Family therapy with Spanish-heritage immigrant families in cultural transition

Increasing numbers of Spanish-heritage immigrant families in the United States are beginning to seek therapy for family conflicts related to their adapation to the new country/culture. This paper focuses on the difficulties experienced by these families and presents issues specific to therapy with them. Effective therapy with these families requires that therapists focus on clarification of the differential adaptation rates of family members and facilitate a resolution of the family's transitional conflicts(s). Six cases involving such families are presented.David A. Baptiste, Jr., PhD, is a Psychologist and Marital and Family therapist in the counseling center at New Mexico State University and in private practice, Las Cruce, NM.Revision of a paper presented to the International Round Table for the Advancement of Counseling, Annual Conference, Utrech, The Netherlands, July, 1985. The author expresses appreciation to Judith Landau-Stanton for her helpful review of an earlier draft of this paper.     

Juggling Multiple Roles and the Act of Resistance

This article addresses some ways mothers cope with the multiple stresses associated with their dual roles as workers and primary family caregivers. During the often stressful family life-cycle when adolescent children are individuating, a mother's active resistance can call attention to her need for support and validation of her efforts. While both parents are in the process of negotiating the intricate balance between letting go and forming new collaborative relationships with their soon to be adult children, heavy responsibilities associated with the maternal role can be especially challenging. In addition to gender-sensitive family interventions, mutual support groups for women who parent can help explore ways to effectively respond to cross-generational conflicts and problem solving.     

Mothering in a Foreign Land

The process of becoming a mother in an adopted land presents unique challenges in identity formation of immigrant mothers. The bidirectional influence of the mother's own transformation and that of the larger family system has significant implications for child development. This article addresses the ways in which cultural displacement has an impact on the dilemmas of motherhood, as evident in adaptation to the immigration process, changing conceptions of gender roles and attachment, bicultural conflicts, and changing family structure and social network. Mothers' attempts to integrate the old and the new cultural frameworks are explored, particularly in the context of psychotherapy. Clinical cases are discussed to illustrate the intrapsychic and interpersonal conflicts faced by immigrant mothers.     

Genetic probes of three theories of maternal adjustment: I. Recent evidence and a model.

Studies focusing on genetic and social influences on maternal adjustment will illumine mother's marriage, parenting, and the development of psychopathology in her children. Recent behavioral genetic research suggests mechanisms by which genetic and social influences determine psychological development and adjustment. First, heritable, personal attributes may influence individuals' relationships with their family members. These genetically influenced family patterns may amplify the effects of adverse, heritable personal attributes on adjustment. Second, influences unique to siblings may be the most important environmental determinants of adjustment. We derive three hypotheses on maternal adjustment from integrating these findings from genetic studies with other contemporary research on maternal adjustment. First, mother's marriage mediates the influence of her heritable, personal attributes on her adjustment. Second, mother's recall of how she was parented is partially genetically influenced, and both her relationships with her spouse and her child mediate the impact of these genetically influenced representations on her current adjustment. Third, characteristics of mother's spouse are important influences on difference between her adjustment and that of her sister's. These sibling-specific influences are unrelated to mother's heritable attributes. The current article develops this model, and [figure: see text] the companion article describes the Twin Mom Study that was designed to test it as well, as its first findings. Data from this study can illumine the role of family process in the expression of genetic influence and lead to specific family interventions designed to offset adverse genetic influences.     

Group intervention for medical patients—A treatment for damaged self-esteem

There is a need to integrate our knowledge of psychoanalytic theory, group therapy and medical care delivery systems. Understanding the importance of selfesteem, based upon the study of psychoanalytic theory, can help to determine appropriate technique in medical groups as well as to add to our understanding of the profound importance of such groups in the delivery of medical care. Groups in hospitals help patients to get in touch with their strengths, feel less isolated, and be more active—all of which enhance selfesteem. As patients participate in groups, narcissistic defenses can be enhanced and the quality of life improved. When interdisciplinary teams participate in patient groups, delivery of medical care can be more comprehensive: The totality of the patient emerges more clearly and staff becomes more aware and sensitive to his/her emotional and physical needs.This paper was presented at Thirty-Sixth Annual Conference, American Group Psychotherapy Association, 1978. The author would like to acknowledge Hazel M. Halloran and Susanne A. Kohut, Director and Associate Director, Department of Social Work, who conceived of and supported the expansion of the group work program in the General Hospital Division of St. Vincent's Hospital and Medical Center of New York. The following professionals contributed clinical material used in this paper: Sara Bookbinder, M.S.W., Carol Coven, M.S.W., Linda Haselman, R.N., Barbara Horn, M.S.W., Kathleen McQuade, R.N., Ellen McGuire, M.S.W., Sister Marita Rose O'Brien, R.N., and Emile Powe, M.D.     

Revisiting rapprochement in the light of contemporary developmental theories

Margaret Mahler's thinking, revolutionary for its time, led to the observational study of mother-infant pairs, followed almost day by day as the preverbal infant developed into a toddler whose increasing cognitive capacities made new demands on the mother's presence and emotional availability. The rapprochement crisis, as formulated based on these observations, is reexamined in the light of contemporary theory, and the concept of co-construction is used to show how mother and toddler repair misunderstandings and inevitable conflicts. With the growth of new verbal capacities during rapprochement, the toddler moves from early, sensorimotor interactions to interactions governed by language, in the process gaining new understanding of his or her emotional life.     

Constructing bridges and systemic connections: In brief dynamic therapy

The author outlines how the conceptual framework which underpins cyclical psychodynamics, a branch of relational psychoanalysis, provides an opportunity for a coherent integration of constructivist CBT principles and techniques and family systems theory within a model of brief dynamic therapy. Drawing upon Wachtel’s articulation of a more flexible notion of the internal world and one in which current interpersonal patterns are seen to shape the psyche and internal conflicts, the author goes on to identify ways in which attending to a client’s behaviour and the ways in which affective experience is expressed interpersonally can open the way to an integration of therapeutic features from constructivist CBT and family systems theory. The contribution that coaching a client in the ways in which they behave interpersonally in the context of both family and workplace relationships can make to therapeutic effectiveness is explored. These themes are illustrated with a case study.     

Effectiveness of Family Systems Theory Interventions on Adolescents with Type 1 Diabetes: A Meta-analysis

The purpose of this review is to synthesize the evidence and determine the efficacy of interventions based on family systems theory in diabetes-related family conflict, self-management, and glycemic control among adolescents with type 1 diabetes. A systematic search of five English databases was conducted. Interventions based on family systems theory in adolescents with type 1 diabetes that reported diabetes-related family conflict, self-management, and glycemic control as outcome variables were included. A total of 14 articles from ten interventions were included. Meta-analysis results revealed that, compared to adolescents who received usual care, adolescents who received family systems theory interventions reported fewer diabetes-related family conflicts with a medium effect size of 0.32 (p?<?0.05), but there was no significant improvement on self-management or glycemic control (p?>?0.05). Family systems theory interventions appear to have beneficial effect on reducing diabetes-related family conflicts for adolescents with type 1 diabetes. Adolescents who have type 1 diabetes and their families may need multidimensional psychosocial programs accompanied by diabetes education to improve glycemic control.

     

Teenage depression: a cultural-interpersonal-intrapsychic perspective

The "crossroads families" are caught between old value systems and American mainstream goals. Traditional family and sex-related roles and orientations conflict with those of the new social system. In turn, neither of the teenager's orientations--toward home or toward peer activity--is validated. In the clinical case presented, Anna, at adolescence, wants to relinquish many of her household chores and enter her social world more fully. She needs unconflictual support for such a move. If this does not take place, her autonomous movement represents an unconscious betrayal of her depleted and controlling mother as well as an abandonment of the parental coalition. This leaves her feeling resentful, guilty, and ultimately unlovable. Attitudes marked by helplessness and confusion are thus significant to the depressed affect that brings this teenager into family therapy. Teenagers of non-Hispanic background who enter family therapy reveal gross overlap with teenagers of the Hispanic "crossroads" family model. Here, the family gives mixed messages for homebound and intimate closeness as well as accomplishment in the societal mainstream. A primary difference between ethnic groups involves the freer expressions of anger and pain between husband and wife in the non-Hispanic families. This is not similar to the backgrounds of the more individuated Hispanic teenagers. While more open expressions of anger within the family do indicate higher levels of autonomy, the hostility that is expressed by the parents presents serious complications when this includes "triangulating" the child into the family tension. Here, as cited, the mother often uses her daughter as a confidant and ally at times of severe parental discord. This places additional strain on the child's conflict with separation. Importantly, the daughter experiences renewed rejection and betrayal when the mother "submits" to her spouse. These are significant family processes that heighten mixed messages around autonomy. Milagros, a depressed (more individuated) adolescent, is consistently entangled into her parent's abrasive relationship. Her interpersonal family struggles have become intrapsychic and, ultimately, transferential.     

Therapy with siblings in reorganizing families

The loss of parenting figures through death, divorce, or other kinds of separation often leaves children without consistent parental support and with increased fears of abandonment. In the natural cycle, siblings can maintain almost lifelong relationships and therefore are in a position to offer each other a significant support system over an extended period of time. We have found that work with sibling subgroups can help children to resolve their individual and shared conflicts as well as to remove interferences to mutually supportive relationships. Illustrative cases are presented and treatment guidelines offered.An earlier version of this paper was presented at the National Conference of the American Association of Psychiatric Services for Children, November 1977, in Washington, D.C. Ms. Rosenberg is grateful to Harvey Falit, M.D., and Fady Hajal, M.D., for their encouragement and support of this work.     

A body with chronic fatigue syndrome as a battleground for the fight to separate from the mother

I describe the therapy of a 20-year-old woman who believed that her difficulties in concentrating and remembering were caused by her 'ME' (Myalgic encephalomyelitis, Chronic fatigue syndrome, or CFS). She had been fathered by a man who never left his own wife. Work with her dreams revealed a within-body drama in which she was locked in an unspeakable fight to the death with her mother. Her symptoms improved after parallels between a dream and an accident showed her own self-destructive hand in her story. Another dream, reflecting her first 'incestuous' affair, showed her search for her original father-self as someone separate from mother, and a later affair provided a between-body drama, helping her to own the arrogant and abject traits she had before seen only as her mother's. I show how we worked in the area of Winnicott's first 'primitive agony' as experienced by a somatizing patient, stuck in a too-close destructive relationship with her mother-body. I discuss how analytical work can be done with the primitive affects and conflicts against which the ME symptoms may be defending.     

RAE WEINER

Rae Weiner, a pioneer of the concept of family therapy with the Philadelphia Child Guidance Clinic and the Family Institute of Philadelphia, died Monday, August 13th at the age of 46. Mrs. Weiner received a bachelor's degree from the University of Pennsylvania and a master of social studies from Bryn Mawr College. Mrs. Weiner joined the Philadelphia Child Guidance Clinic in 1968 where she was instrumental in creating and overseeing family counseling programs. She was also closely affiliated with the Family Institute of Philadelphia, an organization of family therapists and social workers. Mrs. Weiner was president-elect of the Family Institute and served on its executive council. She is survived by her husband, Oscar R. Weiner, M.D., two sons and a daughter.     

"Too late": ambivalence about motherhood, choice, and time

This paper explores a particular constellation of fantasies and defenses that in some women leads to the delay of childbearing. Destructive wishes towards the woman's own womb and her mother's lead to behaviors that sabotage fertility and pregnancy. These wishes and behaviors meet up with an unconscious belief in and commitment to time standing still, and with cultural tropes and trends that obscure intrapsychic conflicts and denials about motherhood, aging, and time. Analysis, like childbearing, is constrained by the reality of time, and the complex untangling and connecting of these three not obviously related threads may not occur until it is, for the woman who wants a child, too late.     

A Relational Approach to Career Counseling: Theoretical Integration and Practical Application

This article reviews the current status of career theory in practice and presents a theoretical overview of relational theory and its logical extension to the career domain. Despite the emergence of literature regarding the interconnectedness of career progress and the quality of relationships in one's life (e.g., D. L. Blustein, 2001; D. L. Blustein, M. S. Prezioso, & D. E. P. Schultheiss, 1995; D. E. P. Schultheiss, H. M. Kress, A. J. Manzi, & J. M. Glasscock, 2001), counseling practice is limited by the absence of a meaningful approach to intervene in clients' relational and career worlds. The relational career counseling approach moves counseling toward a contextually based relational perspective to facilitating career progress. This approach is illustrated with a case example.     

Korean adolescents' "examination hell" and their use of free time

A 15-year-old girl's daily life is a vivid testimony to the hardships the Korean high school student is faced with. She leaves home for school at 7 A. M., taking two lunch bags, one for supper, with her. After regular classes end at 5 P.M., she attends the "autonomous study classes" studying by herself until 10 P.M. The exhausted young girl returns home at about 10:30 P.M. and gets to bed around midnight at the earliest. Under the current system, this will be her life for three years. Of course, there is no guarantee she will be able to enter the university she wants. She has no family life, except for Sundays, and they hardly ever see each other, let alone get together at the dining table for dinner. People call this "ipsi chiok," entrance examination hell. ["High School Students Deprived of Spring," 1996, p. 13].     

The making of a group psychotherapist: Needs and goals for graduate and postgraduate training

Group therapy is a widely practiced, effective, but underrated specialty. Unfortunately, group therapy seems to be taught more haphazardly, with less attention to quality, than is individual therapy. Group therapy has a technique, history, and literature of its own and should be taught independently from individual psychotherapy. The training of psychiatric residents is particularly crucial for group therapy to prosper and be seen as more prestigious. A common core of experience is vital for training in group therapy, whether the trainee's background is psychiatry, psychology, social work, pastoral counseling, or nursing. This core consists of: 1) clinical experience doing group therapy; 2) supervision; 3) a professional training group experience; 4) observation of experienced group therapists; 5) exposure to current thinking in the field; 6) personal group therapy; and 7) a didactic course in theory and technique. Clinical experiences involving cotherapy and combined individual and group treatments are especially useful, both as training and as treatment modalities.He is on sabbatical leave from John Jay College of Criminal Justice where he is Professor of Psychology and was founding Chairman of the Psychology Department.The authors wish to thank Arnold Rachman, Ph.D., Michael Lapidus, M.D., Fayek Nakhla, M.D., Nyapati R. Rao, M.D., and Dorothy Gartner, Ph.D., for their helpful comments on earlier versions of this paper, and Ms. Deloris J. Johnson for her typing and editorial assistance.     

From the private I to the public ear: Effective learning groups for college-age students

This paper addresses the problem of organizing and conducting groups at a college counseling center. It focuses on the importance of a therapist learning from his/her errors, of appropriately matching a client with a particular group and of preparing clients and group leaders for work with a group. The concept of boundary management is used as a way to understand group events and to make sense of group leader errors. Throughout the paper, attention is given to how best to develop groups within the unique framework of a college community.This paper was presented at Brandeis University's Conference on Psychological Work with College Students, November 6, 1982. It was written in the memory of Eugenia Hanfmann, Ph.D., who as Director of the Brandeis University Counseling Center encouraged the author to appreciate the value of learning from his errors! In writing this paper the author is grateful for the support and for the suggestions offered by his colleagues, Bruce Weiss, Ph.D., and E. Martin Schotz, M.D.     

Attachment,Family Therapy,and Relational Psychoanalysis: Introduction to Virginia Goldner’s “Romantic Bonds,Binds, and Ruptures: Couples on the Brink”

Virginia Goldner’s paper reflects her exceptional role as a leader in both the family therapy and relational psychoanalytic worlds. Integrating those domains with theory and attachment and affect regulation, she presents a vivid and elegant theoretical perspective with an acutely empathic and self-reflective account of a torturous case. Commentaries by Leslie Greenberg and Paul Wachtel follow, along with a reply from Goldner.     

Living in with Normal Families

Connie Hansen participated in my project, “Methodology for Studying Family Interaction,” in the mid 1960s. One of the purposes of that project was to compare several groups of families, including “normals.” Connie suggested that it might provide a rich source of data if she were to “live in” with a few of the “normal” families and observe them day to day on their own territory. (A year or so before, Dr. Jules Henry had given a talk to the MRI staff about living-in with “schizogenic” families, and I believe that Connie had discussed her idea with him.) Connie was an experienced family therapist — she was one of Virginia Satir's first students — and a most perceptive observer. She lived with three “normal” families for a week each during 1966–67; she was excited by the wealth of material and exhausted by the experience. She tried to develop a group of central themes from her data and gave me a preliminary draft of a paper in 1969. It clearly contained a number of important observations about the complexities and subtleties of family systems and some beginning attempts at conceptualization. She struggled for years to clarify and elaborate on her material. Several times she sent me portions and fragments of new drafts, each with additional insights, but she was never satisfied with her efforts. It seems a fitting tribute to Connie — she died early in 1979 — to attempt to put together her various drafts. We wanted to publish this very important material in a readable form and yet still preserve the immediateness, enthusiasm, and vividness of her observations. I hope, that if she were to read it, she would not be overly critical of this final draft. JULES RISKIN, M.D. It is a special privilege for me to participate in this posthumous publication of Connie Hansen's unique contribution to the further knowledge of family interaction. She died before the material could be published. I feel particular gratitude to the young woman who entered my first training program in 1961 at the Mental Research Institute. This was a time when such training seemed “far out” and was regarded as “probably only a fad.” She was willing to face the risks inherent to her professional standing by choosing to do this training. It was this same courage together with her imagination and curiosity and her willingness to document her experience without judging it that resulted in the article now being published. Farewell, Connie, and thank you for your presence in my life. VIRGINIA M.SATIR     

Network Intervention with a Family in Crisis

This paper presents the process of network intervention with the Kellys who initially sought help for marital problems, continued in therapy by including their 16-year-old son, and ended up with a network assembly of 35 family members, relatives, friends and neighbors meeting at home to help solve the family's on-going conflicts.