Resolving the trauma organized system of sexual abuse by confronting the abuser: A focal family therapy approach with a woman who was a childhood victim of sexual abuse

The longer-term emotional and interpersonal effects of sexual abuse in childhood are reviewed and approaches to treatment discussed. The notion of a 'trauma organized system' to account for the long-standing effects of abuse is described. A major potential issue in creating therapeutic change is confronting the abuser, and a case is described where a woman brought her family for therapy when it was feared that the father, who had abused her in childhood, might abuse his grandchildren. A focal family therapy approach was used: this takes into account the traumatic nature of abusive events and their long-term organizing effects on individual and family functioning. The process of therapeutic work is described, including the resolution of traumatic effects by confronting the abusive act.     

Concurrent individual and family therapy in a case of elective mutism

In this paper, following a literature review a family containing a child who had been electively mute for four years is described. A concurrent programme of individual and family therapy and the systemic hypothesis which guided these interventions is then presented in detail. Behavioural and psychometric data are presented to illustrate the dramatic improvement which the identified patient showed over the course of treatment. Finally, the probable mechanisms underpinning the child's improvement, and how these differed from our initial expectations, are discussed.     

Research as a family therapy intervention technique

The utilization of the research process as an intervention has recently been described in the family therapy literature. However, it is important to draw a distinction between research as intervention and research as a unique family therapy intervention technique. From a family systems perspective, research as an intervention technique may make therapy more palatable for some families. A case study is presented in which this technique created the context for change for a family involved in a chronic illness research project.The author would like to thank Dr. Wendy L. Watson for her participation as a member of the clinical team and Drs. Fabie Duhamel and Wendy L. Watson for their helpful critiques on earlier drafts of this paper.Supported by a grant from the Albert Foundation for Nursing Research.     

Concomitant group therapy with anorectics and their parents as a supplement to family therapy

A study was made of family therapy with anorexia nervosa patients in a child psychiatric outpatient department. Eight families referred in 1984 were offered group therapy and family therapy simultaneously, one group for patients with anorexia nervosa and one group for their parents. The participants of both groups reported that they had learned a lot from the experience but stated that they felt group therapy could not replace family therapy.     

The structure of interpretations in family therapy: a video-enhanced exploration

A method for assessing the structure of interpretations of family therapy events is described. Family sessions were videotaped; each participant then independently reviewed the tape, stopping it to indicate any significant events and describing the importance of each identified sequence. Qualitative approaches to analyzing the stop points are described, using data from six families and their therapist. This combination of direct session experience and reflective interpretation provides a much-needed perspective on the meaning of sessions and psychotherapeutic interaction. Research and clinical implications for scientifically examining the structure of shared interpretations in family therapy are discussed.     

EMDR as a treatment for improving attachment status in adults and children

IntroductionThe purpose of the article is to examine the current literature regarding evidence for positive change in attachment status following Eye Movement Desensitization and Reprocessing (EMDR) therapy and to describe how an integrative EMDR and family therapy team model was implemented to improve attachment and symptoms in a child with a history of relational loss and trauma.LiteratureThe EMDR method is briefly described along with the theoretical model that guides the EMDR approach. As well, an overview of attachment theory is provided and its implication for conceptualizing symptoms related to a history of relational trauma. Finally, a literature review is provided regarding current preliminary evidence that EMDR can improve attachment status in children and adults.Clinical findingsA case study is described in which an EMDR and family therapy integrative model improved attachment status and symptoms in a child with a history attachment trauma.ConclusionThe case study and literature review provide preliminary evidence that EMDR may be a promising therapy in the treatment of disorders related to attachment trauma.     

Casework towards the family re-integration of a sexually abusive father—a single case study

A family is presented where sexual abuse of one child had occurred but the family wished to stay together. Work with the family over 3 years, during which time the father served a prison sentence, is described.
The problems, for professionals as well as the family, in deciding when a family is safe are discussed.     

Family Therapy After the Divorce: Developing a Strategy

Family therapy with the whole family after a divorce has taken place provides a unique opportunity for intervention. Though the spouses have legally terminated their relationship, their parenting function remains. However, this reality is often clouded by the emotional conflicts generated by the divorce. Family therapy can be useful in facilitating life in the post-divorce period. A four-part model for intervention is described. The first task is to redefine the family as existentially including all members. Next, generational boundaries are firmed in order to reduce the parentification process, often intensified by the parent's physical absence. Third, the family needs to have a replay of the history of the marriage to correct developmental distortions and offer a changce to mourn the loss of the intact family. Finally, the therapists attempt to facilitate an emotional divorce. A case study is presented to elucidate the manner in which these steps unfold in treatment.     

'We are the stuff that dreams are made on': the use of dreams in systemic therapy

This paper considers the place that dream material has occupied in therapy, and particularly family therapy. A rationale will be given for the inclusion of this source of information by systemic therapists. The use of dreams in systemic therapy with individuals, couples and families is described. Dreams are divided into five main categories: those that precipitate therapy, provide hypotheses, as memories, relationship dreams, and those that reflect the process of change. Each category is described and illustrated with relevant clinical material. The paper concludes with a method for working with dreams that is congruent with a systemic perspective applicable to individual, conjoint or family therapy sessions.     

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.     

Juvenile drug addiction: a typology of heroin addicts and their families

In this article the authors propose: 1) a typology of drug addiction cases consisting of four main classes: A. traumatic drug addiction, B. drug addiction from actual neuroses, C. transitional drug addiction, and D. sociopathic drug addiction; 2) a clinical study (with 18 months of follow-up data) involving 131 heroin addicts mostly treated with structural or counterparadoxical family therapy in the same psychotherapy center and in the same year; and 3) some preliminary conclusions emerging from an examination of the four-class typology with respect to the effectiveness of family therapy interventions. If, for example, structural family therapy techniques seem more suitable in type-B cases (similar to cases described by Haley in his Leaving Home), the counterparadoxical techniques are likely to be more effective in type-C cases (similar to the anorectics described by Selvini-Palazzoli).     

Difficulty in implementing a family intervention for bipolar disorder: the predictive role of patient and family attributes

Family affect was examined as a predictor of difficulty implementing a 9-month, manual-based, psychoeducational family therapy for recently manic bipolar patients. Prior to therapy, family members were administered measures to assess both their expressed emotion and affective behavior during a family interaction task. Following family treatment, both therapists and independent observers rated the overall difficulty of treating the family, and therapists also rated each participant's problem behaviors during treatment, in the areas of affect, communication, and resistance. Therapists regarded affective problems among relatives and resistance among patients as central in determining the overall difficulty of treating the family. Relatives' critical behavior toward patients during the pretreatment interaction task predicted both independent observers' ratings of overall treatment difficulty and therapists' perceptions of relatives' affective problems during treatment. Moreover, patients' residual symptoms predicted independent observers' ratings of overall difficulty and therapists' perceptions of patients' resistance to the family intervention. Results suggest that difficulties in conducting a manual-based family intervention can be predicted from systematic, pretreatment family and clinical assessment.     

Family therapy in a community mother and toddler project

A home centred family therapy approach is described based on the McMaster model. This approach was applied in a controlled trial of three forms of intervention for mother and toddler problems. In this paper the experience of applying the approach is reported.     

Redressing the balance—involving children in family therapy

This paper argues that family therapists have tended to ignore the problem of how to engage children in family therapy, and it presents a number of techniques specifically aimed at involving children in therapy. The socio-historical context of childhood is discussed and its implications for therapists examined. A number of visual techniques are then described, illustrated by case examples. These serve the function of addressing the whole family system on a number of levels and involving children fully in the process of therapy.     

Psychiatric referrals by a Juvenile court

A psychiatric service for children has attempted to make effective use of its limited resources by specialising in conjoint family therapy and in the establishment of consistent links with the network of other agencies and services working with parents and children. Since involvement with the law is seen as a point of crisis by a family and by the professionals already involved with it, the Juvenile Court is an important focal point in the network. The referral of a particular adolescent 'patient' to a child psychiatrist is described in detail, and the wider implications are discussed.     

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.     

Behavioral-Systems Marital Therapy: Dealing With Resistance

Recently there has been a dramatic increase in attempts to integrate certain intervention components of behavioral and systems approaches with marital and family therapy. This paper elaborates on a previously described behavioral-systems approach by focusing primarily on the issue of resistance to therapeutic progress within the behavioral framework. First, potential reasons for major resistance phenomena are suggested. Then, in the context of a social learning theory model of assessment and intervention, specific clinical indications are discussed for departing from the basic behavioral approach in order to deal with resistance. Finally, a variety of interpretive and strategic intervention techniques are described and illustrated by clinical case materials     

Measuring Family Therapy Outcome in a Clinical Setting: Families That Do Better or Do Worse in Therapy

This study examined several important family and therapist characteristics as they related to treatment success. A total of 434 families entering family therapy at a sliding-fee clinic in Dallas, Texas were rated (on the Beavers Interactional Competence and Style Scales), and completed several self-report family assessment instruments (Self-Report Family Inventory, FACES III) prior to beginning therapy. The therapists, trainees from various disciplines, had been trained in the Beavers Systems Model. Overall, 75% of the families showed at least some improvement. Those that fared best in therapy were more competent at the outset. While number of therapy sessions was associated with greater gains, there were some families that made great gains in fewer than six sessions. There were important demographic qualities that did not discriminate between greater- vs. lesser-gain families, including income level, ethnicity, therapist gender, and family size. A regression analysis indicated that functional rather than demographic variables were more important in predicting therapy outcome.     

A Full Circle: Psycho-dynamic Understanding and Systems Theory

Two papers published in 1979 are reviewed, one which looked at theories of family interaction and techniques of intervention, and the other at developments of the focal approach to family therapy which has its base in a dynamic understanding of the nature of relationships, but uses a variety of systemic interventions to create change. The development of the approach is described, along with its application to work in the abuse field. A recent case where two daughters were sexually abused by the grandfather who had abused their mother is used as an illustration.