The patient in the family and the family in the patient

The notion that the family is “the unit of care” for family doctors has been enigmatic and controversial. Yet systems theory and the biopsychosocial model that results when it is imported into medicine make the family system an indispensable and important component of family medicine. The challenge, therefore, is to provide a coherent, plausible account of the role of the family in family practice. Through an extended case presentation and commentary, we elaborate two views of the family in family medicine — treating the patient in the family and treating the family in the patient — and defend both as appropriate foci for care by family doctors. The practical problem that arises when the family is introduced into health care is deciding when to concentrate on the family system. The moral problems that arise concern how extensively doctors may become involved in the personal lives of their patients and families. The patient-centered clinical method provides a strategy for handling both problems. Thus, making the family a focus of care in family medicine can be justified on theoretical, practical, and moral grounds.     

The Family Diagram and Genogram: Comparisons and Contrasts

The family diagram and its derivative the genogram are widely used in marriage and family therapy, other mental health disciplines, and family medicine. After a brief history of the origins of the family diagram and genogram, several different areas are compared in order to help distinguish differences between family diagrams and genograms. The results of these evaluations illustrate some similarities in format and symbols due to a common history, but distinct differences in purpose, theoretical basis, rationale for data collection, and interpretation guidelines. Divergent theoretical perspectives explain the differences between family diagrams and genograms. The family diagram is intertwined with Bowen family systems theory, while the genogram emphasizes how the nuclear family interacts within multiple contextual levels. The family diagram and genogram are not synonymous; rather, they are distinctly different methods of family assessment.     

Spatiality of the family's inner structure: choice of seat in family therapy

Many family therapists have observed that the family's choice of seat in the family therapy session provides information concerning the inner structure of the family. The purpose of this study was to study certain aspects of this observation. The selection of seats in family therapy sessions and the mutual distances between family members were investigated for 13 families. The inner structure of the family is described in terms of the existence of problematic relationships and the distribution and quality of power as assessed by the family therapists. The family members' selection of seats in the family therapy session was compared to the sitting order at meals, watching TV at home, and family drawings. It was found that the distance between the father and the patient (a son or daughter) and the location of the father and the mother in relation to each other in the family therapy are more related to the inner structure of the family than to situational factors.     

家庭功能：理论、影响因素及其与青少年社会适应的关系

该文综述了中西方近20年有关家庭功能的定义、理论、影响因素及家庭功能与青少年社会适应关系的研究进展。有关家庭功能的理论可以分为两大类：以家庭发展结果为取向和以家庭发展过程为取向的家庭功能理论。现有研究主要探讨了家庭结构、社会经济地位、家庭关系、发展阶段、生活事件等对家庭功能的影响,并发现家庭功能与青少年的社会适应有着非常密切的关系。文章最后分析了已有家庭功能理论及相关研究的不足,并指出了未来家庭功能领域的研究方向。     

Management of religious issues in family therapy

Social scientists have long emphasized the reciprocal relationship between family and religion in society. Yet the family therapy literature is virtually devoid of consideration of religious variables in family life and function. Four major psychosocial aspects of religion in family life are discussed: sacralization, coalitions with the supernatural, religious conflict as a projection of family conflict, and family conflict as a projection of religious conflict. Clinical issues presented include: family therapy in religious and secular contexts, family religious expectations and transference, therapist religious countertransferences, religious identification in family therapy, and family therapy in different degrees of congruence or difference in religious orientation between the family and the therapist. The family therapist must learn how to correctly interpret and appropriately respond to religious issues as they appear in family life and family therapy.     

Family wealth and parent–child relationships

This study examined associations between self-reported family wealth and parent–child relationships, by contrasting three theoretical perspectives on the shape of the association. The study utilized data from the Norwegian part of the “Health behaviour in school-aged children study (HBSC) 2013/2014”, with a sample of 3383 children aged 11–15 years old. The shape of associations between family wealth and parent–child communication were tested using regression spline models with knots at 1 SD below mean family wealth and at 1 SD above mean family wealth. The regression spline models showed that increasing family wealth was associated with easier family communication, clearer family communication, and higher family support. Results revealed that for boys, the association between family wealth and outcomes was stronger for the lower segment of family wealth, than in medium and high segments of family wealth. For girls, the gradient across level of wealth was monotone, with higher parent–child communication and higher family support at higher family wealth. To conclude, the results from this study suggest a nonlinear pattern of inequality in parent–child relationships across the range of family wealth.     

Behavior modification in marriage counseling

Abstract

Telephone cotherapy via three-way conference call of symbolic-experien-Hal family therapy is presented in a way that captures the spirit of a great pioneer, Carl Whitaker, M.D. The problems of the family, the process of therapy, and the beginning and ending are presented in a manner intended to bring the reader inside the experience. There are particular focuses on the use of family political power by both family therapists and an anguished family member in mobilizing the family for therapy. Impact is demonstrated in helping a family who felt hopeless become hopeful. The family attained a family spirit.     

Family therapy's missing question,why the plight of the modern family?

The field of family therapy has developed rapidly over the last thirty years. The account of its emergence produced by family therapists neglects the socio-historical context and wider issues of social and family change. The contemporary practitioners need to understand this context, and in particular, the extent to which assorted unexamined, and perhaps unwanted, assumptions about the family and about social reality are embedded in family therapy. Hence the paper will explore some of these assumptions in the light of analysis of the technological and intellectual climate in which family therapy emerged, and of social changes affecting marriage and the family.     

Conceptualization and measurement of family outcomes associated with families of individuals with intellectual disabilities

The purpose of this review is to (a) document the current status of conceptualizing and measuring family outcomes related to having a member with an intellectual disability and (b) determine the extent to which family research focuses on internal family characteristics as contrasted to external family support. The reviewers collected 28 articles using the terms well-being, adaptation, family functioning, or family quality of life in the title. Results of our analyses are presented as a comparison between well-being, adaptation, and family functioning articles in one group and family quality of life articles in a second group. Both groups lacked explicit conceptual definitions, theory, and random/representative samples. The articles placed an undue emphasis on maternal participation, and tended to report a single family member score as representative of the whole family. Two major differences between the groups was a tendency for family quality of life studies to be grounded in conceptual frameworks and focus on new instrument development. Recommendations for future research directions are included.     

Existe-t-il une typologie familiale dans les pathologies addictives ? Revue critique de la littérature sur les familles d’adolescents présentant des troubles alimentaires ou des conduites de dépendance aux substances

Among factors favoring the addictive behaviors, some specific family processes are often identified in eating disorders and dependences with psychoactive substances. Different models of systemic orientation described the familial disturbances involved in the addictive pathologies emphasizing either the emotional interaction and the processes of differentiation family, either the structure and the level of family cohesion. This article proposes a critical review of the systemic literature on the familial disturbances involved in the families of adolescents with eating disorders or with a substance-dependence. The systemic models (Bowen, Minuchin) are reference values in the understanding of family processes and therapy with families. The observations of these family processes have been confronted to empirical researches integrating different epistemological levels and different methods. The empirical results are heterogenous concerning the different forms of family functioning associated with these addictive pathologies. The empirical studies support the hypothesis of a family dysfunctioning in the different addictive behaviors and demonstrate the relationship between the severity of familial disorders and the severity of the addictive disorders. However, the family configuration described by the typological models is rarely found complete or with a similar intensity between the families. The studies support the hypothesis of an emotional distance in the family interactions and a lack of parental care which could correspond to factors of chronicity or vulnerability. Comparing the family characteristics of these two types of addictive behaviors, the literature supports the existence of (1) some specific family characteristics according to the type of addictive behavior (in particular the conflict avoidance which appears specifically in anorexic families) (2) some similar family patterns of interactions between the members of addictive families in particular the representation of a low family cohesion, an intergenerational enmeschment and a high level of control. These family patterns suggest rather to a dimensional approach of the family characterized by different protective or risk factors. We suggest that these family patterns could constitute, according to their importance (intensity and frequence), a family risk factor of development or aggravation of the addictive behaviors.     

A family assessment based on the Social Relations Model

One purpose of family assessment is to formulate hypotheses that can guide clinical interventions. Family assessment is based on models about family functioning. In this paper the Social Relations Model ( Kenny and La Voie, 1984 ; SRM) is presented as such a model about family dynamics. Moreover, SRM provides statistical tools to underpin empirical hypotheses about family functioning. An SRM family assessment of a family with a child in child psychiatric care exemplifies the possibilities and limitations of this SRM approach to family assessment. The subject of the family assessment is family members' sense of influence in their family relationships.     

Associations of Parent-Adolescent Discrepancies in Family Cohesion and Conflict with Adolescent Impairment

Family cohesion and family conflict are important protective and risk factors respectively in the development of child psychopathology. Our study examines parent-adolescent discrepancy of the family environment constructs, family cohesion and family conflict, and their associations with adolescent impairment. The sample consists of 141 parent-adolescent dyads evaluated at an outpatient behavioral health clinic. The mean adolescent age is 14.8 (range 11–18) while the mean parent age is 48.9 (range 32–67). Findings show that adolescents report significantly less family cohesion but do not differ significantly in reports of family conflict. Greater family cohesion is associated with less adolescent impairment by multiple reporters. Nonetheless, greater family conflict is associated with more adolescent impairment by the same reporter. The results show that both adolescent and parent reports of family cohesion and conflict are important to consider when integrating information gathered in a clinical assessment.     

流动儿童家庭环境的特点及其对生活满意度的影响

以北京市1018名流动儿童和447名城市儿童为调查对象,采用家庭生活环境调查问卷、家庭功能问卷、学生多维生活领域满意度量表和学生总体生活满意度量表,考察流动儿童家庭环境的特点及其对生活满意度的影响。结果表明:(1)流动儿童的家庭经济状况和家庭功能均显著差于城市儿童。(2)父亲从事体力类工作显著负向预测流动儿童的环境满意度;家庭生活指数显著正向预测流动儿童的家庭、环境满意度及总体生活满意度;家庭居住的社区环境显著正向预测流动儿童的家庭和环境满意度。(3)家庭亲密度显著正向预测流动儿童的家庭、环境满意度和总体生活满意度,家庭的适应性显著正向预测其家庭满意度。     

The crucial roles of attachment in family therapy

This paper's aim is to enable family therapists from whatever approach to address family attachments during their work. It explores the role of attachment in the family, and how to enable therapists to increase security in the family so that family members can solve their own problems during and after therapy. The article gives a brief overview of the nature of family attachment relationships and the influence of secure and insecure attachments within the family and their narrative styles. This is described in language that a therapist might readily hold in mind and share the ideas in dialogue with families. The paper discusses the interplay between insecure attachments and other family problems, such as parental conflict and disagreements over authority. It also discusses ways of establishing a secure therapeutic base and the influence of the therapist's own attachment style. The implications for family therapy practice are described and illustrated by work with a specific family.     

The California Family Health Project: VI. Multidomain Analyses

The preceding articles in this series have reported associations between each of four domains of family variables (World View, Emotion Management, Structure/Organization, Problem Solving) and the Health of adults in a community-based sample of 225 families. In this article, we explore the relationships among all four family domains (73 variables) and between all four family domains and adult Health. The results of both principal components and multidimensional scaling analyses suggested the viability of the four-family-domain framework. As expected, the pattern of relationships among the variables in each family domain was maintained when Health was added to the analyses. Using multidimensional scaling analysis, we also found that the relationship between some family domains and Health changed when viewed in the context of the other family domains. These shifts suggested the importance of family context on the relationship of that family domain and Health. Family World View and Emotion Management maintained their relationships with Health; family Structure/Organization shifted relatively moderately; and Problem Solving shifted substantially. Family World View and family Emotion Management may be relatively more independent in their relation to family member health than family Structure/Organization and Problem Solving.     

Creating a Secure Family Base: Some Implications of Attachment Theory for Family Therapy

The aim of this article is to make attachment research findings available in a form that family therapists can use. In attachment theory, parents are conceptualized as providing a secure base from which a child can explore. Family therapists, however, need a systemic concept that goes beyond the parent/child dyad. The concept of a secure family base is proposed, in which a network of care is made available for all family members of whatever age so that all family members feel secure enough to explore, in the knowledge that support is available if needed. Factors that contribute to the security or insecurity of the family base are outlined. The overall aim of therapy is to establish a secure family base from which the family can explore new solutions to family problems both during and after therapy. The role of the therapist is to help to resolve conflicts that threaten relationships, and to explore relevant belief systems that may be contributing to a sense of insecurity. The conceptual framework presented allows for an integration of family therapy techniques and ideas into a coherent whole. A new school of family therapy is not proposed.     

Children's loneliness, sense of coherence, family climate, and hope: developmental risk and protective factors

The study examined the contributions of individual and familial variables for the prediction of loneliness as a developmental risk and the sense of coherence as a protective factor. The sample consisted of 287 children from grades 5-6. Their loneliness, sense of coherence, hope, effort, and family climate were assessed. Separate hierarchical multiple regression analyses revealed that family cohesion and children's hope contributed to the explanation of the risk and protective outcomes. Yet, the contribution of the family adaptability was not significant. Cluster analysis of the family climate dimensions (i.e., cohesion and adaptability) was performed to clarify the interactive roles of family adaptability together with family cohesion. The authors identified 4 separate family profiles: Children in the 2 cohesive families' clusters (Cohesive Structured Families and Cohesive Adaptable Families) reported the lowest levels of loneliness and the highest levels of personal strengths. Children within rigid and noncohesive family cluster reported the highest levels of loneliness and the lowest levels of children's sense of coherence. The unique role of the family flexibility within nonsupportive family systems was demonstrated. The results further clarified the unique profiles' characteristics of the different family clusters and their adjustment indexes in terms of loneliness and personal strengths.     

Impact of Family Efficacy Beliefs on Quality of Family Functioning and Satisfaction with Family Life

The present study tested with 142 families a structural model of the interplay of perceived dyadic and collective forms of efficacy within the interdependent family system, and how these different forms of efficacy are structurally related to quality of family functioning and satisfaction with family life. Dyadic parent–child efficacy, dyadic spousal efficacy, and filial efficacy were linked to family satisfaction through the mediating impact of collective family efficacy. A high sense of collective family efficacy was accompanied by open family communication and candid disclosure by adolescents of their activities outside the home. Collective family efficacy contributed to parents' and adolescents' satisfaction with their family life both directly and through its impact on quality of family functioning. An alternative structural model in which quality of family functioning affects the different forms of perceived family efficacy and family satisfaction provided a poorer fit to the data.     

Family boundary characteristics,work–family conflict and life satisfaction: A moderated mediation model

Although work–family border and boundary theory suggest individuals' boundary characteristics influence their work–family relationship, it is largely unknown how boundary flexibility and permeability mutually influence work–family conflict and subsequent employee outcomes. Moreover, the existing work–family conflict research has been mainly conducted in the United States and other Western countries. To address these gaps in the work–family literature, the present study examines a moderated mediation model regarding how family boundary characteristics may influence individuals' work–family conflict and life satisfaction with a sample of 278 Chinese full‐time employees. Results showed that employees' family flexibility negatively related to their perceived work interference with family (WIF) and family interference with work (FIW), and both these two relationships were augmented by individuals' family permeability. In addition, WIF mediated the relationship between family flexibility and life satisfaction; the indirect effect of family flexibility on life satisfaction via WIF was stronger for individuals with higher family permeability. The theoretical and managerial implications of these findings are discussed.     

Family Secrecy in Family Therapy Practice: An Explorative Focus Group Study

The aim of this focus group study was to explore the experiences of family therapists working with family secrecy. Our study highlights that family secrets present important and compelling challenges for family therapists. Furthermore, our study reveals that there seem to be some basic strategies family therapists use in dealing with these challenges in therapy sessions. One basic strategy is that family therapists try to guard their position of being a trustworthy therapist for each family member by avoiding becoming stuck in family secrecy. Furthermore, therapists explore ways to guide the family toward the disclosure of the secret in order to alleviate the toxicity of the secrecy. This highlights the importance of the systemic model and how influential this perspective is in family therapy practice. Some participants, however, have in addition a second strategy they sometimes use: talking with the family about secrecy without aiming to disclose the secret. In the discussion section of the article we reflect on the possibility that in the strategic choices family therapists make conceptual issues might be involved. Furthermore, we stress the importance of further research.