The family of later life: Strategies and interventions

The concerns of the family of later life have only recently become evident. Unlike other age groups, when problems of an elder surface, they almost always involve other family members. Family members tend to become highly involved, alter their lives, and offer support. All this provides a ready condition for family pathology to assert itself. Accordingly, three common strategies used by families of later life are presented and discussed. The effect on the whole family system is stressed. Also, two therapeutic interventions are presented. Since problems related to elders are particularly resistant to therapy, these two interventions are designed for well family members. Case material is presented.     

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.     

Breathing life into family processes: introduction to the special issue on families and asthma

This introduction to the special issue dedicated to families and asthma proposes that the study of asthma highlights general systems topics such as integration of individual needs into the group, developmental trajectories of risk and resilience, supportive and destructive patterns of interaction, and the cultural adaptation of family therapy. It briefly introduces papers in the special issue and concludes that asthma can serve as an exemplar in the study of family health due to its comorbidity with mental health problems, potential to affect multiple members of the family, disproportionate influence on low-income and minority families, and multiple avenues for intervention.     

The Scapegoat and the Holy Cow in Group Therapy

Tolstoy once said that all happy families were alike and that all unhappy families were unhappy in different ways. I would say that all unhappy families and all unhappy groups (as in therapy groups) are also alike in certain ways. Both unhappy families and unhappy groups tend to have scapegoats and holy cows, members who are devalued and on whom everything is blamed, and members who are idealized and to whom all credit is given. This paper looks at the etiology of scapegoats and holy cows and how they may be approached in group therapy.     

Therapy with Families in China: Cultural Factors Influencing the Therapeutic Alliance and Therapy Goals

Rapid economic and social development in China is producing opportunities for a better standard of living for many families but also is associated with significant stress. Family therapy is one of the forms of mental health services that have become increasingly available. Western-derived models of family therapy are being used and adapted to meet the cultural traditions and needs of Chinese families. This article describes a variety of Chinese cultural factors that can influence the establishment of therapeutic alliances with family members (communication styles, collectivist values, family roles, and structure) and those that can shape family therapy interventions by addressing contextual factors affecting Chinese families (economic development, migration patterns, academic pressure, and changing gender roles for women). Suggestions are offered for using cultural sensitivity to address these factors tactfully to build strong therapeutic alliances and help families cope with significant life stresses.     

Perception of Cognitive Ability in Families of Adolescents

The families of 20 hospitalized adolescents were compared with a control group of 20 non-pathological families on the accuracy with which family members could predict each others' performance on two tests of intellectual ability. Accuracy of prediction was measured by the discrepancies between actual scores obtained by each family member and the scores other family members predicted he or she would obtain. The control and experimental groups were found to differ significantly on socioeconomic status and intellectual ability, and when these variables were controlled, a covariance analysis revealed no significant difference between the groups on accuracy of predictions. The results suggest that variables other than psychopathology must be taken into account in explaining apparent differences between healthy and disturbed families on measurements of interpersonal judgments. Implications for research and family therapy are discussed.     

Help-seeking behavior in families of schizophrenics

To meet the exigencies of coping with the onset of schizophrenia in the family, caregivers sought out an array of professional and nonprofessional supports. The respondents to a questionnaire, all members of a self-help group, reported considerable merit to the help of friends, relatives, and group members. In contrast, the various forms of therapy were valued little; nearly half found no value at all. These findings are better understood when needs of families are expressed. Of highest priority are understanding of the illness, practical guidance in patient management, and community resources such as housing. These are not typical functions of therapy. Self-help groups may serve these needs better.     

Family therapy vs. parent groups: Effects on adolescent drug abusers

Abstract

The families of adolescent drug abuse clients who were admitted to six outpatient drug-free (OPDF) treatment programs were randomly assigned to either a family therapy method or a parent group method. It was later found that in 93% of the family therapy families, one or both parents participated (N=85); but that in only 67% of the families assigned to a parent group did one or both parents participate (N=50). This is considered to be an important practical advantage for family therapy. At follow-up evaluation 15 months later (after a 6-month course of treatment and a 9-month follow-up period), the clients and their mothers in both groups reported significant improvement on numerous outcome criteria, including reduction in substance use. There was no significant difference between the two groups in degree of improvement.     

Family Cultures in The Context of Migration and Ageing

Intergenerational family relations are embedded in family cultures which influence how families regulate their relations over the whole life span with regard to key issues, such as autonomy and relatedness, or support exchange and reciprocity, and which may vary inter- and intraculturally. Migrant families undoubtedly face a special situation as values and expectations from the culture of origin and from the host cultural context might differ. Not much is known yet about how migrant families adapt their family cultures to the host cultural context. The present article will focus on aspects of intergenerational family regulation by taking into account family cultures of migrant compared to non-migrant families in a life span perspective. We will illustrate our theoretical outline by presenting first results from the IRMA-study comparing Luxembourgish and Portuguese immigrant families living in Luxembourg. We focus on issues of family cohesion, enmeshment and normative expectations regarding adult children’s support for their ageing parents, by drawing both on quantitative questionnaire as well as qualitative interview data. Implications for the experience of ambivalence and conflicts as well as well-being of family members from both generations will be discussed.     

"If I Don''t Get Simple, I Cry"

Poor families have taught us special lessons that are applicable to all families. They have instructed us about the problems, within families, of developing relationships adequate to the tasks of family life. One consequence is that therapists are attending more to the evolution of the structure of family relationships, particularly, the phenomenon of underorganization. Poor families have also provided insight into the dynamic relationship between families and their social context. As a result, a therapeutic perspective is emerging that focuses on the influence of the community on the individual and the family, a perspective that may be called an eco-structural approach to therapy.     

Family Members as Boundary Managers: Behaviors that Promote and Limit Service Members’ Involvement in Daily Family Life

When military service members deploy, they move outside the immediate boundary of their families. However, because boundaries are permeable, service members remain a psychological part of their families in spite of their physical absence. The extent of service members’ continued involvement in daily family life is likely tied to their non-deployed family members’ actions to manage this boundary. In the current study, we were interested in identifying non-deployed family members’ actions to either promote, or limit, service members’ involvement in daily family life during deployment. These actions by family members constitute boundary management behaviors. We collected qualitative data from a sample of Army reservists (N = 13) and their household family members (N = 15). Findings indicated that family members used a variety of boundary management behaviors during deployment, some of which promoted reservists’ involvement, and others which limited it. In addition, boundary management behaviors varied by who they targeted, their intentionality, and their implications for reservists’ well-being. Findings illustrate the value in equipping military families with language that enables them to communicate openly about the significance of their boundary management behavior over the course of deployment so that they may arrive at a balance between stretching and restricting boundaries that best suits their unique needs.     

Searching for a normal life: personal accounts of adults with schizophrenia, their parents and well-siblings

Using a life course perspective, the research examines personal accounts of adults with schizophrenia, and their parents and well-siblings from six families. Accounts of multiple members of the same family, including the family member with schizophrenia, are used to describe how families understand and accommodate life changes that result from the illness. Families describe the loss of a normal life as one of the most devastating aspects of schizophrenia. We present the personal and social losses described by adults with schizophrenia and their well family members, and document families' search for ways that their ill family member can achieve or maintain valued social roles. The concerns of well family members for the future of the ill family member and ways families contemplate transfer of care issues are described. Implications of the study for community research and action are discussed.     

All Absences Are Not the Same: What Happens to the Group Climate When Someone is Absent From Group?

Clinical wisdom dictates that group member absences are harmful to the group; however, this has not been empirically examined. How do group member absences affect the group’s climate, and do absences earlier or later in a group’s life differentially impact group climate? The current study examined the relationship between group member absence and the climate perceptions for attending members, during earlier and later sessions in a group’s development. As hypothesized, a significant interaction was found for group climate and time such that absences during early sessions were significantly related to higher levels of engagement and lower levels of avoidance (a more productive group atmosphere), while absences during later sessions were related to lower levels of engagement and higher levels of avoidance. Implications are discussed.     

Multi-family groups in the treatment of young adults with eating disorders

Multi-family group therapy is a variant of family therapy in which members are able to gain insight and learn from each other, provide support and encouragement, alleviate their sense of isolation and improve communication and social functioning. This study describes a series of multi-family groups conducted within the eating disorder service of a large London NHS Hospital. Ratings made by participants indicated that families viewed the treatment favourably.     

The family void: treatment and theoretical aspects of the synchronous family paradigm

The synchronous paradigm is a model of families whose members remain uninvolved and disconnected from each other yet somehow maintain relatively unvarying or even rigid patterns of behavior. In the synchronous paradigm, calm agreement and harmonious unity of action are valued above all. The concept of synchronous operation was first formulated by Constantine to solve certain theoretical problems growing out of the work of Kantor and Lehr. The theory has been elaborated upon through linkages established with other clinical and theoretical models of family dysfunction. Clinical experience in treating synchronous families has now contributed more detailed and practical understanding. Clinically, disabled synchronous families may present as bland, boring, or even death-like. They may have considerable difficulty accommodating to necessary developmental changes or to the demands of life crises, employing a variety of strategies to maintain the appearance of synchrony at the expense of adaptation. Their ability to ignore change and to absorb interventions can tax the abilities of even the most creative and energetic therapist. On the other hand, the quiet efficiency of the family and the social sensitivity of its members can be strong assets. Awareness of their strengths and special vulnerabilities can help the family therapist work more effectively with synchronous families.     

A short-term grief and loss therapy group: Group members' experiences

Abstract

This article is an evaluative study of a short-term grief and loss therapy group conducted at a large Midwestern university's counseling center. The group was held for students who had experienced loss through death of a significant person. The author examines brief group psychotherapy, special considerations of the college student's grief experience, an adaptation of the brief group model for grieving students, and data gathered from the members of the therapy group. Students' scores on a grief instrument showed mixed results. Group members made journal entries at four times during the group experience. They reported that the group was a supportive and helpful experience; five of Yalom's (1995) eleven therapeutic factors could be discerned. Recommendations regarding the treatment of grieving students in a group setting are made.     

Manipulation of Verbal Behavior of Chronic Hospitalized Schizophrenics in a Group Therapy Situation

This paper describes a semistructured, time-limited model of group treatment for latency age children. The members, all of whom came from reconstituted families, had a variety of reactive, somatoform, and characterological problems. With help from the therapists, each member constructed his or her own genogram which was then discussed by the group as a whole. Because this format incorporated a technique for mapping family structure into a traditional model of children's group therapy, it focused the group's manifest communication on changing family roles and relationships, both as they had occurred in reality and as they were symbolically reenacted within the group process. Feelings of shame, guilt, anger, and loss were markedly ameliorated as the group members studied the structure of their extended families within an environment which encouraged normative peer interaction and progressive emotional development. A brief review of the recent literature on time-limited, theme centered groups for children is included to provide a context for understanding the group.     

Zur Bedeutung von Gruppenleitern in der gruppenpsychotherapeutischen Weiterbildung

Training in group therapy is fundamentally based on self-experience in groups. The importance of the model character of the group leader's role has hardly been subject to empirical research in spite of its highly qualified and specialized requirements. In order to ensure process quality in group therapy training, the effects of the leader's model on the reported learning effects of 413 members in 35 short-term Process (self-awareness) and so-called Special Interest (thematically focused) groups of the American Group Psychotherapy Association (AGPA) were investigated. The first two sessions out of four were investigated by process questionnaires focusing on self-experience, experience of the group atmosphere and subjective impressions of the group leaders' performances. These process variables were later correlated with the overall learning impression after all four sessions. It turned out that particularly those group leaders' styles and attitudes had a strong positive correlation with favourable learning effects, that were decisive and charismatic instead of vague and that group leaders who were experienced by group members as predominantly indecisive, vague and less charismatic were in spite of the fact of being seen as competent and skillful produced weak learning effects. Results are discussed in the light of the need of neophyte group therapists to identify with a leader model promising to provide authority and sovereignity even prior to competence and empathy given the anticipatory fear regarding possible critical group dynamics in future therapy groups.