Behavior Therapy in a Family Context: Treating Elective Mutism

This paper discusses the necessity of using both behavioral and family approaches in combination, while working with electively mute children. The symptom and its significance within the family system is presented along with a rationale for avoiding the pitfalls of individual approaches with such children. A case history outlining specific behavioral techniques is described in detail with an exploration of the use of reinforcement theory, counter-conditioning, and successive approximations in bringing about change in electively mute children. The need for bringing about changes within the family system so as to maintain the changes that have occurred through use of the behavior techniques is discussed and presented as crucial to the treatment process. The paper takes the position that either approach, by itself, will not be effective in helping electively mute children but that the treatment of choice is a combination of therapeutic techniques.     

Family therapy and sex rôle development throughout the life-cycle: a useful concept*

Sex rôle development proceeds throughout the family life-cycle. Significant transition points in the life-cycle may be times in which families get stuck because such development has been hampered in a variety of ways. A life-cycle view of sex rôle development in families has useful, practical implications for family therapists. A five-point model for such development is presented and its use in dealing with family-or-origin, hierarchical/structural and belief system issues in treatment is discussed.     

Toward a generative theory of the therapeutic field

In the various models of family therapy, family systems are described as being patterned and programmed in their operations and development. The regularities and patterns found in family life are believed to be the expression of a program that determines the behavior of the family system and each of its members. Therapists holding this view will use "programming methods" in order to map family phenomena, and therapeutic work will consist of disrupting the problematic sequences in a deterministic way. However, if we take into consideration the impossibility of always linking inputs and outputs and the inability to evaluate consistently the behaviors in a system, problems associated with indeterminancy appear. Under such conditions, it may be impossible for therapists to formulate programs of family functioning. Therefore, we have operationalized a set of methodological principles that can be applied in such conditions. In this article we present the theoretical and practical implications for the field of therapy of "nonprogramming methods." A videotaped session is analyzed in order to show the application of the nonprogramming methods in clinical practice.     

A Case of Functional Urinary Retention: The Use of Family Play Therapy

This case presents a technique for doing family therapy in families with young children. In family play therapy, the entire family plays together, allowing full participation of even the youngest children in the therapeutic process. Standard family therapy interventions in the latter part of each session make use of family interaction patterns and unconscious processes revealed during the earlier play. In the case presented here, the technique was successfully applied to a family with a 3-year-old son who had functional urinary retention. This case also provided an opportunity for interdisciplinary collaboration between the separate Child and Family Services at a major teaching hospital.     

Virginia Satir’s Family Camp Experiment: An Intentional Growth Community Still in Process

In 1976, Virginia Satir began Satir Family Camp (SFC) with therapists and their personal families. Initially, it was a context for the family to experience Satir’s concepts and techniques so that the family system would change along with the therapist. The training of therapists is no longer a significant part of camp; relationships with self, family, friends, and the community is now the main focal point. The process and governance of the camp is presented along with a lengthy anecdote of an experiential family session. These two features—community function and personal/familial growth—inextricably work together to provide a validating environment that supports desired changes.     

Case Report: Object Relations Family Therapy as a Model for Genetic Counseling

Object relations family therapy (ORFT) is a psychoanalytically based approach for the treatment of couples and families which stresses the importance of past relationships. The therapist assumes a parentlike role and provides a holding environment in which clients can explore unconscious motivations. This paper will discuss the applicability of this method to genetic counseling. The case of a couple seen for recurrent trisomies will be presented and used as an example to discuss how ORFT might serve as a framework in a genetic counseling session.     

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.     

Examining the potential impact of a family session in therapeutic assessment: a single-case experiment

Most clinicians concede the benefits of conceptualizing children in systemic terms. Yet, many child assessments involve parents only on a limited basis. The Therapeutic Assessment model for children and families (TA-C) emphasizes parental involvement and family-driven collaboration throughout the intervention. Child TA has shown promise as an effective brief intervention (e.g., Smith, Handler, & Nash, 2010; Tharinger et al., 2009). Family intervention sessions (Finn, 2007; Tharinger, Finn, Austin, et al., 2008) are an integral component of the child TA model in facilitating familial changes. However, TA-C research has yet to empirically examine the potential impact of a family session on treatment trajectory. This case study includes an extended presentation of the development and execution of a family session. The authors use a daily measures time-series experiment to empirically examine the clinical effectiveness of the TA-C and the hypothesis that the family session was a tipping point in the trajectory of improvement.     

The use of structured experiences in family therapy

Structured experiences such as sculpting, psychodrama, rôle-play and growth games are frequently used in family therapy. This article puts forward a framework for the use of structured experiences which can be used in the context of a family session to ensure that the family will gain the maximum learning and change. Use of the framework is illustrated with examples from practice.     

Families and family therapy in Germany

The author describes some of the effects of decades of life under a dictatorship for East Germans and the effects on family life and family therapy of changes following the recent reunification of Germany. A case example illustrates some intergenerational family problems associated with the changes. Contrasts are drawn between East and West Germany and family therapy's present stage of development is depicted in both parts of the reunified country. Germany has approximately 10,000 trained family therapists, a minority of whom work in private practice. The largest amount of family and couples therapy is performed in agencies.Portions of this material were first presented in a poster session at the American Association for Marriage and Family Therapy annual conference in Miami Beach, 1992.     

Using a Constant Family in Role-Plays for Training MFTs

Marriage and Family Therapy training programs use role-plays and simulations to train their students in interviewing skills and in various therapeutic models. A review of literature shows that these training tools do not allow student-therapists to experience therapy beyond the first session. This article presents a modified version of the role-play, in which a constant family is used in preparing student-therapists for clinical work. This article describes a training scenario using the constant family role play and includes feedback from student-therapists. The authors present the benefits, limitations, and potential training considerations that can enhance use of the constant family role play.     

A Family Art Evaluation

A two-hour family art evaluation session has been designed by an art therapist and a clinical child psychologist. It has been used in a child guidance center for the past four years by the authors and other staff. All family members are asked to engage in three tasks: (a) individually developing a scribble into a picture; (b) individually creating a family portrait, and (c) jointly deciding upon and executing a mural. Each task is followed by individual and group discussion of products, associations, and feelings aroused. Occasional “free” art products are collected during the session. The procedure is discussed and illustrated in terms of the rationale for selection of tasks; the sources of data available on individuals, family characteristics, and family interaction patterns; the relationship of the projective and behavioral data to diagnostic conclusions and treatment recommendations; and the implementation and modifications of the technique within the clinic.     

Group Processes in Family Therapy: a Psychoanalytic Approach

This paper describes a model of family therapy that draws on experiences and theories of psychoanalysis as applied to individuals and groups. It suggests concepts that help to understand and work with the family as a system. A brief example is given to illustrate the effort to engage with the patients' immediate feelings in the session in relation to each other and the therapist.     

The child's participation in family therapy: A review and a model

A major gap in family therapy, the treatment of children and adults together, is addressed. The literature on the children's participation is reviewed and a model which systematizes their involvement is presented. The full participation of the child necessitates the use of play. To create a context of play without alienating the rest of the family, action-promoting methods are used. These methods are implemented through family activities and role playing, which are followed by discussion. The advantages, the indications, and the contraindications to the use of action in family therapy are presented.     

Communication flow and change theory within a family therapy supervision model

This article portrays a model of family therapy clinical supervision using change theory that is most appropriate for use with the videotape, audiotape, case presentation and debriefing from the live session. The most powerful tool during this process is that of communication and assessment of change theorys tools of confidence and conviction. The concepts presented are meant to add an additional dimension to family therapy supervision in cooperation of other theories, not as an end in themselves.Special thanks to Ms. Geri Koncilja of the Informational Technology Center at Colorado State University, Pueblo for illustration and graphic assistance.     

Integrative family therapy for high-conflict divorce with disputes over child custody and visitation

A growing number of divorcing families become locked in intractable disputes over child custody and visitation. This article describes an integrative family therapy approach targeted toward such families. Aspects of this treatment include negotiating a clear therapy contract, creating a multipartial alliance with all parties, assessing through the lens of specific understandings about these cases, incorporating multiple therapy session formats, holding both systemic and individual focused perspectives, incorporating a solution-oriented focus, and drawing upon a wide range of intervention techniques. The treatment aims to create a good-enough postdivorce climate in which a new family structure can be constituted in which parents maintain distance from one another, and conflict and triangulation can be minimized.     

Chaotic attractors in the therapeutic system 1

Because little research had been done on the presence and role of latent communication in the context of team‐conducted family therapy, the writers set out to monitor unconscious responses generated under these conditions. Specifically, they investigated an ongoing family treatment situation conducted according to the “reflecting team model.” One team of therapists handles the actual treatment session, while the other observes from behind a one‐way mirror. During the course of a session, the second team makes suggestions to the treatment team either by telephone or by calling the therapists out of the treatment room.

As the project developed, the writers found that the unconscious responses of both family and treatment teams indicated a process at work beyond the conscious intentions of the participants. That is, the therapeutic enterprise was functioning as a dynamical system, whose increasing complexity suggested a self organizing principle at work. This paper traces the development of the system's movement toward greater complexity, identifies the specific interventions that indicate this process, describes how all participants demonstrated a high degree of resonance and synchronization with this overarching‐self organizing pattern. This paper serves to alert therapists to the role of unconscious communication within the therapeutic system and postulates that the generation of form within psychotherapy follows many of the same self organizing processes found in other human and non human systems.     

Predictors of treatment attendance among adolescent substance abusing runaways: a comparison of family and individual therapy modalities

This study explored and compared predictors of session attendance among substance abusing runaway adolescents and their parents using three manual‐driven interventions: ecologically‐based family therapy (EBFT), motivational enhancement therapy (MET), and the community reinforcement approach (CRA). Individual and family‐level variables, as well as time between intake and first session were used as predictors of session attendance. Adolescents (N=179) between the ages of 12–17 years old were recruited from the only runaway shelter in Columbus, Ohio. The findings showed that adolescents assigned to EBFT were more likely to attend at least one therapy session than those assigned to either CRA or MET. Fewer days between intake and the first therapy session were associated with higher family therapy attendance. Overall, individual and family factors predicted therapy attendance but these factors differed depending upon the treatment modality.     

Prolonged Exposure Therapy With an Older Adult: An Extended Case Example

Prolonged exposure therapy (PE) has gained strong empirical support for posttraumatic stress disorder (PTSD) in the general population. However, some authors have suggested that exposure therapies may be less effective for the treatment of PTSD in older adults. There is a paucity of empirical treatment studies for older adults with PTSD. The extant studies are briefly reviewed. There are indications that exposure therapies can be feasible, safe, and efficacious for older adults. However, the degree and maintenance of gains may be reduced in older adults relative to younger adults. A case example is presented to provide a detailed illustration of PE conducted with an older adult. The treatment is presented in five phases, including standard treatment components and suggested modifications for older adults. The modifications include careful use of terminology, slowing down the presentation of some information, involvement of family members, and utilizing technology to minimize the negative effects of physical impairments and stigma.