Medical Family Therapy for a Woman with End-stage Crohn's Disease and Her Son

Medical family therapy grew out of the experiences of family therapists working with other professionals to provide comprehensive, integrated healthcare for patients (McDaniel, Hepworth, & Doherty, 1992). This is the story of one such patient, her son, and those of us who were the three primary participants on her treatment team. To provide an account that comes closest to the experience itself, we have taken quotes from videotaped sessions and electronic mail communications that occurred throughout the course of therapy. Each provider tells part of the story in his or her own voice. The commentary is provided by Susan McDaniel.     

Family Therapy and Drug Abuse: A National Survey

The following report describes the results of a national study of the role of family therapy in the drug abuse field. Characteristics of agencies that work with families are described, as well as the demographic characteristics and psychological problems of the clients most apt to be treated in family therapy. The study also looks at the role and structure of family therapy in the ecological system of the treatment institutions. A profile of the family therapists who are responsible for providing services to families is presented. An attempt was made to assess agencies' level of development with regard to family therapy by using an instrument, The Progress Index for Family Therapy Programs. Generally, findings indicated that there is considerable variation in expertise. More extensive training in family therapy techniques was of major concern, particularly among clinics with a heroin addict population.     

Convening Strategies in Family Therapy

Specific strategies for assembling or convening significant and often reluctant family members for family therapy seem undeveloped in the literature. The author develops and organizes specific convening methods and exemplifies these methods for clinical application. Methods adopted from strategic family therapists, including Haley, Selvini Palazzoli, and Watzlawick, are presented.     

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.     

Dissociative Collusion: Reconnecting Clients with Histories of Trauma in Couple Therapy

This paper introduces the concept of “dissociative collusion” as a helpful theoretical and clinical tool for understanding and working with clients with histories of trauma in couple therapy. The paper describes ways to diagnose and treat dissociative collusion based on the integration of an object relations approach, a relational approach, and a narrative approach. Dissociative collusion, a unique version of the well‐documented “couple collusion,” describes relational unconscious dynamics where split‐off aspects of one or both partners are mutually dissociated in a complementary fashion that becomes a part of the shared unconscious and is reenacted in destructive ways. The dissociative collusion concept is especially relevant to couple therapists who work with clients with histories of trauma, who frequently use dissociation as a primary defense mechanism. We suggest that the challenge and goal for couple therapy with this population are to help them reconnect and better oscillate between dissociated self‐other configurations. A case of couple therapy of a wife who had been a victim of childhood sexual abuse and her husband who displayed frequent use of dissociative defenses is presented.     

An Ecological Approach to Enhancing Parenting Skills in Family Therapy

To increase the effectiveness of parent education interventions, family therapists can address those factors that shape the way in which parents interact with their children. This article presents ecological theory as a framework that can help clinicians expand the range of their parent training efforts. In order to assess the utility of ecological theory for clinical practice, the present study empirically explored the ways in which selected characteristics of parents, children, and the family context related to mothers' parenting behavior. Specific recommendations for family therapists who employ parent training techniques are offered.     

Screening for Physical Violence in Couple Therapy: Methodological,Practical, and Ethical Considerations

Over two-thirds of clients in family therapy clinics engage in some form of physical violence against their partners within the year prior to the initiation of therapy. However, family therapists are aware of only a small proportion of these cases. The purpose of this article is to enhance the ability of family therapists to detect marital violence. We examine client and therapist reasons for why physical violence is not detected. We then review various methods to screen for the presence of physical violence, especially the Conflict Tactics Scales. Finally, indicators of life-threatening violence are presented to help family therapists detect cases that require immediate intervention to protect the partner whose life may be in danger.     

Emotion-Focused Therapy: A Synopsis

The basic principles of an emotion-focused approach to therapy (EFT) are presented. In this view, emotion is seen as foundational in the construction of the self and is a key determinant of self-organization. As well as simply having emotion, people also live in a constant process of making sense of their emotions. Personal meaning emerges by the self-organization and explication of one’s own emotional experience, and optimal adaptation involves an integration of reason and emotion. In EFT, distinctions between different types of emotion (i.e., primary versus secondary, adaptive versus maladaptive) provide therapists with a map for differential intervention. Therapists are viewed as emotion coaches who help people become aware of, accept, and make sense of their emotional experience. Four major empirically supported principles of emotion awareness, emotion regulation, emotion transformation and reflection on emotion guide emotion coaching and serve as the goals of treatment. A case example illustrates how the principles of EFT helped a young woman to overcome her core maladaptive fears and mobilize her ability to protect herself.     

Reflections on Family Therapy in Australia

Family therapy in Australia has been influenced by ideas mostly from North America and Europe. However Australian family therapists have also made their own significant contributions to theory and practice. The vastness of the continent combined with a relatively small population has presented challenges with respect to the formation of a national association and for many years, the Australian Journal of Family Therapy (later the Australian and New Zealand Journal of Family Therapy Board acted as de facto national voice for the discipline. The Australian Association of Family Therapy was formed as recently as 2011. It has a total of over 1,000 members and is the sole organisation representing family therapy and family therapists in Australia. Clinical membership is achieved via successful completion of a 2-year sequence of study in family therapy followed by 50 hours of supervision (or its equivalent). Family Therapy training is mostly delivered in the four most populated states in Australia at both University level and through private organisations registered to provide training at government approved levels. La Trobe University (through the Bouverie Centre), Swinburne University (through the Williams Road Family Therapy Centre) and the University of New South Wales currently provide training leading to specialist qualification in family therapy. A number of other private institutions also provide recognised family therapy training. To date, family therapists and couple therapists in Australia have not in the main shared common platforms such as conferences, training and professional journals. Narrative therapy has also remained somewhat detached from “mainstream” family therapy. Family therapy qualifications are often valued by prospective employers even when duty statements are focused on the more traditional skills of professionals such as psychologists or social workers. Researching family therapy outcomes remains challenging. But although there is increasing practiced-based evidence of the efficacy of family therapy, Australian family therapists as a group are yet to concentrate their efforts on convincing funding bodies of its usefulness. At the same time, via the teaching and promotion of family sensitive practices, systemic ideas are being increasingly incorporated within areas of mental health, disability, alcohol and drug dependency, and within a range of health and welfare areas that impact not just on the individuals but on those close to them.     

Feminist Therapy as a Path to Friendship with Women

While many feminist therapists have found that their personal experiences of friendship have given them an experiential base from which to develop their work, some feminist therapists have had alternative journeys through connections with women. This article explores how the author transformed her childhood and adolescent experiences of relational aggression into a deepened understanding of the value and importance of relationships between women. The contributions of misogyny and sexism to relational aggression among girls and women, and their enduring effects on all women's relationships to other women is explored. Finally, the author describes her intimate e-epistolary friendship with two other women, and considers how the medium of email and other forms of electronic communication may facilitate emotional intimacy for women who have experienced relational aggression with other women.     

Implementing Family-Based Musical Interventions in Family Therapy: A Mixed-Methods Research

Although rarely used by family therapists, musical interventions have the potential to become a more common technique in family therapy. Music’s unique therapeutic properties engage families, including young children and adolescents, in a meaningful, therapeutic, “here-and-now” creative process. Musical interventions act as catalysts, enable direct communication, and augment authentic communication patterns in a playful atmosphere. The purpose of this explanatory mixed-methods research was to obtain a greater understanding of the clinical applicability, therapeutic value and future implementation of a musical intervention carried out by family therapists in a family therapy context. The study explored the outcomes of 35 participating family therapists who attended a designated workshop on a structured family-based musical intervention, 18 of whom then applied 38 family-based musical sessions focused on family roles in their clinical work. The results illustrate the family-based musical intervention is a noteworthy tool for family clinical assessment and treatment, easily applicable in a variety of private and public settings with diverse populations. Musical instruments used as intermediary objects are potent vehicles for growing family awareness, functioning, and congruence, as well as inducing opportunities for change. The family-based musical intervention manifests the potential of an interdisciplinary, holistic, biopsychosocial approach to promoting individual and family wellbeing. The article also addresses ethical considerations and implications for family therapy training and education programs.     

Development of Family Therapy in Ireland

In Ireland family therapy is a small profession, with under 200 registered therapists. The Irish family therapy movement began in the mid-1970s. By 1980 the Family Therapy Network of Ireland in the Republic of Ireland and the Northern Ireland Branch of the UK Association Family therapy had been founded. At present there are three main family therapy training centers in Ireland: two in the south (the Mater University Hospital, affiliated to University College Dublin and Clanwilliam Institute) and one in the north (at Queen’s University Belfast). There is no statutory registration and licensing of family therapists in Ireland. Accredited professional family therapy programs in Ireland are 4-year part-time courses culminating in masters level qualifications. A primary degree in medicine, nursing, psychology, social science or education is a prerequisite for entry. Family therapists in Ireland work in both private practice and the public health service. Most family therapists in the public sector are employed as social workers, psychologists, psychiatrists or nurses, and conduct family therapy as part of their broader professional roles. Couple therapy in Ireland is provided by family therapists, and also by voluntary couple counselors based in networks of local centers, some of which were originally religiously affiliated, without a formal connection to national family therapy associations. The three major future challenges for Irish family therapy are creating a research infrastructure, developing a career structure in the public health service, and introducing statutory registration.     

The Occupational Therapy Elder Abuse Checklist

ABSTRACT

Occupational therapists encounter elder abuse in society and in clinical practice; however, the occupational therapy literature is void of information and tools for assessing and treating individuals at risk. Occupational therapists are in a unique position to identify elder abuse. Definitions of elder abuse, signs and symptoms of elder abuse, and reporting practices required of professionals coming in contact with individuals who may have been abused are presented. The Occupational Therapy Elder Abuse Checklist was developed to assist the occupational therapist as well as other health care professionals in uncovering abusive situations of elders who are either living alone or living with others. Guidelines are provided for use with the tool. A case study illustrates use of the tool for reporting suspected abuse, and the assessment and treatment of an individual who is a victim of elder abuse.     

Community Family Therapy with Military Families Experiencing Deployment

The length and frequency of deployments in the current wars in Iraq and Afghanistan are associated with increased vulnerability for both part- and full-time military families who stand to benefit from systems-oriented practice by marriage and family therapists. Community Family Therapy (CFT) is a modality designed to promote resilience both within and beyond the four walls of the therapy room, facilitate family connections in the community, and empower them for local leadership. The effects of deployment on families are summarized and CFT principles are adapted as a framework for intervention with this population.     

Family Therapy in the Heart of Europe

The article introduces the situation of family therapy and systemic practice in the Czech Republic. It gives an overview of family therapy history and development in the country. Both historical and political background including major transformation events in the last couple of decades are presented so as to explain the contextual frame for major challenges, which Czech family and systemic therapists have been facing in this part of Europe. The current situation of family therapy in the Czech Republic is described in detail with regard to leading figures, major schools, training issues, international exchange and clinical practice in various settings.     

Narrative Child Family Therapy

In this article, child family therapy is presented as a hermeneutic activity shaped by an interest in the evolving narrative. Over brief, analytic play interviews, the therapist documents a child's narrative understanding of the presenting family problem. This allows psychological meaning to be jointly constructed in therapeutic conversation with the child and family. The idea of play as narrative integrates child psychotherapy into recent social constructionist thinking in family therapy. The article also discusses how narrative therapists can use prior theory and training.     

When the Woman Presents Herself as "the Patient"

The thesis of this paper is that women are delegated by their families, by sociocultural norms and stereotypes, and by the psychotherapeutic community to perform in the role of patient. In many cases women are diagnosed, labeled and treated for supposed intrapsychic difficulties without adequate consideration of the relationships of the woman's social system to the dysfunction. This acceptance of the notion of intrapsychic causation in the woman, while ignoring the larger family system, grows out of a cultural world view which stresses individual self-determination is economically rewarding for the therapeutic community (two-thirds of the client population is female), it does a disservice to the woman and her family. A societal myth is perpetuated of the women as the "problem-bearer" and the one who is "sicker" or "crazier" than others in her family. The woman's symptoms need to be viewed as having interpersonal reality; symptoms are tactics of communication not mythological internalized driving forces with special attraction to the female psyche. An attempt will be made to outline how therapists may unwittingly collude in perpetuating the myth of individual dysfunction in the woman. Ideas are presented for viewing the woman's request for service as an attempt to solve a systemic problem and how therapists, by recognizing the function of the symptom in the woman's social system, can help the woman better define and solve the problem.     

Family therapy and outcome: Relationships between therapist and family styles

This study examined therapeutic outcome for a group of 175 clinic families divided into levels of family competence and style, and, later, into seven clinical groupings. The division into these groups was based on the level of rated Competence and Style determined by using the Beavers Systems Model. Therapists also rated their level of Openness/Sharing Strategy, Power Differential, and Partnership with the family at the third session. Results indicate that more competent families who fared well in therapy had therapists who formed a partnership, disclosed strategy, and employed a minimal power differential with the family. The most disturbed families, and those with a Centrifugal style, did better with therapists employing a high power differential and lower levels of openness and partnership. The study also presented the distribution of individual diagnoses by family groups. Implications for family therapists, including the value of family assessment, are provided.     

The Facilitation and Maintenance of the Therapeutic Alliance in Family Therapy

The formation and maintenance of the therapeutic alliance in family therapy involves complexities pertaining to the stabilizing tendency of family systems, and the necessity for negotiation of the goals and tasks of therapy with and among multiple individuals (i.e., the family members) in a context of systemic reciprocity and mutual influence. This article explores the complexities associated with the establishment and maintenance of the therapeutic alliance in family therapy. Alliance stances are presented as clinical applications designed to assist therapists in working with split alliances, establishing within family collaboration, and in negotiating homeostatic processes.