Clinical Guidelines for Working With Stepfamilies: What Family,Couple, Individual,and Child Therapists Need to Know

This article draws on four decades of research and clinical practice to delineate guidelines for evidence‐informed, clinically sound work with stepfamilies for couple, family, individual adult, and child therapists. Few clinicians receive adequate training in working with the intense and often complex dynamics created by stepfamily structure and history. This is despite the fact that stepfamilies are a fundamentally different family form that occurs world‐wide. As a result many clinicians rely on their training in first‐time family models. This is not only often unhelpful, but all too often inadvertently destructive. The article integrates a large body of increasingly sophisticated research about stepfamilies with the author's four decades of clinical practice with stepfamily relationships. It describes the ways in which stepfamilies are different from first‐time families. It delineates the dynamics of five major challenges stepfamily structure creates: (1) Insider/outsider positions are intense and they are fixed. (2) Children struggle with losses, loyalty binds, and change. (3) Issues of parenting, stepparenting, and discipline often divide the couple. (4) Stepcouples must build a new family culture while navigating previously established family cultures. (5) Ex‐spouses (other parents outside the household) are part of the family. Some available data are shared on the impact of cultural and legal differences on these challenges. A three‐level model of clinical intervention is presented: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational Family‐of‐Origin. The article describes some “easy wrong turns” for well‐meaning therapists and lists some general clinical guidelines for working with stepfamily relationships.     

Studying Stepfamilies: Four Eras of Family Scholarship

Historically, there have always been stepfamilies, but until the early 1970s, they remained largely unnoticed by social scientists. Research interest in stepfamilies followed shortly after divorce became the primary precursor to stepfamily formation. Because stepfamilies are structurally diverse and much more complex than nuclear families, they have created considerable challenges for both researchers and clinicians. This article examines four eras of stepfamily scholarship, tracing the development of research questions, study designs and methods, and conceptual frameworks from the mid‐1970s to the present and drawing implications for the current state of the field.     

Stepfamily Relationship Quality and Children's Internalizing and Externalizing Problems

The stepfamily literature is replete with between‐group analyses by which youth residing in stepfamilies are compared to youth in other family structures across indicators of adjustment and well‐being. Few longitudinal studies examine variation in stepfamily functioning to identify factors that promote the positive adjustment of stepchildren over time. Using a longitudinal sample of 191 stepchildren (56% female, mean age = 11.3 years), the current study examines the association between the relationship quality of three central stepfamily dyads (stepparent–child, parent–child, and stepcouple) and children's internalizing and externalizing problems concurrently and over time. Results from path analyses indicate that higher levels of parent–child affective quality are associated with lower levels of children's concurrent internalizing and externalizing problems at Wave 1. Higher levels of stepparent–child affective quality are associated with decreases in children's internalizing and externalizing problems at Wave 2 (6 months beyond baseline), even after controlling for children's internalizing and externalizing problems at Wave 1 and other covariates. The stepcouple relationship was not directly linked to youth outcomes. Our findings provide implications for future research and practice.     

Recoupling in Mid‐Life and Beyond: From Love at Last to Not So Fast

Divorce rates have dropped in the United States, except for couples over 50 where they are rising steeply, along with rates of late‐life recoupling. Both stepcouples and their young adult and adult children in new older stepfamilies are often surprised to find themselves facing many of the same challenges that younger stepfamilies do. Some challenges are even intensified by the decades‐long relationships and additional layers of extended family that come with recoupling after mid‐life. Stepfamilies formed in later life must also negotiate decisions about estate planning and elder care among stakeholders who often have sharply divergent agendas before there is time to establish trusting relationships. This article describes the “normal” challenges facing stepcouples who come together over age 50. It provides evidence‐informed guidance for therapists in meeting these challenges on three levels of clinical work: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational. As in younger stepfamilies, “family therapy” must usually begin in subsystems—often the adult stepcouple and parent–adult child. The article then describes a particularly fraught subgroup of recouplers: over‐50 fathers and their new partners, where the dad's young adult or adult daughter is very unhappy with his new relationship. In these latter stepfamilies, father–daughter repair must precede stepfamily bonding. Stepfamilies that are preceded by a partner's death and those that begin with affairs are also discussed. Finally, some “easy wrong turns” for therapists are described.     

A Typology of Interactional Patterns Between Youth and Their Stepfathers: Associations with Family Relationship Quality and Youth Well‐Being

Stepfamilies are an increasingly common family form, many of which are headed by a resident mother and stepfather. Stepfather–child relationships exert notable influence on stepfamily stability and individual well‐being. Although various stepfather roles have been observed, more research is warranted by which stepfather–child interactions are explored holistically and across a variety of life domains (e.g., recreational, personal, academic, and disciplinary). Thus, the primary purpose of the current study is to explore varying interactional patterns between youth and their stepfathers. A latent class analysis is conducted using a representative sample of 1,183 youth (53% female; mean age = 15.64 years, SD = 1.70 years; 62% non‐Hispanic White) residing in mother–stepfather families from Wave I of the National Longitudinal Study of Adolescent to Adult Health. Latent‐class enumeration processes support a four‐class solution, with latent classes representing inactive, academically oriented, casually connected, and versatile and involved patterns of youth–stepparent interaction. Notable differences and similarities are evident across patterns with respect to family relationship quality, youth well‐being, and socio‐demographic characteristics. Differences are most stark between the inactive and versatile and involved patterns. Ultimately, the results showcase notable variation in youth–stepparent interactional patterns, and one size does not necessarily fit all stepfamilies. Family practitioners should be mindful of variation in youth–stepparent interactional patterns and assist stepfamilies in seeking out stepparent–child dynamics that are most compatible with the needs and dynamics of the larger family system.     

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.     

Mother‐Stepfather Coparenting in Stepfamilies as Predictor of Child Adjustment

Coparenting between biological parents is a strong predictor of child adjustment. To date, however, little is known about the coparenting dynamics between parent and stepparent in stepfamilies. This study aimed at exploring the links between coparenting in the mother–stepfather dyad and child behavior in stepfamilies compared with the links between mother–father coparenting and child behavior in first‐marriage families. Two modes of coparenting were assessed: overt coparenting, that is, coparental behaviors in the presence of the child, and covert coparenting, that is, the way each parent speaks of the other parent to the child. The sample (N = 80) comprised 48 stepfamilies and 32 first‐marriage families with a child between 7 and 13 years old. Overt coparenting was assessed through direct observation in the standardized situation of the PicNic Game. Covert coparenting and child behavior were assessed through mother‐reported questionnaires. Results showed (a) more covert coparenting behaviors in first‐marriage families, (b) no differences in overt coparenting, (c) more child difficulties reported in stepfamilies, (d) less optimal overt coparenting being linked with more difficulties in children in both family structures, and (e) an interaction effect between family structure and coparenting, showing that overt coparenting is linked with child behavior mainly in stepfamilies.     

Testing a Military Family Stress Model

The current study examines a military family stress model, evaluating associations between deployment‐related stressors (i.e., deployment length/number, posttraumatic stress disorder [PTSD] symptoms) and parent, child, parenting, and dyadic adjustment among families in which a parent had previously deployed to Iraq or Afghanistan in the recent conflicts. Married families (N = 293) with at least one child between the ages of 4 and 12 were recruited from a Midwestern state. Service members were from the Reserve Component (National Guard or Reserves); fathers (N = 253) and/or mothers had deployed (N = 45) to the recent conflicts in the Middle East. Multiple‐method (observations of parenting and couple interactions; questionnaires) and multiple informant measures were gathered online and in the homes of participants, from parents, children, and teachers. Findings demonstrated associations between mothers’ and fathers’ PTSD symptoms and a latent variable of child adjustment comprising teacher, parent, and child report. Mothers’ but not fathers’ PTSD symptoms were also associated with dyadic adjustment and parenting practices; parenting practices were in turn associated with child adjustment. The results are discussed in terms of their implications for military family stress research and interventions to support and strengthen parents and families after deployment.     

Cultivating Resilience in Families Who Foster: Understanding How Families Cope and Adapt Over Time

Families who foster offer essential care for children and youth when their own parents are unable to provide for their safety and well‐being. Foster caregivers face many challenges including increased workload, emotional distress, and the difficulties associated with health and mental health problems that are more common in children in foster care. Despite these stressors, many families are able to sustain fostering while maintaining or enhancing functioning of their unit. This qualitative study applied an adaptational process model of family resilience that emerged in previous studies to examine narratives of persistent, long‐term, and multiple fostering experiences. Data corroborated previous research in two ways. Family resilience was again described as a transactional process of coping and adaptation that evolves over time. This process was cultivated through the activation of 10 family strengths that are important in different ways, during varied phases.     

Family factors associated with self‐harm in adults: a systematic review

The aim of this study was to systematically review the literature pertaining to family dynamics in the adult self‐harming population. PsycINFO, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA) were searched for studies containing two keywords, one relating to self‐harm and the second relating to a family relationship. The final search was run on 4 August 2017. The electronic search yielded a total of 2,623 studies; 119 texts were selected for full review and twenty‐seven articles were included in the analysis. Thematic analysis was used to synthesize the results. Results indicated that insecure parental attachments, neglectful, overprotective, disempowering and abusive parenting were associated with self‐harm. Similarly, insecure attachments and abusive relationships with romantic partners were linked to self‐harm. Finally, self‐harm was found to be related to poor family functioning.     

Conducting a Multi Family Member Interview Study

Family researchers have long recognized the utility of incorporating interview data from multiple family members. Yet, relatively few contemporary scholars utilize such an approach due to methodological underdevelopment. This article contributes to family scholarship by providing a roadmap for developing and executing in‐depth interview studies that include more than one family member. Specifically, it outlines the epistemological frames that most commonly underlie this approach, illustrates thematic research questions that it best addresses, and critically reviews the best methodological practices of conducting research with this approach. The three most common approaches are addressed in depth: separate interviews with each family member, dyadic or group interviews with multiple family members, and a combined approach that uses separate and dyadic or group interviews. This article speaks to family scholars who are at the beginning stages of their research project but are unsure of the best qualitative approach to answer a given research question.     

The Evaluation of Family Functioning by the Family Assessment Device: A Systematic Review of Studies in Adult Clinical Populations

A large body of research, documenting the impact of a family's functioning on health outcomes, highlights the importance of introducing the evaluation of patients' family dynamics into clinical judgment. The Family Assessment Device (FAD) is a self‐report questionnaire designed to assess specific dimensions of family functioning. This qualitative systematic review, which follows PRISMA guidelines, aimed to identify the FAD's clinimetric properties and to report the incremental utility of its inclusion in clinical settings. A thorough literature search was performed, using both computerized and manual searches, yielding a total of 148 studies that were included in this review. The FAD has been extensively used in a variety of research contexts. In the majority of studies it was able to discriminate between clinical populations and controls and among groups of patients with different illnesses. The FAD also showed good test–retest and concurrent reliability, and modest sensitivity to change after treatment. FAD‐dysfunctional family functioning was related to several patient clinical outcomes, including lower recovery rates and adherence to treatment, longer recovery time, poorer quality of life, and increased risk of relapse and drop‐out. The present review demonstrates that the FAD is a suitable instrument for the evaluation of family functioning both in clinical and research settings.     

Beyond the Couple: A Qualitative Analysis of Successful In‐law Relationships in Iran

In‐laws can play a significant role in the success or failure of marriages around the world. In the Middle East, recent quantitative research indicates that having trouble with in‐laws is a major predictor of divorce in Iran. To explore this further, we undertook a qualitative (grounded theory) analysis of in‐depth interviews with 17 Iranian daughters‐in‐law, five sons‐in‐law, three mothers‐in‐law, three fathers‐in‐law, and three expert family clinicians. Emergent concepts, themes, and coding categories were consistent with a Family Triad Model (FTM) of successful marital and in‐law relationships, wherein each spouse must (a) form we‐ness with their partner, (b) establish flexible boundaries between themselves and their families of origin, and (c) join their in‐laws. A higher‐order core category suggested that optimal couple and family functioning depends on the coherence or balance of these functions across the triadic role components of spouse, child‐in‐law, and family‐in‐law (or family‐of‐origin). In the changing cultural context of Iran, where blood relations have traditionally held primacy over marital relations, such triadic coherence appears crucial to marital success, at least from the perspective of many women. Our FTM results also highlight the importance of taking in‐laws into account when planning educational, preventative, or clinical interventions.     

Mothers’ Dreams,Children Realities: The Case of Uprooted Families from South Lebanon

In this exploratory qualitative study, 15 mothers and 18 adolescents who, as family members of the South Lebanon Army, were uprooted from that country and now living in Israel, were interviewed separately. The mothers described their image of the adaptive adult, which stressed the positive values of loyalty to the family, orientation toward the group, respect, and acceptance of hierarchy and guided their child‐rearing goals and socialization. The children shared similar attitudes about the importance of family loyalty and orientation toward the group, but differed from their mothers with regard to the issues of respect and obedience. We discussed the notion of “liminality,” to further our understanding of the families in transition and suggest how it applies to the uprooted members of South Lebanon army. We suggest that different time orientations and contextual factors influence the participating mothers’ image of the adaptive adult and the degree to which their children accept it. Implications for research and interventions are also explored.     

Psychometric Properties and Responsiveness to Change of 15‐ and 28‐Item Versions of the SCORE: A Family Assessment Questionnaire

The SCORE (Systemic Clinical Outcome and Routine Evaluation) is a 40‐item questionnaire for completion by family members 12 years and older to assess outcome in systemic therapy. This study aimed to investigate psychometric properties of two short versions of the SCORE and their responsiveness to therapeutic change. Data were collected at 19 centers from 701 families at baseline and from 433 of these 3–5 months later. Results confirmed the three‐factor structure (strengths, difficulties, and communication) of the 15‐ and 28‐item versions of the SCORE. Both instruments had good internal consistency and test–retest reliability. They also showed construct and criterion validity, correlating with measures of parent, child, and family adjustment, and discriminating between clinical and nonclinical cases. Total and factor scales of the SCORE‐15 and ‐28 were responsive to change over 3–5 months of therapy. The SCORE‐15 and SCORE‐28 are brief psychometrically robust family assessment instruments which may be used to evaluate systemic therapy.     

What do We Know about Family Interventions for Psychosis at the Process Level? A Systematic Review

The evidence regarding effectiveness of family interventions for psychosis (FIP) is strong and consistent. However, there is a gap in the research on the process of these interventions, and little is known about their active ingredients. This review aims to identify the active ingredients of FIP. We conducted a systematic literature review, focusing on qualitative research, and analyzed 22 papers in total. We found a single study comprehensively exploring the process of FIP. All other studies focused on particular aspects of process‐related variables. The key elements of FIP seem to be the so‐called “common therapeutic factors”, followed by education about the illness and coping skills training. This review supports the value of a stepped model of intervention according to the needs of the families. However, the evidence reviewed also reveals a gap in the research findings based on the limited research available. FIP are complex, psychosocial interventions with multiple components, and more intensive, qualitative research is needed to establish linkages between process and outcome.     

Those Easily Forgotten: The Impact of Emigration on Those Left Behind

Much has been written about the experiences and stresses of those who emigrate. By contrast, little attention has been paid to the experiences of those who stay behind—family members and friends who for various reasons do not to join their loved ones in the destination country. In this article, I describe the experiences of some South Africans whose families and friends have emigrated. This study forms part of a larger research project focusing on the impact of emigration on South African family life. Twenty‐one participants were interviewed by means of a semistructured interview at least 6 months after one or more family member(s) and/or friend(s) left South Africa, to explore participants’ experiences around their loved ones’ emigration. A thematic analysis of the data reveals that those left behind experience various emotions, ranging from emotional ambivalence to anger and distress. Emigration is mostly experienced as a vast loss, almost akin to a “death,” bringing about significant changes in social networks and relationships. The therapeutic significance of the findings for those working with emigrant families is also explored.     

Profession Differences in Family Focused Practice in the Adult Mental Health System

There is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This article sought to determine practice differences between the differing professions working in adult mental health services in terms of their family focused work. Three hundred and seven adult mental health professionals completed a cross‐sectional survey of family focused practices in adult mental health services. Findings highlight that social workers engaged in more family focused practice compared to psychiatric nurses, who performed consistently the lowest on direct family care, compared to both social workers and psychologists. Clear skill, knowledge, and confidence differences are indicated between the professions. The article concludes by offering direction for future profession education and training in family focused practices.