capacity theory of comprehension, suggested that working memory overload varies across within-structure modifications and subjects. Further-more, this overload may be compounded by subjects’ choices of strategy.     

Detriangulation of Absent Fathers in Single-Parent Black Families: Techniques of Imagery

The projection of the mother's unresolved feelings about an absent father onto one or more of her children-often the eldest son expected to assume the role of parental child-is an obstacle frequently encountered in therapy with single-parent Black families. Acknowledgment and resolution of these feelings by the mother is an important step toward reestablishing generational boundaries and improving communication between mother and children. It is suggested that the empty chair procedure and the use of family photographs are two interventions that can be used within the context of structural and/or transgenerational family therapies to help the mother separate her feelings about the absent father from her feelings about her children. Models for the use of both approaches and the potential benefits of each is presented. The successful outcome of either technique may depend, however, on variables in the family's history and the stage of therapy during which the techniques are introduced.     

The father's shadow/father's body

The shadow of the father plays an important role in a son's ability to live a creatively meaningful life. The mythological basis for the father's shadow is found in the myth of Cronos and his son Zeus. This myth symbolizes a father's body being intimately connected to his son getting in touch with his creative bright shadow. The conclusions reached regarding the importance of the father's shadow are based on research conducted with an ongoing men's group. An early underground phallus dream of Jung is examined, along with the creative work of a patient, both offering evidence of the importance of the body-bond with the father for a son's creative development.David Morgan, CSW, is a psychoanalyst in private practice in New York City and Teaneck, New Jersey.     

Individual Marital Therapy — Have Reports of your Death been Somewhat Exaggerated?

In this reply to Wells and Giannetti's critique of our earlier reviews of research in family therapy, we demonstrate that the sense of absolute certainty with which they reappraise and dismiss as useless the studies we reviewed on individual marital therapy is unjustified. We also consider the implications of their critique and the conclusions they derive from it for public policy and clinical practice. Though we acknowledge the appropriateness of certain aspects of their critique, we continue to hold to our original position that, for now, there is ample empirical warrant for considering conjoint therapy to be the treatment of choice for marital problems.     

Father regression Clinical narratives and theoretical reflections1

The author deals with love‐hate enthrallment and submission to a primitive paternal object. This is a father‐son relationship that extends through increasing degrees of ‘primitiveness’ or extremeness, and is illustrated through three different constellations that constitute a continuum. One pole of the continuum encompasses certain male patients who show a loving, de‐individuated connection to a father experienced as trustworthy, soft, and in need of protection. Further along the continuum is the case of a transsexual patient whose analysis revealed an intense ‘God‐transference’, a bondage to an idealized, feared, and ostensibly protective father‐God introject. A great part of this patient's analysis consisted in a fi erce struggle to liberate himself from this fi gure. The other end of the continuum is occupied by religious terrorists, who exemplify the most radical thralldom to a persecutory, godly object, a regressive submission that banishes woman and enthrones a cruel superego, and that ends in destruction and self‐destruction. Psychoanalytic thinking has traditionally dealt with the oedipal father and recently with the nurturing father, but there is a gap in thinking about the phallic, archaic father, and his relations with his son(s). The author aims at fi lling this gap, at the same time as she also raises the very question of ‘What is a father?’ linking it with literary and religious themes.     

Conjoint Couple's Treatment for Intimate Partner Violence

Abstract

Despite lingering concerns in the field about the wisdom of seeing couples conjointly when there has been Intimate Partner Violence (IPV), the research literature and clinical practice experience both indicate that this approach can be safe and effective for at least some couples. In this paper, we briefly review the existing outcome research on Couple's treatment for IPV and then suggest best clinical practices for this work. Best practices, in our view, include seeing Couple's treatment of IPV as a clinical specialty necessitating specific training, working as part of a coordinated community response to IPV, modification of the structure of therapy to increase safety, as well as careful screening of couples and on-going assessment of the propriety of conjoint treatment.     

Associations Between Clinic-Referred Boys and Their Fathers on Childhood Inattention-Overactivity and Aggression Dimensions

The question asked in this study of 70 clinically referred 6- to 12-year-old boys with behavior problems was whether or not childhood inattention-overactivity and aggression are transmitted specifically from biological fathers to sons. Fathers' self-reported childhood inattention-overactivity on a retrospectively valid measure was exclusively associated with parents' ratings of their sons' current attention problems on the Mothers' Operational Measure for Sub-grouping (MOMS), the Revised Child Behavior Checklist (RCBCL), and an approximated DSM-IV inattention dimension. Fathers' self-reported childhood aggression was not associated with ratings of their sons' aggression on the MOMS or DADS (a parallel instrument for fathers), nor on DSM-III oppositional or conduct disorder dimensions, but it was exclusively associated with RCBCL ratings of sons' aggressive and delinquent behavior. None of the nonspecific correlations (father inattention-overactivity with son aggression or father aggression with son inattention-overactivity) was significant.     

Couples treatment for major depression: critique of the literature and suggestions for some different directions

Current couples approaches to the treatment of depression show considerable promise for some couples, but have substantial room for improvement – in terms of efficacy as well as applicability and acceptability to a broader population. Although conjoint approaches have been shown to be efficacious in reducing couple distress and are possibly efficacious in ameliorating depression that co-occurs with couple distress, methodological problems hamper generalization from the published findings. Therefore, it is not clear that most depressed persons are likely to benefit from currently available conjoint formats. Most basically, there may often be obstacles that prevent or delay partner involvement, highlighting the need for treatments that can enhance relationship functioning without relying on a conjoint format. Existing treatment delivery systems may also fail to reach a considerable segment of the population. Developing a more flexible set of options for implementing couple-focused treatment, as well as rethinking dominant assumptions about depression, may be integral to extending the viability of couples therapy for depression.