The recovering female alcoholic: A family affair

Supported by a review of relevant literature and a case study, the author argues that family therapy intervention enhances the likelihood of a female alcoholic's positive prognosis. With a basis in systems theory, family therapy views the family as a system and, hence, perceives the alcoholism as a symptom of that family. A profile of the female alcoholic, how her drinking affects her family, and the role that family therapy plays in the recovery process are examined.     

Multiple family therapy: current status and critical appraisal

This article provides an updated review and synthesis of the research and clinical literature dealing with multiple family therapy as an identifiable treatment approach. Major emphasis is placed on the literature published since an earlier comprehensive review (63). It is concluded that multiple family therapy is a viable and promising treatment modality, yet one that in clinical practice remains underused, conceptually underdeveloped, and poorly differentiated from other treatment approaches. Recommendations are made and pathways are identified that may promote the further growth and development of the approach.     

Integrating family therapy in adolescent depression: an ethical stance

Adolescent depression, particularly where suicidal behaviour is involved, is a complex and pressing mental health problem and demanding for families, therapists and services alike. This article reviews the evidence-based literature for adolescent depression including family therapy approaches. It suggests an integrative treatment approach that includes individual psychological treatment like CBT, medication where required and a family therapy intervention is supported by the literature. The focus of the latter is psychoeducation, building resilience and hope, enhancing communication, reducing relational conflict between parents and adolescents and addressing attachment and relationship issues. A systemic framework for integrating family therapy in the evidence- based treatment of adolescent depression is described. This is based on an ethic of hospitality towards different languages of therapy, which is illustrated by a detailed example from family therapy practice.     

A Review of Family Therapy in Residential Settings

This article provides an overview of the history of family involvement in residential treatment as well as a synthesis of the research showing family-centered interventions and outcomes for youth in residential settings. There are many methods for engaging families in residential treatment that are discussed in the literature; however, there is a significant gap as the field has not yet identified specific family therapy approaches that demonstrate efficacy in working with youth and their families in this particular setting. A review of the literature over the past 10 years will highlight the emerging family therapy models being utilized in this setting, which include multiple-family group intervention, family-directed structural therapy, and narrative family therapy. The article will also include a discussion of three major, well-established theoretical approaches that have been found to be effective in working with youth with conduct issues and show promise in treating youth and families in the complex setting of residential treatment: brief strategic family therapy, multi systemic therapy, and functional family therapy.     

How to Talk to Christian Clients About Their Spiritual Lives: Insights From Postmodern Family Therapy

Responding to literature calling for the integration of Christian spirituality and postmodern thinking, this article presents a more specific discussion of how postmodern family therapy approaches can be used to open therapy to the spiritual lives of Christian clients. In this article, postmodern family therapy approaches are described and the compatibility of postmodern family therapies and Christian thinking are examined. Finally, we see how a clinical practice based upon postmodern ideas can provide pastoral counselors with useful tools for talking with Christian clients about their spiritual lives. P. Gregg Blanton is Professor of Human Services at Montreat College. He is affiliated with the Pastoral Counseling and Growth Center in Asheville, NC.     

A Life History Model of the Alcoholic Family

Research and clinical interest in the alcoholic family has tended to outpace the development of family-oriented conceptual models of alcoholism. A family development perspective has been almost totally absent, despite the chronic, longitudinal nature of alcoholism. A life history model is proposed that uses the concepts of the “alcoholic system,” family homeostasis, and the “family alcohol phase” as its building blocks. Chronic alcoholism tends to produce distortions in the normative family life cycle. These distortions and their clinical implications are discussed, using four case histories as illustrations of the concepts proposed. The model is also examined in the light of current research findings about the alcoholic family.     

Alcoholism treatment and marriage and family therapists: An empirical study

This article reports on results of a mail questionnaire study conducted among 257 members of the American Association for Marriage and Family Therapy (132 respondents, response rate of 51%) on their attitudes toward alcoholism issues (acceptance of alcoholism as a disease, treatment philosophies used with clients and/or families, and acceptance and use of Alcoholics Anonymous as a resource). Results indicated that 69% of respondents (as compared with 42% formerly) considered alcoholism a disease after MFT education. A combination of individual, family therapy, and AA (81.1%); family therapy (66.7%); and AA only (60.6%) were most often used. Controlled use of alcohol by clients in treatment was believed to be unethical by 43.2%, legal by 39.4% and ineffective by 54.5%.     

Youth Depression in the Family Context: Familial Risk Factors and Models of Treatment

Research on parent risk factors, family environment, and familial involvement in the treatment of depression in children and adolescents is integrated, providing an update to prior reviews on the topic. First, the psychosocial parent and family factors associated with youth depression are examined. The literature indicates that a broad array of parent and family factors is associated with youth risk for depression, ranging from parental pathology to parental cognitive style to family emotional climate. Next, treatment approaches for youth depression that have been empirically tested are described and then summarized in terms of their level of parent inclusion, including cognitive–behavioral therapy, interpersonal therapy, and family systems approaches. Families have mostly not been incorporated into clinical treatment research with depressed adolescents, with only 32% of treatments including parents in treatment in any capacity. Nonetheless, the overall effectiveness of treatments that involve children and adolescents exclusively is very similar to that of treatments that include parents as agents or facilitators of change. The article concludes with a discussion of the implications of these findings and directions for further research.     

An appraisal of chemical aversion (emetic therapy) approaches to alcoholism treatment.

More than 35,000 alcoholics have received chemical aversion (emetic therapy) in at least 75 settings worldwide since the 1930s. This consummatory aversion (CA) treatment, which pairs ethanol ingestion with emetically induced nausea, incorporates the highly efficient variety of learning known as taste aversion (TA) conditioning. The CA literature indicates that emetic therapy should induce conditioned alcohol aversions in many alcoholics. Such aversions have been widely reported by clinicians and have been confirmed by recent psychophysiological evidence. Long standing evidence of treatment effectiveness is found in the results of private hospitals which have consistently produced 1-yr abstinence rates approximating 60%. Diminished alcohol craving is a frequently reported benefit. Few experimental evaluations have been completed, as is generally the case for all alcoholism treatments, but those which used methodologically sound temporal parameters during conditioning have supported the clinical efficacy of emetic therapy. The clear need for more definitive research notwithstanding, there are compelling indications that emetic therapy is a useful component of multimodal treatment within certain alcoholic populations. However, its availability is severely limited. Many alcoholics could probably benefit from expanded treatment availability. The time is ripe for a reevaluation of resistances to the clinical use of emetic therapy alcoholism treatment.     

Occupational Therapy Intervention in the Treatment of Alcoholics

The first section of this article will provide the rationale for all occupational therapists to learn extensively about the isease of alcoholism regardless of area of practice or type of agency where employed. It will offer su estions on how this learning can take place. The second section will take an historic look at occupational therapy literature documenting the use of occupational therapy in alcoholism rehabilitation from 1941 to the present. It will describe modalities currently being used by occupational therapists in alcoholism rehabilitation and discuss expansion of occupational therapy in this practice area.     

A community-reinforcement approach to alcoholism

Several theoretical approaches to alcoholism exist. An opérant reinforcement approach was used in the present study to develop a new procedure that rearranged community reinforcers such as the job, family and social relations of the alcoholic such that drinking produced a time-out from a high density of reinforcement. The results showed that the alcoholics who received this Community-Reinforcement counseling drank less, worked more, spent more time with their families and out of institutions than did a matched control group of alcoholics who did not receive these procedures. This new approach appears to be an effective method of reducing alcoholism. An analysis in reinforcement terms is presented of the etiology, epidemiology, and treatment of alcoholism.     

Distinguishing Between Conceptualizations of Attachment: Clinical Implications in Marriage and Family Therapy

Authors described four distinct conceptualizations of the construct of attachment and identified clinical implications associated with each. Three of the conceptualizations, which are influenced by the work of Bowlby and Ainsworth, seem to have some empirical support; these conceptualizations are compatible with systemic and social constructionist approaches to family therapy. The other conceptualization— Reactive Attachment Disorder (RAD)—contradicts the extensive body of literature associated with the Bowlby/Ainsworth traditions and tends to pathologize children. Therefore, family therapists interested in attachment are encouraged to maintain conceptual clarity in their clinical work and are further encouraged to rely on clinical conceptualizations and interventions that are consistent with the work of Bowlby and Ainsworth.     

Belgrade systemic approach to the treatment of alcoholism: principles and interventions

This article describes an ecosystemic approach to alcoholism (ESTA) developed in Belgrade, Yugoslavia. The fundamental principle is that alcoholism is a problem of the whole context, involving the index patient, the family and wider systems including the work system.
The treatment programme, which integrates contemporary principles of the treatment of alcoholism with family-systems ideas covering biomedical-psychological-sociocultural levels, is also described and illustrated by a detailed case example.     

Developing the Individual: Life Skills and Family Therapy

Two bodies of literature on life skills and on family therapy have developed from different sources but have interesting similarities. Life skills comes from training and educational thinking, and concentrates upon the skills of and strategies for coping. Family therapy focuses upon the disturbance of an individual as symbolic of the dynamics of the family, but has at its roots a more-or-less explicit model of what constitutes an effective family, where the interactions can be readily understood in life-skill terms. The two approaches are compared and contrasted.     

Working with older adults and their families – a review

This paper discusses family work with older adults by exploring some of the related literature published since Herr and Weakland's work in 1979, and compares psychoeducational and systems-based approaches to work with later life families. Issues of bias and omissions in the existing literature, and the definition of family therapy with this client group are raised. Areas for future research are indicated.     

Creating Internships in Marriage and Family Therapy: A Collaboration Between a Training Program and an Offender Reentry Facility

The literature on clinical internships in marriage and family therapy is limited in the discussion of the development of clinical sites as well as the benefits and challenges experienced by students and programs. This article focuses on the development of a marriage and family therapy internship in an offender reentry facility. The process of how students are referred and trained, the rewards and challenges of their work, and the supervision experience are described. The purpose is to inform marriage and family therapy programs about a potential resource for training students.     

Systemic-motivational therapy for substance abuse disorders: an integrative model

Although recent reviews of the literature on families and substance misuse offer compelling evidence that inclusion of families significantly improves treatment engagement, retention and outcome, family therapy remains peripheral in most substance abuse treatment programmes. Furthermore, many of the treatment approaches that have been included under the term 'family therapy' continue to focus on the substance abuser as the sole target of treatment. Still conspicuously absent are treatment models based on family systems approaches, with outcomes targeted at non-abusing family members as well. This article presents an overview of one such family-focused substance abuse treatment model – systemic-motivational therapy – that combines a family systems approach with techniques derived from motivational interviewing, but this time is applied to work with the family as a unit. The background for the development of the model will be described, as well as the assessment/consultation, family-level action plan, and aftercare/relapse prevention phases of the treatment approach.     

Experiential Activities in Family Therapy: Perceptions of Caregivers and Youth

Novel and creative therapeutic modalities have been developed in an effort to increase motivation in family therapy for adolescents and families. Many of these approaches incorporate experiential activities or “family play”, which provides a supplemental approach to traditional talk therapy. Incorporating experiential activities into family therapy sessions has been shown to increase engagement and enhance participation in therapy. Therefore, to understand how families view experiential activities within family therapy, we interviewed nineteen adolescents (age 12–17) and their parents/caregivers who were receiving family therapy augmented with experiential activities. We asked a series of open-ended questions to understand the families’ experiences concerning how they initially felt about participating in family therapy and their perceptions of the experiential activities. The activities involved experiential interactions and skill-building exercises that elicited active participation from all family members and encouraged further discussions. Topics of these activities focused on problem areas the family had identified, such as anger management, problem-solving, improving communication, substance use, expressing feelings, coping, etc. Results showed that most caregivers and youth found the experiential activities helpful in creating positive family interactions and developing communication skills. Caregivers and adolescents noted that the activities increased their desire to participate in family therapy sessions and they were more motivated to engage in the treatment process. Clinicians using the methods discussed in this intervention should be aware of the study’s limitations. Implications for clinical practice and research are discussed.     

Group psychotherapy in a school setting for adolescent children of alchoholics

Adolescents experiencing personal difficulties commonly evidence their problems while in school. Group psychotherapy within the school setting can be an effective means of helping an adolescent subject to stress at home. Parental alcoholism is the problem shared by a group composed of six students led by a clinical social worker. The broader implications of group therapy in a school setting as a means of helping young people with problems that interfere with their education and socialization are also considered.