Systemic Research on Chronicity Factors in Infantile Asthma

This work is the result of research into chronicity factors in infantile asthma. The research had two main goals. The first, using a sample of 100 asthmatic children, was to reconstruct the therapeutic history of the individual patients on the hypothesis that the therapeutic intervention they had undergone in fact conditioned the quality of the cure demand. The second was to evaluate the influence of family dynamics on the chronic development of infantile asthma. A comparison was made between two interactive models using a sample of 10 families with asthmatic children with chronic tendencies and a sample of 10 normal families. The results show that typical dysfunctional interactive patterns exist in the experimental sample and that they are correlated with the perpetuation of the asthmatic symptom. The paper concludes that every therapeutic intervention that is limited to dealing with the biological component of the asthmatic symptom and ignores the influence of family dynamics becomes itself a major chronicity factor. Thus a “systemic” intervention is considered necessary to prevent chronicity.     

A Typology of Ritual: Paradigms for Healing and Empowerment

Myth and ritual are the keys to collective and individual cognitive consonance. Because the postmodern cultural landscape is littered with “broken” myths, people need to learn how to birth viable symbols and create contemporary rituals. This article examines ritual from theoretical, clinical, and practical perspectives. Symbolic cognition and its relation to myth and ritual are discussed. A typology of ritual is abstracted from phenomenological sources. Examples of liberation, transformation, and celebration rituals are given. Elements commonly employed in ritual activity are identified as guides to ritual construction. Finally, suggestions are given concerning how to create powerful and effective personal rituals.     

Annotation: culture and family therapy

This annotation considers the importance of understanding culture for the theory and practice of family therapy. A number of theoretical approaches are described. Some are concerned with ubiquitous and universal family processes like the family life cycle, while others are concerned with the particularity of family life such as the content of myths and rituals. Some practical implications for the participants of the therapy, and the choice of therapeutic approach is discussed.     

Implementing Family-Based Musical Interventions in Family Therapy: A Mixed-Methods Research

Although rarely used by family therapists, musical interventions have the potential to become a more common technique in family therapy. Music’s unique therapeutic properties engage families, including young children and adolescents, in a meaningful, therapeutic, “here-and-now” creative process. Musical interventions act as catalysts, enable direct communication, and augment authentic communication patterns in a playful atmosphere. The purpose of this explanatory mixed-methods research was to obtain a greater understanding of the clinical applicability, therapeutic value and future implementation of a musical intervention carried out by family therapists in a family therapy context. The study explored the outcomes of 35 participating family therapists who attended a designated workshop on a structured family-based musical intervention, 18 of whom then applied 38 family-based musical sessions focused on family roles in their clinical work. The results illustrate the family-based musical intervention is a noteworthy tool for family clinical assessment and treatment, easily applicable in a variety of private and public settings with diverse populations. Musical instruments used as intermediary objects are potent vehicles for growing family awareness, functioning, and congruence, as well as inducing opportunities for change. The family-based musical intervention manifests the potential of an interdisciplinary, holistic, biopsychosocial approach to promoting individual and family wellbeing. The article also addresses ethical considerations and implications for family therapy training and education programs.     

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.     

Therapy with Refugee Families: What Is a “Good” Conversation?

This article addresses the question of what is a “good” conversation by analyzing “poor” conversations. During a project on family therapy with refugee families, we often experienced what we labeled as “poor” conversations. We present examples of a variety of such conversations, which we then analyze with reference to therapeutic maps and central concerns of the therapists. We describe four patterns of therapist/client relationships that emerged from this analysis. The main focus of our discussion is to clarify when “poor” conversations may be an important part of the therapeutic process, and when and how they should be avoided. We believe that the issues we raise are central to therapeutic work in general and not just to therapy with refugee families.     

Relationships between adult attachment representations and family ritual quality: a prospective, longitudinal study

Meaningful family rituals have been associated with positive outcomes for families and children. No studies, however, have investigated predictors of family ritual quality, the identification of which would be important for understanding why some families create and enact meaningful family rituals while others lack rituals or have problematic rituals. We propose that adult attachment security may be an important predictor of family ritual quality because family rituals may provide a sense of stability and cohesiveness for the family. The purpose of this study was to examine relationships between adult attachment representations and the quality of family rituals, using a prospective, longitudinal design. Prior to the birth of their first child, 125 couples completed the Adult Attachment Interview, and a subsample of 70 mothers and 62 fathers completed the Family Rituals Questionnaire when their first child was 7 years old. Different patterns of relationships between attachment representations and family rituals were found for mothers and fathers. Maternal Insecure Attachment was associated with higher routinization of family rituals. Being in a couple with mixed attachment classifications (e.g., one Secure partner and one Insecure partner) was related to a pattern of low routinization and low meaning for family rituals. The results of this study are interpreted in terms of two patterns of rituals that have been described by clinicians--rigid ritualization and underritualization, and suggestions for working with these ritual patterns in families with Insecure attachment are provided.     

Dimensions of family rituals across two generations: relation to adolescent identity.

Family rituals are considered part of a generational process that fosters a sense of identity for individual members and is reflective of the family's shared belief system. The symbolic significance attached to family rituals is considered central to the force of family rituals. Three questions were addressed in the study: (1) Are the dimensions of family rituals viewed similarly across generations?; (2) Is level of ritualization related to adolescent identity?; (3) If there is disagreement about the relative level of ritualization in a family, is there a negative relation to adolescent identity? A total of 77 families with an adolescent member completed the Family Ritual Questionnaire, and the adolescents completed a measure of self-esteem. Results of a factor analysis demonstrated shared representation of family rituals across two generations, with one factor loading on the symbolic qualities of family rituals and the second factor loading on the routine aspects of family rituals. Positive relations were found between adolescent identity and the family's report of symbolic significance and affect associated with family rituals. A negative relation was found between mother-adolescent disagreement about family rituals and adolescent feelings of belonging. Distinguishing between meaning and routine aspects of family rituals is discussed as well as clinical implications.     

Family Ritual and Routine: Comparison of Clinical and Non-Clinical Families

Research demonstrates that the constructive use of family rituals is reliably linked to family health and to psychosocial adjustment. This study explores the relationship between family rituals and child well-being. Two samples participated: 21 families whose adolescent was receiving psychiatric treatment and 21 families in which the adolescent was a public school student. A parent and the adolescent were individually interviewed regarding family rituals and completed standardized measures of adolescent and family functioning. Analyses demonstrated that, in addition to significant sample differences in the expected direction on measures of functioning, the non-clinical families scored significantly higher on the index of family rituality than did the treatment families; this is additional evidence that family rituals are a correlate of child well-being. Further analysis of the data pointed to “people resources” as a robust dimension in its association to adolescent functioning. The role family ritual and routine plays in defining family relationships, both within the nuclear family and with other important adults, was significantly related to clinical status. This work may point to an important, yet overlooked, dimension of family ritual life, the relational qualities of rituals and routines.     

Characteristics of Schizogenic Families During a Joint Story-Telling Task

For a joint family story-telling task, families with a schizophrenic offspring were compared to normal families on the completeness and clarity of the final composite stories and on their interactional behavior. The composite stories from schizogenic families were more “vague and confused”, fragmented, and less complete as to the five components required to satisfy the task instructions. Schizogenic families displayed more conflict, failure, and confusion during the interactional task than control families, and, fathers and mothers of schizophrenic offspring displayed more “anxiety and tension”, “depressive mood”, “evasiveness” and “lack of interest” than fathers and mothers of normal families. Mothers of schizophrenic offspring were also described as more “hostile” than control mothers. Comparing schizogenic families from which the patient was absent during the task with schizogenic families with the patient present, and with control families, indicated that the central findings were not attributable to the immediate presence and participation of the schizophrenic member.     

Family routines and rituals in the context of chronic conditions: A review

This paper is a systematic review of 39 empirical studies on family routines and rituals in the context of a chronic condition of a family member. The search strategy encompassed a wide spectrum of chronic conditions affecting family members from childhood/adolescence to adulthood. Twenty quantitative, 13 qualitative, 3 mixed‐methods, and 3 intervention studies published between 1995 and 2012 were reviewed. A conceptual framework of routines and rituals as key elements of family health was adopted, resulting in three main findings. First, a chronic condition in a family member impacted the frequency and nature of family's routines and rituals. Second, these whole‐family interactions held important functions for individuals and families, constituting strategic resources in the condition's management and opportunities for emotional support exchanges, and providing the family with a sense of normalcy amid the challenges posed by chronic conditions. Third, family routines and rituals were linked to positive health and adaptation outcomes for both patients and family members. Implications for future research include the need for the distinction between routines and rituals against a conceptual background, use of validated assessment methods, and empirical examination of predictors of changes in routines and rituals throughout the course of the condition and of the mechanisms linking these family events to positive outcomes. Conclusions support the inclusion of routines and rituals in a family‐centered care approach to the understanding and treatment of chronic conditions.     

Children with Asthma and Their Families’ Viewpoints on Spiritual and Psychological Resources in Adaptation with the Disease

Recognition of the spiritual and psychological needs of children and their families with chronic asthma disease may be helpful in a successful coping with their problems in order to control over the condition. In a qualitative content analysis study, nine children with moderate to severe asthma and 10 parents were studied in order to discover the resources of compatibility of them. The participants were chosen purposefully and they were asked some semi-structure questions about their experiences. The spiritual and psychological experiences of the participants were divided into two main categories as follows: (1) contrive to religious-belief consisting of three sub-categories known as “religious rituals, believe in a divine predestination, and Islamic-based patience,” and (2) psycho-intellectual management that includes the five sub-categories of “psycho-intellectual attention, maintaining family’s mental peace, reduction in negative burden of disease, satisfaction from optimal treatment, and matching internal desires with disease conditions.” It is recommended that heath care providers by reinforcing parent’s and children’s religious and spiritual backgrounds and according to child’s cognitive development at this age provide a suitable foreground through necessary instructions for children and their families in order to spiritual growth and suitable adaptation with disease.     

Research & clinical exchange

Abstract

Question: I once heard Carl Whitaker say at a workshop that one of the greatest myths about marriage is the idea that “I didn't marry your family, I married you.” This makes me wonder when it would be appropriate to involve the families of the two people planning to get married, when the couple goes for premarital counseling.     

Families' medical myths

A medical myth is defined as a false or distorted belief regarding issues of health within a family. This empirical study considers phenomenology, function and origins of medical myths operating in some forty families encountered in the author's psychiatric practice. Therapeutic strategies found useful in re-editing the myths are described. Implications for the family/medical professional relationship are discussed.     

Cost Effectiveness of Strategies for Recruiting Low-Income Families for Behavioral Parent Training

The goal of this study was to assess cost, effectiveness, and cost-effectiveness of recruitment strategies used to engage low-income families of young children with disruptive behavior disorder to participate in a Behavioral Parent Training (BPT) program. For this analysis, we used data on labor and non-labor resources associated with 13 recruitment strategies implemented in February 2014 through February 2016. We assessed the effectiveness of each strategy as the number of families that enrolled into the study. Cost-effectiveness of each recruitment strategy was expressed as cost per family enrolled; analysis was conducted in 2016. We calculated the cost of total recruitment effort for 13 strategies during the 2-year period to be $11,496 with an average cost of $885 per recruitment strategy or $255 per enrolled family. Across strategies, total costs ranged from $25 to $2540. “University mass e-mail” and “school flyers” resulted in the most phone screens (34 each); however, only 10% of these families enrolled in the study (three and four families, respectively). “Craigslist” was the most effective strategy with 30 families screened and 11 of them enrolling. Three strategies did not yield any participants. The four strategies with the lowest cost per family enrolled were “Facebook page,” “Craigslist,” “university mass e-mail,” and “organization/agency” (<$90). In conclusion, we found that some recruitment strategies were more successful at engaging low-income families to participate in a BPT program than others. Our results indicate that using a combination of recruitment strategies may be the optimal approach for recruiting low-income families.     

English,Christian or Muslim Law: Deconstructing Some Myths

Archbishop Rowan Williams's 2008 lecture, “Civil and Religious Law in England: A Religious Perspective,” has become an historic reference point for discussions about relationships between Islam, religious law and English law. One of the Archbishop's heart-felt pleas was for “deconstruction” of myths about both Islam and the Enlightenment. Continued stereotypes perpetuated by the “Trojan Horse” debate over Birmingham schools and the aftermath of the Charlie Hebdo event suggest the plea went unheard. This article aims to address factors that prevent objective assessment of the relationship between English law, religious laws, Islam and other faiths. It is hoped that this will help the deconstruction of myths by examining what the law says, the claims religious communities make and whether further change is needed. The relationship of religious laws, norms and courts to secular legal systems is a pertinent topic for Christian–Muslim dialogue to which it is hoped that this article might contribute. Amongst issues considered are the scope for more formal recognition or monitoring of religious laws that have an impact on the lives of some UK citizens, and arguments for recognition on the basis that a democracy should reflect all parties to its citizenship and protection of the most vulnerable. As calls for further recognition of religious laws arise, the deconstruction of myths can only smooth the way for their objective assessment.     

Attitudes Toward the Continuation of Family Rituals Among Emerging Adults

In this study we examined college students' assessment of the personal meaningfulness of their families' rituals and their desire to initiate family rituals in the future. Participants were 46 male and 49 female never-married, primarily European American undergraduates at a private east coast university. It was found that women were more likely than men to see themselves initiating future family rituals. The amount of ritual initiation undertaken by participants' same-sex parents and participants' communality were significant predictors of reported likelihood of future ritual initiation. A “caring” parenting style was the only significant predictor of the meaningfulness of rituals. The relationships of respondents' religious and ethnic background and their parents' marital status to their attitudes toward rituals were also examined.     

Cognitive-Behavior Family Therapy: Contemporary Myths and Misconceptions

The field of couple and family therapy has grown in the direction of expanding its horizons by looking toward innovative ideas and whatever works to facilitate change. Despite its demonstrated track record with a broad range of behavioral and emotional disorders, the cognitive-behavior therapies (CBT) may have been underutilized by couples and family therapists unlike some of the more traditional and postmodern approaches. This article explores some of the basic tenets of the cognitive-behavioral approach with families and proposes it as both a useful intervention tool as well as a theoretically compatible model to systemic approaches. In addition, a number of contemporary myths and misconceptions are discussed that may be precluding CBT's utilization by therapists in the field.     

Engaging “Resistant” Families in Treatment

Many families, when presented with the option of family therapy, are less than eager to participate. This paper comprises the second and third parts of a series on engaging “resistant” families. ¹ 1 The first paper in this series, authored by J. M. Van Deusen, M. D. Stanton, S. M. Scott, and T. C. Todd, is entitled “Engaging “Resistant” Families in Treatment: I. Getting the Drug Addict to Recruit His Family Members” and appeared in the International Journal of the Addictions 15 (7): 1069–1089, 1980. A revised and expanded version of Part II is presented in M.D. Stanton, T. C. Todd, and Associates, The Family Therapy of Drug Abuse and Addictions New York, Guilford, in press.
Part II presents 21 principles and a number of techniques and strategies that have been developed for successfuly recruiting such families. These techniques should be applicable for engaging resistant families with all types of presenting problems. Part III provides an analysis of the important variables involved, along with data on cost efficiency and administrative costs. It was found that when therapists had administrative control of their cases, serving in dual roles as both therapists and drug counselors, the recruitment effort was (a) more effective (i.e., complete families, including both parents or parent surrogates, were recruited in 77 per cent of the cases), and (b) twice as cost efficient. Two-thirds of the non-engaged families were not recruited because the index patient would not allow family members to be contacted. Black families were more difficult to recruit than whites. Data on cost efficiency and on the actual administrative costs of recruiting families are also provided. We conclude that the engagement process requires a revision in therapeutic philosophy, since such families are often desperately in need of help but are unavailable unless therapists make a special effort to reach them.     

Value Patterns and Content among Families of Soviet Immigrants: SYMLOG Analysis

The purpose of this qualitative study is to understand and compare two immigrant families whose children perceived their families to be well-functioning, and two families whose children perceived them to be poor-functioning. The method of analysis used for studying the values of the families is based on SYMLOG. Four families, who immigrated to Israel during the early seventies from the former USSR, and whose adolescents were born in Israel, were interviewed. The results show that in the two “well-functioning” families, there is a high degree of consensus on their values — those that they accept, as well as, those that they reject. The two “poor-functioning” families did not exhibit identical value patterns — neither in the values that they favor, nor in those that they reject. In terms of content, in the well-functioning families, there was a strong expression of two values: friendliness and the desirability of self-sacrifice in order to reach family goals. In contrast, in the poor-functioning families, the value of conservatism was salient. Finally, all four families expressed strong opposition to the values of strong individualism and nonconformity. Suggestions for family intervention are offered.