Privileged Communication in Therapy: Special Problems for the Family and Couples Therapist

Misconceptions concerning the existence and scope of the legal privilege for communications in therapy are considered. Basic limitations on the protection afforded by the privilege are treated, as are some major specific exceptions and waivers, particularly as they raise special difficulties for the therapist who works with groups, couples, and families. Practical suggestions for the therapist and directions for policymaking by the helping professions are presented.     

Constructivism and Family Therapy

Personal construct and family systems theories can profit from an exchange of ideas concerning the relationship between their personal and interpersonal aspects of construction. This article examines three possible points of contact between the two orientations. First, we suggest that personal construct psychology could profit from addressing the important contributions of the family context to the development of each individual's system. Second, we address the impact of the person's constructions on the larger family system. Third, we suggest that the family system itself develops a system of shared constructions that define and bind its identity and interactions. Each of these areas of interface carries implications for therapy, and specific intervention techniques corresponding to each of these are discussed.     

Feminism and Family Therapy

Feminism has had a profound effect on contemporary culture and on thinking in most academic fields, including psychoanalysis. Interestingly, until very recently it had made virtually no impact on the theory and practice of family therapy. This paper proposes an explanation for this peculiar phenomenon and argues that family therapy has been considerably handicapped by its insularity from the feminist critique. Utilizing feminist scholarship in psychoanalysis, history, and sociology, the paper analyzes the structural contradictions in family life that family therapists have essentially ignored and then outlines their clinical implications. Key points in the discussion include the argument that systems theory is an inadequate explanatory matrix from which to build a theory of the family, that the archetypal "family case" of the overinvolved mother and peripheral father is best understood, not as a clinical problem, but as the product of a historical process two hundred years in the making, and that power relations between men and women in families function in terms of paradoxical, incongruous hierarchies that reflect the complex interpenetration between the structure of family relations and the world of work. This conceptual model then provides the basis for an analysis and critique of sexual politics as they emerge in the prototypical clinical situation.     

Science and Family Therapy

Family therapists are being exhorted to adopt a social constructionist epistemology and to abandon science as a valid form of knowing. Epistemological objections to science are usually directed at 'positivism', an outmoded view that is largely discredited among practising scientists. Contemporary science, is rather, constructionist, differing from other constuctionist approaches only in ways of arbitrating between world views. Criticisms aimed at science apply to all forms of discourse, including family therapy. I conclude that science has failed family therapy at the practical, not the philosophical level.     

Insurance and Family Therapy

The advent of recent theories of family structure and socially shared psychopathology that have found expression in the practice of family therapy are forcing a re-examination of concepts of individual diagnoses in which the symptoms of an individual family member are viewed as a possible communication from a disturbed family system. In seeking reimbursement for family therapy through health and accident insurance, a problem is occurring because the traditional method of payment is based on the establishment of individual psychiatric diagnoses, and very few companies will insure a family for family therapy. This paper examines the three-part system: insurers, family, and helping professions in relation to the significance of the conflict between traditional concepts of individual psychopathology and recent concepts of socially shared family psychopathology.     

Structural Family Therapy

Research studies show that Chinese communities in the United States are in need of mental health services. Structural family therapy offers an effective model for treating families in need of therapy. This article describes why and how the model can be applied.     

Integrative Family Therapy

This paper describes an integrative approach to marital and family therapy in which psychodynamic (particularly object relations), family systems, and behavioral (particularly cognitive–behavioral) theory are blended in a flexible and tailored therapeutic approach. Human personality in its most significant contexts is a consistent focus. Background factors in the development to the approach and illustrative case materials are included.