Medical or relational language? Problem and goal formulation in family therapy with adolescents conducted in a psychiatric outpatient setting

The constructionist view assumes that therapy participants' maps of understanding depend on the institutional context and their personal perspectives. The purpose of this study was to investigate the initial maps of difficulties reported by family members starting family therapy. 106 families that were referred to a psychiatric institution for outpatient family therapy were asked open-ended questions regarding the context of the referral, and goal and problem formulation for the therapy. The data were analysed via the consensual qualitative research-modified (CQR-M) method, and comparisons between groups were performed. The obtained results show a diversity of perspectives. Of interest was the predominance of medical language in describing the problem and relational language in describing the goal of therapy. An analysis of differences between mothers, fathers, adolescent patient and their siblings was also performed. The findings highlight the complexity of notions that families start family therapy with and may help therapists navigate through the therapeutic contract formulation process.     

Family Forms and Member Well-Being: A Research Agenda for the Decade of Behavior

Few institutions have changed as much in the past quarter-century as have American families. What are the factors affecting change? What are the conditions under which different family forms might best serve the interests of their members? What further changes are required? In this paper societal inequalities manifested within and between two family forms, heterosexual marriage and single-parent families, are reviewed, and a research agenda to assess the conditions under which these different family forms might best serve the interests of their members is posed.     

Family Members as Boundary Managers: Behaviors that Promote and Limit Service Members’ Involvement in Daily Family Life

When military service members deploy, they move outside the immediate boundary of their families. However, because boundaries are permeable, service members remain a psychological part of their families in spite of their physical absence. The extent of service members’ continued involvement in daily family life is likely tied to their non-deployed family members’ actions to manage this boundary. In the current study, we were interested in identifying non-deployed family members’ actions to either promote, or limit, service members’ involvement in daily family life during deployment. These actions by family members constitute boundary management behaviors. We collected qualitative data from a sample of Army reservists (N = 13) and their household family members (N = 15). Findings indicated that family members used a variety of boundary management behaviors during deployment, some of which promoted reservists’ involvement, and others which limited it. In addition, boundary management behaviors varied by who they targeted, their intentionality, and their implications for reservists’ well-being. Findings illustrate the value in equipping military families with language that enables them to communicate openly about the significance of their boundary management behavior over the course of deployment so that they may arrive at a balance between stretching and restricting boundaries that best suits their unique needs.     

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.     

The evolution of family interventions for schizophrenia. A tribute to Gianfranco Cecchin

Family intervention for schizophrenia has informed the whole history of family therapy, although in different fashions. This presentation will deal with the main phases of such intervention, outlining the characteristic features of each one. We can roughly divide the history of family intervention for schizophrenia into four phases: Phase 1 – Conjoint family therapy (1955–1965). Family interventions were aimed at modifying family communication patterns, implying the possibility of a definitive resolution of psychopathology. Phase 2 – Antipsychiatry (1965–1975). This, rather than a treatment model, was a philosophy of psychiatry, which considered schizophrenia as an epiphenomenon of the distortions of Western society. Family treatment was aimed at promoting the awareness of such a dynamic. Phase 3 – Milan systemic therapy (1975–1985). The systemic model was aimed at helping people with schizophrenia to recognize their position within their families (and other significant systems), giving all family members a new sense of their relationships to each other. Phase 4 – Psychoeducation (1985–2005). In most psychoeducational models, schizophrenia was conceived of as a biologically determined disorder. Psychoeducation was a way of helping the not diagnosed family members to cope with problems brought about by the illness, eliciting consensus towards psychiatric treatments such as medication and rehabilitation. A fifth phase of family intervention for schizophrenia is probably developing right now. If this is happening it should probably be an integrative phase, in which different approaches to family dynamics might be bridged and blended, in order to give more effective help to all members of families with schizophrenia.     

Perception of Cognitive Ability in Families of Adolescents

The families of 20 hospitalized adolescents were compared with a control group of 20 non-pathological families on the accuracy with which family members could predict each others' performance on two tests of intellectual ability. Accuracy of prediction was measured by the discrepancies between actual scores obtained by each family member and the scores other family members predicted he or she would obtain. The control and experimental groups were found to differ significantly on socioeconomic status and intellectual ability, and when these variables were controlled, a covariance analysis revealed no significant difference between the groups on accuracy of predictions. The results suggest that variables other than psychopathology must be taken into account in explaining apparent differences between healthy and disturbed families on measurements of interpersonal judgments. Implications for research and family therapy are discussed.     

Qualitative Research in Marriage and Family Therapy: Who is in the Interview?

Qualitative interviews are a rich means of gathering information from families. The qualitative interviewer has a choice of interviewing individual family members, multiple family members at the same time, or a combination. The configuration of interviewees is a choice guided by the epistemology of the researcher, research aims, and questions. This article reviews the literature on interviewing different configurations of family members. A content analysis was conducted on articles in the marriage and family therapy literature from 1990 to 2005. Over half of the articles were conducted with individual family members separate from their families. This finding is discussed in the context of the decision regarding whom to interview.     

Lesbians, gay men, and their parents: family therapy for the coming-out crisis

It is considered psychologically healthy for lesbians and gay men to come out and live outside of the closet. However, parents tend to react with shock, disappointment, and shame when they learn of a son's or daughter's gay sexual orientation. Disclosure often precipitates a painful family crisis, which can lead to cutoffs between members. This article describes family therapy theories and interventions that can aid therapists in sheparding families through the initial stages of the coming-out crisis. Family therapists are advised to acknowledge and address the distinct emotional needs of coming-out individuals and their parents. Parents must grieve and obtain accurate information about gay lifestyles. Lesbians and gay men need support as they struggle to cope with their parents' negative reactions. Family members should be coached to maintain non-combative communication following the disclosure, even if contacts are initially brief and superficial. Case examples, drawn from the author's clinical work, will demonstrate how to address the separate needs of lesbians, gay men, and their parents while maintaining (or rebuilding) family relationships and ultimately guiding families toward successful resolution of this crisis.     

Intrafamilial Separations in the Immigrant Family: Implications for Cross-Cultural Counseling

A structural family therapy (SFT) approach is combined with the paradigm of acculturation to increase counselors' sensitivity to a subcase of immigrant families, namely those whose members arrive at different times in the United States. The focus is on those families in which parents have preceded children in the immigration experience, which creates the challenging scenario of parents being more adapted to the host culture than their children. Written primarily for family counselors working with immigrant children and their parents, the article provides culturally sensitive counseling strategies based on a structural conceptualization of families, as well as suggestions for future research directions.     

What we say we do: results of the 1997 UK Association of Family Therapy Members Survey

This study represents the first UK national survey of family therapists and systemic practitioners. The aim was to provide demographic information of systemic practitioners/family therapists and also to describe their clinical practice. The sampling frame used was the UK Association of Family Therapy membership list and all members were sent a postal questionnaire. The response rate was 33% with 495 out of 1500 questionnaires returned. Among the major findings were: systemic practitioners/family therapists are most likely to work for an NHS trust, to use family therapy techniques/systemic ideas predominantly, and to treat a broad range of client issues. They are also most likely to work with families, and therapy is relatively short term (five to eight sessions) regardless of whether they treat families, couples or individuals. Most family therapists/systemic practitioners use some measure of outcome, although frequently this will be feedback from clients. Supervision is sought by the majority of AFT members. In spite of some methodological limitations, the study provides interesting insights into the training and practice of UK family therapists and systemic practitioners which appears to differ in some respects from our American colleagues. It also provides a baseline for future surveys, making it possible to describe the developments of family therapy and systemic practice in this country.     

Empowering chronic headache sufferers

Chronic headache pain affects sufferers and their families. Many headache sufferers lack self-discipline in controlling their headache pains. Although preventive medication is a must, medical treatment which excludes psychotherapeutic intervention reduces its effectiveness. Sufferers report increased tensions and stress with members of their families. This article reports on a program which includes headache sufferers' involvement in both family and individual therapy activities in a clinical setting. The role of the family therapist is primarily to encourage and empower sufferers to become involved in activities which can promote and increase communication, trust and self-confidence, leading toward a development of skills which can enable sufferers to utilize positive coping strategies in their effort to control headaches.     

Critical consciousness, accountability, and empowerment: key processes for helping families heal

Families are inextricably embedded within their larger sociopolitical contexts, an observation acknowledged by many theorists. The field of family therapy is working on its translation into comprehensive and effective approaches for helping families change. This article illustrates the use of the Cultural Context Model to help families change, guided by the linked foundational concepts of accountability, critical consciousness, and empowerment. The authors support their discussion of theory with examples illustrating the ways in which social patterns connected to race, gender, class, and sexual orientation shape the dilemmas that family members encounter, as well as their access to solutions.     

‘The experiencing of experience’: a Pragmatic reassessment of Rogerian Phenomenology

This paper draws on a study that asked twenty family users about their first session of family therapy. Analyses of the interviews indicated that families entered therapy with a pre-existent knowledge about therapy, which did not always chime with those of professionals and which positioned speakers in ways which governed their expectations and perceptions of therapy. This paper, therefore, is concerned with the acquisition and deployment of knowledge: specifically, the knowledge involved in being a user of family therapy. Three key discourses were identified through this analysis: medical, counselling and consumerist. We aim to illustrate how these discourses served as a resource for members of the family in constructing therapists, therapy and themselves in relation to their experience. The examination of the rhetorical, ideological and practical effects of the positions chosen and the objects constructed, in terms of how speakers wanted to present themselves, with what enhanced or diminished status as patients, shows users actively engaging with the power of therapeutic institutions. Users’ accounts suggest that while most speakers felt anxious about the prospect of therapy, there were clear differences in overall satisfaction/dissatisfaction with the experience according to the synchrony between speakers’ construction of the therapist, and themselves as client/patients. Those who seemed to take a traditional view of therapy within a medical discourse valued therapists who offered diagnosis and a cure; those who sought and experienced a counselling relationship with the therapist found their experience to be constructive in terms of enhanced self-knowledge. We believe that the research findings discussed in this paper have implications for family therapists in accommodating to parental and child positions to maximise the effectiveness of therapy and so minimise drop-out.     

Enlisting family support in drug treatment

Drug abuse programs often experience difficulties involving clients' families in treatment. This article describes general principles and specific techniques for recruiting family members in drug abuse programs and in other treatment settings. Stanton and Todd's principles of recruiting for family therapy in drug programs generally apply, adapted to a project that involves only one family member in multifamily groups and provides psychoeducational training rather than therapy. Additional principles include: focusing on family members who live with the client, tailoring recruitment to the needs of individual families, emphasizing how the family member will benefit, addressing resistance directly, helping families to build a support network, and informing family members of what is expected of them. The psychoeducational approach shows promise as a beneficial adjunct to client-focused treatment and as a gateway to more extensive family treatment.     

Experiential Activities in Family Therapy: Perceptions of Caregivers and Youth

Novel and creative therapeutic modalities have been developed in an effort to increase motivation in family therapy for adolescents and families. Many of these approaches incorporate experiential activities or “family play”, which provides a supplemental approach to traditional talk therapy. Incorporating experiential activities into family therapy sessions has been shown to increase engagement and enhance participation in therapy. Therefore, to understand how families view experiential activities within family therapy, we interviewed nineteen adolescents (age 12–17) and their parents/caregivers who were receiving family therapy augmented with experiential activities. We asked a series of open-ended questions to understand the families’ experiences concerning how they initially felt about participating in family therapy and their perceptions of the experiential activities. The activities involved experiential interactions and skill-building exercises that elicited active participation from all family members and encouraged further discussions. Topics of these activities focused on problem areas the family had identified, such as anger management, problem-solving, improving communication, substance use, expressing feelings, coping, etc. Results showed that most caregivers and youth found the experiential activities helpful in creating positive family interactions and developing communication skills. Caregivers and adolescents noted that the activities increased their desire to participate in family therapy sessions and they were more motivated to engage in the treatment process. Clinicians using the methods discussed in this intervention should be aware of the study’s limitations. Implications for clinical practice and research are discussed.     

Beyond Bipolar Thinking: Patterns of Conflict as a Focus for Diagnosis and Intervention

Most family typologies in the history of family therapy organized the observation according to bipolar scales. The implied assumption of such models is that the attribution of the one observational characteristic is inevitably bound to the negation of its opposite characteristic. This article presents a formal observational schema that has the possibility to grasp contradictory, conflicting characteristics. Using this schema, one can develop a clinically relevant family typology, making distinctions between different patterns of interaction by which conflicts and antagonistic tendencies in families are organized. Clinical observation and experience suggests that one can distinguish families with members with psychosomatic, manic-depressive, and schizophrenic symptoms by the way they overcome conflicts and ambivalence.     

Couple and family therapists’ experiences with Telehealth during the COVID-19 pandemic: a phenomenological analysis

In designing this study, we aimed to obtain a rich, phenomenological understanding of the experiences of couple and family therapists who transitioned their practice to telehealth due to the COVID-19 pandemic. Twelve experienced therapists from the U.S., Spain and Australia were interviewed in depth about their experiences of this transition, particularly how they developed and maintained therapeutic alliances in a virtual context with couples and families suffering pandemic-related hardships. The qualitative analysis identified 40 themes reflecting participants’ initial impressions of telehealth and their positive and negative reactions and adjustments to practicing remotely. Upon overcoming some initial wariness about providing services virtually, many participants described advantages to this way of working with families. Indeed, participants were creative in adjusting to this novel therapy modality, finding new ways to connect emotionally with their clients, to work meaningfully with children, to assess in-session dynamics, and to ensure their clients’ privacy and safety. Notably, several participants commented on the relatively slower development of alliances with new cases and the challenge of repairing split alliances between family members. Many of these difficulties were described as due to having minimal access to their clients’ raw emotions and the inability to use typical systemic interventions, such as moving family members around physically. Participants also reflected on being a “participant observer” to the upheaval caused by the pandemic, a distressing experience they shared with the families in their care.

     

Families Leaving Family Therapy After One or Two Sessions: A Multiple Descriptive Case Study

A multiple case study design was used to discover something of the experiences of families, therapists, and members of the reflecting team of the first and or second session of family therapy in an attempt to answer questions regarding why families drop out after only one or two sessions. It was found that the families attending these sessions found them to be ineffective in assisting them to re-author the stories of their lives. There many reasons for this being the case.     

A Mother-Child, Multiple-Family, Counseling Program: Procedures and Results

The purpose of this study was to determine the effects of a family counseling program on the following variables: (a) parents' family satisfaction, perceived integration, and family congruence; (b) the number of positive and negative responses communicated among family members; and (c) an undesirable behavior exhibited by one child in the family. The sample consisted of 14 families in the experimental condition and 11 families in the control condition.
Mother and one child had responsibility for teaching other family members the principles taught during the multiple-family category sessions.
The findings indicated: (a) parents receiving family counseling increased significantly their family-satisfaction and perceived-integration scores as compared to the parents not receiving counseling; (b) families receiving counseling increased significantly the number of positive responses among them compared with the control families; (c) children receiving counseling decreased significantly the frequency of exhibiting a specific undesirable behavior; and (d) no significant differences were found between the groups of families in parents' family-congruence scores and in the number of negative responses communicated among family members.