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.     

Working with transnational immigrants: expanding meanings of family, community, and culture

An increasing number of recent immigrants maintain intense connections with their countries and extended families. The complexity of relationships that arise from transnational connections calls into question dominant discourses about family bonds and requires that we adopt new theory and treatment considerations. The relational stresses and the almost untenable choices that economic immigrants face take the form of separations and reunions of parents and children, and difficult gender or generation transformations that need to be considered against this new transnational backdrop. This article proposes a model that encompasses foundational approaches with new approaches in family therapy by focusing on three crucial contexts for work with immigrants: the relational, the community, and the cultural-sociopolitical. Family therapists are also encouraged to create collaborative links with migration studies, a growing interdisciplinary field.     

Alternative strategies for creating "relational" family data

A major problem facing family clinicians and researchers is creating data that will reflect the family as a unit. To address this problem, we present a framework for family assessment based on three measurement strategies: individual family member assessment, relational family assessment, and transactional family assessment. Within this context, we present several categories of methods for combining individual family member data into "relational" scores that reflect the couple or family as a unit. The problems and benefits of each method are presented, and it is suggested that the choice of method is dependent upon the content of the assessment, the theory underlying the content, and the statistical properties of the individual family member scores.     

Relational factors and family treatment engagement among low-income,HIV-positive African American mothers

Clinically derived hypotheses regarding treatment engagement of families of low-income, HIV-positive, African American mothers are tested using univariate and multivariate logistic regression models. Predictors are baseline family relational factors (family support, mother's desire for involvement with family, and family hassles) and mother's history of substance dependence. The study examines a subsample of 49 mothers enrolled in a clinical trial testing the efficacy of Structural Ecosystems Therapy (SET). SET is a family-based intervention intended to relieve and prevent psychosocial distress associated with HIV/AIDS. Participants in the subsample were randomly assigned to SET and attended at least two therapy sessions. Findings reveal that family relational factors predicted family treatment engagement (family support, p < .004; mother's desire for involvement with family, p < .008; family hassles, p < .027). Family support predicted family treatment engagement beyond the prediction provided by the other relational factors and the mother's own treatment engagement (p < .016). History of substance dependence was neither associated with family treatment engagement nor family support. Post hoc analyses revealed that family hassles (p < .003) and mother's desire for involvement with family (p < .018) were differentially related to family treatment engagement in low- versus high-support families. Implications for clinical practice and future research are discussed.     

Twenty years of family therapy in Israel: a personal journey

This article is a personal statement of my beliefs and practice of family therapy, from the time I first introduced the concept to Israel over twenty years ago to the present day. It reflects the evolution and changes in my clinical work against the background of major developments in the field of family therapy.     

A simplified version of the SYMLOG Trait Rating Form

This paper describes a brief measure of Bales's three SYMLOG dimensions. A sample of 204 undergraduates with a mean age of 24.7 yr., 72.4% of whom were women, completed the usual version of the SYMLOG Trait Rating Form. This could also be scored as if it were a simplified version, omitting some items. The Simplified Measure of the SYMLOG Trait Rating Form correlated fairly highly with the full form--with r between .87 and .89 for the corresponding versions of all three scale dimension scores--making it a suitable substitute for research or illustrative purposes on occasions when respondents' time is of the essence.     

The emergence of "family integrity" in later life

In contrast to the rich and abundant literature on the early stages of the family life cycle, there are relatively few theoretical accounts of family developmental processes in the second half of life. In an effort to address this imbalance, we introduce the concept of "family integrity" to refer to the ultimate, positive outcome of an older adult's developmental striving toward meaning, connection, and continuity within his or her multigenerational family. Subjectively, for the older adult, family integrity may be experienced as a deep and abiding sense of peace and/or satisfaction with his or her multigenerational family relationships, past, present, and future. It is the result of a growing concern for relational closure that typically begins to emerge in mid-life and gains ascendance in later-life. Objectively, at the level of observable relational processes, it is manifest in three interrelated competencies of the family as a system: (a) the transformation of relationships over time in a manner that is dynamic and responsive to the changing life cycle needs of individual family members, (b) the resolution or acceptance of past losses or family conflicts, with the dead as well as the living, and (c) the shared creation of meaning by passing on individual and family legacies within and across generations. As a construct, family integrity involves processes at multiple levels of social organization. At the individual level, it refers to an older adult's inner experience of satisfaction or "completeness" in the context of his or her family relationships. At the family level, it refers to observable relational competencies and transactions that contribute directly to an elder's sense of meaning, purpose, and connection with others. Simultaneously, at the level of culture and society, there are values and rituals that influence whether individuals experience meaning and purpose within the multigenerational family.     

Trainee perspectives on their family therapy training

Although research into family therapy training is increasing it has so far mostly focused on the process of the teaching and acquisition of certain concepts and skills. In contrast, the experience of training as family therapists has rarely been investigated. This paper reports on the impact of family therapy training at one training institution in the UK on the personal, relational and professional identities of trainees. Six family therapy trainees were interviewed using semi‐structured interviews at regular intervals over a period of approximately twenty months. Interpretive phenomenological analysis (IPA) was employed to analyse the interviews. The results suggest that participants often found the experience of training as a family therapist overwhelming and de‐skilling, but that it nevertheless provoked a re‐evaluation of some of their established personal, relational and professional identities. In many cases these re‐evaluations seemed to have preceded a process of individuation, of assuming a different or more complex identity.     

Understanding Forgiveness as Discovery: Implications for Marital and Family Therapy

This article explores the concept of forgiveness in relationship systems and examines various conceptualizations and definitions found in the literature. Forgiveness is described as a complex psychological and relational process that is more a discovery than an act of will. A rationale for viewing forgiveness in a contextual, historical, and relational attachment paradigm is presented, and the association of forgiveness with empathy and emotional intelligence is discussed. Marital and family therapists are encouraged to attend to contextual family of origin issues and to facilitate an empathic relational environment where ambivalence is expected and tolerated for enhancing the process of forgiveness. Relevant clinical cases are shared to illustrate the process of forgiveness as discovery.     

Felt obligation and the family life cycle: A study on intergenerational relationships

Since the 1990s researchers have considered as the dominant view on family obligation a set of responsibilities, duties, and obligation of care and assistance, that adult children should assume when parents are old or infirm. This concept is limited, because it assumes that family obligation is salient only in one period of life: when parents reach old age and are infirm. In contrast, a relational approach to family obligation considers family relationships as central to understanding children's duties and responsibilities. Following Stein, family obligation can be defined as felt obligation: expectations for appropriate and negotiated behaviour, perceived within the context of specific personal relationships with kin across life course. Felt obligation is conceptualized in five dimensions: a duty to maintain contact, assistance, avoidance of conflict, personal sharing, and self‐sufficiency. The purpose of the present study was to analyze perceptions of felt obligation in intergenerational relationships (parent–child and family of origin) in different phases of the family life cycle in a specific cultural context (Italy). The sample was composed of 92 parents with children of different ages (infants, school‐aged children, and young adults). The measure addressed the five dimensions of felt obligation, all assessed in various phases of family life. Results indicated differences in dimensions of felt obligation between intergenerational relationships (both parent–child and with family of origin). Some of these differences, such as self‐sufficiency and personal sharing, assumed more importance and salience in some periods of the life cycle than in others.     

Mother- and daughter-in-law relationship within a South African context: Influence of family systems

This study explored family system influences on mother-in-law and daughter-in-law relationships in a South African setting. A convenience sample of 20 mothers-in-law (age range from 40 to 86) and 20 daughters-in-law (age range from 20 to 60) were informants. They had been in a mother- and daughter-in-law relationship for at least six months. The participants completed open-ended interviews on their relational experiences in the context of family. Data were analysed applying Interpretative Phenomenological Analysis (IPA). Five family system relational context themes emerged: positive mother- and daughter-in-law relationship, conflicted the mother-son relationship, historic experience of the mother-in-law with her own mother-in-law, and partnership in upbringing of grandchildren.     

Exploring Levinas: the ethical self in family therapy

From a systemic perspective, people are relational beings located in wider systems of interaction, conversation and meaning. As for social constructionists, the self is positioned and storied through language and dialogue. Yet is the self no more than the multiple conversations and relations it enters into? Systemic therapists informed by psychoanalytic thinking describe a reflective self, responsive to inner conversation about emotional experience ( Flaskas, 2005 ). Those working in mental health services contend with the biological and ‘cognitive‐mindful’ self. Perhaps the self can be defined in many ways or languages as a deconstructive both/and. In this paper the systemic, relational or dialogic self in family therapy is discussed from the perspective of the ethical philosophy of Emmanuel Levinas. For Levinas ethical intersubjectivity is what makes subjectivity and thinking possible. The self is respons‐ibility to other or, as Derrida (1999) says, ‘consciousness is hospitality’ (p. 48). Yet for both Derrida and Levinas the relational self is also a separate and unique self. The ethical self is discussed in relation to family therapy practice.     

The space of reflection: thirdness and triadic relationships in family therapy

This article explores ideas about threes and the triadic space of reflection. Early family therapy theory offered rich ideas about triadic relationship patterns. Contemporary practice frameworks have generated reflective therapeutic practices and an attention to reflexivity. Meanwhile, a contemporary theory constellation allied with psychoanalysis has studied the capacity for ‘thirdness’ in intersubjective relating, reflective functioning and mentalization, and the triadic space of thinking. The article reviews this psychoanalytic theory, explores symbolic thirdness alongside actual triadic relating, and maps an understanding of the space of reflection as triadic and relational. Thinking about the space of reflection as triadic and relational offers one way of orienting ourselves to reflective processes and an inclusive frame for valuing both the earlier family therapy attention to relationship patterns and the different, current contemporary family therapy practices of reflection.     

Structural family therapy with Mexican-American family systems

Characteristics of traditional Mexican-American families with consequent family rules that affect these family systems are discussed along with selected clinical cases. The specific cases discussed involve: (1) interactions with family of origin in intercultural marriages, (2) intracultural differences in levels of acculturation and traditional family rules, and (3) extended family impact in response to severe life crisis. The development of therapeutic processes from structural and strategic family therapy approaches, which reflect appreciation for cultural differences and strengths, is suggested.This material was presented at the annual meeting of the Texas Association for Marriage and Family Therapy, January, 1994, San Antonio, TX.     

Responsive care management: family decision makers in advanced cancer

The purpose of this prospective study was to develop a grounded theory explaining the process that family decision makers use to make care decisions with or for a family member with advanced cancer. Adult surrogate decision makers were recruited for multiple interviews over the patient's care trajectory: 40 surrogates provided 80 semi-structured interviews. Analysis of these narratives revealed a process of responsive care management that is inclusive of, but not limited to, decision-making roles. Monitoring, buffering, and taking over comprise the three phases of the process. Decision making was embedded within the family member's broader relational and care responsibilities.     

The Genogram as a Tool in Career Counseling

A genogram is a three-generational graphic representation of a client's family of origin. The author depicts a sample genogram and outlines a three-part approach for use of a genogram in career counseling. Several possible uses are suggested.     

Treating family relational trauma: a recursive process using a decision dialogue

This article describes a therapeutic process that combines individual and family sessions to maximize therapeutic opportunities to bring forward, understand, validate, and empower children's experience as equal participants in family therapy. The aim is to strengthen relational bonds within the family. Drawing from earlier work with families where incest had occurred, the authors present a recursive process that utilizes a "decision dialogue" to link individual and family sessions. Clinical examples are provided.     

Attachment-based family therapy for depressed adolescents: programmatic treatment development

Few effective psychosocial treatment models for depressed adolescents have been developed, let alone ones that use the developmentally potent context of the family as the focus of intervention. Attachment-based family therapy (ABFT) is a brief, manualized treatment model tailored to the specific needs of depressed adolescents and their families. Attachment theory serves as the main theoretical framework to guide the process of repairing relational ruptures and rebuilding trustworthy relationships. Empirically supported risk factors for depression are the primary problem states that therapists target with specific treatment strategies or tasks. Parent problem states include criticism/hostility, personal distress, parenting skills, and disengagement. Adolescent problem states include motivation, negative self-concept, poor affect regulation, and disengagement. Intervention tasks include relational reframing, building alliances with the adolescent and with the parent, addressing attachment failures, and building competency. A small, randomized clinical trial provides initial support for the model. Several process research studies, using both qualitative and quantitative methods, have helped refine the clinical guidelines for each treatment task. ABFT is a promising new treatment for depressed adolescents and more research on it is warranted.     

A generalized family of coefficients of relational agreement for numerical scales

A family of coefficients of relational agreement for numerical scales is proposed. The theory is a generalization to multiple judges of the Zegers and ten Berge theory of association coefficients for two variables and is based on the premise that the choice of a coefficient depends on the scale type of the variables, defined by the class of admissible transformations. Coefficients of relational agreement that denote agreement with respect to empirically meaningful relationships are derived for absolute, ratio, interval, and additive scales. The proposed theory is compared to intraclass correlation, and it is shown that the coefficient of additivity is identical to one measure of intraclass correlation.The author thanks the Editor and anonymous reviewers for helpful suggestions.