Selective mutism in children: A structural family therapy approach to treatment

When children refuse to speak in some social settings, but can understand and speak in other settings, the diagnosis of selective mutism must be considered. A review of the literature describes the disorder, the various types of mutism, and related family dynamics. A family systems approach to treatment using structural family therapy is suggested. The case history presented illustrates one type of mutism as well as the family rules and hierarchy which appeared to be maintaining it. Structural and strategic family systems theory techniques that were used to move the family toward resolution of this problem are discussed.Diane Wolf Tatem, MA, MS, completed graduate work in marriage and family therapy at New Mexico State University, Las Cruces, NM. She is employed at Life Management Center of El Paso's Child Development Services and also has a private practice in marriage and family therapy in El Paso, Texas. Robert L. DelCampo, PhD is a professor of family science at New Mexico State University and maintains a private practice with Associates for Marriage and Family Therapy in Las Cruces, NM. Please address all correspondence to Dr. DelCampo at Box 3470, New Mexico State University, Las Cruces, NM, 88003-3470.Appreciation is expressed to Dr. Charles Huber, New Mexico State University in Las Cruces, for his insightful critique of the final draft of this paper. This paper was presented at the Texas Association for Marriage and Family Therapy Annual Conference, January 25–29, 1995 in Dallas, TX.     

Wilderness family therapy: An innovative treatment approach for problem youth

We present a treatment program (The Family Wheel) designed to integrate wilderness therapy interventions with family therapy for the treatment of troubled adolescents. The Family Wheel program was conducted in the high desert of southern Idaho. Participation in this four-day program required parents and their adolescent children to engage in an intensive experiential family therapy while camping and trekking in the wilderness. An evaluation of the program revealed positive outcomes for the programs' participants. The theory, research, and pragmatics of conducting such an innovative program are discussed.     

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.     

An ecological approach to child and family clinical and counseling psychology

The ecological model of child and family clinical and counseling psychology considers mental health service delivery within a health maintenance framework, approaching the complexity of children's behavior in a systematic and organized fashion using science-based intervention practices. The service delivery framework integrates assessment, intervention, and motivation at all phases of an intervention. Assessments enhance the participants' and professionals' appraisal, which in turn impact motivation to change. Interventions are sensitive to assessment-based targets and participant motivation. A menu of interventions range from assessment, feedback, and brief interventions to more extensive mental health services, potentially integrated with other community agencies and school settings. The ecological model suggests revisions in the conceptualization of child and adolescent psychopathology, training for mental health professionals, and strategies for the design and testing of interventions. In general, a reformulation of mental heath services for children and families within an ecological framework enhances the potential for integrating science and practice.     

Families and family therapy in Germany

The author describes some of the effects of decades of life under a dictatorship for East Germans and the effects on family life and family therapy of changes following the recent reunification of Germany. A case example illustrates some intergenerational family problems associated with the changes. Contrasts are drawn between East and West Germany and family therapy's present stage of development is depicted in both parts of the reunified country. Germany has approximately 10,000 trained family therapists, a minority of whom work in private practice. The largest amount of family and couples therapy is performed in agencies.Portions of this material were first presented in a poster session at the American Association for Marriage and Family Therapy annual conference in Miami Beach, 1992.     

Involving the family in the evaluation and treatment of the child patient: A psychodynamic approach

The purpose of this article is to provide psychotherapists with a tool for family evaluation using the basic principles of psychodynamic work; and to introduce a transitional format for therapists who have practiced family evaluations in their training institutions and now need to adapt this model to the private practitioner's office. A case example illustrates: (1) Use of the therapist's unconscious for diagnosis of the child and its family, (2) joining the family's intersubjective space, and (3) use of play and therapist's neutrality as ways that the psychodynamically oriented clinician involves the family in the evaluation and treatment of the child.     

The use of interpreters in family therapy with deaf persons

The paper discusses the use of interpreters in family therapy with deaf person families. Issues from the perspective of the therapist, the interpreter, and the family are presented.Portions of this paper were presented at the annual meeting of the Texas Association for Marriage and Family Therapy in San Antonio, TX.     

Systemic insight in family therapy

Systemic epistemology calls for a concept of Systemic Insight, a restructuring insight that has to do with truly grasping systemic reality. Systemic Insight is action and change-oriented, grounded in the direct systemic experience of the client, and based on the how instead of the why of the relationship problem. Its results affect the whole system. The author elucidates the definition and therapeutic application of this concept, expanding on five major ingredients and illustrating in a verbatim case and commentary specific guidelines for designing interventions which procure Systemic Insight.The concept of Systemic Insight was first presented by the author as a workshop at the European Family Therapy Association International Congress: Feelings and Systems, Sorrento, Italy, November, 1992. I would like to thank Ms. Sara Iwanir, Dr. Haviva Ayal, my co-directors, and especially my husband Ron for his unending support and the helpful out of the profession fresh views.     

Attentional disengagement in adults with Williams syndrome

Williams syndrome (WS) is a neurodevelopmental disorder characterized by a distinctive behavioral and cognitive profile, including widespread problems with attention. However, the specific nature of their attentional difficulties, such as inappropriate attentional allocation and/or poor attentional disengagement abilities, has yet to be elucidated. Furthermore, it is unknown if there is an underlying difficulty with the temporal dynamics of attention in WS or if their attentional difficulties are task-dependent, because previous studies have examined attention in established areas of deficit and atypicality (specifically, visuospatial and face processing). In this study, we examined attentional processing in 14 adults with WS (20–59 years) and 17 typically developing controls (19–39 years) using an attentional blink (AB) paradigm. The AB is the decreased ability to detect a second target when it is presented in close proximity to an initial target. Overall, adults with WS had an AB that was prolonged in duration, but no different in magnitude, compared with typically developing control participants. AB performance was not explained by IQ, working memory, or processing speed in either group. Thus, results suggest that the attention problems in WS are primarily due to general attentional disengagement difficulties rather than inappropriate attentional allocation.     

The growing pains of family therapy in Singapore

Family therapy in Singapore is both short on history and overdue for development. Through in‐depth interviews with six experienced local family therapists and trainers, this article explores the challenges of family therapy development in Singapore, giving particular attention to practice, supervision, training, and research. Over time, family therapy practitioners in Singapore have gained insights in applying systemic ideas in this pluralistic society where there is a rich mix of race and ethnicity. This article highlights the contribution Singapore's experience of family therapy can make to a more global picture, in view of its rich multicultural context despite significant challenges.     

Applying Delphi methodology in family therapy research

The Delphi technique, which is increasingly seen in family therapy publications, encourages the articulation of refinement in family therapy practice and theory. Combining both quantitative and qualitative methodology, this technique involves consideration of information that might otherwise have been overlooked. Due to lack of clarity on this approach, a dilemma exists in applying this research procedure in family therapy. To remedy this deterrent, this paper reviewed 11 studies and outlined use of the technique in regard to design, procedure, and sampling.     

Joining with all members of a family system: The rhetoric of antilogic in family therapy dialogue

Family therapists face a significant rhetorical challenge in working with families that disagree about the problematic life-situation which brought them to therapy. Therapists must find a way to join with disagreeing family members and then find a way to engage in a therapeutically useful conversation with them. Thus, they must deal resourcefully with contradictions. This article explores the ways that the Sophistic rhetorical concept of antilogic may be employed in helping therapists join and then engage in a therapeutically useful conversation with families who hold contradictory views concerning the problem that brought them to therapy.The author wishes to thank Ronald Chenail, PhD, Douglas Flemons, PhD, and Shelly Green, PhD, for their assistance in the development of this project.     

The integration of individual and family therapy

It is time to put an end to the separation in training programs between individual and family therapy. Competent therapists should be able to think at an intrapsychic and circular level concurrently. Training programs should maintain their current major focus and develop their minor area of expertise sufficiently so that their graduates can practice both individual and family therapy and choose whichever modality is more appropriate to the case at the time. Bridge concepts, essential differences, and some integrative approaches in individual and marriage and family therapy are discussed.     

Stories we tell each other: A comparison of families' and their therapists' explanations of presenting problems

This study reports the explanations of presenting problems given by 10 mothers of children referred to a department of child and family psychiatry and their therapists. Video-recordings of therapists' pre-session meetings and the initial therapy sessions were searched for explanatory statements. These statements were then coded. It was found that therapists referred to past events, present circumstances, relationships, and possible future events in their explanations of presenting problems significantly more frequently than mothers. It was rare for mothers to speak in terms of past or future events at all. The mothers explained difficulties in terms of character traits significantly more often than did the therapists. The implications of these findings are discussed.Thanks to all of the child and family consultation team at 1 Wolverton Gardens for their participation in this research and particularly to Ruth Kossoff for her great help with organising data collection.     

Utilizing structural family therapy and systems theory in the business world

The structure of businesses and the structure of families are very similar, considering the fact that so many businesses are owned or operated by families. Structural family therapists who are knowledgeable in systems theory and have an adequate understanding of the underlying concepts of structural family theory (including hierarchy, boundaries, and coalitions) can translate their knowledge to the structure of businesses and organizations. The purpose of this paper is to illustrate the similarities between the structures of families and businesses. In doing so, an application of structural family theory to the business world (employee assistance programs, business consultation, and family businesses) will be demonstrated.     

Young Asian children with learning and behaviour problems: A family therapy approach

The paper describes work with five Asian families. The children were failing and showing signs of behavioural disturbance at infant or junior school, and it was felt that this could be due to family psychopathology. Communication with the adults presented some difficulty to the therapist, and there was the additional problem of distinguishing between those patterns of behaviour which were pathological and those which were merely unfamiliar. The approach used was pragmatic and based on the assumption that there is sufficient 'psychic unity' between people of different cultural backgrounds to be used therapeutically, even when communication is difficult.