Using masks as therapeutic aids in family therapy

'Man is least himself when he talks in his own person, give him a mask and he will tell the truth' (Oscar Wilde).
This paper describes an innovative technique which uses masks as therapeutic aids in treating families in conflict. Structured within the framework of interpersonal perception, this technique uses play, humour, and the power and 'magic' of masks paradoxically to 'unmask' family members and facilitate reality-testing of perceptions distorted by the emotional masks individuals create and project onto each other. Mask usage is suggested as an adjunct to other therapeutic approaches currently used with families. Caveats and contradictions for the technique are presented. A case study illustrates the use of the technique with a reconstituted family.     

Simulation as a tool in family therapy research

The efficacy and validity of simulation for purposes of training and evaluation are well established. Simulation has proven valuable in human behaviour research as well. However, based on the belief that families and other small groups behave differently, many family theorists have concluded that simulation may not be valid for family research despite the fact that some empirical studies showed little difference between simulated and actual families, suggesting that the disparity may not be as great as commonly believed. Ongoing and future studies controlling for 'time together', a dimension presumed to be critical in comparing simulated with actual families, may demonstrate that differences are not sufficiently large to preclude the use of simulated families in family research. Methodological problems are addressed and directions for future research proposed.     

Research as a family therapy intervention technique

The utilization of the research process as an intervention has recently been described in the family therapy literature. However, it is important to draw a distinction between research as intervention and research as a unique family therapy intervention technique. From a family systems perspective, research as an intervention technique may make therapy more palatable for some families. A case study is presented in which this technique created the context for change for a family involved in a chronic illness research project.The author would like to thank Dr. Wendy L. Watson for her participation as a member of the clinical team and Drs. Fabie Duhamel and Wendy L. Watson for their helpful critiques on earlier drafts of this paper.Supported by a grant from the Albert Foundation for Nursing Research.     

Using relational reflexivity as a resource in teaching family therapy

In this paper we talk about creating coherence and transparency in the relationships between teacher, model of adult learning and subject taught. We describe how we have made connections between adult learning theory and family therapy to generate resources for action in teaching on the qualifying level course at Northumbria University. Using a recent teaching session and the voices of trainees, we illustrate these connections with an example of teaching about relational reflexivity, using methods which enabled us to generate reflexive ‘flow’ in the learning context.     

Countertransference as a corrective emotional experience in existential family therapy

An existential approach to family psychotherapy should be cognizant of both individual human development and family life cycle growth. In Existential Family Therapy a family developmental challenge often occurs when the developmental progression needs of one family member challenge the pace of total family developmental progression. In such a situation intervention by the therapist should occur in a way that facilitates both individual and family developmental growth. Such interventions often best occur through the creative and controlled use of the family therapist's countertransference feelings in a way that helps the family accept and master its developmental challenges. Case material is provided to illustrate the described intervention approach.     

The family as its own reflecting team: a family therapy method

Social research has suggested that people, in general, tend to overestimate their skills and abilities. Interestingly, research has found that peers are better predictors of a person's behaviour than self‐assessment, suggesting that others know us better than we know ourselves. Family therapists should be aware that family members might not give accurate accounts of themselves. In order to overcome this problem, therapists should incorporate peer assessments into therapy. Reflecting teams and videotaping do incorporate peer assessments, yet these methods can be impractical. This article describes a method of family therapy using enactments as a means of setting up the family as its own reflecting team. The method suggests that the family and therapist switch roles several times during the enactment, and then encourages a discussion on the peer observations on how each person addresses a problem in the family. Case examples illustrate how feedback from peers promotes insights.     

Observing the therapeutic alliance in family therapy: associations with participants' perceptions and therapeutic outcomes

Positive and negative alliance‐related behaviours of thirty‐seven families seen in brief family therapy were rated from videotapes using the System for Observing Family Therapy Alliances ( Friedlander et al., 2006b ). Positive associations were found between in‐session behaviour and participants' perceptions of the alliance and improvement so far both early (session 3) and later in therapy (session 6). Binary logistic regression showed that successful outcomes (defined as consensus by therapist and all family members on general improvement and reduced problem severity) were significantly predicted by positive individual behaviour (Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System) in session 3 and productive within‐family collaboration (Shared Sense of Purpose within the Family) in session 6. Shared Sense of Purpose was the alliance indicator most consistently associated with clients' and therapists' perceptions of therapeutic progress; moreover, it was the only alliance indicator to improve significantly over time in treatment.     

Videotaped simulated families as a tool in family therapy outcome research

Twenty-two therapists who had treated 57 families in brief conjoint family therapy under supervision responded to a videotaped simulated family as if they were treating it. Their responses were audiotaped and coded on a system devised for this study. Positive relationships were found between the ratings of expertise based on the coding system, and independent ratings of the treated families' satisfaction with treatment and the status of the presenting symptoms 6 months after termination. Videotaped simulated families are potentially useful as standardizable methods of revealing individual differences in therapists for family therapy outcome research.     

Videotaping as a therapeutic tool in psychodynamic infant– parent therapy

This paper describes an infant–parent therapy technique that involves the videotaping of the sessions, with subsequent reviewing and discussion with the mother. The technique has been designed as a part of psychodynamic therapeutic work with infant–parent dyads. It is based on a concept of the centrality of maternal past and current experience and associated representations in the pathogenesis of the relational pathology. Videotape replay provides an accelerated access to early maternal memories and promotes enlightening awareness of the links between maternal past experience and present behaviors with her child, which can lead to insight and therapeutic change. The technique advances the development of the therapeutic alliance and thus facilitates successful use of other dyadic treatment modalities that can be used along with psychodynamic therapy. It lessens maternal feelings of being criticized by a therapist and, therefore, can be helpful when the maternal ability to develop a trusting relationship with a therapist is of particular concern. Pertinent theoretical and practical issues are discussed. The method is illustrated by excerpts from therapeutic work with a six‐month‐old boy and his mother. © 2000 Michigan Association for Infant Mental Health.     

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.     

Concomitant group therapy with anorectics and their parents as a supplement to family therapy

A study was made of family therapy with anorexia nervosa patients in a child psychiatric outpatient department. Eight families referred in 1984 were offered group therapy and family therapy simultaneously, one group for patients with anorexia nervosa and one group for their parents. The participants of both groups reported that they had learned a lot from the experience but stated that they felt group therapy could not replace family therapy.     

Family of origin as a therapeutic resource for adults in marital and family therapy: you can and should go home again.

This paper presents a general method of involving adults who are in marital and family therapy in sessions with their family of origin, offering a clinical application of the author's depth theoretical orientation. The method is based on the thesis that current marital and family difficulties are elaborations of relationship problems of the spouses in their original families. If adults are able to go back to deal directly with past and present issues with their families or origin, an opportunity exists for reconstructive changes to come about in their present family. This present work is compared with Bowen's methods. Procedures are outlined for preparing for these sessions and for overcoming resistances. Typical courses these sessions tend to take are described, and some preliminary results are presented. Several case histories are presented, and theoretical and clinical implications of this method are discussed.     

Play therapy as a family restructuring technique: A case illustration

This paper presents a general treatment approach which uses play to integrate individual and family psychotherapy when working with young children as identified patients. Play therapy techniques are explored with regard to their potential impact upon a family system. Perspectives on concurrent and conjoint family oriented treatment using play are discussed with a focus upon achieving both individual and family system growth.     

Sequential analysis as a method of feedback for family therapy process

Abstract

The purpose of this study was to examine the relationship between therapist verbal behavior and family cooperation and resistance during the second session of family therapy with juvenile delinquents. Sequential analysis was used to investigate the impact of one therapist's behavior on family resistance and cooperation in a sample of 12 families. The results of the sequential analysis revealed that therapist “support” and “teach” behaviors were associated with significant increases in the likelihood of family cooperation. The study provides an example of how sequential analysis can be used to inform family therapists about the impact of their behavior on families.     

Orthodoxy in family therapy practice as servant or tyrant

This paper considers some of the pitfalls of a single-model approach to family therapy. It does not argue a 'right' way of practising family therapy, but proposes that the therapist needs to have available a range of approaches on which to draw. This also raises certain problems for training in family therapy, which are highlighted. A case is discussed in the light of a number of perspectives, to demonstrate how approaches can be used in complementary fashion. Finally, reference is made to some of the agency constraints which also make it difficult to practise any one model in a 'pure' form.     

The family therapist as a change agent: Using principles and strategies of organization development in family therapy

Abstract

Families are compared to work organizations from a systems perspective, establishing parallels in needs for change and growth. The theoretical underpinnings of Organization Development (O.D.) are reviewed and discussed in light of their use in conceptualizing family therapy. From this systems viewpoint, the consultant role, systems diagnosis and a variety of O.D. interventions are proposed to the family therapist.     

Rationale and directions for an increased emphasis on the therapeutic relationship in family therapy

This paper argues the need for an increased emphasis on the therapeutic relationship in family therapy. The ways in which the field of family therapy has eschewed the importance of the therapeutic relationship are discussed. Therapeutic alliance research from the field of individual psychotherapy and research on the importance of relationship factors to family therapy are reviewed. Suggestions for family therapy theory, practice, and research are presented.An earlier version of this article was presented at the 1992 Western Canadian Conference on Family Practice.     

An exploratory study into how a sample of a British South Asian population perceive the therapeutic alliances in family therapy

There is currently little research on the therapeutic alliances in family therapy, and even less on those from minority ethnic backgrounds. This paper reports on how British South Asians attending family therapy perceive the alliances, and compares this to the constructs of a newly developed tool – the System for Observing Family Therapy Alliances. Nine participants were interviewed and thematic analysis was employed to analyse the data. The results suggest that certain aspects of the alliances may need more attention when working with this ethnic group. These are safety in front of the therapist and emotional connection to the therapist (including feelings towards the reflecting team and consideration of ethnically matching therapist and client). In general, the quality of the alliance is seen as more important than employing culturally specific techniques. The implications for diversity and family therapy training are discussed.