Treating family relational trauma: a recursive process using a decision dialogue

This article describes a therapeutic process that combines individual and family sessions to maximize therapeutic opportunities to bring forward, understand, validate, and empower children's experience as equal participants in family therapy. The aim is to strengthen relational bonds within the family. Drawing from earlier work with families where incest had occurred, the authors present a recursive process that utilizes a "decision dialogue" to link individual and family sessions. Clinical examples are provided.     

Multiple Overt Incest as Family Defense Against Loss

A case report of father-daughter incest is presented that illustrates the way in which overt incest can function as a multi-determined familial defense against separation and loss. The case is further distinguished by: (a) multiple incest and (b) family therapy — an approach infrequently described in the literature on this problem. The authors have adopted the psychodynamic view that incest expresses the collective psychopathology of all the family members as well as their common adaptational capacities. Specifically, we have attempted to demonstrate that separation anxiety was a shared dread in this family and that incest defended against this painful prospect.     

Making Sense of Abuse: Case Studies in Sibling Incest

This case study focused on the process of making sense of abuse in two Latino families experiencing sibling incest. Participants included five male children ranging in age from 8 to 15 that were members of two families dealing with the issue of sibling incest. The purpose of this study was to build understanding of how families experience sibling incest and its role in their families. Clinical data from therapy sessions was analyzed to reveal that families made sense of the incest in different ways including abuse as normal and abuse as a mistake. Central concepts that explained how the families responded to the sibling incest included (1) level of family cohesion, (2) role of secrecy, and (3) view of outside systems. The findings suggest that treatment needs to include an in-depth assessment regarding these issues.     

The Impact and Status of Carol Fowler's Supramodal Theory of Multisensory Speech Perception

ABSTRACT

One important contribution of Carol Fowler's direct approach to speech perception is its account of multisensory perception. This supramodal account proposes a speech function that detects supramodal information available across audition, vision, and touch. This detection allows for the recovery of articulatory primitives that provide the basis of a common currency shared between modalities as well as between perception and production. Common currency allows for perceptual experience to be shared between modalities and supports perceptually guided speaking as well as production-guided perception. In this report, we discuss the contribution and status of the supramodal approach relative to recent research in multisensory speech perception. We argue that the approach has helped motivate a multisensory revolution in perceptual psychology. We then review the new behavioral and neurophysiological research on (a) supramodal information, (b) cross-sensory sharing of experience, and (c) perceptually guided speaking as well as production guided speech perception. We conclude that Fowler's supramodal theory has fared quite well in light of this research.     

The paradox of innocence dissociative “adhesive”; states in perpetrators of incest

This paper attempts to develop a phenomenology of the perpetrator's conviction of innocence in a condition of actual guilt. This phenomenology is developed through the investigation of dissociative states in a certain type of incestuous perpetrator: one who is herself a survivor of sexual abuse, physical abuse, or both. Clinical material suggests that certain types of schizoid perpetrators can genuinely experience the incestuous act as not really real not really sex, not really mine. This clinical phenomenon is examined from the perspective of two contemporary theoretical trends: the new view of the self as multiple (Bromberg, 1993; Mitchell, 1993), and the neo‐Kleinian formulation of “adhesive”; (Mitrani, 1994) or “autistic‐contiguous”; (Ogden, 1989, 1990) modes of pseudo‐object relatedness. Incestuous acts are conceived as occurring within a prelinguistic modality, and are therefore not encoded in discursive, autobiographical memory. The coexistence of dissociated, multiple self states and modalities accounts for the contradictory levels of object relatedness, memory, and concern frequently encountered in perpetrators of incest.     

Theorizing About Power: Intersecting the Ideas of Foucault with the “Problem” of Power in Family Therapy

How to theorize about power has been a controversial issue in systemic family therapy, which, in its understanding of power, has shown the legacy of Gregory Bateson's ideas in terms of its earlier censorship of the concept of power as well as in the way in which the more recent challenges continue to be framed in relation to Bateson's position. This essay examines the work of the French philosopher, Michel Foucault, and his ideas on power in relation to family therapy themes. The main aim in intersecting Foucault's ideas with the “problem” of power in family therapy is to shed a different light on the way in which family therapy has theorized about power. A strong point of connection is made between Foucault's commitment to a relational analysis of power and family therapy's commitment to recursive analysis. However, a number of major contrasts are also identified. These contrasts are used to underline the need for family therapy to abandon the restrictions of Bateson's ideas on power, and to tackle the task of developing and using a recursive understanding of power.     

Interdependence of Stress Processes Among African American Family Members: Influence of HIV Serostatus and a New Infant

This study makes a theoretical contribution to stress process research by using a systemic approach to contextualize individual outcomes within the framework of other family members' experience. Utilizing a mixed model approach, indicators of the stress process of urban low-income HIV + African American recent mothers were found to affect the psychological distress and perceived adequacy of coping of multiple other family members. These relationships were found to be strongest proximal to birth and to be exacerbated by HIV infection. Social support to the mother was found to have differential effects depending on whether it was from the immediate family or outside sources. HIV infection of the recent mother was found to affect family members both through relationships of the mother's stress process and through their own coping responses.     

Intimate Partner Violence in African Immigrant Communities in the United States: Reflections from the IDVAAC African Women’s Round Table on Domestic Violence

African women face many challenges when they come to the United States due to the immigration experience, acculturation, and leaving family members in countries of origin. Intimate partner violence (IPV) complicates African women’s experience within their home countries as well as in the United States. There is little literature on IPV in African ethnic groups. This information is even sparser regarding IPV among African immigrant and refugee communities in the United States. To better address the needs of these communities, the Institute on Domestic Violence in the African American Community brought together service providers and survivors representing 16 different African countries to attend a roundtable and explore issues of IPV. This article highlights the unique challenges they identified.     

Therapeutic Groundhog Day – exploring the impact of the theory/approach on the self of the therapist

The ‘use of self’ of the therapist is a concept that can be considered from numerous directions. An underrepresented aspect of ‘the self of the therapist’ is the influence of the theoretical orientation and associated skills. As part of a recursive process, the theory and techniques shape the therapist's emergent self in the therapeutic relationship. This teaching event was designed to provide an opportunity for trainee therapists to experience contrasting ‘selves’. This is developed through role play where ‘family’ and ‘therapists’ attempt to reproduce the same episode but each is responded to with a different model and skill.     

Family-focused management: Treatment of choice for deviant and dependent families

Abstract

Helping professionals working with troubled families takes two approaches. One approach, noting that the identified patient's family's behavioral interactions have positive and negative effects on the patient and his symptoms, advocates involving family members in the treatment process. The other approach, noting that the identified patient alone has the power to resolve his problem, advocates treating the patient independently of the family. This latter approach, in effect, relieves family members of the painful feelings of responsibility. At first glance, these two approaches appear to be in conflict, and it is no wonder that professionals choose to remain with one or the other. Both points of view are valid, so that approaches need to be developed which incorporate both.     

An historical perspective of incest

Incest has been documented in most civilizations and for as long as can be remembered. This article begins with a brief historical overview of incest across cultures and times. The second part includes a review of several theories that place the significance of the incest taboo in an historical continuum.     

Applying a Family Resilience Framework in Training,Practice, and Research: Mastering the Art of the Possible

With growing interest in systemic views of human resilience, this article updates and clarifies our understanding of the concept of resilience as involving multilevel dynamic processes over time. Family resilience refers to the functioning of the family system in dealing with adversity: Assessment and intervention focus on the family impact of stressful life challenges and the family processes that foster positive adaptation for the family unit and all members. The application of a family resilience framework is discussed and illustrated in clinical and community‐based training and practice. Use of the author's research‐informed map of core processes in family resilience is briefly noted, highlighting the recursive and synergistic influences of transactional processes within families and with their social environment. Given the inherently contextual nature of the construct of resilience, varied process elements may be more or less useful, depending on different adverse situations over time, with a major crisis; disruptive transitions; or chronic multistress conditions. This perspective is attuned to the diversity of family cultures and structures, their resources and constraints, socio‐cultural and developmental influences, and the viability of varied pathways in resilience.     

Hearing Metaphor: An Approach to Working with Family-Generated Metaphor

This article presents a step-by-step approach to working with family-generated metaphor in family therapy. Although the use of therapist-generated “therapeutic metaphors” has been widely advocated and practiced for many years now, less attention has been paid to the metaphors used by family members. We argue that the family's metaphors are a neglected linguistic resource in family therapy. Highlighting and validating these metaphors produces a therapeutic conversation in which the voices of family members are heard more clearly by the therapist, and the families' own imaginative energies are engaged in defining and pursuing the goals of therapy. Several case examples illustrate the use of this approach with children of various ages.     

Mothers', fathers' and children's perceptions of parents' expectations about children's family obligations in nine countries

Children's family obligations involve assistance and respect that children are expected to provide to immediate and extended family members and reflect beliefs related to family life that may differ across cultural groups. Mothers, fathers and children (N = 1432 families) in 13 cultural groups in 9 countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand and United States) reported on their expectations regarding children's family obligations and parenting attitudes and behaviours. Within families, mothers and fathers had more concordant expectations regarding children's family obligations than did parents and children. Parenting behaviours that were warmer, less neglectful and more controlling as well as parenting attitudes that were more authoritarian were related to higher expectations regarding children's family obligations between families within cultures as well as between cultures. These international findings advance understanding of children's family obligations by contextualising them both within families and across a number of diverse cultural groups in 9 countries.     

Parenting after Weight Loss Surgery: A Conceptual Model and Two Case Reports

The ways families approach eating, shape, and weight can result in stress for individual family members and challenge the overall functioning of the family. This is further complicated among families with a parent who has history of obesity or undergone weight loss surgery (WLS). Although WLS can positively impact other family members, it can also exacerbate conflicts regarding feeding and weight. Such conflicts can involve uncertainty regarding the extent to which the entire family should make the dietary changes recommended for the post-WLS parent. Conflict might also center on the appropriate level of concern regarding the children’s risk of developing (or maintaining) obesity. This paper uses two case examples to describe the application of a specialized, time-limited intervention: Parent-Based Prevention following Bariatric Surgery (PBP-B). The program was developed to address the unique challenges and concerns that arise after, or are exacerbated by, WLS. Each detailed case example illustrates a common child-feeding challenge and the employment of key PBP-B strategies throughout the course of treatment. In the first case, the parent who had undergone WLS believed the family’s current eating behaviors were the same as those that had led to her own overeating, obesity, and co-occurring psychiatric symptoms, while her husband disagreed. In the second case, both parents were concerned about their son’s weight, yet due to their prior eating histories, they felt unable to construct boundaries around the feeding experience. Both cases follow families through the entire intervention and illustrate key points and challenges. These cases underscore the need for novel treatment modalities to support families following parental WLS.     

Academic Pathways and Children of Immigrant Families

In this study, we examined the relationships between family, school, and community contexts and academic achievement during middle childhood among children of Portuguese, Dominican, and Cambodian immigrant families. We interviewed approximately 350 children from 2 age cohorts spanning first through third and fourth through sixth grades annually across 3 years. Additionally, we collected interviews with parents, measures from teachers, school administrative information, and community ethnographies to understand the various contexts of children's academic achievement. Using a "mixed-methods" approach, we qualitatively coded children's academic success from school records and teacher's responses about the student into 1 of 5 pathways representing children who were "excelling, positive, neutral, negative, or abysmal" across all 3 years of the study. We then used ordinal regression modeling to examine the relationships between child, family, school, and community factors and child academic pathway. Commonalities in findings across the 3 immigrant groups reveal the importance of good school attendance. Divergences between the 3 immigrant groups highlighted family and cultural influences on positive child academic achievement such as synchronicity between child and school values, the children's own academic self-concepts, and academic aspirations. We integrated quantitative findings with the profiles from ethnographic research of the study's communities for an in-depth examination of the mechanisms behind early educational success among children of immigrants.     

‘The Ancient Cult of Madame’: when therapists trade curiosity for certainty

An experience in which the author followed his own objectives rather than the patient's, leading to a tragic end, is evoked as a frame for the presentation and discussion of a family treatment where the therapeutic process led by the therapist may have exceeded the needs and expectation of the family members. This is followed by a discussion about potential problems caused by a therapist's fascination for family stories, since its effects may be epistemologically discontinuous from, if not contradictory to, Cecchin's recommendation for ‘curiosity’ as a central dictum of the therapist's stance.