A Narrative Approach to Child and Family Therapy in Africa*

Professional family therapy in Africa is heavily influenced by theories and principles of Western family practice. Its practice structure and philosophies are however grounded on African family values and the principles and orientations of traditional African psychology. This paper presents a clinical report that illustrates adaptations we make to incorporate compatible aspects of narrative family practice in African and Western cultures. A summary of African family values and child psychology intended as a background perspective is provided. The paper is significant against the background of the current need for forging multiculturally relevant healing methods that fit well with the globalized nature of the contemporary world. Augustine Nwoye, PhD, is Associate Professor and Chairman, Department of Psychology, Kenyatta University, Nairobi, Kenya (amnwoye@avu.org). Professor. Nwoye has developed an African paradigm for mental health and, in particular, for family and couple therapy. He also has experience in dealing with stress and multiple losses, especially surrounding HIV/AIDS within an African context. *An earlier version of the paper was presented to the members of staff and students of the Faculty of Education, University of Cambridge, England, UK, and the initial version was presented to the members of the Family Therapy Program of the Faculty of Medicine of the University of Calgary, Calgary, Canada. I wish to thank Dr. Colleen McLaughlin (University of Cambridge) and Professor Karl Tomm (University of Calgary) for their invitation, assistance, time, attention, and suggestions.     

On Becoming a Profession: The Growth of Marriage and Family Therapy in India*

The practice of couple and family therapy has a long history in India. This article tracks some of the people, places, and contexts associated with the growth of marriage and family therapy (MFT) as a profession in the Indian context. Two of the authors outline their own introduction to MFT and work within this field in different cities in India in the last two decades. Based on their professional experiences and a pilot study conducted in Chennai, the authors document the needs of providers in the areas of systems-based therapy training and the practice of MFT. The role of the Indian Association for Family Therapy (IAFT) and suggestions for the future growth of the field are also highlighted. Mudita Rastogi, PhD, Professor, Illinois School of Professional Psychology, Argosy University, 1000 Plaza Drive Schaumburg, IL 60173 (MuditaRastogi@hotmail.com). Rajeswari Natrajan, PhD, Assistant Professor, Alliant International University, 2500 Michelson Drive, Suite 250, Irvine, CA 92612-1548. Volker Thomas, PhD, Associate Professor, Purdue University, 1200 West State Street, Fowler Memorial House, Purdue University, West Lafayette, IN 47907-1269. *Portions of this paper are based on Rajeswari Natrajan’s dissertation at Purdue University. **Rastogi and Natrajan share first authorship for this paper.     

Marital Conflict Among Parents: Implications for Family Therapy with Adolescent Conduct Disorder

Conduct disorder is associated with several causative and maintaining factors, with family functioning being an important one. This is especially true in the Indian context, where a lot of the problem behaviors manifested by adolescents with conduct disorders are in the family context. Marital relationship of the parents is a key aspect of family functioning, affecting a number of other dimensions of family functioning, including adolescent adjustment. The paper highlights the role of parents’ marital conflict in the emergence and maintenance of adolescent conduct problems. The importance of family therapy in managing adolescent conduct disorder is discussed through case examples from India. Shalini Anant, MPhil, PhD Scholar, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India. Ahalya Raguram, PhD, Additional Professor, Department of Clinical Psychology, NIMHANS, Bangalore 560029, India. Address correspondence to Shalini Anant (shalinianant@gmail.com).     

Family Resilience and the Management of Fibromyalgia: Implications for Family Therapists

Fibromyalgia Syndrome (FMS) is one of the most troubling rheumatic disorders for patients, significant others, and the health care providers who treat them. Responses from 150 participants provided valuable information on the relationship between family resilience and the management of fibromyalgia. Self reported family stressors, strains, and distress were significantly associated with an increase in health problems/functional disability, whereas family hardiness and family social support were associated with a decrease. Family stressors and family strains were also positively associated with the frequency of medication use. Medical family therapy interventions that consider the familial context are recommended for treatment. Additional implications for clinical practice and future research are discussed. J. Cameron Preece, PhD, Sage Health Care, PLLC, 339 Allumbaugh Street, Boise, ID 83704. Jonathan G. Sandberg, PhD, Department of Marriage and Family Therapy, Syracuse University, Syracuse, NY 13244. (jgandbe@syr.edu) Special thanks go to Linda Stone Fish, PhD, for her support and guidance throughout the study.     

“Almost There”...Why Clients Fail to Engage in Family Therapy: An Exploratory Study

A great deal of clinical research has sought to describe and suggest remedies for the client dropout phenomenon. However, few studies have addressed the equally pervasive, yet often ignored, non-engagement problem. An exploratory study was conducted to understand why many clients fail to engage in family therapy services after they have completed the initial intake. The results of the study suggest that therapist gender and experience level, clinic policies regarding videotaping sessions, family concerns, and changes in the presenting problem prior to the first session, had an impact on potential clients’ decision to engage in therapy. Implications and future research are discussed.Meng-ning Wang, MA, a doctoral student, and Jonathan Sandberg, PhD, a faculty member in the Marriage and Family Therapy Program at Syracuse University at Syracuse University are co-first authors. Amy Zavada, MA, Tziporah Rosenberg, MA, Aaron Jeffrey, MA, and Justin McPheters, MA, are doctoral students, and Mona Mittal, PhD, and Anne Gosling, PhD, are faculty in the same program.     

Counselor values—Client freedom

A framework for an approach to counseling which respects the freedom of clients and yet leaves them open to the consideration of different value systems is presented. The framework is based upon values shared by many counselors and a stage model of counseling compatible with different theoretical approaches. It is hoped that consciousness of shared values and continuing dialogue will lead to a greater commonality of values.Michael J. O'Brien is Professor of Psychology at Loyola University of Chicago. He is active in the undergraduate Applied Psychology Program where there is a dual emphasis on theory and practice. For eleven years he was director of the M.A. program in Counseling Psychology for religious workers. (It is now a part of the Institute of Pastoral Studies at Loyola.) His thinking on values has developed through the realization of the central part values in counseling. This article strives to synthesize devergent approaches to the question of values.     

Bilateral Art: Integrating Art Therapy,Family Therapy,and Neuroscience

This paper describes the systemic use of a neurologically-based art therapy modality—bilateral art—that engages both dominant and non-dominant hands in the process of creating images in response to opposing cognitions or feelings. It describes both neuroscience and family therapy perspectives that argue for the use of bilateral art. A specific protocol for bilateral art therapy is provided along with a case study demonstrating integration of the protocol into the systemic treatment of a young family. Carole M. McNamee, PhD, is Research Professor and Clinical Associate, Director of the Arts in Healthcare Project, The Family Therapy Center, Department of Human Development, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061 (cmcnamee@vt.edu).     

Totemic therapy

Totemic therapists, those recognized as healers because of their identification with an ethnic subculture, religious group, or social cause, are a factor in modern society often overlooked or underestimated as a mental health resource. Whatever the advantages and disadvantages of totemic therapy, such therapists will be in increasing demand as pluralistic social trends continue. It is therefore realistic to ask how their skills may be increased and their services better utilized.Ronald R. Lee, Ph.D., was born in Melbourne, Australia, and received his Ph.D. in Pastoral Psychology from Northwestern University/Garrett Evangelical Theological Seminary in 1965. He is Professor of Pastoral Psychology and Counseling at Garrett-Evangelical Theological Seminary and is a Diplomate in the American Association of Pastoral Counselors.     

Fitting a square peg in a square hole: Using metaphor in narrative therapy

This paper examines the assumptions of the narrative mode of therapy and the assumptions of therapeutic metaphors. The premise is that the use of metaphor fits the assumptions of narrative therapy and can enhance and expand narrative therapy. This paper examines the structure and types of metaphor, explores their fit within the narrative model, and gives three case examples which illustrate the use of metaphor in narrative therapy.Kevin Lyness, MS, is a doctoral candidate, MFT Program, 1269 Fowler House, Purdue University, West Lafayette, IN 47907-1268, and a doctoral candidate in the MFT Program, Purdue University. Volker Thomas, PhD, is assistant professor, Marriage and Family Therapy Program, 1269 Fowler House, Purdue University, West Lafayette, IN 47907-1269. Reprint requests should be sent to the first author.     

Unheard Voices: Experiences of Families Living with HIV/AIDS in India*

This study was aimed at understanding the impact of HIV on the family system in the Indian context. A sample of 20 families caring for a relative living with HIV/AIDS (PLWHAs) was recruited from a HIV counseling clinic at the National Institute for Mental Health and Neuro Sciences and a respite home for PLWHAs in Bangalore City in southern India. Qualitative data were collected from these families using a semi-structured interview guide and recorded in the form of narratives. Analysis of these data revealed the following themes: Stigma and discrimination; disclosure; changes in family functioning; financial difficulties; fears of the family; and helplessness. Each theme was presented in detail and implications for intervention to help these families and their PLWHAs discussed. V.A.S. Krishna, PhD, MPE, Fogarty Funded Post Doctoral Fellow, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63108 (krishnavas@epi.wustl.edu). Ranbir S. Bhatti, PhD, Professor of Family Therapy, Montfort College, Bangalore, Former Professor and Head, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (ranbirbhatti@yahoo.com). Prabha S. Chandra, MD, Additional Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (prabhachandra@rediffmail.com). Srilatha Juvva, PhD, Reader, Department of Family and Child Welfare, Tata Institute of Social Sciences (TISS), Mumbai, India 400088 (juvvas@tiss.edu). *The authors would like to thank all the PLWHAs and their family members for volunteering to be part of this study. Post-doctoral Fellowship support for Dr. V.A.S. Krishna from Fogarty Grant—TW05811 (LB Cottler, PI).     

How to Talk to Christian Clients About Their Spiritual Lives: Insights From Postmodern Family Therapy

Responding to literature calling for the integration of Christian spirituality and postmodern thinking, this article presents a more specific discussion of how postmodern family therapy approaches can be used to open therapy to the spiritual lives of Christian clients. In this article, postmodern family therapy approaches are described and the compatibility of postmodern family therapies and Christian thinking are examined. Finally, we see how a clinical practice based upon postmodern ideas can provide pastoral counselors with useful tools for talking with Christian clients about their spiritual lives. P. Gregg Blanton is Professor of Human Services at Montreat College. He is affiliated with the Pastoral Counseling and Growth Center in Asheville, NC.     

An Overview of Primary Care Family Psychology

This paper describes the application of family psychology to the primary care setting—in service, education and training, and scholarship. Primary care family psychology integrates family systems with biopsychosocial theory, yielding an approach that is uniquely suited to the generalist demands of primary care. This approach attends especially to the effects of relationships on health and healthcare, using the family as a potential resource to the patient just as the healthcare team is a resource to the clinician. Training opportunities in primary care family psychology are growing. The University of Rochester School of Medicine and Dentistry fellowship is described as an example, with core primary care family psychology training in four different clinical sites: Family Medicine, Internal Medicine, Pediatrics, and Obstetrics/Gynecology. Susan H. McDaniel is Professor of Psychiatry & Family Medicine, Director of Family Programs & the Wynne Center for Family Research in Psychiatry, and Associate Chair of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York. Dr McDaniel also directs the Primary Care Family Psychology Fellowship. Picter LeRoux is Associate Professor of Psychiatry & Pediatrics, and Director of the Family Therapy Training Program in Psychiatry, University of Rochester School Medicine and Dentistry, Rochester, New York. Dr. LeRoux also heads the Pediatric Track of the Primary Care Family Psychology Fellowship.     

Quantitative and Qualitative Research: Beyond the Debate

Psychology has been a highly quantitative field since its conception as a science. However, a qualitative approach to psychological research has gained increasing importance in the last decades, and an enduring debate between quantitative and qualitative approaches has arisen. The recently developed Mixed Methods Research (MMR) addresses this debate by aiming to integrate quantitative and qualitative approaches. This article outlines and discusses quantitative, qualitative and mixed methods research approaches with specific reference to their (1) philosophical foundations (i.e. basic sets of beliefs that ground inquiry), (2) methodological assumptions (i.e. principles and formal conditions which guide scientific investigation), and (3) research methods (i.e. concrete procedures for data collection, analysis and interpretation). We conclude that MMR may reasonably overcome the limitation of purely quantitative and purely qualitative approaches at each of these levels, providing a fruitful context for a more comprehensive psychological research.

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.     

Gender, Power, and Relationship Ethics In Family Therapy Education

Awareness and sensitivity about gender issues have central positions in family therapy education. Traditionally gender relationships have been treated as either a reflection of cultural values and norms or as a dynamic of the way that men and women deal with the other sex. This paper presents the findings of a qualitative study that examines the meaning and enactment of gender issues in the supervisory process in family therapy. Based on that study, the authors developed a strategy for raising issues of gender equity in clinical training and describe the effects of that strategy on one practicum.Professor of Family and Child Sciences and the director of the Interdivisional Program in Marriage and Family Therapy at Florida State UniversityAn associate professor of Family and Child Sciences and the co-director of the Family Policy and Research Unit in the Family Institute at Florida State University     

Persistence in seminary and in ministry

A follow-up study of 672 seminary students from 14 seminaries who took the Theological School Inventory in 1962 and 574 from 10 seminaries who took it in 1973 investigated factors involved in persistence in seminary and in ministry. Among those found were definiteness of decision, interest in parish ministry, a supportive spouse, unambivalent resolution of the authority problem, good role models in father and ministers. Motivations included redemptive outreach, pastoral care, Christian insight and scholarship, the encouragement of other people and a sense of effectiveness in ministry.Dr. Cardwell is Assistant Professor of Psychology and Counseling at Christian Theological Seminary, 1000 W. 42nd St., Indianapolis, Indiana 46208. This study was the basis for her Ph.D. dissertation, Indiana University, June, 1978. TSI data for the 1973 subjects were made available by Richard A. Hunt, Ph.D., Professor of Psychology, Southern Methodist University, and Director of Ministry Inventories, P.O. Box 8265, Dallas, Texas 75205. TSI data for the 1962 subjects were coded and made available by Edgar W. Mills. Ph.D., presently visiting Associate Professor of Sociology, University of Texas, San Antonio, formerly Director, Ministry Studies Board. Special credit is due the 16 seminaries who cooperated by furnishing follow-up data.     

The Efficacy of Behavioral Couples Therapy and Emotionally Focused Therapy for Couple Distress

Twenty treatment outcome studies, 13 of which evaluated behavioral couples therapy (BCT) and seven of which evaluated emotionally focused therapy (EFT) were reviewed, leading to the following conclusions. BCT leads to short and long-term gains for moderate to severe couple distress. In the long term BCT probably leads to no better outcomes than its constituent components—behavioral exchange training and communication and problem solving skills training. Addition of a cognitive therapy component to BCT or the use of a variety of treatment formats does not improve the efficacy of BCT. Integrative couples therapy and insight-oriented marital therapy may be more effective than BCT, but studies supporting this conclusion require replication. EFT leads to short and long-term gains for mild to moderate couple distress. Addition of a cognitive therapy component to EFT does not enhance its efficacy. EFT may be more effective than problem solving therapy and less effective than integrated systemic therapy, but the two studies supporting this conclusion require replication.Michael Byrne, PhD, is a Clinical Psychologist, Midland Health Board, Ireland; Alan Carr, PhD, is Director of the Clinical Psychology Training Programme, Department of Psychology, Arts Building, University College Dublin, Belfield, Dublin 4, Ireland (alan.carr@ucd.ie). Marie Clark, PhD, is Lecturer, Department of Psychology, University of Surrey, United Kingdom.     

Selective mutism in children: A structural family therapy approach to treatment

When children refuse to speak in some social settings, but can understand and speak in other settings, the diagnosis of selective mutism must be considered. A review of the literature describes the disorder, the various types of mutism, and related family dynamics. A family systems approach to treatment using structural family therapy is suggested. The case history presented illustrates one type of mutism as well as the family rules and hierarchy which appeared to be maintaining it. Structural and strategic family systems theory techniques that were used to move the family toward resolution of this problem are discussed.Diane Wolf Tatem, MA, MS, completed graduate work in marriage and family therapy at New Mexico State University, Las Cruces, NM. She is employed at Life Management Center of El Paso's Child Development Services and also has a private practice in marriage and family therapy in El Paso, Texas. Robert L. DelCampo, PhD is a professor of family science at New Mexico State University and maintains a private practice with Associates for Marriage and Family Therapy in Las Cruces, NM. Please address all correspondence to Dr. DelCampo at Box 3470, New Mexico State University, Las Cruces, NM, 88003-3470.Appreciation is expressed to Dr. Charles Huber, New Mexico State University in Las Cruces, for his insightful critique of the final draft of this paper. This paper was presented at the Texas Association for Marriage and Family Therapy Annual Conference, January 25–29, 1995 in Dallas, TX.