ABSTRACTS OF LITERATURE

This theoretical essay offers a critique of individual psychotherapy versus the advantages of family therapy. Theories of family pathology, models, techniques, and indications, are reviewed and the relationship of family therapy to behavior therapy, multiple-impact therapy, home visits, crisis therapy, network therapy, and multiple-family group therapy are discussed.     

Redressing the balance—involving children in family therapy

This paper argues that family therapists have tended to ignore the problem of how to engage children in family therapy, and it presents a number of techniques specifically aimed at involving children in therapy. The socio-historical context of childhood is discussed and its implications for therapists examined. A number of visual techniques are then described, illustrated by case examples. These serve the function of addressing the whole family system on a number of levels and involving children fully in the process of therapy.     

Multiple theoretical approaches to supervision: choices in family therapy training

The supervision techniques used in structural, strategic, family-of-origin, and experiential family therapy training are discussed and compared, with emphasis on the isomorphism between supervision and therapy in each school. The usefulness of each supervisory model is related to supervisees' needs at different levels of training. Recommendations are made about the sequence of family therapy training, including the utility of eclectic versus purist family therapy training programs for trainees at different levels of experience.     

Engagement techniques in family therapy

A number of basic engagement techniques in family therapy are identified and illustrated. These include (1) techniques that enable the therapist to achieve a position of influence with family members or to gain entry into the family system, (2) techniques utilized in teaching the family how to behave in the therapy setting, and (3) the tactics the therapist may use to manage difficult moments in the session. Issues in the relationship between technique and the theory and practice of family intervention are also examined.A videotape (Wells, R.A., & Page, M.H.Engaging the Family in the Helping Process: Basic Techniques. Pittsburgh, PA: UIRC, 1979) is available from the author. Discussion with such colleagues as Patrick McNamee, Larry Pacoe, Mary Page, and Susan Schilling has been invaluable.     

The impact of structural family therapy training on conceptual and executive therapy skills

The importance of empirical evaluations of family therapy training is gaining increased recognition. This study reports the results of a controlled assessment of a training seminar in structural family therapy. Changes in the conceptual and executive skills of 44 therapy trainees (22 family trainees and 22 controls) were assessed over a 16-week period using repertory grid and videotaped therapy simulation techniques. Results indicated significant conceptual gains in family therapy trainees, but only among those with little previous exposure to family training. Differences in the overall number as well as the type of interventions were also noted. Results generally supported the predicted impact of therapy training, but left unanswered questions regarding the unique impact of family therapy training over individual training. These qualifications are discussed and directions for future work are highlighted.     

Multiple Family Group Therapy: A Review of the Literature

This review focuses upon multiple family group therapy, its origin in the intersection of family and group therapies, its use in a variety of settings, its specific techniques and group development in individual and ongoing meetings, its goals and dominant themes, its parallels in family and group work. Also discussed are evaluation of outcome of this therapy modality and those dynamics thought to contribute to family change. Areas for further investigation are outlined.     

Culturally Competent Family Interventions: Review and Case Illustrations

Family therapy is often the treatment of choice for culturally diverse clients. This article provides a critical review of culturally competent assessment and intervention strategies for use with ethnic minority families in the U.S. A culturally informed view of the definition of family health and dysfunction is presented, basic structure and goals of family therapy are delineated, and family therapy process and techniques are addressed. Clinical vignettes are provided to illustrate critical points.     

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.     

Family of origin: An experiential workshop

Abstract

A rationale is presented and a one day, content-free family of origin experiential workshop is described in detail. The workshop is designed for clients in ongoing family therapy. Its purposes are 1) motivating family members to engage in family of origin investigations; 2) supplying information in a supportive experiential learning paradigm for use in ongoing peer and multiple family therapy groups; 3) minimally teaching procedures for conducting a Bowen-like search; 4) contributing to an agency-wide atmosphere of intrigue and support for intergenerational therapeutic work. Sculpture, role-play and dramaturgical techniques are interwoven into a fabric deliberately left unfinished in order to provide maximal material for the ongoing family therapy.     

Family Therapy With Irish-Americans

This paper presents a paradigm for understanding the cultural values and family patterns of Irish-American families and offers suggestions for clinical intervention. Families' correspondence to the model described will depend upon their level of acculturation, socioeconomic status, and other contextual factors. The paradigm suggests a number of issues that may create difficulties for the therapist and for the family in therapy. In general, behavioral techniques, Bowen systems therapy, and strategic interventions may be more useful than techniques emphasizing expression of emotions in therapy or direct attempts to alter communication or family behavior in therapy sessions, as used in structural therapy.     

Values and Ethics in Family Therapy

This article is an introduction to this special issue on values and ethical issues in family therapy. The author discusses the historical context for the rising interest in these issues in family therapy, describes the rationale for this special issue, and presents a framework for analyzing the core values of the prominent models of family therapy. The ethical debate over use of paradoxical techniques in family therapy is used as an illustration of a values clash between different models of family therapy.     

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.     

Structural Family Therapy for Children of Divorce: Case Reports

Structural family therapy techniques for treating families with a parental divorce in which a child is symptomatic are described. The family configurations considered are: mother, child, and maternal grandparents; overprotective mother and child; helpless and mildly neglectful mother; father; new family formation; and couples who divorce and marry new spouses.     

Juvenile drug addiction: a typology of heroin addicts and their families

In this article the authors propose: 1) a typology of drug addiction cases consisting of four main classes: A. traumatic drug addiction, B. drug addiction from actual neuroses, C. transitional drug addiction, and D. sociopathic drug addiction; 2) a clinical study (with 18 months of follow-up data) involving 131 heroin addicts mostly treated with structural or counterparadoxical family therapy in the same psychotherapy center and in the same year; and 3) some preliminary conclusions emerging from an examination of the four-class typology with respect to the effectiveness of family therapy interventions. If, for example, structural family therapy techniques seem more suitable in type-B cases (similar to cases described by Haley in his Leaving Home), the counterparadoxical techniques are likely to be more effective in type-C cases (similar to the anorectics described by Selvini-Palazzoli).     

The Single-Case Design in Family Therapy Evaluation Research

This paper discusses the need for the development of new research designs for family therapy evaluation, and a manner for meeting that need. The single-case research design has gained acceptance as bona fide experimental designs for evaluating the effectiveness of intervention techniques in drug and psychotherapy outcome research. Although the need for more outcome studies on the effectiveness of family therapy has been frequently noted, there has been virtually no use of the single-case design in family therapy outside of the behavior modification literature on families. This paper presents potential benefits of the application of single case-design for the practice of family therapy. Preliminary guidelines are suggested for the application of these designs.     

Experiential Family Therapy: An Innovative Approach to the Resolution of Family Conflict in Genetic Counseling

Experiential family therapy is an intuitive approach that utilizes active, multisensory techniques. These techniques, such as role plays and drawings, increase the family's expression of affect and uncover new information. Increased affect and uncovered information stimulate change and growth in the family system. Experiential techniques are especially useful when more traditional, verbal-based communication is not effective. In this article, I will present a pediatric case in which the patient, a 7-year-old boy diagnosed with autism, was referred to the genetics clinic to rule out the presence of an associated genetic disorder. I will then describe a hypothetical second counseling session with the same family and suggest how three experiential family therapy techniques: family drawing, empty chair technique, and continuums might be used in the session to help resolve a marital conflict between the patient's parents.     

Play therapy as a family restructuring technique: A case illustration

This paper presents a general treatment approach which uses play to integrate individual and family psychotherapy when working with young children as identified patients. Play therapy techniques are explored with regard to their potential impact upon a family system. Perspectives on concurrent and conjoint family oriented treatment using play are discussed with a focus upon achieving both individual and family system growth.     

Creating a Secure Family Base: Some Implications of Attachment Theory for Family Therapy

The aim of this article is to make attachment research findings available in a form that family therapists can use. In attachment theory, parents are conceptualized as providing a secure base from which a child can explore. Family therapists, however, need a systemic concept that goes beyond the parent/child dyad. The concept of a secure family base is proposed, in which a network of care is made available for all family members of whatever age so that all family members feel secure enough to explore, in the knowledge that support is available if needed. Factors that contribute to the security or insecurity of the family base are outlined. The overall aim of therapy is to establish a secure family base from which the family can explore new solutions to family problems both during and after therapy. The role of the therapist is to help to resolve conflicts that threaten relationships, and to explore relevant belief systems that may be contributing to a sense of insecurity. The conceptual framework presented allows for an integration of family therapy techniques and ideas into a coherent whole. A new school of family therapy is not proposed.     

Family-based treatment for adolescent substance abuse: controlled trials and new horizons in services research

This article provides an overview of controlled trials research on treatment processes and outcomes in family-based approaches for adolescent substance abuse. Outcome research on engagement and retention in therapy, clinical impacts in multiple domains of adolescent and family functioning, and durability and moderators of treatment effects is reviewed. Treatment process research on therapeutic alliance, treatment fidelity and core family therapy techniques, and change in family processes is described. Several important research issues are presented for the next generation of family-based treatment studies focusing on delivery of evidence-based treatments in routine practice settings.     

Chronic Eating Disorders in Therapy: Clinical Stories Using Family Systems and Psychoanalytic Approaches

This paper presents three pieces of work, all focused around a person presenting with a long history of disordered eating patterns. One treatment was a couple therapy, one a family plus individual therapy and the third a purely individual therapy. The three different psychotherapies demonstrate an approach which uses psychoanalytic as well as family therapy thinking and techniques. The material is offered to show examples of the clinical practice within which individual and couple or family therapy constitute a range of psychotherapeutic responses to people and, in particular, to people with eating disorders. The context of the therapy is described in some detail as it accounts for many features of the treatments, for example, that they are justified within the institution by having been subject to empirical investigation. A metaphor, that of the medieval castle, is offered as an evocation of the experience of the person that is relevant in the practice of both individual and family therapy.