Avoiding Colonizer Positions in the Therapy Room: Some Ideas About the Challenges of Dealing with the Dialectic of Misery and Resources in Families

Some authors have argued that certain acts of family therapists—despite their best intentions—may represent a form of colonizing the family. When acting as a colonizer, a therapist is understood as becoming overly responsible for the family and focusing too strongly on change. In so doing, the therapist disrespects the family's pace, and neglects their own resources for change. This paper aims to highlight the need for therapists to be hypersensitive both to the resources of families entering therapy as well as to the impact of prevailing ideologies on their own positioning in the session. The kind of sensitivity advocated here is dialectical in the sense that every family is understood as having potentials promoting dynamism, happiness, and well-being as well as potentials contributing to stagnation, unhappiness, and misery. In this article, using illustrations from clinical practice, we present some ideas for resisting the tendency by the therapist to assume a colonizing position as a professional solver of problems for families. Our main aim here is to redirect the therapist toward connecting with the family's suffering, as well as with the resource repertoire it has developed for navigating and negotiating its way through life.     

The use of family myths as an aid to strategic therapy

The concept of family myth can be used by the therapist to help organize the wealth of information provided by a family in therapy. Rituals, symbols and metaphors can be viewed as structurally related components within the family myth system which enable the therapist to interpret non-literal, analogic communications as a coherent yet primarily symbolic, narrative about the family's shared perceptions of its functioning. The concept of myth is explored in relation to mythology, the family therapy literature, and a case study. Several strategic intervention strategies are proposed which utilize the family's own metaphors, symbols and rituals to re-edit the family myth. Re-editing the myth on a symbolic level should be associated with improved system functioning, including more concrete areas of the family's life.     

Brief Therapy: Two's Company

The triad is a key element in family therapy. It is clinically useful to conceptualize it as a unit with a structure of its own. This paper suggests that a typical triadic system consists of a pair of allies and an isolate, or "odd-man-out," all of whom are "stuck" in a rigid pattern that has become dysfunctional. The therapist can break the pattern by developing interventions specifically designed to create new alliances and thus broaden the family's behavioral repertoire.     

The process of enabling change: a study of therapist interventions in family therapy

We describe the application of discursive analysis to the task of researching family therapy process. Through the analysis of a central theme in two family therapy treatments, we found that individual family members move to using a wider range of discourses on the central theme by the end of therapy. Using the example of one family's therapy sessions, we examine how the therapist contributes to the new meanings and views that emerge, and present our analysis of the therapists' interventions in relation to the 'production' of these alternative meanings. It is argued that discourse analysis can fruitfully be applied to family therapy process research and could contribute to theoretical concepts of change and therapeutic competence.     

Employing the God-Family Relationship in Therapy with Religious Families

In many religious families, God functions as a crucial family member, stabilizing interpersonal relationships and engaging in daily family transactions. In the psychological role of a transitional object, God can be usefully employed by the family therapist in therapeutic interventions, when the therapist keeps the focus upon the interpersonal relationship with God rather than the specific content of religious beliefs. This approach can access a vital resource in the family, particularly when conditions for therapy are otherwise difficult, such as an isolated, enmeshed dyad presenting alone for therapy. Four case examples illustrate how one may use this approach in family therapy.     

The Therapeutic Advantage to the Family Therapist of Intervening in the Family-Clinician System

Attempting family therapy in the context of a family-clinician system poses extreme difficulties for the therapist. He cannot be effective if he diagnoses only the family system. He must broaden his analysis to include other clinicians' transactions with the family. Once he accomplishes this perceptual leap, he can intervene in the family-clinician system most effectively with paradoxical methods. He may find that a change in his own contribution to the system solves the family's problem.     

Bullying: A Family and School System Treatment Model

Because bullying is often conceptualized as a school problem, most interventions are school-based and exclude the family. However, joint family and school involvement must occur for long-term problem resolution. This article incorporates structural and narrative interventions within a family and school system treatment model comprised of the following stages: structuring change, changing the story, and solidifying change. The therapist helps to shift family structure, while also changing the dominant bullying story. This article also examines the appropriate implementation of the birth certificate for new identity formation, and death certificate for bullying cessation.     

Reflections during a study on family therapy with drug addicts

This article presents ideas and reflections emerging during a project on family therapy with drug abusers. Initially inspired by the writings of Stanton and Todd on the subject, the project developed into a recursive and self-reflective process, characterized by increasing doubts about the usefulness of categorization of families, of pre-planning therapy, and of the therapist as an "expert." The limitations of approaches that emphasize the importance of understanding the family structure as the basis for changing it are discussed, particularly with respect to how they decrease therapist flexibility and may block the family's finding their own solution. Alternative approaches to practice and research are also discussed, bearing on ideas particularly formulated by theoreticians and practitioners inspired by second-order cybernetics.     

Family Themes: Transmission and Transformation

This article describes a method for doing therapy that uses multisystemic themes that combine meaning and action to facilitate therapeutic change. By identifying central themes that operate at the individual, dyadic, triadic, whole family, inter-generational, and sociocultural levels, the therapist is able to develop effective interview questions and design useful interventions. In this method, behavioral symptoms are framed as a current manifestation of an overarching theme. This orientation enables family and therapist to de-pathologize symptoms and work collaboratively toward change. Case examples from a wide variety of families with differing presenting problems, interactional patterns, three-generational histories, and cultural backgrounds, illustrate the efficacy of the method.     

Issues arising from intra-cultural family therapy

Family therapists often consider culture and religion when a family's background or beliefs are different from their own. This paper explores some issues which may arise in family therapy when the family and the therapist come from the same culture or religion (in this particular case, Judaism), especially when this culture is a minority in society.     

Understanding the family in multiple cultural contexts: Avoiding therapeutic traps

Developing a balanced picture of a family's functioning is difficult when the family is culturally different from the therapist. Open-minded family therapists often translate culturally different traits and behaviors as culturally appropriate and exclude them from clinical judgment, which can limit therapeutic range and effectiveness. The following case study about an Indian family with a mentally retarded child is especially illustrative of the dilemmas facing the therapist working with families of different backgrounds. Therapeutic traps were avoided by having the family assess its own differences, while the therapist held steadfast to social interconnectedness as essential to healthy family functioning.An earlier and somewhat different version of this material appeared under a different title in Families, published by the Family Institute of Philadelphia.     

Family system functioning: behavior in the laboratory and the family treatment setting

The Family System Functioning (FSF) scale is a new instrument for measuring dimensions of the intrafamilial environment thought to be important in recovery from major psychiatric illness. Modest statistical correlations were obtained when FSF ratings of laboratory-based family interactions were compared with researcher-guided therapist ratings of FSF based upon the family's behavior in family therapy sessions during the subsequent month. The data from these two settings provide support for the validity of some of the scales. Because of the modest size of the correlations, however, behavior in the laboratory setting may not always be an accurate indicator of how the family will behave in the early weeks of family therapy.     

'But they aren't motivated …' issues concerned with encouraging motivation for change in families

This article is an attempt to provide some frameworks for understanding aspects of the context of families which support or constrain motivation for change. A theme of the entire paper is that ambivalence is normal and that it is therefore useful to regard families both as motivated to change and motivated to maintain stability. Part I focuses particularly upon family–referrer– therapist relationships and Part II upon family–therapist relationships. Part I begins with an exploration of the idea of motivation as a process and outlines the usefulness of the concept of ambivalence. Its main focus however is upon the importance of considering referrers when attempting to assess the motivation of family members for change.
Part II considers the relationship between the family and the therapist and takes account of some important aspects of the contexts of both. It ends with a summary of some experiential exercises which enable one's personal understanding of motivation issues to develop.     

Long-term family therapy: A developmental approach

The emphasis in family therapy literature on brief therapy has given a false sense of what family therapy can accomplish. While it has helped to develop different theories of change and refine techniques to deal with resistance, it has caused many clinicians to mistake technique for treatment. A long term developmental approach is advocated in which the family therapist is the general practitioner rather than the specialist. This paper is the result of a 30-year caseload in which there was a group of multi-therapy families.     

Family Therapy and Alternative Medicine: Acupuncture as a Case in Point

Collaboration between family therapists and alternative medicine practitioners is recently cultivated ground that may prove to be fertile territory for the application of family therapy skills. Acupuncture and family therapy are two healing practices that differ in cultural tradition, language, and technique, yet they appear to share some underlying assumptions suggestive of a natural alliance in helping people with a variety of biopsychosociospiritual problems. This paper describes the process of interdisciplinary collaboration between an acupuncturist and family therapist via a clinical vignette, identifying different types of referral situations, and suggesting factors of effective collaboration that can synergistically enhance a patient and family's treatment.     

Therapeutic Relationship

This article addresses the important role of the therapeutic relationship in cognitive-behavioral therapy (CBT). As has been noted from the inception of CBT, there are critical features of both the therapist and the relationship that optimize the likelihood of therapeutic success, and this article briefly describes these features. It is further argued that a successful therapeutic relationship in CBT is not static but is flexible and adaptive both across and within clients, as their needs and concerns vary. A positive therapeutic relationship is viewed within CBT as a necessary but insufficient condition for change, as the relationship serves as a foundation upon which interventions are scaffolded, but that the client’s response to various interventions itself shapes the interactions between therapist and client. Finally, it is argued that the key therapeutic ingredients of CBT are largely teachable, and the article provides several suggestions to promote an effective therapeutic relationship in CBT.     

Using psychodynamic concepts in strategic family therapy: A suicidal adolescent case

This paper describes the treatment of a suicidal adolescent with strategic family therapy. The cotherapists conceptualized the case psychoanalytically and systemically. They propose that their understanding of psychodynamics enhanced their ability to tailor their interventions to the family's unique style and capacities. Rather than dismiss psychodynamic concepts as irrelevant to strategic family therapy, they maintain that an appreciation of individual members' ego strengths, defenses, affects, and unacknowledged impulses leads to the construction of more effective metaphors and a set of interventions more isomorphic to family patterns.     

Expanding Uses of the Telephone in Family Therapy

The telephone has been used as an instrument for live supervision. This article describes innovative uses of the telephone by a family therapy training team, including (a) strategic calls to the therapist; (b) calls from the team to family members; and (c) calls between family members. Case examples describing the interventions and their impact are given. Both training and therapeutic benefits are discussed.     

Amelioration of transference resistance: substitute therapists in milieu group psychotherapy

Building upon Wolf's (1949) notion of the use of an alternate session in group psychotherapy, this paper suggests that an alternate therapist substituting for an absent regular therapist in milieu group psychotherapy can facilitate similar therapeutic benefits. The mechanism of this process of overcoming transference resistance is seen as twofold: (1) sessions with a substitute therapist allow patients to confront the infantilization often present in a milieu setting and experiment with more autonomous ego functioning. (2) Sessions with a substitute therapist create conditions which are apart from the ongoing process of the therapy group, thereby allowing for a therapeutic splitting process to develop wherein transference feelings about the regular therapist can be expressed to his or her "alter ego." Several case vignettes are presented in order to illustrate the clinical utility of a substitute therapist.     

A Family Therapist for Life: Observations and Options

“Life” is used here in the chronological sense of years spent as a family therapist and in the existential sense of experiencing “life” in terms of satisfaction, meaning, and vitality in one’s living. In the 1950s, there were few guidelines for professionals recognizing the need for working therapeutically with families. Becoming and being a family therapist are discussed, along with lifetime learning about family and tolerance for ambiguity in understanding family and marital relationships and dynamics; flexibility in implementing therapeutic interventions; functioning in ways that fit with one’s personality, beliefs, and principles; working where one functions best; and what works at what stage for the family therapist and relating these to establishing and maintaining “life” in one’s living.