The Anorectic Process in the Family: A Six-Stage Model as a Guide for Individual Therapy

This article presents a conceptual framework for individual treatment with chronic anorectic patients. In the first part of the article, the six-stage model for the anorectic process developed over the past years by M. Selvini-Palazzoli and her team is briefly explained. After presenting the model, we then discuss some related concepts, namely, "family game," "rule," and "strategy." Finally, the therapeutic technique in individual treatment is discussed. Two basic assumptions underlie this technique: first, the therapeutic relationship is instrumental, its main purpose being to improve the patient's personal relations outside therapy; second, the focus of the treatment is on the strategic incapacity of the patient who is caught up in and unable to cope with the "concealed family game."     

The Self-Report Questionnaire as a Change Agent In Family Therapy

Results of a recent study of the sexual behavior of a group of married couples indicated that the process of completing daily self-reports of sexual behavior induced changes in the activities measured. On the strength of these results and other reports indicating that self-monitoring may induce behavioral change, a procedure for using self-report questionnaires as agents of change for families in therapy was devised and clinically tested. Application of the procedure to a variety of clinical problems is described.     

Developing the Individual: Life Skills and Family Therapy

Two bodies of literature on life skills and on family therapy have developed from different sources but have interesting similarities. Life skills comes from training and educational thinking, and concentrates upon the skills of and strategies for coping. Family therapy focuses upon the disturbance of an individual as symbolic of the dynamics of the family, but has at its roots a more-or-less explicit model of what constitutes an effective family, where the interactions can be readily understood in life-skill terms. The two approaches are compared and contrasted.     

Individual,Marital, and Family Therapy

Two therapists have recently suggested that marital therapy is either a shadow of individual therapy (Robert Harper) or eclipsed by family therapy (Jay Haley). We offer an apologia for marital therapy. We suggest that empirical evidence shows that it works. Further, clients often request it and resist a redefinition of marital concerns as individual or family problems. Finally, people value a focus on the marriage because (a) it blends individual rights and communal responsibilities and (b) it is the only voluntary relationship between dyads with the family. We conclude that marital therapy, when requested and appropriate, is legitimate and effective.     

IV. A Family Group Therapy Technique for a Stalemate in Individual Treatment

Abstract

This paper explores the trend away from offering process-oriented groups on inpatient units, given decreasing lengths of stay, increasing acuity levels, and current biases toward psychoeducational groups and cognitive-behavioral treatments. A model for doing process-oriented groups that provides a structure while allowing a theme to emerge and maximal interaction to take place is presented. A case is made for the benefits of process-oriented inpatient groups as compared to, and complementary with, psychoeducational, cognitive, and behavioral approaches. Clinical vignettes illustrate typical themes and dynamics emerging in process-oriented inpatient groups.     

Charting as a Multipurpose Treatment Intervention for Family Therapy

This paper discusses the behavior modification technique of charting as a double-bind communication. Though the procedure was initially employed as a step in demonstrating operant conditioning ( 7 ) and later in diagnosis of the antecedents and consequences maintaining undesired behavior ( 8 ), it also proved one of the more powerful therapeutic interventions. Literature reviews on treatment programs for obesity ( 6 ) and behavioral approaches to marital therapy ( 2 ) support this contention. Its efficacy can be explained by integrating the viewpoints of behaviorist and family therapy approaches espoused by Haley ( 4 ) and Weakland et al . ( 9 ). Following are brief case reports in which charting resulted in quick and sometimes dramatic change.     

Understanding Forgiveness as Discovery: Implications for Marital and Family Therapy

This article explores the concept of forgiveness in relationship systems and examines various conceptualizations and definitions found in the literature. Forgiveness is described as a complex psychological and relational process that is more a discovery than an act of will. A rationale for viewing forgiveness in a contextual, historical, and relational attachment paradigm is presented, and the association of forgiveness with empathy and emotional intelligence is discussed. Marital and family therapists are encouraged to attend to contextual family of origin issues and to facilitate an empathic relational environment where ambivalence is expected and tolerated for enhancing the process of forgiveness. Relevant clinical cases are shared to illustrate the process of forgiveness as discovery.     

Case Report: Object Relations Family Therapy as a Model for Genetic Counseling

Object relations family therapy (ORFT) is a psychoanalytically based approach for the treatment of couples and families which stresses the importance of past relationships. The therapist assumes a parentlike role and provides a holding environment in which clients can explore unconscious motivations. This paper will discuss the applicability of this method to genetic counseling. The case of a couple seen for recurrent trisomies will be presented and used as an example to discuss how ORFT might serve as a framework in a genetic counseling session.     

Defection, Termination, and Continuation in Family and Individual Therapy

Patients applying to a child study center over a period of one year were referred for either individual or family evaluation and therapy. The present study focused on comparative rates of defection (failure to appear for first session), premature termination (one to three sessions), and continuation (more than three sessions) of treatment. Structured interviews were conducted on the telephone to explore the reasons for termination or continued treatment. Three main findings emerged: (a) Drop-out rates for family therapy are significantly different than for individual treatment; (b) Major reasons for terminating or continuing treatment, in either modality, seem related to patients evaluations of their therapists; (c) Fathers of patients play a pivotal role in determining whether families terminate or continue in treatment.     

Family Therapy and Alternative Medicine: Acupuncture as a Case in Point

Collaboration between family therapists and alternative medicine practitioners is recently cultivated ground that may prove to be fertile territory for the application of family therapy skills. Acupuncture and family therapy are two healing practices that differ in cultural tradition, language, and technique, yet they appear to share some underlying assumptions suggestive of a natural alliance in helping people with a variety of biopsychosociospiritual problems. This paper describes the process of interdisciplinary collaboration between an acupuncturist and family therapist via a clinical vignette, identifying different types of referral situations, and suggesting factors of effective collaboration that can synergistically enhance a patient and family's treatment.     

Family Therapy in Trouble: Psychoeducation as Solution and as Problem

The authors cite clinical literature attesting to the importance of recognizing the family, rather than the individual, as the proper locus of conceptualizing, diagnosing, and treating mental illnesses. Specifically with regard to severe psychiatric illnesses, in particular schizophrenia, family dysfunction contributes to the emergence of the illness, significantly affects its course, and strongly influences the achievement and maintenance of treatment gains. Currently, a movement is afoot to limit sharply the amount and kind of treatment offered to schizophrenic patients and their families. Rooted in a “medical model” or “biogenic” view of the etiology of schizophrenia, this school of thought prescribes psychoeducation as the family treatment of choice. The present article looks at some misconceptions regarding treatment that prompted a widespread turning away from psychoanalytically oriented family psychotherapy for schizophrenic patients and their families, examines the reductionism (biological and behavioral) inhering in the exclusive use of psychoeducation, and looks at the clinical dangers of such reductionism. Finally, it proposes that family psycho-therapists should not abandon a concern with the inner lives of severely ill patients and their families in the face of spuriously generalized claims made by reductionist researchers.     

Combined Individual/Marital Therapy: A Conflict Resolution Framework and Ethical Considerations

This paper illustrates how couple and individual treatment formats can be intertwined. A conflict resolution theoretical framework structures treatment around three goals: (1) relieving symptoms (anger, depression, and marital distress), (2) facilitating resolution of the couple's conflicts, and (3) building communication and conflict resolution skills. The literature review focuses on why combining individual and couple therapy is often important for married clients. Two Bicycles, an illustrative case incorporating both conjoint and individual interventions, is presented and analyzed with regard to when each format seems beneficial. Ethical and practical issues raised by dual format treatment include potential harm, informed consent, dual roles, confidentiality, and time and financial costs.     

Family Therapy for an Adult Child Experiencing Bullying and Game Addiction: An Application of Bowenian and MRI Theories

Bowenian theory and MRI family therapy model were chosen to treat a Korean male adult client whose symptomatic problems were bullying and game addiction. To test its validity of therapeutic effectiveness, the following case analysis methods were used: narrative analysis of interview contents, categorization of the nine sessions of verbatim, videotaping, and notes according to classified concepts (i.e., triangulation), and explanation using matrix and network. Results showed that low level of differentiation, patterns of emotional cutoff, and dynamics of triangulation were clearly present in this client. After MRI family therapy, changes were evident in perceptive references, communication patterns, stress-coping mechanism, symptomatic behaviors, and intra-family relationships.