Third‐Order Thinking in Family Therapy: Addressing Social Justice Across Family Therapy Practice

We contend that the field of family therapy is undergoing a notable shift from second‐ to third‐order thinking. We offer theoretical support and examples to demonstrate how third‐order thinking provides a framework for integrating heightened sociocultural attunement into family therapy practice. We discuss the importance of third‐order thinking relative to being prepared to invite families into third‐order change. Finally, we offer a case example to show specific guidelines for third‐order practice.     

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.     

Second-Order Change in Marriage and Family Therapy: A Web-Based Modified Delphi Study

Second-order change is a central concept in Marriage and Family Therapy, but still remains poorly operationalized. We conducted a web-based modified Delphi study with 31 established faculty members currently teaching in COAMFTE-accredited Master's and Doctoral programs in the United States and in Canada to identify consensus regarding second-order change concepts, clinical operationalization, evaluation, and teaching principles. Numerous exemplars of first and second-order change were generated, but consensus on most items was low. Consensus was highest for pedagogy and low regarding concepts and clinical examples of first-order change and evaluation of second-order change. Results suggest clearer definitions and better measurement of systemic change are needed.     

Constructivism and Family Therapy

Personal construct and family systems theories can profit from an exchange of ideas concerning the relationship between their personal and interpersonal aspects of construction. This article examines three possible points of contact between the two orientations. First, we suggest that personal construct psychology could profit from addressing the important contributions of the family context to the development of each individual's system. Second, we address the impact of the person's constructions on the larger family system. Third, we suggest that the family system itself develops a system of shared constructions that define and bind its identity and interactions. Each of these areas of interface carries implications for therapy, and specific intervention techniques corresponding to each of these are discussed.     

Feminism and Family Therapy

Feminism has had a profound effect on contemporary culture and on thinking in most academic fields, including psychoanalysis. Interestingly, until very recently it had made virtually no impact on the theory and practice of family therapy. This paper proposes an explanation for this peculiar phenomenon and argues that family therapy has been considerably handicapped by its insularity from the feminist critique. Utilizing feminist scholarship in psychoanalysis, history, and sociology, the paper analyzes the structural contradictions in family life that family therapists have essentially ignored and then outlines their clinical implications. Key points in the discussion include the argument that systems theory is an inadequate explanatory matrix from which to build a theory of the family, that the archetypal "family case" of the overinvolved mother and peripheral father is best understood, not as a clinical problem, but as the product of a historical process two hundred years in the making, and that power relations between men and women in families function in terms of paradoxical, incongruous hierarchies that reflect the complex interpenetration between the structure of family relations and the world of work. This conceptual model then provides the basis for an analysis and critique of sexual politics as they emerge in the prototypical clinical situation.     

Science and Family Therapy

Family therapists are being exhorted to adopt a social constructionist epistemology and to abandon science as a valid form of knowing. Epistemological objections to science are usually directed at 'positivism', an outmoded view that is largely discredited among practising scientists. Contemporary science, is rather, constructionist, differing from other constuctionist approaches only in ways of arbitrating between world views. Criticisms aimed at science apply to all forms of discourse, including family therapy. I conclude that science has failed family therapy at the practical, not the philosophical level.     

Insurance and Family Therapy

The advent of recent theories of family structure and socially shared psychopathology that have found expression in the practice of family therapy are forcing a re-examination of concepts of individual diagnoses in which the symptoms of an individual family member are viewed as a possible communication from a disturbed family system. In seeking reimbursement for family therapy through health and accident insurance, a problem is occurring because the traditional method of payment is based on the establishment of individual psychiatric diagnoses, and very few companies will insure a family for family therapy. This paper examines the three-part system: insurers, family, and helping professions in relation to the significance of the conflict between traditional concepts of individual psychopathology and recent concepts of socially shared family psychopathology.