Engagement techniques in family therapy

A number of basic engagement techniques in family therapy are identified and illustrated. These include (1) techniques that enable the therapist to achieve a position of influence with family members or to gain entry into the family system, (2) techniques utilized in teaching the family how to behave in the therapy setting, and (3) the tactics the therapist may use to manage difficult moments in the session. Issues in the relationship between technique and the theory and practice of family intervention are also examined.A videotape (Wells, R.A., & Page, M.H.Engaging the Family in the Helping Process: Basic Techniques. Pittsburgh, PA: UIRC, 1979) is available from the author. Discussion with such colleagues as Patrick McNamee, Larry Pacoe, Mary Page, and Susan Schilling has been invaluable.     

Guidelines for clinicians considering family therapy research

This paper is written by clinicians for clinicians who are thinking about or planning to evaluate family therapy. The basic premise is that to be successful a research project must be built from the beginning on a very solid foundation. This foundation is built from a careful consideration of various research problems which are interrelated yet which can be solved when addressed in a particular sequence. The paper describes eight stages which must be followed in any research project. The authors illustrate these stages with examples from their own experience with a family therapy process research study lasting five years. This project did not produce reliable results, but the authors learnt important lessons about such things as the way a particular theory may lead a researcher to select data which cannot be reliably observed; and the way in which practical constraints can erode the reliability of the outcome. Discussion of why and where the project went wrong offers direction and warnings for the prospective clinician/researcher.     

Epistemological confusion in family therapy and research

Family therapy began as a movement sparked by a small group of behavioral scientists who challenged the orthodoxies of medical and psychodynamic therapies. This movement signalled the beginning of an epistemological shift, the roots of which can be found early in this century in the physical sciences. As the field has grown and become for many a means of livelihood rather than an experimental thrust, though exploration of epistemological issues has continued, a split has developed in the field that mirrors the epistemological split currently visible in Western society. The predominant reality system of the Western world remains rooted in Cartesian/Newtonian, nineteenth-century mechanistic and reductionistic "common sense," even though the basis for a new, nonmechanistic and nonreductionistic reality system has been emerging in the twentieth century. The juxtaposition of both reality systems in the field of family therapy has produced much confusion. This article attempts to clarify the basis for that confusion.     

The practice of community family therapy

This paper presents a summary of the basic theories and methods of Community Family Therapy (CFT), a relatively new therapeutic approach developed in response to the need for effective intervention in treating low-income, urban families. CFT operates outside of the traditional therapeutic box, successfully combining family therapy techniques with developmental and motivational theories, community mental health, social work, economic development, and community mobilization strategies. CFT utilizes a dualistic approach in which both client and therapist become involved with the same three levels of engagement. Specifically, the client strives for: (a) personal and family change and growth-level 1, (b) accessing community resources-level 2, and (c) leadership development and civic action-level 3. Also, CFT calls upon therapists to strive for: (a) personal growth and maturation-level 1, (b) collaboration with community resources for professional support-level 2, and (c) operation as a "citizen therapist," through civic action and volunteer services-level 3.     

Intregrating family therapy into in-patient paediatric settings: a model

This paper describes the integration of structural family therapy and systemic consultation into an in-patient paediatric unit. Two case examples illustrate the approach used. It is concluded that six stages are involved in the successful integration of a systemic approach: planning and convening an initial staff meeting, developing a structural hypothesis, enlisting hierarchical support in the ward system, holding the family meeting, reconvening the professional team and disengaging the family and ward system.     

Applying Delphi methodology in family therapy research

The Delphi technique, which is increasingly seen in family therapy publications, encourages the articulation of refinement in family therapy practice and theory. Combining both quantitative and qualitative methodology, this technique involves consideration of information that might otherwise have been overlooked. Due to lack of clarity on this approach, a dilemma exists in applying this research procedure in family therapy. To remedy this deterrent, this paper reviewed 11 studies and outlined use of the technique in regard to design, procedure, and sampling.     

Reflecting team processes in family therapy: a search for research

Tom Andersen's Reflecting Team approach is widely (and creatively) employed in family therapy. Despite continuing enthusiasm for the practice, however, there are few journal articles reporting empirical research and only one (now dated) review of the literature. After defining reflecting team processes through practices that are embedded in particular approaches to knowledge construction and theoretical interpretation, we offer an overview of the empirical research found in our search of the literature. In the second half of this article we ask why there is so little existing research in this area. Various possible explanations are explored and future directions proposed. We conclude that a dialogue around the complex interweaving of practice, theory and research (that is, praxis) would be a helpful overall stance to adopt in relation to future work in this area.     

Simulation as a tool in family therapy research

The efficacy and validity of simulation for purposes of training and evaluation are well established. Simulation has proven valuable in human behaviour research as well. However, based on the belief that families and other small groups behave differently, many family theorists have concluded that simulation may not be valid for family research despite the fact that some empirical studies showed little difference between simulated and actual families, suggesting that the disparity may not be as great as commonly believed. Ongoing and future studies controlling for 'time together', a dimension presumed to be critical in comparing simulated with actual families, may demonstrate that differences are not sufficiently large to preclude the use of simulated families in family research. Methodological problems are addressed and directions for future research proposed.     

Multiracial recruitment in the field of family therapy: an innovative training program for people of color

This article describes the creation of a training program designed to increase the number of family therapists of color in the family therapy field. In 1992, a partnership between New York City schools of social work, community agencies, and the Ackerman Institute for the Family created the Diversity and Social Work Training Program. Elements critical to the program's success were recruitment strategies, mentorships, partnerships with outside organizations, provision of a long-term institutional commitment, biracial collaborations, and institutional change. This article describes the design, structure, and process of this program's evolution and its impact 12 years later.     

Introducing research methods and reflexivity into family therapy training

Research training does not always sit easily with family therapy trainees due to the perceived difficulty of the terrain and the mismatch between the primacy given to research and their developing expertise in the clinical work. Despite these tensions, research forms a core component to advanced training and is a requisite module for students completing an M.Sc. Following the provision of suboptimal teaching in research methods for M.Sc. candidates, a substantial redesign of the course was undertaken, taking into account the context of students' learning. This paper reports on the contextual influences on this new approach, and outlines the key pedagogical strategies that support student learning within the formal teaching sessions and beyond. We present a summary of the outcomes so far.     

A microcomputer-based laboratory for psychopathology research in rural settings

An Apple-based computer system for research use in rural mental health settings is described. Hardware and software modifications are detailed. Techniques to aid in the acceptance of psychopathology research programs in these rural settings are discussed.     

Medical family therapy: an emerging arena for family therapy

This paper describes an important recent development in American family therapy. Medical family therapy uses a biopsychosocial systems model to work with families who have a member with a chronic illness or disability. The authors maintain that family therapy has tended to embrace the mind–body split and to view itself too narrowly as a mental health specialty. Medical family therapists work collaboratively with physicians and other health professionals to help families achieve a sense of agency and communion in facing some of the greatest challenges that life brings.     

Brief strategic family therapy: lessons learned in efficacy research and challenges to blending research and practice

In this article, we present key lessons that we have learned from (1) a long program of research on an empirically supported treatment, brief strategic family therapy (BSFT), and (2) our ongoing research and training efforts related to transporting BSFT to the front lines of practice. After briefly presenting the rationale for working with the family when addressing behavior problems and substance abuse in adolescent populations, particularly among Hispanic adolescents, we summarize key findings from our 30-year program of research. The article closes by identifying barriers to the widespread adoption of empirically supported treatments and by presenting current work within the National Institute on Drug Abuse's Clinical Trials Network that attempts to address these barriers and obstacles.     

Videotaped simulated families as a tool in family therapy outcome research

Twenty-two therapists who had treated 57 families in brief conjoint family therapy under supervision responded to a videotaped simulated family as if they were treating it. Their responses were audiotaped and coded on a system devised for this study. Positive relationships were found between the ratings of expertise based on the coding system, and independent ratings of the treated families' satisfaction with treatment and the status of the presenting symptoms 6 months after termination. Videotaped simulated families are potentially useful as standardizable methods of revealing individual differences in therapists for family therapy outcome research.     

Systemic family therapy can be manualized: research process and findings

Determining the efficacy of therapeutic interventions is becoming an increasing political and ethical necessity. Comparative therapeutic outcome trials are most powerful when there is a precise specification, or manualization, of the forms that therapies took. Manuals have begun to be developed for structural/behavioural family therapy and couple therapy. The development of these manuals is often reliant on experts' self-report, rather than a systematic analysis of the therapeutic process as it happens. This can limit their validity and applicability to standard clinical practice. In addition, no manuals exist which reflect less structured forms of family therapy aimed at incorporating systemic, postmodern and narrative frameworks. The feasibility of producing a workable manual that reflects the fluidity of such practices has been questioned.
A research project to systematically create and test such a manual is reported. Multiple data sources and research methods, primarily qualitative, were applied to generate a rich specification of the therapy. In reporting these results the contents of various aspects of the final manual are indicated. Procedures to ensure that the prescribed practice is consistent with a widely used approach to systemic family therapy are also described.
The manual will be an important tool for outcome research and therapeutic practice. The account of the research process should be helpful to researchers engaged in constructing a manual for other models of family therapy based on a rigorous analysis of actual practice. The manual itself is available for use by outcome researchers who wish to evaluate this widely used form of systemic family therapy.     

Attachment and family therapy: clinical utility of adolescent-family attachment research

The divide separating research and clinical work is narrowing. New therapies have been informed by research from specialties such as developmental psychology and developmental psychopathology. In this article, we attempt to illustrate the usefulness of research on attachment relations for family-based therapy with adolescents. We examine the clinical utility of adolescent attachment research within the context of multidimensional family therapy, an empirically supported treatment model that has incorporated developmental research, including basic research on attachment, in its assessment and intervention framework.