Systemic change in limited family therapy

Some families present with so many problems and disordered family processes that where and how to begin is an extremely important question. When premature termination of therapy also appears likely, a family therapist may simply attempt to initiate a structural change within the family system so that the family can continue on its own. This article describes the responses of a highly chaotic family to such a single therapeutic intent.     

EPISTEMOLOGY EXTENDED

A common presupposition in epistemology is that the processes contributing to the generation of knowledge do not extend beyond the knower's skin. This paper challenges this presupposition. I adduce a novel kind case that causes trouble for a number of even the most promising accounts of knowledge in current literature (virtue epistemological and modal accounts), at least so long as the presupposition is in place. I then look at a couple of recent accounts of knowledge that drop the presupposition and expressly allow the relevant processes to extended beyond the knower's skin. While these accounts can handle the problem case, they encounter difficulties elsewhere: extension occurs too easily and so the accounts predict knowledge where they ought not. Finally, I offer a novel way of extending epistemology and argue that it can steer clear of the problems on both sides.     

Patient‐focused research supported practices in an intensive family therapy unit

The aim of this study is to explain how families evaluate and describe the use of two measures, the session rating scale and the outcome rating scale, in order to monitor therapeutic work. This study is methodologically based on modifications of methodical hermeneutics and consensual qualitative research. The results confirm the feasibility of these scales although some difficulties were identified. The analysis of the family interviews identified four conversational processes: communicating, focusing, structuring and exploration. These arise through the application of the scales, indicating their usefulness as conversational tools. In general, it is suggested that all the measurements and tools applied can be seen as therapeutic tools that are especially useful for establishing conversations and strengthening collaboration between service users and therapists. This brings the practice of monitoring therapeutic work into close contact with postmodern‐oriented forms of therapy.     

Codependency: An Empirical Study from a Systemic Perspective

To empirically investigate the construct validity of codependency, differences between young adults on a measure of codependency on theoretically relevant variables were examined. Compared with individuals who scored low on codependency, those who obtained high scores reported significantly more family of origin difficulties and parental mental health problems, problematic intimate relationships including relationships with chemically dependent partners, and personal psychological problems including compulsivity. Contrary to prevailing theoretical predictions the high codependency group did not contain more individuals whose parents had alcohol or drug abuse problems, or a higher level of childhood physical or sexual abuse. These results suggest that co-dependency is one aspect of wider multigenerational family systems problems which are not unique to families where drug and alcohol abuse or physical and sexual abuse are major concerns.     

Special tasks of commuter students

Commuter students have special adjustment problems that are quite different from those of students in a residential college. Most commuter students come from families who have never before sent a family member to college, and these students must bridge the gap between the family- and community-oriented life they have always known and the university setting in which they now function. Specifically, they must cope with such maturational tasks as dealing with authority, managing impulses, maintaining self-esteem, and establishing a suitable identity. The author emphasizes that it is the job of counselors to assist these students by providing an understanding of their conflicts, supporting them in their difficulties, and modifying institutional practices where it is deemed necessary.     

Levels of Meaning in Family Stress Theory

Major stressful life events, particularly those that have chronic hardships, create a crisis for families that often leads to reorganization in the family's style of functioning. A major factor in this reorganization is the meaning the family gives to the stressful event. Often the meaning extends beyond the event itself and leads to a changed view of the family system and even to a changed view of the world. Building on other family stress models, we elaborate the family's definition of the stressor into three levels of family meanings: (1) situational meanings, (2) family identity, and (3) family world view. Examples from clinical work and studies of families adapting to chronic illness are used to illustrate the relationship between these three levels of meaning, particularly as they change in response to crisis. Implications for clinical and empirical work are discussed.     

No regrets: Custodial mothers' accounts of the difficulties and benefits of divorce

This study examines the accounts of 80 divorced single mothers in order to consider various emotional processes involved in the mothers' postdivorce family reorganization. A qualitative analysis was conducted on written responses to an open-ended question. Concerns tended to center around how the divorce had affected the children as well as various difficulties associated with single parenting. Loss and guilt on the part of many mothers was tempered by positive attributions about how divorce actually gave way to greater personal happiness, better parent-child relationships, and more rewarding lives. Focusing on the benefits of divorce appeared to be an important means of coping with many of the problems inherent in single parenting. Implications for treatment are discussed from an ecological perspective which emphasizes the therapist's role in helping mothers to create contexts of support.This research was funded in part by grant number 9103 from the Women's Research Institute, Virginia Polytechnic Institute and State University.     

Parent and Family Impact of Autism Spectrum Disorders: A Review and Proposed Model for Intervention Evaluation

Raising a child with an autism spectrum disorder (ASD) can be an overwhelming experience for parents and families. The pervasive and severe deficits often present in children with ASD are associated with a plethora of difficulties in caregivers, including decreased parenting efficacy, increased parenting stress, and an increase in mental and physical health problems compared with parents of both typically developing children and children with other developmental disorders. In addition to significant financial strain and time pressures, high rates of divorce and lower overall family well-being highlight the burden that having a child with an ASD can place on families. These parent and family effects reciprocally and negatively impact the diagnosed child and can even serve to diminish the positive effects of intervention. However, most interventions for ASD are evaluated only in terms of child outcomes, ignoring parent and family factors that may have an influence on both the immediate and long-term effects of therapy. It cannot be assumed that even significant improvements in the diagnosed child will ameliorate the parent and family distress already present, especially as the time and expense of intervention can add further family disruption. Thus, a new model of intervention evaluation is proposed, which incorporates these factors and better captures the transactional nature of these relationships.     

Asthma,Power, and the Therapeutic Conversation

Previous research has indicated that family therapy may be of use when a child has chronic, uncontrolled asthma. The significant power relations were considered to be those between the child and the parents. In this article, I examine the wider contextual relations that the family encounters when asthma is a problem, and suggest that these relations are unable to be understood without more thoroughly theorizing power. Because of power relations, the meanings of therapeutic encounters for families and health care professionals may not be consensual. The effect may be to hamper adequate asthma management. I suggest that when Foucault's work is examined alongside that of Hoffman, and Anderson and Goolishian, then the processes that distort these understandings are more readily understood. These ideas are illustrated with examples from a rsearch project.     

Coherent accounts of coping with a chronic illness: convergences and divergences in family measurement using a narrative analysis

Researchers and clinicians have shown increasing interest in family narratives as an avenue for accessing the family meaning-making process. In this study, we examine the convergences and divergences between narrative assessment, family self-report, and verbal accounts of family climate. Sixty-two families with a child with pediatric asthma were interviewed about the impact that asthma had on family life. These interviews were coded for narrative coherence, relationship expectations, and engagement with the interviewer. Primary caregivers were also interviewed using the Five Minute Speech Sample (FMSS) and completed self-report assessments of family functioning (Family Assessment Device [FAD]; Impact on the Family Scale [IOF]). Contrary to prediction, narrative coherence was higher in those cases where Emotional Over-involvement (EOI) was present on the FMSS. Narrative coherence and engagement with the interviewer were positively related to self-report of family problem solving, communication, and affective responsiveness as measured on the FAD. Divergences and convergences between different types of family measurement are discussed in light of meaning-making processes associated with coping with a chronic illness.     

Disability in the family: a life span perspective

This article provides an overview of disability in families. The goal of the article is to raise awareness of the status of people with disabilities and their families to develop culturally relevant psychological support. Families have widely varying perspectives on disability; those perspectives influence responses to disability from the preconception and prenatal developmental stages through old age. An international literature review is provided with consideration of cultural meanings of disability, preparation for dealing with disability, coping strategies, support, developmental dynamics, competing needs of family members, and ethics. Voices of people with disabilities and their families are included.     

Basic concepts in existential psychotherapy with couples and families

Existential psychotherapy with couples and families is a treatment approach that pays close attention to both problems and the meanings and meaning potentials to be found in daily marital and family life. The author reviews both the elements and treatment dynamics to be found in existential treatment with couples and families and overviews the practice of creative interaction between the existential psychotherapist and the marital and/or family members requesting help.     

Reality construction at the family/society interface: the internalization of family themes and values

An important component of the socialization function of the family continues to be the preparation of the young for integration into society. Empirical data, particularly from therapeutic settings, indicate that some children are notably well prepared for the world outside their families, while others have hardly been prepared at all. Adolescence is typically the time when these coping skills are most obvious. This paper addresses the issue of socialization of the young for participation in society. Building upon the "family theme" motif, the family is viewed as a micro-society. The issue of congruence between family themes and societally shared meanings is considered, utilizing ideas from the social construction of reality theories of Berger and Luckmann (1966). Three ideal-types of family themes are developed relative to their external world meanings. Previous work on family themes typically has failed to deal with the interpretative function of family meanings. How the family "explains" the family-external meanings is addressed.     

Self-relation of adolescents in a family with a step-father

This article represents an empirical study of adolescent's self-relation in a family where the mother has re-married. In many studies self-awareness and its functional aspect--self-relation--are selected as new stages in adolescence. The family is considered to be the most important factor in a child's and adolescent's personality development. Literature reviews on the specifics of a child's development in a family with a second marriage present some of the problems facing the parents and children in it. In the present article, problems of relations between children and parents are discussed. A principal finding of this report is that adolescents from families with a stepfather have a less flexible self-relation than adolescents from families with the biological father; to have a positive self-relation they need defence mechanisms. At the same time, analysis of adolescents' drawings shows that adolescents from families with a stepfather exclude themselves from the family system. In addition, the article discusses gender differences in self-relation in two types of families.     

Pathways to problems – an exploratory study of how problems evolve vs dissolve in families

A social constructionist and a systemic lens are combined to consider the nature of the development of problems in families. An exploratory qualitative study is presented in which families were invited to discuss their constructions of the onset of difficulties and their subsequent progression. Qualitative data are presented from two groups of families: where there had been spontaneous recovery (SR) as opposed to where the problems were still current (PC). The findings suggest that a combination of factors, including helpful inputs in the form of practical assistance and non-pathologizing definitions can help avert descent into pathology. However, the ability of families to recognize and utilize positive inputs also appeared to be related to their available resources, including their 'spare emotional capacity' . The findings lend some weight to the clinical view that early validation and support is essential for families to help them to utilize their natural self-healing capabilities.     

The family life cycle: Impressions

This paper is concerned with the kind of everyday family experiences that most of us have gone through. It is written in a style that is more poetry than science, but, like poetry, probably gets closer to the truth about the nature of family life than does more technical conceptual material. Too often professionals write in such abstract, theoretical terms about families that they end up sounding unlike any family you ever knew. In this paper, I tried to write about the natural, typical incidents that occur to people as they get married, have kids, grow old, and die. It is hoped that the reader will connect and identify with these evocations, get shocks of recognition, as well as, who knows, some private chuckles. Families are where you live, emotionally and physically. Our family experiences — the passions, hates, loves, mysteries, paradoxes, measureless sacrifices, joys, injustices, jealousies, storms, comforts, bonds, and patterns— are burned into the cauldrons of the mind. The family memories lived through intimate others persist through space and time, sometimes sharply, usually as vague wisps of unremembered pasts, shaping the meanings of our lives and those close to us. The family, not anatomy, is destiny.a founder and past president of the American Family Therapy Academy.Editor's Note: This paper by Jim Framo was written 25 years ago, but for various reasons has not been published until now. Despite the fact that it focuses on the traditional middleclass family in the United States, it has wider implications and appeal than that focus.     

The Oedipus complex as observed in work with couples and their children

In work with couples where there is a child referred to a Child and Adolescent Mental Health Service, there are opportunities to observe and to work with unresolved Oedipal issues brought by the parents to the task of creating a family. These conflicts can be seen enacted by the child or children, either internally or externally. Examples are given from five cases: the first two from brief family work where the children are under five and the difficulties are to some extent resolved. The next two demonstrate more intractable problems of psychopathology where the parental Oedipal conflicts are handed down to the next generation, and the paper concludes with an example of couple work in relation to individual therapy with a child, where despite the pressure of considerable pathology in the parents' backgrounds there is a will to integration and progress is made.     

Pathways of Risk and Resilience: Impact of a Family Resilience Program on Active‐Duty Military Parents

Over the past decade, studies into the impact of wartime deployment and related adversities on service members and their families have offered empirical support for systemic models of family functioning and a more nuanced understanding of the mechanisms by which stress and trauma reverberate across family and partner relationships. They have also advanced our understanding of the ways in which families may contribute to the resilience of children and parents contending with the stressors of serial deployments and parental physical and psychological injuries. This study is the latest in a series designed to further clarify the systemic functioning of military families and to explicate the role of resilient family processes in reducing symptoms of distress and poor adaptation among family members. Drawing upon the implementation of the Families Overcoming Under Stress (FOCUS) Family Resilience Program at 14 active‐duty military installations across the United States, structural equation modeling was conducted with data from 434 marine and navy active‐duty families who participated in the FOCUS program. The goal was to better understand the ways in which parental distress reverberates across military family systems and, through longitudinal path analytic modeling, determine the pathways of program impact on parental distress. The findings indicated significant cross‐influence of distress between the military and civilian parents within families, families with more distressed military parents were more likely to sustain participation in the program, and reductions in distress among both military and civilian parents were significantly mediated by improvements in resilient family processes. These results are consistent with family systemic and resilient models that support preventive interventions designed to enhance family resilient processes as an important part of comprehensive services for distressed military families.