The hidden meanings of metaphors in family therapy

This study investigates how two therapists' beliefs and practices influence the therapeutic process when they organize social interaction according to a metaphor of a royal family. The therapeutic process is described through the case of a boy called Pelle. He comes to therapy together with his family. It is shown how the therapists collaborate in the process of implementing the worldview of the predefined normative standard for family life. In the short term the therapists' use of the metaphor can be seen as an intervention to accomplish immediate change in a non-threatening way. In the long term the cost of using the metaphor was that the mother got a confirmation about herself as a less powerful parent and the child got an image of being a failure. This study points out that metaphors as therapeutic tools have to be analyzed critically before they are used or more specifically the therapists have to examine what kind of values and meanings are hidden in the metaphor and who will gain and loose if it is used as an intervention.     

New branches on the Tree of Knowledge. Challenges for systemic family therapists

Faced with today's challenges, I question whether the framework for family therapy provided by systemic thinking is sufficient when working with children and teenagers. The aim of this paper is not to argue for an eclectic model for therapy, but rather to encourage a critical dialogue between various bodies of knowledge. The paper raises the discussion of how family therapists relate to knowledge external to the therapy field. Contemporary developmental psychology, neurobiology, behavioural genetics and group socialization theory are highlighted as useful bodies of knowledge for family therapists. Examples from clinical practice are used to illustrate this.     

Psychoanalysis and family therapy: Freud's Dora case reconsidered

Freud's Dora case is considered from the perspective of family therapy. Her illness is homeostatic; it holds two disturbed fractured families together. Freud considered his analysis a failure; from a systems point of view it was a partial success. His challenging technique is similar to that of modern family therapists. The theories of change underlying family therapy and psychoanalysis are compared. There are many similarities. They are mutually compatible disciplines, working at different levels.     

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.     

Feminism and family therapy—a possible meeting point

This paper centres on the question ‘Is it possible to be a feminist and to practise family therapy?’ We explore the essence of feminism and family therapy and conclude that a style of feminist family therapy is possible. Feminist family therapy has a particular theoretical base and is characterized by a particular combination of practice principles. It also raises general issues for the training and practice of all family therapists.     

Narrative Therapy's Relational Understanding of Identity

We describe how we think of identity as relational, distributed, performed, and fluid, and we illustrate the use of this conceptualization within a narrative worldview. Drawing on the work of Michael White, we describe how this relational view of identity leads to therapeutic responses that give value to interconnection across multiple contexts and that focus on becoming rather than on being. We show how a narrative worldview helps focus on the relational, co‐evolving perspective that was the basis of our early attraction to family therapy. We offer detailed examples from our work of practices that help us stay firmly situated in a relational worldview that is counter to the pervasive influence of individualism in our contemporary culture.     

Do primary care psychological therapists ‘think family’? Challenges and opportunities for couple and family therapy in the context of ‘Improving Access to Psychological Therapies’ (IAPT) services

Very little couple or family work takes place in primary care despite the advantages offered by the context. This pilot study investigated the experiences of primary care adult therapists regarding the place of families in their clinical work. Semi‐structured interviews with seven therapists were analysed using interpretative phenomenological analysis. The findings tentatively suggest that primary care psychological therapists ‘think family’ primarily from the perspective of their main therapeutic model when offering individual therapy. Some study participants questioned the appropriateness of their family/context focus. Family members were extremely rarely seen together. Facilitating factors included supervision and training. Barriers to family work were both external (the work setting) and internal (beliefs about it). The impact of the current dominance of cognitive behavioural therapy in National Health Service adult psychological therapy services and the development of Improving Access to Psychological Therapies (IAPT) services on the provision of couple and family therapy are discussed. Some challenges and opportunities presented by IAPT for couple and family therapy are explored.     

'We are the stuff that dreams are made on': the use of dreams in systemic therapy

This paper considers the place that dream material has occupied in therapy, and particularly family therapy. A rationale will be given for the inclusion of this source of information by systemic therapists. The use of dreams in systemic therapy with individuals, couples and families is described. Dreams are divided into five main categories: those that precipitate therapy, provide hypotheses, as memories, relationship dreams, and those that reflect the process of change. Each category is described and illustrated with relevant clinical material. The paper concludes with a method for working with dreams that is congruent with a systemic perspective applicable to individual, conjoint or family therapy sessions.     

Integrative Shifts for the Theory and Practice of Family Systems Therapy

This paper describes several disagreements among approaches to family therapy and proposes two conceptual shifts providing a more integrative perspective. The first shift focuses on the implications of different ways therapists orient themselves to the developing structures of the therapy system and to the disabled structures of the client system. The second shift reconsiders theoretical approaches in terms of the types of distance they require of the therapist and the types of information these distances provide and ignore. Finally, the paper also discusses a means for classifying the different types of goals therapists establish for their clients, emphasizing that these goals must be consistent with the clients' views of themselves and the world.     

Influence of Racial/Ethnic Membership and “Therapist Culture” on Therapists' Worldview

The authors investigated 2 competing hypotheses related to therapists' worldview and therapists' race/ethnicity: (a) whether therapists of different racial/ethnic groups differed on worldview reflecting group membership, and (b) whether therapists were similar to each other on worldview reflecting membership in a “therapist culture.” Results indicated that therapists shared similar worldviews regardless of group membership, and differences found between therapists based on racial/ethnic membership were minimal.     

Overpopulation and the Lifeboat Metaphor: A Critique from an African Worldview

This article is a contribution to overpopulation discourse in environmental ethics. It is based on the hypothesis that, even though the idea and reasoning behind Garret Hardin’s lifeboat metaphor are crucial within the current environmental crisis, from an African perspective, the metaphor raises a number of questions. The article argues that the lifeboat metaphor poses an ethical challenge to most communities particularly in Africa because it runs contrary to their political and cultural worldview. I advance two central claims in the framework of insights from an African worldview. First, the ethics behind the lifeboat metaphor is deeply dependent upon political power differentials, particularly between affluent and poor nations. Second, the metaphor fails to take into consideration the cultural understanding of population in Africa.     

What we say we do: results of the 1997 UK Association of Family Therapy Members Survey

This study represents the first UK national survey of family therapists and systemic practitioners. The aim was to provide demographic information of systemic practitioners/family therapists and also to describe their clinical practice. The sampling frame used was the UK Association of Family Therapy membership list and all members were sent a postal questionnaire. The response rate was 33% with 495 out of 1500 questionnaires returned. Among the major findings were: systemic practitioners/family therapists are most likely to work for an NHS trust, to use family therapy techniques/systemic ideas predominantly, and to treat a broad range of client issues. They are also most likely to work with families, and therapy is relatively short term (five to eight sessions) regardless of whether they treat families, couples or individuals. Most family therapists/systemic practitioners use some measure of outcome, although frequently this will be feedback from clients. Supervision is sought by the majority of AFT members. In spite of some methodological limitations, the study provides interesting insights into the training and practice of UK family therapists and systemic practitioners which appears to differ in some respects from our American colleagues. It also provides a baseline for future surveys, making it possible to describe the developments of family therapy and systemic practice in this country.     

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.     

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.     

On the Psychology of the Uncertain Self and the Integration of the Worldview Defense Zoo

In this paper, I focus on two issues raised against the uncertainty management model that I proposed. The first issue has to do with the need for deeper insight into psychological processes instigated by uncertainty concerns, including the possibility of positive responses to uncertainty. The second issue revolves around the question to what extent uncertainty management is the core motive (vs. a core motive) of worldview defense and sense-making. By discussing these two issues, I hope to (a) make my view on uncertainty management processes clearer, (b) note explicitly that I was advocating a core motive of worldview defense (not the core motive), and (c) propose a research agenda for future research. I end the article with a plea for research studies that focus on moderators of worldview defense motives. These moderator studies may help to integrate the large variety of core motives proposed in the literature to underlie worldview defense strategies.     

Die verbale Aktivit?t in therapeutischen Dialogen

The discourse in psychotherapeutic treatment is less specific than usually expected so the question arises whether different therapy methods are different in the style of communication. In this study the verbal activity and other characteristics of the discourse of therapist and patient for sessions from two psychoanalytic, two psychodynamic and two cognitive behavior therapies were compared. Psychoanalytic therapists were found to talk the least and behavior therapists the most. Patients talk nearly the same amount in all therapies. As therapists of psychoanalytic treatment talk less than behavior therapists the percentage of patient talking is highest in psychoanalytic therapy. Further formal characteristics: statements are the most frequent form of intervention in behavior therapy (51?%), followed by psychodynamic (36?%) and psychoanalytic therapy (27?%). The most frequent form of intervention in psychodynamic and psychoanalytic therapy is listening, whereas it is only a small part of communication in behavior therapy. Questions are asked most often in behavior therapy. Hence there are significant differences which correspond to the theory of treatment, between the three methods in discourse behavior on a single case level.     

The complaining client and the troubled therapist: a discursive investigation of family therapy

In this paper I examine two important issues for family therapy research. I attend to the concept of complaints, highlighting the conversational structure they take in a family therapy setting. I do this by outlining how clients construct their complaints and examining how the family therapist receives them. Data is taken from a corpus containing four different families and two different therapists, and is subjected to discursive analysis in order to provide a rich analysis of not just what is happening in the talk but how it is happening. I conclude that complaints are not received as useful to the therapeutic process, despite their constructed importance to the client, and therefore there are wider implications for therapy and professionals more generally, particularly implications for multi-agency communication.     

The limits of systems therapy: The problem of intimacy

By placing so much emphasis on systemic thinking, marriage and family therapists have lost sight of the individual within the system. One of the limits of a systemic therapy is its capacity to deal with problems in intimacy, a central problem in marital therapy. A knowledge of individual development is crucial for family therapists. The two themes dealt with in this paper are 1) some concepts of self psychology which can be useful in understanding the fear of intimacy, and 2) at what point, in couples' therapy, it is advisable to shift to individual therapy for one or both partners.     

Family therapists in trauma-response teams: bringing systems thinking into interdisciplinary fieldwork

Attention to the mental health facets of disaster-preparedness and trauma-response teams has increased considerably over the past decade. As family therapists take part in these efforts, they bring with them a worldview that adds valuable contributions to the nature in which fieldwork is conducted and the manners in which interdisciplinary teams function on the ground. In this article, we present how systems thinking sensitizes trauma workers to a variety of clinical presentations and biopsychosocial complexities inherent in this work. We describe common clinical- and practice-related challenges, alongside practical strategies for effectively dealing with these challenges. We draw upon our experiences as family therapists trained in the field of trauma, and our work as field responders, supervisors and team leaders across a variety of local and large-scale disaster events and contexts.