Management of religious issues in family therapy

Social scientists have long emphasized the reciprocal relationship between family and religion in society. Yet the family therapy literature is virtually devoid of consideration of religious variables in family life and function. Four major psychosocial aspects of religion in family life are discussed: sacralization, coalitions with the supernatural, religious conflict as a projection of family conflict, and family conflict as a projection of religious conflict. Clinical issues presented include: family therapy in religious and secular contexts, family religious expectations and transference, therapist religious countertransferences, religious identification in family therapy, and family therapy in different degrees of congruence or difference in religious orientation between the family and the therapist. The family therapist must learn how to correctly interpret and appropriately respond to religious issues as they appear in family life and family therapy.     

Fixation and Regression in the Family Life Cycle

In spite of the obvious fact that families differ significantly depending upon their current stage of the life cycle, most of the family therapy literature focuses on intervening in ongoing family interaction without specific attention to the dimension of family development. Family sociologists, on the other hand, while not dealing with modifying family functioning, have provided more detailed tools with which to understand variations in family functioning based on stages of family development. Our work with families in acute distress suggests the need to increase the specificity with which our assessments and interventions are tailored, by incorporating the family developmental view. This paper explores the utility of the family developmental view using the concepts of fixation and regression in the family life cycle. These concepts were found to be relatively refined and quite pragmatic assessment devices that assist therapists in specifying developmental issues of the family. Case examples of actual families in crisis are presented in order to demonstrate the utility of these conceptual tools.     

Family Secrecy in Family Therapy Practice: An Explorative Focus Group Study

The aim of this focus group study was to explore the experiences of family therapists working with family secrecy. Our study highlights that family secrets present important and compelling challenges for family therapists. Furthermore, our study reveals that there seem to be some basic strategies family therapists use in dealing with these challenges in therapy sessions. One basic strategy is that family therapists try to guard their position of being a trustworthy therapist for each family member by avoiding becoming stuck in family secrecy. Furthermore, therapists explore ways to guide the family toward the disclosure of the secret in order to alleviate the toxicity of the secrecy. This highlights the importance of the systemic model and how influential this perspective is in family therapy practice. Some participants, however, have in addition a second strategy they sometimes use: talking with the family about secrecy without aiming to disclose the secret. In the discussion section of the article we reflect on the possibility that in the strategic choices family therapists make conceptual issues might be involved. Furthermore, we stress the importance of further research.     

Understanding families in their own context: schizophrenia and structural family therapy in Beijing

Evidence from a number of family intervention strategies demonstrates a beneficial impact on the course of schizophrenia. It appears that different family interventions have generic features that aid the patient to avoid relapse and improve functioning. A significant challenge for researchers is to modify these generic strategies to be sensitive to different cultural groups in order to ensure their effectiveness. Chinese culture, with its distinct cultural norms governing family interaction and intense stigma towards the mentally ill, would seem to raise a particular challenge.
This paper offers an account of an eclectic model of structural family therapy that incorporates psychoeducation and behavioural treatments for schizophrenia as a theoretical guide to working in a cross–cultural context. A Beijing family, consisting of parents and their daughter with schizophrenia, were seen for sixteen months during a trial of family intervention in China. Through structural family concepts, China's sociocultural context of treatment resource constraints, population policy and stigma are examined and the impact of the illness on family organization is explored.     

Satisfaction with Family Life in South Africa: The Role of Socioeconomic Status

This paper investigates the determinants of self-reported satisfaction with family life, applied to the South African context, with socioeconomic status (SES) as the main covariate and family functioning as the secondary covariate of interest. An individual-, household-, and subjective SES index is constructed via multiple correspondence analysis. Structural equation modelling (SEM) and multiple-group SEM (MGSEM) are used to analyse the role of SES in explaining satisfaction with family life. Higher levels of SES, especially household SES and subjective SES, are related to greater satisfaction with family life. Family functioning, in terms of better family flexibility, is associated with higher satisfaction with family life. The MGSEM results indicate that the role of family flexibility in explaining satisfaction with family life is similar across SES quartiles; family flexibility is an important predictor of family-life satisfaction, regardless of SES quartile.     

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.     

Rites of passage in families with adolescents

In previous generations society defined expectations and constructed events to promote individual development, a functional family organization, and cultural continuity. Culturally defined and accepted rites of passage that were previously observed in families with adolescents have given way to a more vague and meaningless set of adolescent expectations and affirmations. It is proposed that this change has interfered with the mission of the family to promote functional adolescent development and with the ability of the family during this life cycle stage to operate with a sense of community attachment. This paper addresses the importance of rites of passage as they pertain to family development and change and presents ideas about making them explicit in family therapy to change family interaction and structure. Prescribed family rituals that are straightforward, developmentally relevant, and interactional can be effective without consideration to whether they are paradoxical. Three clinical illustrations are presented to highlight this therapeutic approach.     

The importation,transmission, and moderation of stress in the family system

Despite its importance in community psychology, the stress process is still viewed primarily as an individual-level phenomenon, little research being conducted on the dynamics of stress in a social system such as the family. Propositions derived from a model of family stress were tested using data from a cross-sectional survey of family triads (father, mother, and adolescent). Two measures of distress were related significantly to both macro-and microstressors, and perceived social support did not buffer this relationship. Stressors endogenous to the family were significantly associated with those exogenous to the family (stressor importation hypothesis); contrary to prediction, this relationship did not vary across family members or family types (high vs. low cohesion). Distress in some family members was significantly associated with stressors experienced by other family members (stress transmission hypothesis); this relationship did not vary across family types but did vary across family members to some extent in that stress was transmitted from adolescents to parents to a greater degree than vice versa.     

Family Conflict and Violent Electronic Media Use in School-Aged Children

Using a national sample of children aged 6 to 12 (N = 1,075), this study examined the relative merits of 3 theoretical perspectives on the relation between family conflict and children's use of electronic media (television and electronic games with violent content): (a) the family context hypothesis, whereby family conflict is positively related to violent electronic media use because family tensions will be reflected in children's interest in media with violent content; (b) the reaction hypothesis, whereby family conflict is positively related to nonviolent media use because children seek out nonviolent media content as a reaction against conflict in their family environment; and (c) the escape hypothesis, whereby family conflict is positively related to total electronic media use because children use media to escape family conflict regardless of content. Results supported the family context hypothesis. There was no support for the reaction and escape hypotheses.     

社会关系模型在家庭研究中的应用

社会关系模型在20世纪80年代被引入至家庭研究领域,并在多种家庭关系的研究中加以应用和拓展.在该领域中,社会关系模型主要采用循环设计,将变异分解为个体水平、关系水平和家庭水平的效应,也可以分析个体水平和关系水平的互惠效应,代际内部和代际之间的互惠效应,以及家庭成员的相似性等问题;其数据分析的方法主要有单个家庭效应值的计算以及结构方程模型的分析方法两种.今后的研究可以在体现家庭关系的复杂性、三人家庭数据的处理、各效应的外部效度指标以及缺失值的处理等方面进行拓展.     

Ethical Issues in Family-Centered Primary Care

In 1969 a new primary care medical specialty, family practice, was formally created. One element in the development of this specialty from the roots of general practice was an understanding of the importance of family process in health and health care. Family physicians are now trained to work with families in the provision of primary medical care, and many provide some formal family counseling and therapy. The family physician who works with families faces many of the same ethical conflicts with which family therapists are confronted. The primary relationship of the family physician to his or her patients, however, as the provider of continuing health care, modifies these conflicts and creates new and vexing problems.     

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 functioning within the context of families with adolescent children in urban India

Research on family functioning within given cultural contexts is needed. This study aims to describe salient dimensions of family functioning in two urban contexts in India and to examine differences in family functioning by sociodemographic groups. We measured differences in family functioning using cross-sectional survey questionnaire data collected from 13 to 15-year-old adolescents and one of their parents/primary caregivers in Mumbai (n = 843) and Kolkata (n = 913) during 2019–2020. We drew a multi-stage sample representative of neighborhoods and households in both cities. We assessed a multi-dimensional family functioning latent factor that included parent-reported measures (parent–adolescent communication, family cohesion, and parent monitoring of peers) and adolescent-reported measures (parent support, family cohesion, and parent supervision). Our results support an overall measure of family functioning manifested by multiple dimensions for parent- and adolescent-reported data. Families with male adolescents had worse adolescent-reported family functioning in Mumbai and parent-reported family functioning in Kolkata. Higher socioeconomic status was associated with better parent-reported family functioning in both cities and better adolescent-reported family functioning in Kolkata. Muslim religious identification in Kolkata and the Hindi native language in both cities were associated with better adolescent-reported family functioning. Our findings indicate heterogeneity in family functioning across demographic and social-cultural groups within the two urban contexts of India. This study may inform the development of culturally congruent prevention interventions for families with adolescents in India.     

Associations of Parent-Adolescent Discrepancies in Family Cohesion and Conflict with Adolescent Impairment

Family cohesion and family conflict are important protective and risk factors respectively in the development of child psychopathology. Our study examines parent-adolescent discrepancy of the family environment constructs, family cohesion and family conflict, and their associations with adolescent impairment. The sample consists of 141 parent-adolescent dyads evaluated at an outpatient behavioral health clinic. The mean adolescent age is 14.8 (range 11–18) while the mean parent age is 48.9 (range 32–67). Findings show that adolescents report significantly less family cohesion but do not differ significantly in reports of family conflict. Greater family cohesion is associated with less adolescent impairment by multiple reporters. Nonetheless, greater family conflict is associated with more adolescent impairment by the same reporter. The results show that both adolescent and parent reports of family cohesion and conflict are important to consider when integrating information gathered in a clinical assessment.     

Involving Family Members in the Treatment of OCD

This review focuses on previous research with families of adults and children with obsessive‐compulsive disorder (OCD). Three primary areas of research are covered: (i) characteristics of family members and the family environment; (ii) the prediction of treatment response based on family variables; and (iii) the inclusion of family members in treatment. Much of the research supports a hypothesized model of family response to symptoms of OCD that ranges on a continuum from overly accommodating to overly antagonistic. Further research indicates that responses at either extreme of this continuum are associated with poorer response to both exposure and response prevention (ERP) and pharmacotherapy. Finally, results of preliminary treatment outcome studies suggest that family‐based interventions aimed at reducing such responses and/or including family members in ERP as coaches or co‐therapists may enhance patients' response to treatment. Based on current theory and research, suggestions for future research and general recommendations for involving family members in treatment are made.     

The patient in the family and the family in the patient

The notion that the family is “the unit of care” for family doctors has been enigmatic and controversial. Yet systems theory and the biopsychosocial model that results when it is imported into medicine make the family system an indispensable and important component of family medicine. The challenge, therefore, is to provide a coherent, plausible account of the role of the family in family practice. Through an extended case presentation and commentary, we elaborate two views of the family in family medicine — treating the patient in the family and treating the family in the patient — and defend both as appropriate foci for care by family doctors. The practical problem that arises when the family is introduced into health care is deciding when to concentrate on the family system. The moral problems that arise concern how extensively doctors may become involved in the personal lives of their patients and families. The patient-centered clinical method provides a strategy for handling both problems. Thus, making the family a focus of care in family medicine can be justified on theoretical, practical, and moral grounds.     

Emigration as Family Strategy in Chinese Context: Emigration from Fuqing,China

This study explores how family characteristics affect the emigration of family members from the city of Fuqing, China, a major migrant-sending area in China. We focus our discussion on three related questions: how family demographic characteristics affect a family’s participation in emigration, the number of family members involved in emigration, and the locational diversification of family members overseas. Our findings show that family income is related to whether the family has any members overseas and their numbers. Second, a larger family is more likely to participate in migration. These findings are consistent with the argument that migration is a joint family decision. Third, effects of demographic characteristics of different generations on emigration indicate again that migration is a family matter. Finally, our Fuqing findings show no clear patterns of family members settling in the same country if more than one member is overseas.     

Family Therapy Training in Clinical Psychology Programs

In a national questionnaire survey of graduate programs offering the Ph.D. or Psy.D. in clinical psychology, the status of family therapy training was examined. With a 79 per cent response rate (102 programs), the study found that 10 per cent of the nationwide faculty identified themselves as primarily family therapy oriented, 32 per cent of the programs had no family-oriented faculty members, 18 per cent of all psychotherapy courses were family therapy courses, and 21 per cent of the schools had no family therapy course. The ratings of the importance of providing students with family therapy training were found to be unrelated to the number of family therapy courses available but positively correlated with the percentage of family therapy courses within the total curriculum.     

Family Functioning and Coping Behaviors in Parents of Children with Autism

We analyzed family dynamics and coping behaviors of parents with a child with an autistic spectrum disorder. Previous research suggests that moderate levels of cohesion and adaptability are associated with higher levels of positive coping, and that the more coping strategies a family implements, the greater their satisfaction with family functioning. Using a family systems approach, the relationships among the familial variables of cohesion, adaptability, and social support were evaluated for their contributions to coping in the family unit. We also compared the responses of mothers and fathers. Surprisingly, for these parents of children with autism, those who rated their family as enmeshed implemented more positive coping strategies than did those from other cohesion styles. This finding suggests that the enmeshed style may be more adaptive for a family that encounters extreme challenges. Notably, mothers and fathers agreed on all variables except for perception of social support from family and friends. Mothers perceived more social support from family and friends. The results lead to several interesting suggestions for future research.