The patient in the family and the family in the patient

The notion that the family is “the unit of care” for family doctors has been enigmatic and controversial. Yet systems theory and the biopsychosocial model that results when it is imported into medicine make the family system an indispensable and important component of family medicine. The challenge, therefore, is to provide a coherent, plausible account of the role of the family in family practice. Through an extended case presentation and commentary, we elaborate two views of the family in family medicine — treating the patient in the family and treating the family in the patient — and defend both as appropriate foci for care by family doctors. The practical problem that arises when the family is introduced into health care is deciding when to concentrate on the family system. The moral problems that arise concern how extensively doctors may become involved in the personal lives of their patients and families. The patient-centered clinical method provides a strategy for handling both problems. Thus, making the family a focus of care in family medicine can be justified on theoretical, practical, and moral grounds.     

Management of religious issues in family therapy

Social scientists have long emphasized the reciprocal relationship between family and religion in society. Yet the family therapy literature is virtually devoid of consideration of religious variables in family life and function. Four major psychosocial aspects of religion in family life are discussed: sacralization, coalitions with the supernatural, religious conflict as a projection of family conflict, and family conflict as a projection of religious conflict. Clinical issues presented include: family therapy in religious and secular contexts, family religious expectations and transference, therapist religious countertransferences, religious identification in family therapy, and family therapy in different degrees of congruence or difference in religious orientation between the family and the therapist. The family therapist must learn how to correctly interpret and appropriately respond to religious issues as they appear in family life and family therapy.     

Behavior modification in marriage counseling

Abstract

Telephone cotherapy via three-way conference call of symbolic-experien-Hal family therapy is presented in a way that captures the spirit of a great pioneer, Carl Whitaker, M.D. The problems of the family, the process of therapy, and the beginning and ending are presented in a manner intended to bring the reader inside the experience. There are particular focuses on the use of family political power by both family therapists and an anguished family member in mobilizing the family for therapy. Impact is demonstrated in helping a family who felt hopeless become hopeful. The family attained a family spirit.     

Understanding families in their own context: schizophrenia and structural family therapy in Beijing

Evidence from a number of family intervention strategies demonstrates a beneficial impact on the course of schizophrenia. It appears that different family interventions have generic features that aid the patient to avoid relapse and improve functioning. A significant challenge for researchers is to modify these generic strategies to be sensitive to different cultural groups in order to ensure their effectiveness. Chinese culture, with its distinct cultural norms governing family interaction and intense stigma towards the mentally ill, would seem to raise a particular challenge.
This paper offers an account of an eclectic model of structural family therapy that incorporates psychoeducation and behavioural treatments for schizophrenia as a theoretical guide to working in a cross–cultural context. A Beijing family, consisting of parents and their daughter with schizophrenia, were seen for sixteen months during a trial of family intervention in China. Through structural family concepts, China's sociocultural context of treatment resource constraints, population policy and stigma are examined and the impact of the illness on family organization is explored.     

Fixation and Regression in the Family Life Cycle

In spite of the obvious fact that families differ significantly depending upon their current stage of the life cycle, most of the family therapy literature focuses on intervening in ongoing family interaction without specific attention to the dimension of family development. Family sociologists, on the other hand, while not dealing with modifying family functioning, have provided more detailed tools with which to understand variations in family functioning based on stages of family development. Our work with families in acute distress suggests the need to increase the specificity with which our assessments and interventions are tailored, by incorporating the family developmental view. This paper explores the utility of the family developmental view using the concepts of fixation and regression in the family life cycle. These concepts were found to be relatively refined and quite pragmatic assessment devices that assist therapists in specifying developmental issues of the family. Case examples of actual families in crisis are presented in order to demonstrate the utility of these conceptual tools.     

The crucial roles of attachment in family therapy

This paper's aim is to enable family therapists from whatever approach to address family attachments during their work. It explores the role of attachment in the family, and how to enable therapists to increase security in the family so that family members can solve their own problems during and after therapy. The article gives a brief overview of the nature of family attachment relationships and the influence of secure and insecure attachments within the family and their narrative styles. This is described in language that a therapist might readily hold in mind and share the ideas in dialogue with families. The paper discusses the interplay between insecure attachments and other family problems, such as parental conflict and disagreements over authority. It also discusses ways of establishing a secure therapeutic base and the influence of the therapist's own attachment style. The implications for family therapy practice are described and illustrated by work with a specific family.     

家庭收入与儿童早期的社会能力：中介效应与调节效应

以325名幼儿为被试,收集母亲报告的家庭人均月收入、儿童一般社会能力和家庭环境,及教师报告的师生关系,考察了家庭收入在儿童早期社会能力中的作用,及家庭社会文化环境在其中的中介作用和家庭情感环境在其中的调节作用。结果发现：(1) 高收入家庭儿童的一般社会能力及师生关系质量显著高于低收入家庭的儿童;(2) 在家庭收入对儿童一般社会能力的预测中,家庭社会文化环境中的智力-文化取向与社交-娱乐取向均发挥了中介作用,家庭情感环境中的控制性发挥了调节作用,且家庭智力-文化取向的中介作用受到了家庭控制性的调节;(3) 在家庭收入对师生关系质量的预测中,家庭情感环境中的控制性和矛盾性发挥了调节作用。     

Countertransference as a corrective emotional experience in existential family therapy

An existential approach to family psychotherapy should be cognizant of both individual human development and family life cycle growth. In Existential Family Therapy a family developmental challenge often occurs when the developmental progression needs of one family member challenge the pace of total family developmental progression. In such a situation intervention by the therapist should occur in a way that facilitates both individual and family developmental growth. Such interventions often best occur through the creative and controlled use of the family therapist's countertransference feelings in a way that helps the family accept and master its developmental challenges. Case material is provided to illustrate the described intervention approach.     

Spatiality of the family's inner structure: choice of seat in family therapy

Many family therapists have observed that the family's choice of seat in the family therapy session provides information concerning the inner structure of the family. The purpose of this study was to study certain aspects of this observation. The selection of seats in family therapy sessions and the mutual distances between family members were investigated for 13 families. The inner structure of the family is described in terms of the existence of problematic relationships and the distribution and quality of power as assessed by the family therapists. The family members' selection of seats in the family therapy session was compared to the sitting order at meals, watching TV at home, and family drawings. It was found that the distance between the father and the patient (a son or daughter) and the location of the father and the mother in relation to each other in the family therapy are more related to the inner structure of the family than to situational factors.     

Resilience in Families in Which a Parent has Died

Using a cross-sectional survey research design, the present study aimed to explore and explicate those resiliency factors that enable families to adjust and adapt successfully after the loss of a parent. Thirty-nine families completed questionnaires, including an open-ended question in which they were asked to report the most important factors or strengths that they felt helped their family through the stressful period. Results indicate that intrafamilial support, such as emotional and practical support amongst family members, and family hardiness characteristics, such as the internal strengths and durability of the family unit, contribute to resilience within the family. Individual characteristics, for example positive personality characteristics such as optimism, are equally important. Support from extended family and friends, as well as support obtained from religious and spiritual beliefs and activities, were reported as facilitating successful adjustment to the loss.     

Systemic change in limited family therapy

Some families present with so many problems and disordered family processes that where and how to begin is an extremely important question. When premature termination of therapy also appears likely, a family therapist may simply attempt to initiate a structural change within the family system so that the family can continue on its own. This article describes the responses of a highly chaotic family to such a single therapeutic intent.     

Emigration as Family Strategy in Chinese Context: Emigration from Fuqing,China

This study explores how family characteristics affect the emigration of family members from the city of Fuqing, China, a major migrant-sending area in China. We focus our discussion on three related questions: how family demographic characteristics affect a family’s participation in emigration, the number of family members involved in emigration, and the locational diversification of family members overseas. Our findings show that family income is related to whether the family has any members overseas and their numbers. Second, a larger family is more likely to participate in migration. These findings are consistent with the argument that migration is a joint family decision. Third, effects of demographic characteristics of different generations on emigration indicate again that migration is a family matter. Finally, our Fuqing findings show no clear patterns of family members settling in the same country if more than one member is overseas.     

Post-traumatic stress disorder in families

When one or more members of a family are traumatized, the entire family can suffer from post-traumatic symptoms. Unfortunately, this may go unrecognized by the family, friends, and professionals. A cycle of post-traumatic victimization and fragmentation of family integrity can lead to disastrous consequences. The post-traumatic phases leading to such a destructive outcome are discussed in detail. Treatment of the traumatized family should include psychoeducational, psychodynamic, systemic, behavioral and spiritual interventions.     

Family Therapy in France: A Brief Overview

The major issues in contemporary family therapy in France are described: Difficult beginnings, the practice of family therapy today, training and professionalisation, organization for family therapy, journals and publishing, and perspectives for family therapy in France.A psychiatrist, Head of Hospital Psychiatric and Mental Health Center near Paris (Ville Evrard. France 93330) and a family therapist     

Family Functioning and Social Support in Men and Women Diagnosed with Depression in China

Previous research has demonstrated the association between family functioning and depression. This study evaluated family functioning and perceived social support in men and women in Shanghai who had received a diagnosis of a major depressive disorder (N = 100), including sixty-six women and thirty-four men. The relationship between family functioning and social support of outpatients with major depressive disorders was explored using the Chinese Family Assessment Device and the Multidimensional Scale of Perceived Social Support. The scores from all dimensions of family functioning for both men and women indicated that depressed men and women all reported experiencing unhealthy family functioning. The clinical implications of these findings for the developing practice of family therapy in China are discussed.     

Enlisting family support in drug treatment

Drug abuse programs often experience difficulties involving clients' families in treatment. This article describes general principles and specific techniques for recruiting family members in drug abuse programs and in other treatment settings. Stanton and Todd's principles of recruiting for family therapy in drug programs generally apply, adapted to a project that involves only one family member in multifamily groups and provides psychoeducational training rather than therapy. Additional principles include: focusing on family members who live with the client, tailoring recruitment to the needs of individual families, emphasizing how the family member will benefit, addressing resistance directly, helping families to build a support network, and informing family members of what is expected of them. The psychoeducational approach shows promise as a beneficial adjunct to client-focused treatment and as a gateway to more extensive family treatment.     

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.     

Family functioning of Chinese families in an impoverished neighborhood in Hong Kong

Consonant with the family stress model, in this study family economic disadvantage, concomitant with cumulative family stressors, concurrently contributed to poor family functioning of 504 Chinese families in an impoverished neighborhood in Hong Kong, in which the latter factor appeared to be more pronounced. Implications were briefly discussed.     

Family history and gender roles: Critical factors in practitioners' views of family interactions

This study examined practitioners' perceptions of family and individual family member functioning in relationship to family roles, gender of family leadership, beliefs about the consequences of maternal employment, and paternal division of responsibility in practitioner family of origin. Practicing counselors and mental health therapists rated two videotaped family interviews, one demonstrating a matriarchal style of family interaction and the second a patriarchal style. Findings indicated that practitioners were vulnerable to view a patriarchal style of family interaction as more healthy in comparison to a matriarchal style and that their perceptions of family members were related to personal beliefs about the consequences of maternal employment and to personal family history. These and other findings suggest that practitioners may be prone to errant perceptions and misguided intervention related to personal history and attitudes.