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 Family Therapist Behavior Scale (FTBS): Development and Evaluation of a Coding System

This study evaluated the validity and reliability of a new coding system — The Family Therapist Behavior Scale (FTBS) — that was designed to identify and study clinically relevant verbal behaviors of short-term, problem-oriented family therapists. Validity was assessed by testing the scale's ability to discriminate significant, predicted differences between the in-therapy behaviors of eight beginning family therapists conducting observed interviews and eight advanced family therapists conducting supervisory interviews. All of the sessions, which were initial interviews, were videotaped. Two coders rated three five-minute samples from each of the 16 tapes with the FTBS. The validity results supported over 50 per cent of the 16 research hypotheses. The reliability analysis, based on the actual study data, indicated that the interrater reliability of the 19 category FTBS differed from chance at less than the .001 level of significance. The implications of these findings are examined and future research directions are identified.     

At-risk children in Christian families concerning alcohol use

Health educators proposing alcohol prevention programs for a church setting face a variety of problems. Information only preventive types of alcohol programs are being increasingly criticized. The purpose of this study was to identify variables that best predict use of alcohol for children in fundamentalist Protestant Christian families. Three hundred and two students currently enrolled in a mandatory health course at a fundamentalist Protestant Christian university responded to a questionnaire designed to identify contextual or environmental risk factors for alcohol use. A significant difference was found in five of 15 established environmental factors. This paper suggests that an alcohol education program that focused on these differences would be advantageous for the health educator to carry out in the church setting.     

Family Survivors of Homicide: I. Symptoms,Syndromes, and Reaction Patterns

As more and more mental health clinicians become involved in the criminal justice system, family therapists will see increasing numbers of crime victims in their caseloads, and some of these families will have lost loved ones to murder. Part I of this two-part article describes the common and atypical symptoms, syndromes, and reaction patterns shown by families who have experienced the murder of a loved one. Part II will present a practical model for treating family survivors of homicide that incorporates cognitive-behavioral, psychodynamic, family systems, and existential components. Throughout, the emphasis is on therapists being equipped with a sufficiently broad range of clinical tools to treat these survivors flexibly, effectively, competently, and compassionately.     

Family Survivors of Homicide: II. Practical Therapeutic Strategies

As more and more mental health clinicians become involved in the criminal justice system, family therapists will see increasing numbers of crime victims in their caseloads, and some of these families will have lost loved ones to murder. Part I of this two-part article described the common and atypical symptoms, syndromes, and reaction patterns shown by families who have experienced the murder of a loved one. Part II presents a practical model for treating family survivors of homicide that incorporates cognitive-behavioral, psychodynamic, family systems, and existential components. Throughout, the emphasis is on therapists being equipped with a sufficiently broad range of clinical tools to treat these survivors flexibly, effectively, competently, and compassionately.     

Clinicians' fidelity to a manual-based family treatment as a predictor of the one-year course of bipolar disorder

This study assessed whether therapist adherence to the family focused treatment model for patients with bipolar disorder and their relatives was associated with patient outcomes at one year after treatment entry. A total of 78 videotaped sessions of FFT consisting of 26 families with a member with bipolar disorder (3 sessions/family) were rated on fidelity using the Therapist Competence/Adherence Scale (TCAS; see Endnote 1, p. 130). Patients' outcomes (relapse status) were assessed using the Brief Psychiatric Rating Scale (BPRS) and selected items from the Schedule of Affective Disorders and the Schizophrenia-Change (SADS-C) scale (measured at 3-month intervals for 12 months). Contrary to expectations, therapist fidelity was not related to overall outcome as assessed by the BPRS and the SADS-C. Among patients who did relapse, higher levels of cooperation among therapists predicted a later date for relapse than did lower levels of cooperation. Surprisingly, and in opposition to the study's hypotheses, patients who were hospitalized because of relapses had therapists who were rated as more competent in their ability to conduct the problem-solving module of FFT. Study implications are discussed.     

Difficulties in Family Therapy Evaluation I. A Comparison of Insight vs. Problem-Solving Approaches II. Design Critique and Recommendations

In Part 1, an outcome study comparing two methods of family treatment, is reported. Families were randomly assigned to one of two forms of conjoint therapy: an Insight-oriented treatment (N = 10 ) or a Problem-Solving intervention (N = 10 ). The results on self-report measures of family functioning indicate that the Problem-Solving intervention produced more favorable changes after three months. Experienced therapists did better than inexperienced therapists in the Insight-treatment condition but level of experience did not make a difference in the Problem-Solving therapy. A group of eight families who dropped out of the Insight-treatment group provided data on correlates of premature termination. In Part II, the study is critically reviewed. The practical obstacles to implementing an experimental design in a clinic setting are considered. Special attention is given to issues involving the selection of treatment and control conditions: sampling and the measurement of outcome. Alternatives to experimental designs are considered.     

Families of Adolescent Drug Abusers Are “Rigid”: Are These Families Either “Disengaged” or “Enmeshed,” or Both?

The FACES instrument, based on Olson's Circumplex Model of family functioning, was administered to 96 adolescent drug-abuse clients and their parents. The majority of these families categorized themselves as "disengaged" (rather than "enmeshed") on the cohesion dimension, and as "rigid" (rather than "chaotic") on the adaptability dimension. These findings were unexpected as they were substantially different from published findings on families with other types of problems. Family therapists, utilizing Olson's Clinical Rating Scale for the Circumplex Model, characterized significantly more of these same families as "enmeshed," rather than "disengaged." Possible explanations for the difference between the therapists' perceptions and the families' self-perceptions are discussed.     

The Self- and Other-Blame Scale (SOBS). The background and presentation of a new instrument for measuring blame in families

This article presents an account of the development and reliability of an observational instrument to measure blame: the Self- and Other-Blame Scale (SOBS). Fifty-one eating disordered patients together with eighty of their relatives were interviewed using a semi-structured family interview. Videotapes were assessed by two independent raters. Inter-rater reliability was good for both dimensions of SOBS: self-blame (SB) and other-blame (OB). One of the aims in developing the instrument was to be able to explore the relationship between self- and other-blame and criticism. Preliminary data are presented showing the distribution of SOBS scores within families rated as high or low on Expressed Emotion (EE). High EE was associated with high levels of self-blame in the parents, but not in the patients. Fathers in high EE families were more blaming of the patient than those in Low EE families but this was not true for mothers' levels of daughter blaming.     

Power and influence in the environment of family therapy*

This paper explores some of the ways in which family therapy theory and practice limits an appreciation of the contexts of families and family therapists. It focuses particularly upon how the rules which underlie patterns of relationships in social systems are made and maintained more by one part of a system than by another, and considers this (a) within families, (b) within various aspects of the social environment of families, and (c) within the organizational contexts of family therapists. It then proposes that the systemic thinking which family therapists apply to families is potentially applicable to wider contexts including international relationships.     

Power and influence in the environment of family therapy

This paper explores some of the ways in which family therapy theory and practice limits an appreciation of the contexts of families and family therapists. It focuses particularly upon how the rules which underline patterns of relationships in social systems are made and maintained more by one part of a system than by another, and considers this (a) within families, (b) within various aspects of the social environment of families, and (c) within the organizational contexts of family therapists. It then proposes that the systemic thinking which family therapists apply to families is potentially applicable to wider contexts including international relationships.     

Engaging “Resistant” Families in Treatment

Many families, when presented with the option of family therapy, are less than eager to participate. This paper comprises the second and third parts of a series on engaging “resistant” families. ¹ 1 The first paper in this series, authored by J. M. Van Deusen, M. D. Stanton, S. M. Scott, and T. C. Todd, is entitled “Engaging “Resistant” Families in Treatment: I. Getting the Drug Addict to Recruit His Family Members” and appeared in the International Journal of the Addictions 15 (7): 1069–1089, 1980. A revised and expanded version of Part II is presented in M.D. Stanton, T. C. Todd, and Associates, The Family Therapy of Drug Abuse and Addictions New York, Guilford, in press.
Part II presents 21 principles and a number of techniques and strategies that have been developed for successfuly recruiting such families. These techniques should be applicable for engaging resistant families with all types of presenting problems. Part III provides an analysis of the important variables involved, along with data on cost efficiency and administrative costs. It was found that when therapists had administrative control of their cases, serving in dual roles as both therapists and drug counselors, the recruitment effort was (a) more effective (i.e., complete families, including both parents or parent surrogates, were recruited in 77 per cent of the cases), and (b) twice as cost efficient. Two-thirds of the non-engaged families were not recruited because the index patient would not allow family members to be contacted. Black families were more difficult to recruit than whites. Data on cost efficiency and on the actual administrative costs of recruiting families are also provided. We conclude that the engagement process requires a revision in therapeutic philosophy, since such families are often desperately in need of help but are unavailable unless therapists make a special effort to reach them.     

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

This study aimed to compare therapists’ observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists’ contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients’ engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists’ alliance‐building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.     

Culturally sensitive therapy? Examining the practice of cross‐cultural family therapy

This article is drawn from a research project that examines cross‐cultural family therapy sessions in order to consider what constitutes culturally sensitive practice. A discourse analytic approach was adopted in the analysis of three sessions from two families where the family and the therapists originated from different ethnic backgrounds. This article is based around part of the research findings connected to one of the families, and focuses upon the ways in which ‘culture’ is talked about in therapy (the term ‘culture’ will be referred to in inverted commas in order to acknowledge its complexity as is emphasized in this article). This allows for an examination of the cultural assumptions that we hold as therapists, which are enacted in therapy with effects on all participants and upon the course of the therapy. The value of qualitative research methods in examining the cultural assumptions we bring to therapy is highlighted as one way of improving culturally sensitive therapeutic practice, especially with regard to therapist reflexivity.     

Wholism in the family: Implications for the church from a Jungian perspective

The article examines the influence of the over emphasis upon selfactualization, hedonism and individualism in the American family today. The result has been the submergence of the wholistic function of the family which not only includes self-actualization and individuation, but also intimacy, self-surrender, and commitment. In this context, the article emphasizes a wholistic approach to families within the church and draws upon Jungian psychology for its direction.     

Overt and Covert Coparenting Processes in the Family

This article introduces a new self-report instrument designed to measure the frequency of parental behaviors thought to promote or undermine children's sense of family. Members of 103 married couples rated their behavior in both public (all family members present) and private (alone with child) contexts. Factor analyses of these data revealed four distinct factors indexing: behaviors in the service of promoting a sense of Family Integrity; largely covert parent-to-child communications undermining, or conveying Disparagement of, the coparental partner; overt interparental Conflict in the presence of the child; and coparental disciplinary activities (Reprimand). Significant husband-wife correlations were found on each of the four individual subscales. Construct-specific intercorrelations also obtained between like scales on the new measure and on the Family Environment Scale and Quality of Coparenting Scale. Cluster analyses of husbands' and wives' scores on the four Coparenting Scale factors suggested five “types” of coparenting families: Disconnected, Supportive, Average, Distressed-Conflicted, and Passionate. These clusters, along with the value of self-report instruments in assessing coparenting behaviors that may be largely clandestine in nature, are discussed.     

The ‘healthy’ family*

The importance of concepts and hypotheses about ‘healthy’ families for family therapists is stressed. A number of different approaches to defining ‘health’ is described. Concepts and hypotheses of family therapists from different schools are integrated into a more encompassing theory, thereby focusing on statements with respect to personality, cognition, behaviour, communication, relationship, role, family system and network. It is noted that family therapy literature lacks information about ‘healthy’ families. Moreover, nearly all statements are non-scientific and normative as they are not founded on empirical research.     

The influence of therapist experience upon evaluative perceptions of family members

Abstract

This study investigated the influence of experience in family therapy on therapists' evaluative perceptions of family members. Beginning students in family therapy, advanced students, and experienced staff rated members of 100 families according to the Semantic Differential technique. Contrary to expectations, beginning students did not evaluate identified patients more favorably than parents. Staff and advanced students, however, rated parents more favorably than identified patients. Beginning students were also found to evaluate all family members more favorably than staff and advanced students. These results were discussed in terms of experienced therapists initially taking the side of the parents and the effects this potential source of bias may have on the course of family therapy.     

What we say we do: results of the 1997 UK Association of Family Therapy Members Survey

This study represents the first UK national survey of family therapists and systemic practitioners. The aim was to provide demographic information of systemic practitioners/family therapists and also to describe their clinical practice. The sampling frame used was the UK Association of Family Therapy membership list and all members were sent a postal questionnaire. The response rate was 33% with 495 out of 1500 questionnaires returned. Among the major findings were: systemic practitioners/family therapists are most likely to work for an NHS trust, to use family therapy techniques/systemic ideas predominantly, and to treat a broad range of client issues. They are also most likely to work with families, and therapy is relatively short term (five to eight sessions) regardless of whether they treat families, couples or individuals. Most family therapists/systemic practitioners use some measure of outcome, although frequently this will be feedback from clients. Supervision is sought by the majority of AFT members. In spite of some methodological limitations, the study provides interesting insights into the training and practice of UK family therapists and systemic practitioners which appears to differ in some respects from our American colleagues. It also provides a baseline for future surveys, making it possible to describe the developments of family therapy and systemic practice in this country.