Family therapy and soiling

Children and families referrred for soiling problems present special challenges to family therapists. Behaviour modification and the externalizing approach of White and Epston are considered in relation to these challenges. Externalizing may offer advantages over existing approaches and deserves systematic evaluation.     

Family therapy and psychopathology: developments in research and approaches to treatment

The impact of family approaches in understanding and treating psychopathology is reviewed for the following disorders: schizophrenia, mood disorders, anxiety disorders, psychoactive substance use disorders, eating disorders, and conduct disorders in children. Family-oriented interventions are concluded to be useful in treating disorders when applied flexibly and multi-dimensionally and when used in conjunction with psychopharmacological or other valid individual treatment approaches.     

Hard-to-manage preschool boys: Family context and the stability of externalizing behavior

Preschool boys identified by their teachers as active, inattentive, and impulsive (N=42) were compared with matched classroom controls (N=43) and with parentidentified problem boys (N=27) on measures of family functioning often associated with children's problem behaviors, including family history of psychopalhology, stressful life events, and family composition. Teacher-identified and parent-identified problem boys did not differ on measures of family adversity, and both groups came from less well functioning families than comparison boys. Mothers of problem boys, regardless of referral source, were more negative and controlling toward their sons when observed in a compliance task. Children's problem behaviors were moderately stable over a oneyear follow-up period; initial symptom levels, maternal self-reported depression, and negative maternal control predicted follow-up ratings of externalizing problems.Thanks are expressed to Clea Angell, Clare Flanagan, Julie Hunt, Patricia Huszar, Andrea Lurier, Sarah McAuliffe, Jasmine Sardessai, and Teri Sobolik for help with data collection, coding, and analysis. We are grateful to the staff of the many preschools in the Pittsburgh area who facilitated our work. Special appreciation is expressed to the children and parents who participated in this study.Portions of these data were presented at the Rochester Symposium on Developmental Psychopathology, Rochester, New York, October 1988, and at the Society for Research in Child and Adolescent Psychopathology, Costa Mesa, California, February, 1990. This work was supported by grant R0I MH32735 from the National Institute of Mental Health to Dr. Campbell.     

Family therapy training methods: minimal contact with an agency

This paper describes the development, implementation and monitoring of a family therapy training programme with several special features. Training was given to staff of a large agency at a site distant from the trainers. Because input from trainers was limited, peer-group self-directed teaching approaches were used. Formal evaluation demonstrated that the programme was successful. This report describes the concepts, methods and techniques which were employed in this programme and which can be easily used in other settings.     

Family therapy for bulimia nervosa in adolescents: an exploratory study

Family therapy has only rarely been reported as a treatment for bulimia nervosa and not specifically’for adolescents. This account describes family therapy with eight adolescents who suffered from bulimia nervosa. Change was measured by assessing symptomatic behaviours and global measures of family and social function prior to treatment and again one year later. At reassessment there was a significant reduction in bulimic behaviours although many had some continuing symptoms. Some aspects of the therapy are described and implications for further study of treatment for adolescent bulimia are discussed.     

Family therapy with deaf persons: the systemic utilization of an interpreter

This paper discusses the theory and practice of providing family therapy to families in which there are hearing parents and at least one Deaf child, particularly regarding the optimal utilization of an interpreter. The therapist must be knowledgeable about the psychosocial effects of deafness, the cultural aspects of deafness, and preferably be able to use American Sign Language and Signed English. The therapeutic benefit of utilizing an interpreter extends far beyond simply facilitating communication between each family member whose primary-language is either spoken English or Sign Language. The presence of an interpreter helps the therapist to modify family rules that deny the implications of deafness and prohibit the use of Sign Language, to modify the balance of power in the family, and to encourage participants to exhibit the ego defense mechanisms of projection and transference. The family therapist can utilize those subtle yet profound influences to therapeutic advantage.     

Family therapy and communion

There has been a shift of healing authority in our culture from priestly practitioners to scientific and medical practitioners. As part of this change the care and healing of stressed or broken families is now seen as the responsibility of the family therapist. A consequence of this has been some role confusion on the part of the clergy and therapists. A comparison of the symbolic complex of belief and value systems used in MacGregor's team-family method of family therapy and Joseph Haroutunian's theology of the church shows four striking similarities. The implications of these similarities for the continued confusion or clarity of the roles of priest and therapist are noted.Rev. Fitchett is Chaplain-Supervisor and Assistant Professor, Department of Religion and Health, Rush-Presbyterian-St. Luke's Medical Center, 1753 West Congress Parkway, Chicago, Illinois 60612.     

Family therapy: An evolving story

Contemporary Family Therapy -     

Family structure,maternal employment,and change in children's externalizing problem behaviour: Differences by age and self-regulation

This study used a latent difference score growth model to investigate how changes in family structure (biological father and stepfather residence) and maternal employment are associated with American children's externalizing problem behaviours (EPB) from ages 4–10 and whether these associations vary by children's level of self-regulation. For all 4-year-old children, living with a biological father at age 4 was associated with reductions in EPB at ages 4–6 and later years, with no variation by child self-regulation. Living with a stepfather at age 4 was associated with higher levels of EPB at age 4; however, for less-regulated children, stepfather residence at ages 4 and 8 was associated with reductions in EPB between ages 4–6 and 8–10, respectively. Greater employment hours were associated with increased EPB in the next 2 years for less-regulated children of all ages; however, except for the age 4–6 transition, there was a lagged association that reduced behaviour problems after 2 years and outweighed short-term increases.     

Family therapy and clinical psychology

The results of a survey of 111 clinical psychologists in the Republic of Ireland along with some comparable data from US and UK surveys were used to address a series of questions about the link between family therapy and clinical psychology. Family therapy was not a clearly identifiable sub-specialty within clinical psychology in Ireland. Family therapy theoretical models were used by more than a quarter of the Irish sample to conceptualize their work but by less than a tenth of US and UK respondents. In all three countries about a tenth of treatment time was devoted to the practice of family therapy. In Ireland, the use of family systems models, family assessment interviews and family therapy was more common within the child and family specialty than within the mental handicap or adult mental health clinical psychology specialties. The experience of live supervision and participation in family or couples therapy were important formative factors in the development of some clinical psychologists. Further training in systemic consultation, particularly in situations where an abuse of power has occurred, was identified in the survey as a priority area for continuing professional development. The evolving relationship between family therapy and clinical psychology is discussed in the light of these findings.     

Family therapy and incomplete families

Much of the literature in family therapy refers to the clinically orientated work with well-motivated families using specific techniques. This article briefly outlines the two main theoretical stances within family therapy as a whole, and describes three categories of incompleteness in families with particular reference to the idea of 'masked' incompleteness. This is illustrated by five case examples which show some of the common difficulties of working with families whose disturbance includes a masked incompleteness. The inadequacies of a singular treatment approach with such families are outlined, and it is suggested that the 'systems' approach in particular has limitations and possible contra-indications in such circumstances. It is argued that the more eclectic and pragmatic approach described, whilst remaining within the boundaries of family therapy as a whole, is likely to offer a more effective consideration of the long term needs of such families.     

Family therapy and psychosomatic illness

The author suggests that clinical experience has developed to the point where the question can be asked, “Is a specific psychosomatic illness responsive to a specific type of family therapy?” Examples such as structural family therapy in childhood diabetes, asthma, pain, and anorexia nervosa; cognitive family therapy in adult chronic pain; and marital group behaviour modification in adult obesity, chronic pain, and myocardial infarction, are critically reviewed. The evidence suggests, but does not yet prove, that specific types of marital and family therapy may be effective in a few specific psychosomatic problems, a useful adjunctive therapy in some psychosomatic problems, and that family assessment is helpful in the management of all psychosomatic problems.