Extreme itching treated by a family systems approach

A case study is presented in which a 16-year-old daughter developed extreme itching and scratching behavior that was triggered by the occurrence of manifested parental conflict. The daughter's scratching also served the family function of helping the parents avoid marital conflict. Family treatment consisted of helping the parents manifest, negotiate, and resolve marital conflict issues in front of the daughter so that she could experience the benefits of dealing with a family conflict in a functional way. This approach has helped the daughter decrease her anxiety about conflict situations which, in turn, has resulted in a significant decrease in her itching and scratching behavior. In addition, the parents report an improved marital relationship now that the daughter's itching no longer occurs and no longer interrupts the parents' attempts to negotiate marital conflict issues.     

The educational therapy contribution to a family systems approach

This article draws on the experience of one specialist education unit to demonstrate the usefulness of engaging families directly in the treatment of children showing difficulty in managing tasks and relationships in school. It will look at the overlap of psychoanalytic and systemic ideas and show how theory and practice from both 'schools of thought' allow for a fuller understanding of blocks to school success and also support the family and child in their efforts to 'defeat' a difficulty. I look in particular at the way a psychodynamic focus on a child's inner world can work alongside the systemic focus on family structure, hierarchy and history.     

A family systems approach to grief

This article blends two important viewpoints on grief: a stage theory on the individual's grief and the family systems literature on grief. A case study is examined from both the individual and systemic viewpoints. Pastoral implications for intervention with the case study family as a system are noted. The theological questions which the family and pastor face are also discussed.     

A behavioural and systems approach to family therapy: a position paper

An integrated model of a behavioural and systems approach to family therapy is presented, the main premise being that family interactions are affected by reciprocal determination of cognitions, feelings and behaviours in relation to the environment. Assessment involves a systematic exploration of the interaction and transactional patterns within the family, and the identification of the dysfunctional aspects of such patterns. The main aim of the intervention is to produce change in family behaviour by addressing the important cognitive and affective issues. This entails techniques such as cognitive restructuring, social modelling and operant conditioning which can be used separately, in parallel, or in combination. Whether one or more of these techniques is used depends on the nature of the family's problems and the aims of treatment.     

Elective mutism in children: A family systems approach

Abstract

Elective mutism in children is a relatively rare symptom which is more prevalent in the kindergarten population and has a higher incidence among immigrant families. Treatment strategies for this silent symptom include speech therapy, behavior modification, psychoanalytic, psychotherapeutic, family systems and a combination of these approaches. This paper reviews the types of elective mutism and proposes common characteristics of elective mutists' families. The potential for a redefinition of the term “elective mutism” is examined. It is concluded that family dynamics are an integral part of the elective mutism problem and need to be considered in a comprehensive treatment plan.     

Extreme interpersonal sensitivity in family members

Abstract

The concept of extreme interpersonal sensitivity is introduced and the literature relating to it is reviewed. Although considerable clinical evidence gives credence to the relative ubiquity of this phenomenon in enmeshed families, the concept is only indirectly alluded to by family theorists. Extreme interpersonal sensitivity seems to be characteristic of a lack of individuation in the family system. Clinical examples are offered to clarify this concept.     

A family systems approach to conciliation in separation and divorce

This paper argues for a family systems approach to families who are in conflict during the process of divorce, particularly in relation to custody and access for their children. The concept of 'conciliation' as a brief method of intervention is both defined and discussed and principles and skills are identified. The influence of the context within which conciliation is practised and in particular, the power which the conciliator holds, or is perceived by the family to hold, is also discussed. These ideas are illustrated by case examples.     

Application of a family systems approach to working with people affected by HIV disease – two case studies

HIV infection, with its particular modes of transmission, affects relationships, interrupts the normal life-cycle and brings different challenges to patients and their contacts as they pass through the asymptomatic and symptomatic phases to the terminal stages of illness. This paper describes a family systems approach to therapy with people affected by HIV disease, illustrated by two case examples.     

A family systems approach to child–parent separation: 'developmental closure'

This paper presents a family systems model for considering the interactive events that occur when a child and parent move towards closing their relationship and separating. This process typically involves the child being 'received into care' and is identified as developmental closure . Different stages of this process are exemplified clinically and the therapeutic principles that guide work with families struggling with such difficulties are outlined.     

The rainbow bridge: an approach to family systems via Howards End

Bateson's ideas of artistic expression, the continuity of Art and Science and the nature of Mind are used as cues for the exploration of Howards End, E. M. Forster's novel of family life. Illustrations of systemic concepts are given from the text. Particular relevance is suggested for the use of literary examples in family therapy training and in the development of family systems theory.     

A family/systems approach to illness-maintaining behaviors in chronically ill adolescents

A distressingly significant number of chronic, seriously ill adolescents demonstrate poor medical management of their illnesses through "illness-maintaining behaviors." These behaviors are defined in this article as any action that compromises chronically ill adolescents' care and prevents them from functioning optimally. Current conceptualizations of illness-maintaining behaviors offer explanations that view these behaviors as individually focused, using either psychodynamic or behavioral models. This article, however, presents a family systems model of illness-maintaining behaviors. A therapeutic framework leading to specific intervention strategies is also developed.     

Multi-agency family systems

The term 'multi-agency' family is preferred to 'disorganized' family. Multi-agency family systems present special problems of the relationships (a) within the family, (b) between family and professional network, (c) among members of the professional network and (d) between family, network and treatment centre to whom the family is referred. Pressures on the family and professional workers can create a locked system which prevents natural development of the family or effective problem solving by the workers. A systems approach to such problems is presented which includes consultation to the family/professional network system.     

Training in family psychology: a competencies-based approach

After providing an overview of the family psychology landscape and the competencies-based movement in professional psychology, attention is paid to eight family-specific competencies in the following areas: the application of scientific knowledge to practice, psychological assessment, psychological intervention, consultation and interprofessional collaboration, supervision, professional development, ethics and legal issues, and individual and cultural diversity. Effective strategies for providing family-focused education and training to psychology trainees at the doctoral, internship, and postdoctoral levels and to psychologists through continuing professional education in these core competency domains are provided.     

A combined therapeutic approach in a family setting

Combined treatment approaches, co-therapy and family work are three concepts which are under much discussion in psychiatry. This paper describes the systematic use of an integrated treatment approach used by co-therapists working with families in which a child was the referred patient. The rationale behind this approach together with its advantages and disadvantages are discussed. The authors conclude that the approach is sufficiently promising to merit formal evaluation.     

Anticipatory loss: a family systems developmental framework

This article provides a family-systems developmental framework for anticipatory loss in situations of physical illness, disability, and long-term psychiatric disorders, and offers a conceptual base for theory building, clinical practice, and research. A family systems-illness model that integrates psychosocial types and phases of illness with family variables, in particular, developmental patterns and beliefs systems, provides a foundation to rethink and expand our approaches to threatened loss.     

Structural family therapy with Mexican-American family systems

Characteristics of traditional Mexican-American families with consequent family rules that affect these family systems are discussed along with selected clinical cases. The specific cases discussed involve: (1) interactions with family of origin in intercultural marriages, (2) intracultural differences in levels of acculturation and traditional family rules, and (3) extended family impact in response to severe life crisis. The development of therapeutic processes from structural and strategic family therapy approaches, which reflect appreciation for cultural differences and strengths, is suggested.This material was presented at the annual meeting of the Texas Association for Marriage and Family Therapy, January, 1994, San Antonio, TX.