Evaluating Training Needs for Home-Based Family Therapy: A Focus Group Approach

Therapists and supervisors engaged in the delivery of home-based services participated in two rounds of focus groups. Participants discussed the challenges they face doing home-based therapy, and how an accredited family therapy program could modify its curriculum to better prepare trainees to meet these demands. Eight topic areas considered necessary for home-based practice were identified and the implications for training reviewed. The focus group methodology is described in detail and is recommended as a useful tool to assess training needs and as a way of promoting improved collaboration among training sites.     

Minding the Gap not Bridging the Gap: Family Therapy From a Psychoanalytic Perspective

Following recent interest in this journal in building bridges between a psychoanalytic and systemic approach to family therapy (Vol. 19, 1997), the authors take up the debate. A clinical vignette from a recent article is used for discussion and, in order to describe further work from a psychoanalytic perspective, two case vignettes are presented. The comparisons are discussed with particular reference to the concepts of projective identification, transference/countertransference and internal object relations.     

Treating Insecure Attachment in Group Therapy: Attachment Theory Meets Modern Psychoanalytic Technique

Attachment theory is a comprehensive, empirically supported theory of emotional, relational, and neurophysiological development. Modern psychoanalysis is a theory of technique that addresses early psychological deficits and conflicts considered beyond the reach of traditional psychoanalysis. Both orientations have influenced the theory and practice of group psychotherapy and emphasize personality maturation as a treatment goal. This paper explores their potential synergies when treating preoedipal, insecurely attached emotional states, disrupted emotional self-regulation, and impaired mentalization. Theoretical and technical applications are suggested that may enhance the treatment of disordered attachment in group psychotherapy. By addressing insecure attachment as resistance, modern psychoanalytic techniques may engage the emotional substrates of the attachment process to facilitate the expansion of relational capacities, mentalization, self-regulation, the differentiation of self/other representations, and epistemic trust.     

Psychoanalytic Models of the Mind for Couple and Family Therapy

This paper describes an object relations theory of mind that highlights the interactive origin of psychic function and the beginnings of mental structure in the infant's relationships within the family group. Based on this model, psychoanalytic family and couple therapy employs the interactions between family and therapist to detect and work with developmental failures in holding and containment, skewed family projective identification, and attacks on linking, which characterize pathological and traumatized families. The coming together of transference generated by the family as a group and the therapist's countertransference are the fulcrum on which such therapy turns. An extended vignette of a session is used to illustrate the application of object relations theory to the therapeutic process of family therapy.     

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.     

Multi-Family Group Therapy: A Multidimensional Approach

The procedures, dynamics, and process of multi-family group therapy are presented with case examples from the authors' practice.     

Family Therapy Study Group: The Mumbai Experience

Family therapy training in India is not provided in a systematic manner. Only one institution, the National Institute of Mental Health and NeuroSciences at Bangalore, offers this training, in the form of a three-month program. Consequently, a workshop on basic skills in Family Therapy was conducted in February 2003, at Mumbai, by a trained family therapist from Bangalore. The workshop resulted in founding the Family Therapy Study Group (Mumbai), a non-registered body, in March 2003 so that learning could continue to occur. The group meets once a month for two hours and has had 18 such meetings at this writing. This paper describes the objectives, activities, significant achievements, and future plans of the study group.     

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.     

A Feminist Approach to Family Therapy

Although family therapy recognizes the importance of the social context as a determiner of behavior, family therapists have not examined the consequences of traditional socialization practices that primarily disadvantage women. The unquestioned reinforcement of stereotyped sex roles takes place in much of family therapy. A feminist therapy orientation that considers the consequences of stereotyped sex roles and the statuses prescribed by society for females and males should be part of family therapy practice. This paper describes the ways in which family therapists who are aware of their own biases and those of the family can change sexist patterns through applying feminist principles to such areas as the contract, shifting tasks in the family, communication, generational boundaries, relabeling deviance, modeling, and therapeutic alliances.     

A Cognitive-Behavioral Approach to Family Therapy

Although cognitive behavioral spectrum approaches with individual children are plentiful and demonstrate effectiveness, cognitive behaviorally oriented clinicians are frequently left to their own devices when it comes to treating families. Cognitive behavioral family therapy is a relatively recent development and there are precious few reports of its clinical use. This article presents a conceptual foundation and clinical rubrics for the practice of cognitive behavioral family therapy. Basic theoretical background information is presented and places the therapeutic processes and procedures in a proper context. Session structure in cognitive behavioral therapy is illustrated and the way it propels therapeutic momentum and adds focus to each session is explained. Rudimentary processes of self-monitoring, self-instruction, rational analysis, and behavioral enactment are described and augmented with case material. Finally, the conclusion offers directions for further theory building, research, and clinical practice.