Contrasting four major family therapy paradigms: implications for family therapy training

Four major paradigms of family therapy are contrasted: affective-experiential, structural, strategic and Milan. The differences are defined according to the way in which therapists think and behave in relation to their premises about change, and they are discussed under the following headings: historical roots and understanding of symptom formation; therapists' stance and techniques used in change; focus, goals and locus of change; and time perspective in change. Some suggestions are made with regard to training family therapists based on the differences that emerge when contrasting these models of family therapy.     

The crucial roles of attachment in family therapy

This paper's aim is to enable family therapists from whatever approach to address family attachments during their work. It explores the role of attachment in the family, and how to enable therapists to increase security in the family so that family members can solve their own problems during and after therapy. The article gives a brief overview of the nature of family attachment relationships and the influence of secure and insecure attachments within the family and their narrative styles. This is described in language that a therapist might readily hold in mind and share the ideas in dialogue with families. The paper discusses the interplay between insecure attachments and other family problems, such as parental conflict and disagreements over authority. It also discusses ways of establishing a secure therapeutic base and the influence of the therapist's own attachment style. The implications for family therapy practice are described and illustrated by work with a specific family.     

Gender and illness: implications for family therapy

This paper outlines the importance of considering gender when working with professionals and families dealing with a life-threatening or chronic illness. Clinical vignettes are used to demonstrate the importance of addressing gender to avoid attributing pathology to behaviour that could otherwise be viewed as normal. The particular contribution of the family therapist is highlighted, including suggestions about how systemic interventions can be introduced to enhance the capacity of those involved to deal with the transitions demanded by such illnesses.     

Resilience concepts and findings: implications for family therapy

Resilience is a term used to describe relative resistance to psychosocial risk experiences. There is abundant evidence that there is enormous variation in children's responses to such experiences but research to determine the processes underlying the variations needs to take account of several crucial methodological issues. The findings emphasize that multiple risk and protective factors are involved; that children vary in their vulnerability to psychosocial stress and adversity as a result of both genetic and environmental influences; that family-wide experiences tend to impinge on individual children in quite different ways; that the reduction of negative, and increase of positive, chain reactions influences the extent to which the effects of adversity persist over time; that new experiences which open up opportunities can provide beneficial 'turning- point' effects; that although positive experiences in themselves do not exert much of a protective effect, they can be helpful if they serve to neutralize some risk factors; and that the cognitive and affective processing of experiences is likely to influence whether or not resilience develops. The implications of these findings for family therapy are considered in terms of the need for therapists to look carefully at the ways in which different risk factors interact; to assess and take account of individual differences in susceptibility; to consider the extent to which risk factors impinge on the individual and, in that connection, to note the importance of patterns of social interaction outside as well as inside the family; to appreciate the role of both the peer group and individual characteristics in the development of negative and positive chain reactions; and to pay attention to the ways in which individuals process their experiences.     

Cross-cultural perspectives: implications for attachment theory and family therapy

Cross-cultural perspectives have always been useful for understanding behavior. They clarify the distinction between aspects that are essentially part of the human condition and those that are the most responsive to variation. The interesting article by Rothbaum and his colleagues is in that tradition, contrasting the cultural values and family patterns in Japanese society with those of Western cultures, including our own, and suggesting that these differences shape the nature and course of attachment. It stimulates questions about what we have taken for granted in our theories and in our evaluations of dysfunctional behavior.     

Short term family therapy following parental loss: A case report

Summary The main therapeutic task was to help the family gradually finish the natural mourning process that was initially impeded by their denial. Negative memories of father, as well as the favorable ones, were brought to light, the expected punishment for the verbalization of these feelings was not fulfilled, and the family had a second chance to work through the mourning process in an atmosphere of acceptance, understanding, and support.The author wishes to express appreciation to Daniel Offer, M.D., and Andrea H. Lazarus, M.S., for their assistance.     

Discovering forgiveness through empathy: implications for couple and family therapy

This article explores the concept of forgiveness in the context of couple and family therapy. Forgiveness is described as a complex psychological and relational process that is more a discovery via understanding and empathy than an act of will. Empathy is related to emotional intelligence, and the developmental and relational benefits of both are discussed. A rationale for viewing forgiveness in a contextual (family of origin), historical and relational attachment paradigm is offered. Relevant clinical cases illustrate the process of forgiveness as discovery in the context of an empathic relational environment where ambivalence is anticipated and respected.     

The formalization of family therapy training—issues and implications

This paper highlights the emerging debate, particularly evident in the U.K. and Australasia, regarding the desirability of more formalized training programmes for family therapy. The professionalization of family therapy is under way. The implications of this process for training structures, the role of the family therapist, the nature of family therapy associations and thus the ultimate goals of family therapy are summarized. Alternative models of training structures, their ideological bases and the implications of these alternatives for the nature of an association and the family therapy process are then briefly discussed. In summary, some priorities for a desired model of family therapy training are listed for discussion.     

Drawing a family map: an experiential tool for engaging children in family therapy

Inclusion of children in the treatment process is a central aspect of the discipline of family therapy. Young children's verbal skill and level of abstraction may not be suited to ‘talking therapy’, but they have an intuitive grasp of family life which is invaluable, and their views and needs should be considered when effecting change in the family system. A method is offered to engage young children, adolescents and adults of divergent verbal skills into a shared process. It requires no special set‐up or tools, only paper and markers. Distance and proximity are represented in a simple map of the family, adding symbols for affection and conflict. A spatial representation of the family system is created, and may be referred to in the course of the therapy.     

Self-compassion reduces parental burnout: Mediation roles of parental psychological control and support

This study investigated the mediating role of parental psychological control (PPC) and support in the relationship between self-compassion and parental burnout syndrome. The study participants included 1185 Vietnamese parents who completed questionnaires regarding demographic information, parental burnout, self-compassion, parental support of the child, and PPC. We used data analyses, including structural equation modeling, to test the mediation roles of PPC and parental support of the child. Our main findings include: (1) self-compassion had a significant negative effect on parental burnout; (2) the mediation roles of PPC and parental support of the child were also significant. These results suggest that parents with high self-compassion tend to provide more support for children in daily parenting, which helps reduce parental burnout. In contrast, parents with low self-compassion were more likely to use PPC, which exacerbated their burnout. The results from this study provide suggestions for creating effective interventions in the family context to reduce parental burnout and improve parenting effectiveness.     

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.     

The comparative efficacy of Milan family therapy for disturbed children and their families

This paper describes a study comparing the efficacy of Milan family therapy with that of other treatments routinely used in an out-patient child psychiatry department. Some 118 subjects were allocated on a random, prospective basis to one of two treatment groups, the Milan family therapy group or the other treatments group. The methods of assessment included semi-structured interviews, questionnaires, visual analogue scales and standardized therapy schedules. The results showed that whilst subjects in both treatment groups achieved comparable symptomatic improvement at the end of treatment and at six-month follow-up, the Milan approach produced more changes for family members other than the referred child as well as requiring less treatment time than the other treatments.     

The family roles of siblings of people diagnosed with a mental disorder: Heroes and lost children

In order to cope with the diagnosis of mental illness in a family member, siblings may be forced to adjust their roles in the family. Taking into account the crucial role that some siblings play in caregiving for the mentally ill especially when the parents are no longer available, it is imperative to develop awareness of their unique needs and address them. Thirty‐three adult siblings of people diagnosed with a mental disorder completed the Role Behaviour Inventory (RBI) and a general questionnaire including open‐ended questions regarding the roles they played in their families of origin. Findings from the inventory and general questionnaire suggest that the well siblings score higher on two roles, the Hero and Lost Child, and lower on the Mascot and Scapegoat roles relative to a comparison group (N = 33). Being a sibling caregiver emerged as a risk factor to assume certain dysfunctional roles in the family. Implications for future research and therapy are discussed.     

The application of a domains‐based analysis to family processes: implications for assessment and therapy

Social domains are classes of interpersonal processes each with distinct procedural rules underpinning mutual understanding, emotion regulation and action. We describe the features of three domains of family life – safety, attachment and discipline/expectation – and contrast them with exploratory processes in terms of the emotions expressed, the role of certainty versus uncertainty, and the degree of hierarchy in an interaction. We argue that everything that people say and do in family life carries information about the type of interaction they are engaged in – that is, the domain. However, sometimes what they say or how they behave does not make the domain clear, or participants in the social interactions are not in the same domain (there is a domain mismatch). This may result in misunderstandings, irresolvable arguments or distress. We describe how it is possible to identify domains and judge whether they are clear and unclear, and matched and mismatched, in observed family interactions and in accounts of family processes. This then provides a focus for treatment and helps to define criteria for evaluating outcomes.     

Healing traumatized children: creating illustrated storybooks in family therapy

In this article we describe the therapeutic practice of creating illustrated storybooks in family therapy with traumatized children. Illustrated stories offer a predictable structure to sessions and facilitate engagement and participation of children in therapy. The therapeutic emphasis of storybooks can be adjusted to take into account a child's life story, verbal capacity, level of anxiety, and traumatic hyperarousal. The creation of storybooks is an active process that embraces important aspects of trauma-specific interventions, including expression of trauma-related feelings; clarification of erroneous beliefs about the self, others, or the traumatic event; and externalization of traumatic stimuli into artwork, allowing for exposure and habituation of the arousal response. A focus on visual images together with narrative takes advantage of children's developmental capacities and spontaneous pleasure in the creation of art, thus minimizing anxiety and enhancing feelings of mastery, competence, and hope. The creation of storybooks is compatible with family interventions that foster a safe family context, strengthen attachment relationships, insure appropriate structure and boundaries, and enhance parenting capacity as well as those interactions that facilitate understanding and dialogue between family members.