Childhood Obesity in a Chinese Family Context

This qualitative study explored themes that described families with obese children in Chinese society. Eight obese children and their families participated in the study. Six of the children were male and two were female, ranging in age from 7 to 13. The themes found were: over-involvement between allied parent and obese child, coalition, diffused boundary between extended family and nuclear family, lack of conflict resolution, and disengaged couple boundary. In this study, the significant role that may be played by the extended family in contributing to a child’s obesity, as well as female power dominance in the domestic sphere are considered. Implications for therapy are discussed.     

Need for Family Therapy Services for Middle-Class Families in India

This qualitative study explored the needs of Indian middle-class families for family therapy services. Four focus group interviews were conducted with middle-class parents in Madras, India. Participants were introduced to the concept and practice of family therapy and were encouraged to take a more active role in supporting the services they suggested. Participants identified problems faced by Madras middle class families and five different types of services that they were aware of. Three categories of need for family therapy were identified from the narratives of the participants. Several themes fit in each of the three categories. Implications for clinical application are discussed.     

ABSTRACTS OF LITERATURE

Schizophrenia is due to a combination of genetic and environmental factors. The author asserts that there has previously been an error in conceiving the patient as being molded completely by external circumstances. In fact, it is the patient's behavior, which is a transformation of family irrationality, that constitutes schizophrenia. In 75 per cent of cases of schizophrenia seen by the author in private practice, the mother did not fit the image of the so-called “schizophrenogenic mother.” In this technique for teaching family therapy, the students take the roles of the family. Procedures, selection of players, formulating the problem, the value of the experience, and ground rules are described. This is a case report and follow-up over nine years of an alcoholic woman. The patient and husband were treated for 35 sessions by cotherapists in conjoint marital therapy. Although there was improvement in the family patterns and in drinking behavior during the treatment, the improvement did not last after termination. The case suggests that marital therapy in the absence of other treatment interventions is ineffective in changing the long-run course of women alcoholics. Based on the author's practice on an inpatient unit that specializes in the study of aggressive behavior, he describes family dynamics and treatment when the identified patient suffers from “episodic violent behavior.” The sample focuses on adolescents, most of whom had episodes of suicidal behavior and who had some evidence of “organic involvement.” Typical family patterns include overly close alliances by the adolescent with one or both parents and transmission by parents of inconsistent values regarding aggression. Family therapy is seen as the preferred treatment approach and emphasizes family ways of handling dyscontrol episodes and the responsibility of the patient for his or her actions. No results are reported. This study attempts to link family variation and core relationships in types of families with the mental health of children. Sample was from a black, poor, urban community defined in terms of the adults present in the home. Eighty-six family types were found falling into ten major classes. Measures of mental health in children were done on psychological well-being of the children and on Social Adaptational Status. Results indicate that family type is strongly related over time to child's SAS and his or her psychological well-being. Mother-alone families entail the highest risk in terms of social maladaptation and psychological well-being of the child; the presence of certain second adults has important ameliorative functions—mother/grandmother families being nearly as effective as mother/father families, with mother/stepfather families similar to mother-alone in regard to risk. Inferences from this data and implications and interventions are discussed. This is a clinical essay on the role of family therapy for black families. In addition to the usual family stresses, black families are subject to the additional strain of discrimination. Support is achieved mostly from the family and from the kinship network, rather than the community. Treatment strategies for this situation are proposed. This essay reviews recent regulations concerning consent procedures and protection of privacy as they apply to children and their families. Rigorous sample selection, nearly complete follow-up, and objective assessment of outcome are virtually impossible at this point. It is concluded that compliance with current “subjects' rights” regulations sometimes seems potentially more harmful to the subjects than the research itself. One case example is presented in support of the hypothesis that brief family therapy has the potential to lead to individual personality changes that are long-lasting. The identified patient was a 15½ year old boy with the symptom of having a falsetto voice. Father, mother, and child were seen in twelve family therapy sessions with changes in the boy's self-image documented in “man-figure” drawings. Nine-month follow-up revealed no recurrence of the presenting symptom and an improvement in social and familial relationships of the identified patient. This is another in a series of papers from a divorce-counseling project. The focus in this paper is on preventive clinical interventions developed for children of various ages in divorcing families. Developmental assessment was achieved with a “brief” history from the parents, detailed information from school, and “direct observation” of the child. This paper covers treatment strategies, interventions, failures, therapist's role, and professional dilemmas in divorce counseling of 60 families with 131 children between the ages of 3 and 18 at the time of divorce. The technique of counseling was to see one parent and child separately by the same therapist three to six times over a three-month period. This is a research study to provide data on the question of whether the disturbed behavior of parents with a schizophrenic child preexists or is a response to an identified patient's pathology. Method was to administer a conceptual task called the Twenty Questions Task individually to each family member and to the family as a unit with a sample of 36 schizophrenic families, 13 non-schizophrenic controls, and 38 normal controls. Results “indicated that far more schizophrenic sons than control sons were much more efficient individually than with their families.” A number of schizophrenic sons performed competently as individuals, but the subsequent performance of parents and sons together on the same task was generally inferior to that of the son alone. Results suggest that the parental behavior plays a part in the etiology of schizophrenia.     

Differences in Self-Report Among Incest Family Members

A questionnaire study was conducted among incest families to study their perceptions of social background factors, how long the incest relationship lasted, who was involved, the history of incest in the family, emotional and psychological factors, and the consequences of the incest for the family. It was hypothesized that incest offenders, their spouses and incest victims all tend to report the above in a manner that reflect positively upon their own role in the incest relationship. The results showed clear differences in the reposts of the three groups. The paper concludes that such differences in perceptions must be incorporated in family therapy strategies as well as in our knowledge base of incest families.     

Family Therapy in Outdoor Behavioral Healthcare: Current Practices and Future Possibilities

This paper highlights the role of the family in the treatment of youth who attend Outdoor Behavioral Healthcare (OBH) programs. It discusses the history of OBH, provides a critical overview of the research on the impact of OBH programs on family functioning, and discusses the importance of increased intentional integration of family therapy into OBH settings. To show this integration, this study presents a case study that highlights the role of the family, as well as the home family therapist throughout the phase of OBH treatment. Areas for future esearch are provided as well as suggestions for the increased utilization of adventure activities with families.     

Making Sense of Abuse: Case Studies in Sibling Incest

This case study focused on the process of making sense of abuse in two Latino families experiencing sibling incest. Participants included five male children ranging in age from 8 to 15 that were members of two families dealing with the issue of sibling incest. The purpose of this study was to build understanding of how families experience sibling incest and its role in their families. Clinical data from therapy sessions was analyzed to reveal that families made sense of the incest in different ways including abuse as normal and abuse as a mistake. Central concepts that explained how the families responded to the sibling incest included (1) level of family cohesion, (2) role of secrecy, and (3) view of outside systems. The findings suggest that treatment needs to include an in-depth assessment regarding these issues.     

Effective functioning in dual-career families: an investigation

This study is concerned with the commonalities inherent in diverse psychotherapeutic strategies, despite seemingly discontinuous theoretical stances. Two approaches were evaluated with respect to effective family functioning, viz. Analytical Psychology and Systems Theory. Analytical Psychology posits the growth of conscious awareness in the individual as the source of therapeutic change. Problem centred systems therapy of the family emphasizes the importance of teaching clinically presenting families to negotiate collectively family rules and expectations and thus to allocate and monitor roles via clear and direct verbal communication. Both positions thus stress the reflective mode as a pivotal factor in effective problem solving. Analytical psychology maintains that conscious awareness expands to the extent that the individual integrates the contrasexual aspect of the personality, that is, the affective, expressive mode or 'feminine principle' in the male, or the instrumental, assertive 'masculine principle' in the female. Such individuals are said to be 'androgenous'. It was therefore hypothesized that such individuals would more readily be able to negotiate family rules and expectations in a manner consistent with a major therapeutic thrust of family therapy. These clinically derived hypotheses were subjected to an empirical test by assessing twenty, non-clinical, dual-career families where both parents pursued careers and were therefore presumably both required to share instrumental and affective roles on the basis of mutual agreement. Results indicated that negotiation contributed significantly to successful role fulfilment and effective family functioning, thus substantiating the focus of family therapy strategies upon clear and direct communication and role allocation.     

A Review of Family Therapy in Residential Settings

This article provides an overview of the history of family involvement in residential treatment as well as a synthesis of the research showing family-centered interventions and outcomes for youth in residential settings. There are many methods for engaging families in residential treatment that are discussed in the literature; however, there is a significant gap as the field has not yet identified specific family therapy approaches that demonstrate efficacy in working with youth and their families in this particular setting. A review of the literature over the past 10 years will highlight the emerging family therapy models being utilized in this setting, which include multiple-family group intervention, family-directed structural therapy, and narrative family therapy. The article will also include a discussion of three major, well-established theoretical approaches that have been found to be effective in working with youth with conduct issues and show promise in treating youth and families in the complex setting of residential treatment: brief strategic family therapy, multi systemic therapy, and functional family therapy.     

Narrative Therapy Pathways for Re-authoring with Parents of Adolescents Coming-out as Lesbian, Gay, and Bisexual

Narrative therapy with parents as they are coming to terms with their adolescent sons’ and daughters’ coming-out as lesbian or gay provides a framework for reauthoring stories and revisioning identities as they negotiate the challenge of becoming lesbian/gay-membered families. Recognized for complementing the elements of multicultural practice, narrative therapy offers therapeutic interventions that are culturally sensitive and acknowledge the role of power and privilege in socially imaging what it means to be lesbian or gay. In this article the familiar storylines that these families bring into therapy are illustrated, and family work with parents of lesbian, gay, and bisexual adolescents is conceptualized using a narrative therapy lens.     

The unraveling of a treatment paradigm: a followup study of the Milan approach to family therapy

A 2-year followup study was conducted to determine the efficacy and degree of satisfaction with Milan-style family therapy with families refractory to other treatment interventions. Fourteen families and 5 couples who received Milan-style family therapy participated in the study. Family outcome was found to be improved in 56% of parents and 89% of identified child-patients at followup. Improved self-outcome at followup was reported by 56% of fathers, 67% of mothers, and 78% of identified child-patients. A substantial percentage of fathers (68%) and mothers (59%) reported that at least one family member sought further therapy posttreatment. Factors associated with either parent's positive perception of the treatment in general included the time interval between sessions, experiencing the treatment as brief rather than long, and positive feelings for the group behind the mirror. Mothers who reported liking the treatment reported better family outcome. For mothers, disliking the treatment was related to family members seeking further treatment. The more negative the mothers' and fathers' spontaneous comments about therapy were, the more likely that a family member would seek further alternative psychotherapy. The outcome results are explained in terms of the treatment families' negative reactions to some aspects of the therapist's stance and to the group behind the one-way mirror, as in Milan-style therapy. The importance of modifying Milan-type therapy to foster a positive attitude toward the treatment procedures and the therapist's interventions is discussed.     

RECONSIDERING RESEARCH ON DIVORCE, FAMILY LIFE CYCLE, AND THE MEANING OF FAMILY

This article analyzes functionalist and normative assumptions about marriage, divorce, family, and gender in developmental models of family life cycle. An interdisciplinary review of the literature in family development, family sociology, and family therapy reveals how a deficit comparison model implicitly informs the discourse in the study of single-parent families, women who are alone, and the adjustment of women and children to divorce. A feminist critique of family life cycle as the prevailing conceptual model in family development and therapy is presented, and postmodern definitions that deconstruct the concept of family are discussed. Future perspectives for research on family life and form are considered in terms of new action theory that considers divorce as a mode of resistance and change for women and families.     

Family Factors in the Development and Management of Anxiety Disorders

Family variables are thought to play a key role in a wide variety of psychopathology according to many theories. Yet, specific models of the development of anxiety disorders place little emphasis on general family factors despite clear evidence that anxiety runs in families. The current review examines evidence for the involvement of a number of family-related variables in the development of anxiety disorders as well as the importance of families in their management. Evidence across most areas is shown to be weak and inconsistent, with the one exception being an extensive literature on the role of parenting in the development of anxiety. There is also currently little evidence that family factors have a strong role to play in the treatment of anxiety, aside from research demonstrating the value of parents and partners as non-critical supports in therapy. The promises and hints in the literature, combined with the currently inconsistent methods, suggest that considerably more research is needed to determine whether specific family factors may yet be shown to play a key role in the development and management of anxiety disorders.     

Aging families: The personal, permanent group

Later life families present a very special instance of group psychotherapy with older adults. This paper describes the challenges faced by later life families, including major life events to which multiple family members must adapt, and the increasing dependency of some elderly members. A developmental framework for later life problems is offered as a therapy frame useful to families. Key aspects of therapy process with later life families are also presented. Goals, strategies, structures of therapy, and the therapist’s role are all shaped by the long and intimate history of the members of this special form of group.     

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.     

Treatment of families during life transitions: matching treatment to family response

This article examines the conceptualization and treatment of families during normative and non-normative life transitions. Variables identified by individual and family developmental theorists account for some variation in responses of families to life transitions. Three family variables are identified as critical to practitioners' understanding of families: disruption of time schedules, number of new decisions involving initial disagreement, and pretransition family conflict. Different responses are hypothesized for families high or low on each variable. Six treatments of families are identified: historical family therapy, structure/process family therapy, experiential family therapy, psychoeducational approaches, family crisis intervention, and enrichment. The likelihood of success of each treatment is predicted on the basis of a family's response to the transition.     

Children of victims of terrorist activities: A family approach to dealing with tragedy

Abstract

The present report deals with the treatment of families of victims of terrorist activities. Such families are subject to an initial crisis situation involving severe stress as well as disruption in family role structure and homeo-stasis. Much of the trauma precipitated by such events is a result of their suddenness, their salience in the public consciousness and the consequent stigma they produce towards survivors and/or relatives of victims. A number of specific issues were common in the two case studies presented in this report as well as in other families affected by terrorism. These included dealing with the need to be a superparent and correcting unrealistic expectations, teaching effective limit setting including giving permission to be a parent, giving permission to be an adult, dealing with guilt and phobic reactions as well as family and network reorganization. Therapy concentrated on promoting family strengths and coping and deemphasized individual pathology. Common to most families treated was the strong desire of the victim's children to be treated as normal and not as psychological casualties. Thus, family therapy proved to be an ideal treatment modality for dealing with the tragic loss. By focusing on the problems of day-to-day living, the mourning work evolved naturally in the course of therapy. Specific therapeutic modalities such as cotherapy and network intervention facilitated family adjustment considerably.     

In-Home Family Therapy as a Prevention of Foster Care Placement: Clients' Opinions About Therapeutic Services

The purpose of this qualitative study was to explore clients' perceptions of the in-home family therapy services they received. The sample consisted of 20 low-income families who were at risk for having their children placed in foster care, but who had ultimately retained custody of their children. Results indicate that families view in-home family therapy as a useful intervention. They expressed appreciation for the therapists, their availability, and the support offered. Participants also stated that they wished services could have been more frequent and longer-term. Implications for researchers and practitioners are discussed.     

ABSTRACTS OF LITERATURE

Family care is defined as "the practice of placing mental patients in foster homes, either as an alternative to or as a transition from continued hospitalization." After tracing the development of family care, the authors suggest that patients are faced with the dilemma of returning to their families where they are caught up in a pathological role or remaining in the artificial environment of a hospital with pressures toward regression. A third alternative is family care. Group therapy with after-care patients and similar techniques are said to be appropriate for family care patients with the new environment providing a testing ground for patterns in living and an emotional climate for growth.     

Measuring Family Therapy Outcome in a Clinical Setting: Families That Do Better or Do Worse in Therapy

This study examined several important family and therapist characteristics as they related to treatment success. A total of 434 families entering family therapy at a sliding-fee clinic in Dallas, Texas were rated (on the Beavers Interactional Competence and Style Scales), and completed several self-report family assessment instruments (Self-Report Family Inventory, FACES III) prior to beginning therapy. The therapists, trainees from various disciplines, had been trained in the Beavers Systems Model. Overall, 75% of the families showed at least some improvement. Those that fared best in therapy were more competent at the outset. While number of therapy sessions was associated with greater gains, there were some families that made great gains in fewer than six sessions. There were important demographic qualities that did not discriminate between greater- vs. lesser-gain families, including income level, ethnicity, therapist gender, and family size. A regression analysis indicated that functional rather than demographic variables were more important in predicting therapy outcome.     

Theme-focused family therapy: the inner emotional world of the family

This paper is an account of a method of family work developed for social workers in social services departments which allows them to work with the emotional impact on children and adults of traumatic events in family life. Theme-focused family therapy has been designed to meet the needs of the families and also to enable social workers and their supervisors to develop both psychodynamic and systemic perspectives m their work with families. It is a staged approach, moving from individual work to a structured family interview through to a series of theme-focused family sessions. It is phased in this way both to facilitate the development of a therapeutic attachment between social worker and family and to take account of the crises that can interrupt planned work in social services departments. Theme-focused family therapy is carried out in partnership with families, and gives children a voice and a leading role in the therapeutic process. The approach is illustrated with a case example.