Treatment of families during life transitions: matching treatment to family response

This article examines the conceptualization and treatment of families during normative and non-normative life transitions. Variables identified by individual and family developmental theorists account for some variation in responses of families to life transitions. Three family variables are identified as critical to practitioners' understanding of families: disruption of time schedules, number of new decisions involving initial disagreement, and pretransition family conflict. Different responses are hypothesized for families high or low on each variable. Six treatments of families are identified: historical family therapy, structure/process family therapy, experiential family therapy, psychoeducational approaches, family crisis intervention, and enrichment. The likelihood of success of each treatment is predicted on the basis of a family's response to the transition.     

ABSTRACTS OF LITERATURE

This is a clinical controlled study comparing the effects of "behaviorally" orientated family therapy, "client-centered" family therapy, and no therapy at all for families with a delinquent member. Sample included 99 families randomly assigned to treatments. Results indicated the efficacy of the behavioral family therapy in reducing recidivism.     

Family Centred Brief Solution-focused Therapy with Chronic Schizophrenia: a Pilot Study

The purpose of the study was to pilot a family centred brief solution-focused therapy model (BSFT) with families and clients diagnosed with schizophrenia. A control group of clients and their families received traditional outpatient therapy, while an experimental group of clients and their families were treated with a BSFT model. All participants were pre-tested and then post-tested with the Family Environment Scale after five therapy sessions over a ten-week period. Significant differences between the groups were found on expressiveness, active-recreational orientation, moral-religious emphasis and family incongruence. The participation of families and clients with schizophrenia in family centred brief solution-focused therapy produced encouraging results and demonstrated the need for expanded studies using BSFT with other chronically mentally ill clients and their families.     

A Review of Family Therapy in Residential Settings

This article provides an overview of the history of family involvement in residential treatment as well as a synthesis of the research showing family-centered interventions and outcomes for youth in residential settings. There are many methods for engaging families in residential treatment that are discussed in the literature; however, there is a significant gap as the field has not yet identified specific family therapy approaches that demonstrate efficacy in working with youth and their families in this particular setting. A review of the literature over the past 10 years will highlight the emerging family therapy models being utilized in this setting, which include multiple-family group intervention, family-directed structural therapy, and narrative family therapy. The article will also include a discussion of three major, well-established theoretical approaches that have been found to be effective in working with youth with conduct issues and show promise in treating youth and families in the complex setting of residential treatment: brief strategic family therapy, multi systemic therapy, and functional family therapy.     

The centrality of values in families and family therapy

Values are discussed in terms of development, nature, and implications for family therapy. Clinical examples are used to demonstrate concepts and a model is presented which depicts how the various leverages utilized in family therapy relate to family values. Individual development, cultural heritage (legacy), the nuclear family system, and the contemporary context are described as factors which interact to form values. A case is made for conceptualizing values as central to family therapy relative to engaging families, intervening in families, and evaluating therapeutic impact.     

Therapy with Families in China: Cultural Factors Influencing the Therapeutic Alliance and Therapy Goals

Rapid economic and social development in China is producing opportunities for a better standard of living for many families but also is associated with significant stress. Family therapy is one of the forms of mental health services that have become increasingly available. Western-derived models of family therapy are being used and adapted to meet the cultural traditions and needs of Chinese families. This article describes a variety of Chinese cultural factors that can influence the establishment of therapeutic alliances with family members (communication styles, collectivist values, family roles, and structure) and those that can shape family therapy interventions by addressing contextual factors affecting Chinese families (economic development, migration patterns, academic pressure, and changing gender roles for women). Suggestions are offered for using cultural sensitivity to address these factors tactfully to build strong therapeutic alliances and help families cope with significant life stresses.     

Indications for selecting family or individual therapy

Indications for either individual therapy or family therapy as treatments of first choice are identified at the initial family assessment.
A family approach is suggested in (1) scapegoating systems where the symptom is essential to the family homeostasis; (2) enmeshed families where communications are confused and diffuse; (3) paranoid-schizoid families where the family denies the symptoms and (4) families in a current acute shared crisis.
Individual treatment is indicated when (1) the patient has suffered traumatic separations; (2) separate help is asked for; (3) the therapist considers individuation necessary and (4) unusual life experience. Clinical examples are given.     

Multiple family therapy: an overview

In recent years there has been increased interest in working with groups of families systemically. Multiple family therapy is applied in different settings and to a whole range of different presentations. These include work with multi-problem families; with schools, parents and pupils; with adult mentally ill individuals and their families; and with eating-disordered teenagers and their families. Principles and aims of multiple family therapy are presented, specific projects described and trends for future work outlined.     

Schizophrenia and the Family: II. Adverse Effects of Family Therapy

Theoretical formulations of the past thirty years have championed the hypothesis that family interaction contributes heavily to the etiology of schizophrenia, a position that has dominated contemporary family therapy even in the absence of solid empirical confirmation. The possibility that sociogenic modeling of schizophrenia is not only incorrect but even harmful to families, and to the relationship between families and clinicians, has never been taken seriously, despite its implications for the practice of family therapy. The author describes untoward effects of the sociogenic hypothesis in his own ten-year experience with families of chronic schizophrenics and examines pertinent reports in the family therapy literature, offering the reinterpretation that many communicational aberrations are adaptations to two therapist attributes: (a) failure to absolve the family of initial causal responsibility, and (b) failure to inform the family about the nature of the illness.     

Enlisting family support in drug treatment

Drug abuse programs often experience difficulties involving clients' families in treatment. This article describes general principles and specific techniques for recruiting family members in drug abuse programs and in other treatment settings. Stanton and Todd's principles of recruiting for family therapy in drug programs generally apply, adapted to a project that involves only one family member in multifamily groups and provides psychoeducational training rather than therapy. Additional principles include: focusing on family members who live with the client, tailoring recruitment to the needs of individual families, emphasizing how the family member will benefit, addressing resistance directly, helping families to build a support network, and informing family members of what is expected of them. The psychoeducational approach shows promise as a beneficial adjunct to client-focused treatment and as a gateway to more extensive family treatment.     

Family Therapy in Chinese Culture and Context: Lessons from Supervising Therapists-in-Training in China

Systemic family therapy as an essential paradigm for treating couples and families has gone global since its initial rise to popularity. According to researchers, China has signaled a strong desire for training in systemic family therapy. Even though this mode of mental health service is a foreign import to China, the surge in interest for Western psychotherapy for individuals and families grows by leaps and bounds. However there has been evolving conversations about the transportability of systemic family therapy from the West to the East. Using a qualitative focus group format, this study explored the experiences of sixteen Chinese couple and family therapists on their perspectives in adapting systemic family therapy concepts to the local Chinese context. Results reveal the interplay between the systems of the changing Chinese family structure and of the application of family therapy models that originated from the West must work harmoniously in order to enhance the goodness of the familial system within the evolving Chinese society in the 21st century.     

Family Therapy and Drug Abuse: A National Survey

The following report describes the results of a national study of the role of family therapy in the drug abuse field. Characteristics of agencies that work with families are described, as well as the demographic characteristics and psychological problems of the clients most apt to be treated in family therapy. The study also looks at the role and structure of family therapy in the ecological system of the treatment institutions. A profile of the family therapists who are responsible for providing services to families is presented. An attempt was made to assess agencies' level of development with regard to family therapy by using an instrument, The Progress Index for Family Therapy Programs. Generally, findings indicated that there is considerable variation in expertise. More extensive training in family therapy techniques was of major concern, particularly among clinics with a heroin addict population.     

Need for Family Therapy Services for Middle-Class Families in India

This qualitative study explored the needs of Indian middle-class families for family therapy services. Four focus group interviews were conducted with middle-class parents in Madras, India. Participants were introduced to the concept and practice of family therapy and were encouraged to take a more active role in supporting the services they suggested. Participants identified problems faced by Madras middle class families and five different types of services that they were aware of. Three categories of need for family therapy were identified from the narratives of the participants. Several themes fit in each of the three categories. Implications for clinical application are discussed.     

Family therapy for childhood depression: researching significant moments

This paper is a qualitative family therapy process study which is part of a larger European-based outcome study comparing family therapy to child psychotherapy plus parent support for depressed children and their families. The family therapists and two clinical supervisors from the original study formed themselves into a research team to study the process of therapy with twelve families. Therapists selected the significant moments from fifty-nine sessions, and were then interviewed by the research team using a standard protocol to investigate the therapists' own thinking about the significant moments. Applying a thematic analysis, the significant moments were clustered into eleven themes. The paper discusses the rationale for this model of research, which is well suited for clinical teams, and the application of the themes to therapeutic work with depressed children and their families.     

Measuring Family Therapy Outcome in a Clinical Setting: Families That Do Better or Do Worse in Therapy

This study examined several important family and therapist characteristics as they related to treatment success. A total of 434 families entering family therapy at a sliding-fee clinic in Dallas, Texas were rated (on the Beavers Interactional Competence and Style Scales), and completed several self-report family assessment instruments (Self-Report Family Inventory, FACES III) prior to beginning therapy. The therapists, trainees from various disciplines, had been trained in the Beavers Systems Model. Overall, 75% of the families showed at least some improvement. Those that fared best in therapy were more competent at the outset. While number of therapy sessions was associated with greater gains, there were some families that made great gains in fewer than six sessions. There were important demographic qualities that did not discriminate between greater- vs. lesser-gain families, including income level, ethnicity, therapist gender, and family size. A regression analysis indicated that functional rather than demographic variables were more important in predicting therapy outcome.     

Family therapy and social control with incestuous families

The family therapy and social control model describes first the relationship between unplanned change and developmental growth. With many families, the family therapist works to both provoke change and encourage growth. However, some out-of-control families present a level of danger to a family member that outside controls, such as child protective services, must be used. This model clarifies the complementary but independent roles of family therapy and social control in helping out-of-control families. Intervention with incestuous families is presented as illustrative of the model.My thanks to the staff of Child Protective Services, the Juvenile Court, Yuma Police Department, Yuma County Sheriff's Department, Adult Probation Department, and the staff and group members of Yuma County, Arizona Parents United for showing that shared concern about the well-being of children can make a real difference in working with families. My appreciation to William C. Nichols, EdD, Elora Cornille and Dale Brotherton for their helpful suggestions on a earlier version.     

Medical family therapy: an emerging arena for family therapy

This paper describes an important recent development in American family therapy. Medical family therapy uses a biopsychosocial systems model to work with families who have a member with a chronic illness or disability. The authors maintain that family therapy has tended to embrace the mind–body split and to view itself too narrowly as a mental health specialty. Medical family therapists work collaboratively with physicians and other health professionals to help families achieve a sense of agency and communion in facing some of the greatest challenges that life brings.     

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 process in the treatment of intrafamilial child sexual abuse

The paper describes the changes in family dynamics that occur throughout the process of family-orientated treatment of families where father–daughter incest or stepfatherr–stepdaughter child sexual abuse has occurred. A detailed step-by-step analysis of the developing family process in incest families during therapy is given. The analysis establishes the nature of the original pattern of family relationships, explores the impact made by crisis intervention on the family structure and then outlines therapy and termination of treatment. Characteristic mechanisms in the family process during therapy are described. A detailed clinical example demonstrates the basic therapeutic moves and the mechanisms involved.     

RECONSIDERING RESEARCH ON DIVORCE, FAMILY LIFE CYCLE, AND THE MEANING OF FAMILY

This article analyzes functionalist and normative assumptions about marriage, divorce, family, and gender in developmental models of family life cycle. An interdisciplinary review of the literature in family development, family sociology, and family therapy reveals how a deficit comparison model implicitly informs the discourse in the study of single-parent families, women who are alone, and the adjustment of women and children to divorce. A feminist critique of family life cycle as the prevailing conceptual model in family development and therapy is presented, and postmodern definitions that deconstruct the concept of family are discussed. Future perspectives for research on family life and form are considered in terms of new action theory that considers divorce as a mode of resistance and change for women and families.