Evaluating family therapy: a comparison of the Milan and problem solving approaches

This paper describes a study comparing the Milan approach with problem solving family therapy. Twenty families were assigned to one of the treatments and data were collected assessing symptomatic (first order) and systemic (second order) changes. The results showed that families in both treatment groups achieved favourable changes in their presenting symptoms. Those families receiving the Milan approach showed a statistically significant improvement in second order changes compared with the problem solving group. Issues relating to treatment outcome, first and second order changes and methodology are presented.     

Client-centred therapy and family therapy: a review and commentary

This article sets out to redress the relative neglect of the client-centred tradition within family therapy. A review of the limited literature emanating from both client-centred therapy and family therapy is provided, supported by a commentary. An argument is made for the relevance of client-centred principles in responding to contemporary concerns about disrespectful practice.     

Mother-blaming in family therapy: An empirical investigation

Abstract

This study tested two hypotheses derived from the feminist critique of family therapy in a sample of AAMFT members. The stimulus was a brief vignette of an initial therapy session with a family presenting a teen-aged child as the identified patient. It was hypothesized that family therapists would rate the mothers in the vignette as more dysfunctional than fathers. It was also hypothesized that mothers would be asked to bear more of the burden of change in treatment plans written by subjects. Neither hypothesis was supported. However, respondents did rate the concerned parent, regardless of sex, as more dysfunctional. Since this is a role often occupied by women, this finding may indicate some gender bias.     

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.     

The end-of-session message in systemic family therapy: a descriptive study

A retrospective case note review was conducted with the aim of describing the end-of-session messages conveyed during Milan-style systemic family therapy. Fifty consecutive families treated in an adult family clinic were included. A classification of messages was developed; for each type of message the mean number per therapy session was calculated and the rates compared both within and between four systemic categories of family. 'Supportive/engaging' messages were given more frequently than 'hypothesis-related' messages in each systemic category and this difference was most marked in families with grief as the central issue. More 'acknowledgement' messages were used in the 'grief' group than in the 'separation/individuation' group. 'Hypothesis-related' messages were used more often in the 'separation/individuation' group than in the 'grief' group. We discuss possible reasons for the observed patterns and compare different ways in which the message can be conceived and implemented.     

Family therapy without the family: a framework for systemic practice

This paper contrasts the basic tenets of systemic thinking with some guiding principles of the psychodynamic approach, and outlines specific techniques which family therapists can use when seeing individuals. It is argued that a useful systemic framework can be maintained if the therapist aims to keep the therapy system 'open' for relevant others to join at any time.     

The family therapy journals in 2002: a thematic review

This article reviews the principal English-language (including British) family therapy journals for the year 2002. A number of common themes and threads predominate within these journals. Articles relating to these themes are reported under distinct headings. These themes were: responding to 9/11; marital therapy and diversity practice. Significant research papers are incorporated into the relevant heading. This is the final thematic review undertaken by the current author.     

The family therapy journals in 1997: a thematic review

This review considers papers that were published within the principal family therapy journals for the year 1997. The clearest themes that emerged were on the nature of love, gender and collaborative approaches.     

The family therapy journals in 1999: a thematic review

This paper reviews the principal family therapy journals for the year 1999. Of the themes that emerged, 'reaching out' with systemic practice, developing a political edge, gender issues and developments in theory will be discussed. The paper concludes with a resumé of the research reported in these journals for the review period.     

The family therapy journals in 2001: a thematic review

This article reviews the principal English–language (including British) family therapy journals for the year 2001. Articles are clustered around various common themes which include marital therapy and cultural competency. There is also a discernible interest in working with populations that have received less attention from family therapists such as substance misusers. Within this literature there is also a trend to 'import' ideas and methods from other therapeutic traditions. Important research papers are noted from within these categories, rather than having a separate section. As this is the fifth in a series of reviews, a 'look back' at trends within the family therapy literature concludes the paper.     

The family therapy journals in 2000: a thematic review

This article reviews the principal English-language (non-British) family therapy journals for the year 2000. Articles are clustered around various common themes that include spirituality, creativity and inventiveness, therapy with gay and lesbian clients and 'community practice'. It concludes with a resumé of the research reported in these journals for the review period.     

A systemic view of family therapy ethics

A critical review of the literature on family therapy ethics is used to develop the proposition that a more systemic analysis is needed, one that includes the levels of therapist and society as well as patient (family). These ideas are discussed through reexamining the issues of family secrets, therapist deceptiveness, and therapist advocacy of personal (feminist) values.     

Sexual revictimization among women: A review of the literature focusing on empirical investigations

This article provides a review of the literature on sexual revictimization among women, focusing on empirical evaluations of theories of revictimization. Theories of revictimization can be categorized into eight major areas: spurious factors, situational or environmental variables, disturbed interpersonal relationships, cognitive attributions, self-blame and self-esteem, coping skills, perception of threat and trauma-related symptomatology, and general psychological adjustment. In general, none of these theories has received unequivocal empirical support. Situational variables and general psychological adjustment have received modest support as factors that differentiate revictimized women from non-revictimized women. Our ability to interpret this trend is limited, however, by the preponderance of retrospectively designed investigations in this area.     

The comparative efficacy of Milan family therapy for disturbed children and their families

This paper describes a study comparing the efficacy of Milan family therapy with that of other treatments routinely used in an out-patient child psychiatry department. Some 118 subjects were allocated on a random, prospective basis to one of two treatment groups, the Milan family therapy group or the other treatments group. The methods of assessment included semi-structured interviews, questionnaires, visual analogue scales and standardized therapy schedules. The results showed that whilst subjects in both treatment groups achieved comparable symptomatic improvement at the end of treatment and at six-month follow-up, the Milan approach produced more changes for family members other than the referred child as well as requiring less treatment time than the other treatments.     

Changes of expressed emotion in systemic family therapy

This study measured the levels of expressed emotion throughout the course of systemic family therapy-Videotapes of the first, second and final sessions of therapy were rated for twelve families, by an independent rater who was not involved in the treatment. Six of the therapies were completed before the study began, and six were rated prospectively. Emotional over-involvement and criticism were found to be significantly reduced from the early stages, while warmth was found to increase later. The findings are discussed in relation to the systemic model.     

The child's participation in family therapy: A review and a model

A major gap in family therapy, the treatment of children and adults together, is addressed. The literature on the children's participation is reviewed and a model which systematizes their involvement is presented. The full participation of the child necessitates the use of play. To create a context of play without alienating the rest of the family, action-promoting methods are used. These methods are implemented through family activities and role playing, which are followed by discussion. The advantages, the indications, and the contraindications to the use of action in family therapy are presented.     

The empirical and theoretical base of family therapy and multiple family day therapy for adolescent anorexia nervosa

There is growing empirical evidence that family therapy is an effective treatment for anorexia nervosa, particularly in adolescence. This is in spite of the fact that the theoretical model from which most of the empirically based treatments are derived appears flawed. This paper provides a brief overview of the research evidence from treatment studies and studies of family functioning. It suggests that the main limitation of earlier theoretical models is their focus on aetiology rather than on an understanding of how families become organized around a potentially life-threatening problem. An alternative conceptual model is presented, and its application to family therapy and multiple-family therapy for adolescent anorexia nervosa is described. The treatment approach focuses on enhancing the families' own adaptive mechanism and mobilizing family strengths.