Organizing concepts in family therapy

Abstract

Harry Stack Sullivan (1953, p. 11) spoke fondly of the time when therapy would become “easy.” By that he meant he looked forward to the day practitioners would know precisely what to do to help their clients regardless of the symptoms they presented. He was wise enough to know, of course, that the time he anticipated would not arrive soon, for he said he would be a long-forgotten myth before it came. Those who practice in the third decade after Sullivan's demise know that we are probably no closer to the halcyon conditions he longed for than he and his associates were in the 1940's. In fact, psychotherapy is under stronger attack for lack of precision (effectiveness) now than at any time in the recent past.     

The integration of individual and family therapy

It is time to put an end to the separation in training programs between individual and family therapy. Competent therapists should be able to think at an intrapsychic and circular level concurrently. Training programs should maintain their current major focus and develop their minor area of expertise sufficiently so that their graduates can practice both individual and family therapy and choose whichever modality is more appropriate to the case at the time. Bridge concepts, essential differences, and some integrative approaches in individual and marriage and family therapy are discussed.     

Rhetorical theory and family therapy practice

The study found that a connection exists between rhetoric and therapy because both fields are interested in using language as a tool for generating change. Persuasion is viewed as inherent in human communication, even though people do not necessarily intentionally attempt to persuade others. Following a brief (but detailed) explanation of the theoretical stance which informs the implementation of rhetorical techniques in therapy, three pragmatic exemplars are offered to demonstrate the employment of two classical rhetorical concepts, the parastasis catalogue and syncrisis.The authors are grateful to Sandra Kodner, MS for her participation in the development of this project.     

Resilience concepts and findings: implications for family therapy

Resilience is a term used to describe relative resistance to psychosocial risk experiences. There is abundant evidence that there is enormous variation in children's responses to such experiences but research to determine the processes underlying the variations needs to take account of several crucial methodological issues. The findings emphasize that multiple risk and protective factors are involved; that children vary in their vulnerability to psychosocial stress and adversity as a result of both genetic and environmental influences; that family-wide experiences tend to impinge on individual children in quite different ways; that the reduction of negative, and increase of positive, chain reactions influences the extent to which the effects of adversity persist over time; that new experiences which open up opportunities can provide beneficial 'turning- point' effects; that although positive experiences in themselves do not exert much of a protective effect, they can be helpful if they serve to neutralize some risk factors; and that the cognitive and affective processing of experiences is likely to influence whether or not resilience develops. The implications of these findings for family therapy are considered in terms of the need for therapists to look carefully at the ways in which different risk factors interact; to assess and take account of individual differences in susceptibility; to consider the extent to which risk factors impinge on the individual and, in that connection, to note the importance of patterns of social interaction outside as well as inside the family; to appreciate the role of both the peer group and individual characteristics in the development of negative and positive chain reactions; and to pay attention to the ways in which individuals process their experiences.     

Indications for selecting family or individual therapy

Indications for either individual therapy or family therapy as treatments of first choice are identified at the initial family assessment.
A family approach is suggested in (1) scapegoating systems where the symptom is essential to the family homeostasis; (2) enmeshed families where communications are confused and diffuse; (3) paranoid-schizoid families where the family denies the symptoms and (4) families in a current acute shared crisis.
Individual treatment is indicated when (1) the patient has suffered traumatic separations; (2) separate help is asked for; (3) the therapist considers individuation necessary and (4) unusual life experience. Clinical examples are given.     

The psychosomatic family model. A critical analysis of family interaction concepts

The psychosomatic family model of Minuchin and his colleagues is one of the best known and influential viewpoints in the field of family therapy. This article critically analyses this model and related concepts, focusing on the lack of clear definitions, especially with regard to the interactional concepts: enmeshment, rigidity, overprotectiveness, and lack of conflict resolution. Each concept is discussed, concluding with the recommendation of a new definition, so that the model can be empirically verified. The authors suggest that Minuchin's model can be reduced to three fundamental interactional dimensions : the intensity of intrafamilial boundaries, the degree of the family's adaptability, and the family's way of handling conflicts. A research method is presented in which the way of assessing these interactional dimensions is demonstrated.     

Using psychodynamic concepts in strategic family therapy: A suicidal adolescent case

This paper describes the treatment of a suicidal adolescent with strategic family therapy. The cotherapists conceptualized the case psychoanalytically and systemically. They propose that their understanding of psychodynamics enhanced their ability to tailor their interventions to the family's unique style and capacities. Rather than dismiss psychodynamic concepts as irrelevant to strategic family therapy, they maintain that an appreciation of individual members' ego strengths, defenses, affects, and unacknowledged impulses leads to the construction of more effective metaphors and a set of interventions more isomorphic to family patterns.     

Normal crises: Stage theory and family therapy

Abstract

The theme of the Twenty-Third Georgetown University Symposium on Family Theory and Family Psychotherapy, held November 8 and 9,1986, in Washington, DC, was Toward a Science of Human Behavior. The program included famed sociobiologist Edward O. Wilson as the Distinguished Guest Lecturer; a special panel discussion about what is involved in moving toward a science of human behavior; a presentation by Murray Bowen, Director of the Georgetown University Family Center; a presentation by Walter Toman, who is well-known for his research on sibling position; and 10 other presentations related to various aspects of family systems theory and therapy.     

Concurrent individual and family therapy in a case of elective mutism

In this paper, following a literature review a family containing a child who had been electively mute for four years is described. A concurrent programme of individual and family therapy and the systemic hypothesis which guided these interventions is then presented in detail. Behavioural and psychometric data are presented to illustrate the dramatic improvement which the identified patient showed over the course of treatment. Finally, the probable mechanisms underpinning the child's improvement, and how these differed from our initial expectations, are discussed.     

Depressed youth: treatment outcome and changes in family functioning in individual and family therapy

This study explores the role of family functioning in therapeutic change in focused individual psychodynamic psychotherapy (FIPP) and time‐limited systems integrative family therapy (SIFT) for depressed children and adolescents. After a screening process, 72 participants aged 8 to 15 were randomized to either FIPP or time‐limited SIFT. Assessments took place prior to, at the end of, and 6 months after treatment. Families in both SIFT and FIPP showed a small but significant and sustained improvement in family functioning by the end of treatment in both mothers' self‐reports and family therapists' assessments. Better family functioning at baseline in mothers' self‐reports and improved family functioning during SIFT, as assessed by family therapists, predicted a sustained decrease in self‐reported depressive symptoms. Results indicated that time‐limited SIFT may be more effective with younger children and in patients without a diagnosis of double depression than adolescents.     

Learning family therapy: The dilemmas of an individual therapist

Individual therapists who begin doing family therapy often encounter some special difficulties directly related to their prior training and experience. Some therapeutic techniques of individual therapy, such as understanding and explaining the patient's problems on the basis of faulty parenting, must be relinquished and alternative means of alleviating guilt must be adopted. In doing family therapy individual therapists must adapt to the fact that they are less important than they are used to being and have less control over content and emotional tone of sessions. They must change their conceptions about the importance of privacy and secrecy. This article discusses some of the problems encountered when one is not thoroughly committed to a family therapy approach to treatment. Countertransference difficulties, problems stemming from wanting change, and the differing nature of the gratifications in the two therapeutic modalities are other topics discussed.     

The problem of gender in family therapy theory

The field of family therapy is now a continuous process like a car cruising on automatic control with the driver comfortably in the lotus position. Family therapy theory rests on normative concepts of the traditional family and idealized conceptions of family relationships. Inequalities in the family associated with gender have been regarded as of little importance to the development of macro theory in the field. The two most influential therapeutic models, psychodynamic and systemic approaches, are each marked by gender bias. The alpha prejudice of psychodynamic theories exaggerates gender differences; the beta prejudice of systemic approaches ignores them. The construction of gender role concepts has led to a false dichotomy, whether supported by traditionalists or feminists. On close examination, gender role ideals turn out to be simplifications and caricatures. The uncritical use of gender role concepts supports power differences between men and women and ignores the complexities and commonalities of human experience. The failure of family therapy theory to deal with gender issues needs to be addressed if a theory that is not just "more of the same" is to be developed.     

Multiple family therapy for anorexia nervosa: concepts, experiences and results

Multiple family therapy (MFT) is an increasingly popular treatment approach for adolescents suffering from anorexia nervosa and their families. This paper describes the ingredients and different phases of this treatment, and outlines its indications and contra‐indications. Relationship patterns in families containing anorectic teenagers are examined, with a special emphasis on identifying areas for change in family relationships. Results with regard to the overall acceptability of the approach are presented.     

Cross-cultural perspectives: implications for attachment theory and family therapy

Cross-cultural perspectives have always been useful for understanding behavior. They clarify the distinction between aspects that are essentially part of the human condition and those that are the most responsive to variation. The interesting article by Rothbaum and his colleagues is in that tradition, contrasting the cultural values and family patterns in Japanese society with those of Western cultures, including our own, and suggesting that these differences shape the nature and course of attachment. It stimulates questions about what we have taken for granted in our theories and in our evaluations of dysfunctional behavior.     

Application of family therapy theory to complex social issues: using the WebQuest in family therapy training

This paper describes how the WebQuest is used to foster critical thinking and application of theory to complex social problems in a Master's level class on contemporary family therapy theories. The issue of child trafficking and prostitution is explored through the web‐based inquiry learning where scaffold learning is provided. Scaffolding includes resource links and guidance on cognitive and social skills, which are provided to facilitate the learner's development. The WebQuest design includes the task, the process and the evaluation rubrics. Student feedback on the WebQuest was positive and included increased motivation in learning, critical thinking and global awareness.