Family therapy with delinquents: a critical review of the literature

A critical review of the theoretical and outcome studies on family therapy with delinquents is presented. Assessment of the theoretical developments reveals that families of delinquents may be distinguishable from other families by their interactional sequences and processes. The available outcome studies within the field indicate that family therapy is viable for interventions with this population, with behavioral, structural, strategic, and communication approaches receiving the most support, but more specific and robust evidence is still needed. Trends in the research and critical issues are identified and used to provide suggestions for future research and practice.     

Coming to terms with coming out: review and recommendations for family systems-focused research.

For lesbian, gay, and bisexual (LGB) adolescents and young adults, coming out to family members, especially parents, is a major psychological decision and hurdle due to both perceived fears and actual negative consequences. But beyond the literature on factors associated with the decision to come out and parents' initial reactions to the disclosure, empirical studies of what unfolds afterward, and how the family adjusts to the LGB adolescent's identity over time, are sparse and scattered. This article reviews and integrates findings from studies of the individual-, dyadic-, and family-level variables associated with positive outcomes, focusing particularly on relationship variables. Methodological concerns within this body of research are discussed, and research recommendations are offered. A preliminary working model of how families successfully come to terms with coming out is proposed to guide future research that will advance theory and clinical work with LGB youth and their families.     

Building a research base for community services for children and families: What we know and what we need to learn

We examine the knowledge base for community-based mental health services for youth and their families. A brief historical perspective on the development of community services is presented, and the fundamental components of a comprehensive child mental health service system are described. Outcome studies for service components as well as the service system as a whole are summarized. Research related to the context of treatment, i.e., service setting, cost, is presented. The authors conclude that a research base for child and family services is emerging, but there is still a paucity of well designed studies that address the complexities of a community-based system as well as the critical outcome questions that need to be addressed. Finally, promising service system developments are described and recommendations for future research are presented.     

Involving family members in the treatment of OCD

This review focuses on previous research with families of adults and children with obsessive-compulsive disorder (OCD). Three primary areas of research are covered: (i) characteristics of family members and the family environment; (ii) the prediction of treatment response based on family variables; and (iii) the inclusion of family members in treatment. Much of the research supports a hypothesized model of family response to symptoms of OCD that ranges on a continuum from overly accommodating to overly antagonistic. Further research indicates that responses at either extreme of this continuum are associated with poorer response to both exposure and response prevention (ERP) and pharmacotherapy. Finally, results of preliminary treatment outcome studies suggest that family-based interventions aimed at reducing such responses and/or including family members in ERP as coaches or co-therapists may enhance patients' response to treatment. Based on current theory and research, suggestions for future research and general recommendations for involving family members in treatment are made.     

Introduction to the Technical Series: What is Science,and How Does It Help Us?*

Editor's Note: Readers trained in research have no need of a series of articles that introduce the value of the scientific method and the basic factors that comprise good research methodology. But readers who are primarily trained to do clinical work with families will find that today's healthcare environment increasingly requires that they be good consumers of research, as well as an increasing need for them to participate in studies of the models we wish to preserve. At a recent NIMH‐sponsored conference, a speaker lamented the probable demise of some of our more interesting family approaches because third‐party payers tend to support only evidence‐based interventions. Clearly, we need to be able to defend our practices, and understanding the value and essential components of scientific methodology and research studies is likely to become even more important in the future. This new series will attempt to provide an orientation for those of our readers who are interested. We welcome your response to these articles and your suggestions for future segments.     

Different Pathways to Juvenile Delinquency: Characteristics of Early and Late Starters in a Sample of Previously Incarcerated Youth

We examined the differences between early and late start juvenile delinquents in a sample of 531 previously incarcerated youth in Oregon's juvenile justice system. Data were analyzed with logistic regression to predict early start delinquency based on four explanatory variables: foster care experience, family criminality, special education disability, and socioeconomic status. Youth with foster care experience were four times more likely to be early start delinquents than youth with no foster care experience. Youth with a family member convicted of a felony were two times more likely to be early start delinquents than youth with no family felony. Implications for future research are discussed, as well as implications for practice and policy. We suggest that future studies examine differences between male and female delinquents, the effects of foster care on children, and interfamilial processes that facilitate criminal behavior. Efforts to support children and families at risk of abuse and neglect should be reexamined in light of the results of our study, which adds to the emerging knowledge base regarding the relationships between violence experienced in early childhood, and future criminal behavior.     

Partner Enabling of Substance Use Disorders: Critical Review and Future Directions

Substance use disorders affect not only the identified client but significant others as well. Dyadic and family dysfunction is typically associated with a family member's alcohol or drug abuse. One area of research interest based on clinical conceptions of these families is that of partner support or coping in response to the addiction. Female partners of male alcoholics have received much of this clinical and research attention, and have alternatively been labeled as codependents, co-alcoholics, or enablers. Broadening the therapeutic emphasis beyond the impaired individual underscores the systemic notion that a loved one's addiction necessarily affects spouses and partners, and that partner responses may in turn affect drinking or drug behaviors. The present article contrasts the enabling and codependency constructs, reviews empirical studies of enabling, and offers a conceptualization of partner responses to addiction that could enhance future research efforts and clinical applications in this area.     

Involving Family Members in the Treatment of OCD

This review focuses on previous research with families of adults and children with obsessive‐compulsive disorder (OCD). Three primary areas of research are covered: (i) characteristics of family members and the family environment; (ii) the prediction of treatment response based on family variables; and (iii) the inclusion of family members in treatment. Much of the research supports a hypothesized model of family response to symptoms of OCD that ranges on a continuum from overly accommodating to overly antagonistic. Further research indicates that responses at either extreme of this continuum are associated with poorer response to both exposure and response prevention (ERP) and pharmacotherapy. Finally, results of preliminary treatment outcome studies suggest that family‐based interventions aimed at reducing such responses and/or including family members in ERP as coaches or co‐therapists may enhance patients' response to treatment. Based on current theory and research, suggestions for future research and general recommendations for involving family members in treatment are made.     

Father Enrollment and Participation in a Parenting Intervention: Personal and Contextual Predictors

Fathers are an important, though often underrepresented, population in family interventions. Notably, the inclusion of ethnic minority fathers is particularly scarce. An understanding of factors that promote and hinder father participation may suggest strategies by which to increase fathers’ presence in studies designed to engage the family unit. The current research examined Mexican origin (MO) fathers’ involvement in a family‐focused intervention study. Participants included 495 fathers from eligible two‐parent MO families with an adolescent child. Individual, familial, and culturally relevant predictors based on father, mother, and/or child report data were collected through pretest interviews and included in two separate logistic regression analyses that predicted the following: (1) father enrollment in the study and (2) father participation in the intervention. Results indicated that higher levels of maternal education and lower levels of economic stress and interparental conflict were associated with increased father enrollment in the study. Rates of father participation in the intervention were higher among families characterized by lower levels of interparental conflict, economic stress, and Spanish language use. Results highlight the relevancy of the familial and environmental context to MO fathers’ research participation decisions. These findings as well as their implications for future research and practice are discussed.     

Pathways Between Social Support,Family Well Being,Quality of Parenting,and Child Resilience: What We Know

We contribute to the theoretical and research knowledge base regarding the pathways between parental social support, family well being, quality of parenting, and the development of child resilience in families with a child with serious emotional problems. Little conceptual development has been done that provides a theoretical framework for studying the relationships among these variables. We identify key findings from social support theory and research, including the impact of social support on family well being and the parents’ capacity to parent, and the experience of parental social support in families with a child with a disability. We review the constructs of family well being, quality of parenting, and child resilience. Further, we explain the pathways between parental social support, family well being, quality of parenting, and child resilience in families with a child with serious emotional problems. Key variables of the model and the nature of their inter-relationships are described. Social support is constructed as a protective mechanism with main and buffering effects that can impact family well being, quality of parenting, and child resilience at a number of junctures. The conceptual model’s implications for future theory development and research are discussed.     

Family Adjustment to Childhood Cancer: A Systematic Review

This systematic review integrates qualitative and quantitative research findings regarding family changes in the context of childhood cancer. Twenty-eight quantitative, 42 qualitative, and one mixed-method studies were reviewed. Included studies focused on family functioning, marital quality, and/or parenting in the context of pediatric cancer, were written in English, and were published between 1996 and 2009. Overall, qualitative findings show that families alter roles, responsibilities, and day-to-day functioning to accommodate the needs of children with cancer. Although some degree of family reorganization is normative, the extent and impact of these changes varies. Quantitative work shows that mean levels of family functioning (e.g., cohesion, flexibility) are similar between families facing cancer and normative or comparison samples. However, families follow different trajectories of improvement, decline, or stability in family closeness and marital quality. Parenting has received limited quantitative research attention, but qualitative work suggests that parents perceive deeper bonds with ill children and may spoil or overprotect them. Conclusions support future work examining the influence of family-level variables on the adjustment of individual family members.     

Coping with Stress in Families of Servicemen: Searching for “Win-Win” Solutions to a Conflict between the Family and the Military Organization

The objective of this research was to explore the coping patterns of servicemen's families with the competing demands of two institutions: the military organization and the family. The sample comprised one hundred career soldiers along with their families. The research instruments included individual interviews, a battery of questionnaires, and a role-playing task. Examination of the couple's joint coping modes yielded two major categories of families — families that were successful in their efforts to resolve the military vs. family conflict, and families that did not manage to reconcile the competing demands of these two domains. Within each of these two categories there were a variety of distinct profiles. To compare the dynamics of successful coping with less successful coping regarding the military vs. family conflict, a conceptual model was suggested. This model subsumes the antecedent variables (job issues, support network, and couple relationships); mediating variables (cognitive appraisal of conflict severity and coping potential, as well as actual coping strategies); and outcome variables reflecting the degree of adjustment to the military vs. family conflict.     

Trusting families: Responding to Mary Ann Meeker, "Responsive care management: family decision makers in advanced cancer"

Mary Ann Meeker's article admirably reminds readers that family members are involved in--or "responsively manage"--the care of relatives with severe illness in ways that run considerably beyond the stereotypes at play in many bioethical discussions of advance directives. Her observations thus make thinking about the role of families in healthcare provision more adequate to the facts, and this is an important contribution. There's reason to be worried, however, that one explicit aim of the article--to ease the standing anxieties that many clinicians and ethicists have about the reliability of family members as proxy decision makers--will be frustrated by its very success. Those already inclined to suspicion may tend to think that the more intricate and pervasive the ways in which families influence the healthcare decision making of their sick, the more chances they have for altering the connection between patients' interests and the actions of professional providers. To determine whether and when such alterations are something to be concerned about, we'll need to supplement a better grasp of the pertinent facts with a deeper sense of how human agency works and why we value it. We may also need some reminders about the defensibility of diverse moral understandings. Although both professionals and family members may profess an ethic that sets patients' interests above those of non-patients--as Meeker's own results suggest--any strict allegiance to such a framework may be more notional than normative--as her findings also hint. The actual working norms (among professionals, as well as within families) will likely be more complex, but not necessarily any the less defensible for that.     

Operationalizing Family Resilience: A Methodological Strategy

This article explores several research design and analysis strategies for examining family resilience, and presents a strategy argued to reflect the process-oriented nature of this construct. We advocate a quantitative, longitudinal strategy, sensitive to both the context of a family and the unique stressor being examined. Our strategy was tested with longitudinal data, assessing transitions relating to the birth of a first child. Challenges connected with this model are presented, as well as clinical implications and directions for future research. Identifying differing resilience trajectories which families exhibit in response to stress may aid in identifying factors instrumental in shaping those trajectories.     

One Roof,Three Generations: Grandparental Co-residence and Child Outcomes in China

This study examined the association between grandparental co-residence and child academic and behavioral outcomes using a sample from Shanghai, China (n = 1,763), and was built on two theoretical perspectives: intergenerational solidarity theory and the contextual model of family stress. These models integrate the impact of residential and relational proximity to grandparents on child well-being and underscore the importance of family context. This study also explored the moderating effects of family resources using proxies that prior theoretical and empirical studies have found to be important to such associations: family income, parental education, hukou status, and subjective social status. Results indicated that among families without co-residing grandparents, rural and low-income parents reported their children to have more externalizing behavioral issues than their respective urban and non-low-income counterparts. In addition, children who resided in poorly resourced families (i.e., low family income, low parental education, low subjective social status, or rural hukou status) tended to benefit from living with grandparents compared to their well-resourced counterparts in terms of lower externalizing and internalizing behaviors reported by teachers. These results do not negate the potential beneficial effects of living with grandparents for children in well-resourced environments. Implications for practice and policy, as well as future research directions, are discussed.     

Family interaction and communication deviance in disturbed and normal families: a review of research.

Recent family interaction studies are reviewed with an emphasis on looking for dimensions along which disturbed and normal families differ. Several areas of consistency in the literature were found, including: family coalition patterns, patterns of conflict, flexibility versus rigidity, family effectiveness and efficiency, and deviant styles of communication. It was concluded that several measures reliably discriminate disturbed from normal families and that one type of measure in particular is a reliable predictor of thought disorder in offspring. Implications for clinical practice and future research are discussed.     

Searching for a normal life: personal accounts of adults with schizophrenia, their parents and well-siblings

Using a life course perspective, the research examines personal accounts of adults with schizophrenia, and their parents and well-siblings from six families. Accounts of multiple members of the same family, including the family member with schizophrenia, are used to describe how families understand and accommodate life changes that result from the illness. Families describe the loss of a normal life as one of the most devastating aspects of schizophrenia. We present the personal and social losses described by adults with schizophrenia and their well family members, and document families' search for ways that their ill family member can achieve or maintain valued social roles. The concerns of well family members for the future of the ill family member and ways families contemplate transfer of care issues are described. Implications of the study for community research and action are discussed.     

Stress for families today

Rapid changes in family life have created enormous challenges and pressures on developing families - divorce, two working parents, disappearance of the extended family, unclear cultural values for our children's future, poorly defined support systems for stressed families, inadequate substitute care when both parents work-all contribute to an anxious atmosphere for young families. Parents who must return to work „too early”︁ (and we have no established standards yet for what this means to either child or adult development) seem to grieve about the loss of the relationship with the developing child. They may even set up defenses against making a strong and painful attachment. They may not become involved in the child's development in a way that will foster their own development as nurturing adults. The grieving and the necessary defenses against it are predictable and must be mitigated in order to foster nurturing adults within the family. Children must be provided with caring, intensely involved adults in order to assure their optimal future development. We must provide them and their parents with adequate substitute care. This paper suggests adjustments at the industrial level that must be made to foster parental involvement and to assure positive outcomes for future generations.     

Family Therapy in Outdoor Behavioral Healthcare: Current Practices and Future Possibilities

This paper highlights the role of the family in the treatment of youth who attend Outdoor Behavioral Healthcare (OBH) programs. It discusses the history of OBH, provides a critical overview of the research on the impact of OBH programs on family functioning, and discusses the importance of increased intentional integration of family therapy into OBH settings. To show this integration, this study presents a case study that highlights the role of the family, as well as the home family therapist throughout the phase of OBH treatment. Areas for future esearch are provided as well as suggestions for the increased utilization of adventure activities with families.     

Fortalezas Familiares Program: Building Sociocultural and Family Strengths in Latina Women with Depression and Their Families

The purpose of this article is to describe Fortalezas Familiares (FF; Family Strengths), a community‐based prevention program designed to address relational family processes and promote well‐being among Latino families when a mother has depression. Although depression in Latina women is becoming increasingly recognized, risk and protective mechanisms associated with children's outcomes when a mother has depression are not well understood for Latino families. We begin by reviewing the literature on risk and protective psychosocial mechanisms by which maternal depression may affect Latino youth, using family systems theory and a developmental psychopathology framework with an emphasis on sociocultural factors shaping family processes. Next, we describe the theoretical basis and development of the FF program, a community‐based 12‐week intervention for Latina immigrant women with depression, other caregivers, and their children. Throughout this article, we use a case study to illustrate a Latina mother's vulnerability to depression and the family's response to the FF program. Recommendations for future research and practice include consideration of sociocultural processes in shaping both outcomes of Latino families and their response to interventions.