Providing therapy to children and families in foster care: a systemic-relational approach

Foster care is a system created to protect children from an unsafe home environment yet multiple foster home placements, conflictual or nonexistent relationships between foster parents and birth parents, long, drawn out court battles, and living in an on-going state of not knowing when or if they will be going home are just some of the challenges many children in care are expected to manage. This paper presents a guide for therapists working with families involved in foster care. Utilizing ideas from the postmodern therapies and structural family therapy, suggestions will be provided about who needs to talk to whom about what, when to have these necessary conversations, and how to talk to people in a way that mobilizes adults to take action for the children, with the goal of minimizing postplacement trauma, strengthening and repairing relational bonds, and moving children out of foster care and into permanent homes as quickly as possible.     

Between pink and blue: a multi-dimensional family approach to gender nonconforming children and their families

Families of gender nonconforming children need to negotiate the interactions between two gender systems: a rigid gender binary imported from familial, social, and cultural experiences and a fluid gender spectrum articulated by their child. This article reviews parental reactions to nonconforming gender developments and poses that the parental mandates of protection and acceptance are problematized by the difference of gender norms between the child and the family, as well as the child and the environment. Through multiple therapeutic modalities-parental coaching and education, parent support group, and child and family therapy-the author illustrates interventions supporting both parents and prepubescent children in their negotiation of safety, connection, and fluidity. Case vignettes illustrate the method in action.     

Walking in sacred spaces in the therapeutic bond: therapists' experiences of compassion satisfaction coupled with the potential for vicarious traumatization

The therapeutic bond is at the heart of effective therapy, yet few studies have examined therapists' experience of this bond. Using a qualitative study design, this exploratory study examines the experiences of couple and family therapists in relation to their perceptions of the satisfactions and risks involved in the therapeutic bond. The research was conducted using grounded theory methodology and eight in-depth interviews were conducted with therapists working in five counseling agencies in Sydney, Australia. Therapists described the importance of the 3 component parts of the therapeutic bond: the empathic connection between therapist and client; the role investment of the client; and the mutual affirmation experienced by both therapist and client in the therapeutic process. Walking in sacred spaces with the client was seen as both enriching and challenging for the therapist. The therapeutic bond gave therapists intense satisfaction and posed risks for them, especially when working with traumatic client experiences. However, the findings suggest that the experience of compassion satisfaction and the development of vicarious resilience counter-balanced the intense difficulty of bearing witness to clients' traumatic experiences and the potential for vicarious traumatization. The implications for sustaining couple and family therapists in their work are discussed.     

A narrative evaluation of a psychoeducation and a therapeutic alliance intervention for parents of persons with a severe mental illness

Most attempts to study the impact of psychosocial interventions on parents of persons with severe mental illness (SMI) are quantitative. The purpose of the present study was to investigate the subjective experience of parents of persons with SMI who participated in either a psychoeducational intervention which emphasized providing information on the illness and support, or a therapeutic alliance focused intervention (TAFI) which emphasized the alliance between the group members and group leaders. Ninety-three parents, who participated in either one of these two interventions, were interviewed using the Narrative Evaluation of Intervention Interview. Results show that participants found both interventions to be beneficial with no statistical differences in the level of perceived change. Themes describing change in relating to illness were significantly more frequently mentioned by participants in the TAFI group, whereas significantly more participants in the family psychoeducation interventions reported that implementation and information provided contributed to positive change. Also participants in the TAFI reported significantly more often that group regulation contributed to change. As both interventions were perceived as contributing, the findings support the relationship orientation to psychosocial interventions, which stresses the quality of the social support and interpersonal interaction as the source of positive outcomes of intervention.     

Navigating Critical Theory and Postmodernism: Social Justice and Therapist Power in Family Therapy

The family therapy field encourages commitment to diversity and social justice, but offers varying ideas about how to attentively consider these issues. Critical informed models advocate activism, whereas postmodern informed models encourage multiple perspectives. It is often not clear how activism and an emphasis on multiple perspectives connect, engendering the sense that critical and postmodern practices may be disparate. To understand how therapists negotiate these perspectives in practice, this qualitative grounded theory analysis drew on interviews with 11 therapists, each known for their work from both critical and postmodern perspectives. We found that these therapists generally engage in a set of shared constructionist practices while also demonstrating two distinct forms of activism: activism through countering and activism through collaborating. Ultimately, decisions made about how to navigate critical and postmodern influences were connected to how therapists viewed ethics and the ways they were comfortable using their therapeutic power. The findings illustrate practice strategies through which therapists apply each approach.     

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.     

Collaborative helping maps: a tool to guide thinking and action in family-centered services

This article highlights "disciplined improvisation" as a metaphor for community-based work with multi-stressed families. It introduces Collaborative Helping maps as a tool that both helps workers think their way through complex situations with families and provides a structure to support constructive conversations between workers and families about challenging situations. The article illustrates this map through a clinical vignette and uses interviews with workers to highlight ways in which the map can both enhance worker thinking and support constructive conversations between workers and families about problems that could easily divide them and lead to polarization and escalating tension.     

Healing Intergenerational Wounds: An Integrative Relational–Neurobiological Approach

Old resentments and unfinished business from the family of origin can constrain adults in current relationships with parents or siblings and negatively affect relationships with partners or children. This article explores how old wounds get reactivated in current relationships and contribute to the intergenerational transmission of painful legacies and trauma. Building on intergenerational family theory and interpersonal neurobiology, the dynamics of reactivity and pathways for growth are explored. While much of the time the human brain is on autopilot, driven by habits and emotional reactivity, we are capable of bringing prefrontal thoughtfulness and choice to close relationships. Rather than being victims of parents or our past, we can become authors of our own relational life. Interventions are offered to help adult clients “wake from the spell of childhood,” heal intergenerational wounds, and “grow up” relationships with family of origin. The damage caused by parent‐blaming in therapy is explored and contrasted with Ivan Boszormenyi‐Nagy's emphasis on rejunctive action and cultivating resources of trustworthiness in intergenerational relationships. The family is considered both in its cultural context—including stressors and resources for resilience—and in its life cycle context. Aging in the intergenerational family is discussed, focusing on ways adult children and their parents can grow and flourish with the challenges at this time of life. Throughout, the theme of relational ethics—how we can live according to our values and “reach for our best self” in intergenerational relationships—informs the discussion.     

Speaking of privilege: family therapy educators' journeys toward awareness and compassionate action

This study explores how family therapy educators from privileged social locations understand issues of privilege and the process by which they integrate their personal and professional journeys to create and model equity in family therapy training and professional development. These educators developed awareness about issues of privilege and oppression and owned their privilege. Increased awareness involved personal struggles with guilt and managing internalized voices of prejudice that are constantly reinforced in society. These educators adopted a stance of action and accountability for equity. We hypothesize that the process leading to owning one's privilege involves the ability to be compassionate for others' suffering and one's own limitations.     

A qualitative examination of the work–family interface: Parents of children with autism spectrum disorder

Within the work–family literature little is known about the work–family challenges and opportunities faced by families that have one or more children with autism spectrum disorder. However, it has been consistently demonstrated that parents of children with autism spectrum disorder are at a higher risk of experiencing a host of negative outcomes. Using a qualitative design, within grounded theory, the present study sheds light on the needs, experiences, and challenges that parents of children with autism spectrum disorder face and also offers insight into ways to expand the scope of work–family research in this area. The present research provides evidence of how the family domain can greatly impact experiences and decisions made in the work domain for families with special needs. The present research adds to the small but growing literature examining the interplay between home and work life for families with special needs and demonstrates that this is an important research domain in need of additional conceptual and empirical consideration.     

A qualitative examination of the work–family interface: Parents of children with autism spectrum disorder

Within the work–family literature little is known about the work–family challenges and opportunities faced by families that have one or more children with autism spectrum disorder. However, it has been consistently demonstrated that parents of children with autism spectrum disorder are at a higher risk of experiencing a host of negative outcomes. Using a qualitative design, within grounded theory, the present study sheds light on the needs, experiences, and challenges that parents of children with autism spectrum disorder face and also offers insight into ways to expand the scope of work–family research in this area. The present research provides evidence of how the family domain can greatly impact experiences and decisions made in the work domain for families with special needs. The present research adds to the small but growing literature examining the interplay between home and work life for families with special needs and demonstrates that this is an important research domain in need of additional conceptual and empirical consideration.     

Disentangling the Relations Between Different Components of Family Socioeconomic Status and Chinese Preschoolers’ School Readiness

Family socioeconomic status (SES) has been frequently linked to children’s early development. Treating SES as an aggregated variable has many issues, as different components of SES may relate to child outcomes through divergent mechanisms. The purpose of the study was to examine whether parents’ engagement in home learning activities and children’s participation in extracurricular activities (EAs) would function as pathways through which individual SES components related to children’s school readiness. A total of 588 families with preschool‐aged children were recruited from Guangdong province in China. Children’s receptive vocabulary, Chinese reading, and early math skills were individually assessed at three time points, and children’s social skills were rated by parents. Parents reported their engagement in home learning activities with children and their children’s participation in EAs. The results showed that all three components of family SES were related to multiple aspects of children’s school readiness, but through different pathways. Parental income was related to children’s school readiness through EA participation only; parental education and occupational status were associated with school readiness via both parental engagement and child EA participation. The findings suggest that considering SES components separately will produce a more nuanced understanding of the divergent pathways through which family SES may relate to children’s school readiness. Chinese government may provide parent education programs focused on cognitive stimulation for low‐SES families to promote children’s school readiness. Furthermore, the government needs to ensure children’s equal access to EAs to prevent increasing the developmental gap among children from discrepant socioeconomic backgrounds.     

Exposing operations of power in supervisory relationships

Through a poststructural lens, we examine how power may show itself in relationships between supervisees and supervisors, producing both helpful and harmful effects. Drawing from our own experiences, as well as conversations with other members of our supervisory group, we demonstrate how privileged discourses around professional status, gender, and race may bring about difficulties including a sense of doubt, worry, inadequacy, and a fear of speaking up. We also illustrate how these difficulties can be addressed in a manner that may lessen their influence, while increasing supervisees' sense of agency.     

Developing an outcome-based assessment for family therapy training: the Rochester Objective Structured Clinical Evaluation (ROSCE)

This paper addresses a growing need for cost-effective, outcome-based assessment in family therapy training. We describe the ROSCE, a structured, evidence-informed, learner-centered approach to the assessment of clinical skills developed at the University of Rochester Medical Center. The ROSCE emphasizes direct observation of trainees demonstrating clinical competencies. The format integrates both formative and summative assessment methods. It can readily be adapted to a wide variety of educational and training settings.     

A socio-emotional relational framework for infidelity: the relational justice approach

Current clinical models for addressing infidelity tend not to make social context issues a central focus; yet, societal gender and power structures, such as female responsibility for relationships and limited male vulnerability, affect the etiology of affairs and create power imbalances in intimate relationships. How therapists respond to these societal influences may either limit or enhance the mutual healing of both persons in the relationship. Thus attention to these societal processes is an ethical issue. This paper presents one perspective, the Relational Justice Approach, for working with infidelity. It places gender, power, and culture at the center of intervention in couple therapy, and includes three stages: (1) creating an equitable foundation for healing, (2) placing the infidelity in a societal context, and (3) practicing mutuality. Each stage is illustrated with case examples and contrasted with current practice regarding infidelity.     

Parents Taking Action: A Psycho‐Educational Intervention for Latino Parents of Children With Autism Spectrum Disorder

The increased prevalence of autism spectrum disorder (ASD) among Latino children, later diagnosis, limited access to bicultural specialist support, and worsened health outcomes when compared to non‐Latinos points to the need for a culturally relevant parent education intervention. This pilot study examined the feasibility, acceptability, and preliminary outcomes of a culturally derived intervention, Parents Taking Action, for 19 Spanish‐speaking mothers of children with ASD. This study introduces the Promotora de Salud Model of intervention delivery to the autism field. A mixed‐methods design including one group pre‐ and posttest design and focus groups was used to evaluate the outcomes of PTA. We found that the intervention was both feasible to implement and acceptable to participants. We also found significant increases in empowerment oriented outcomes for parents between pre‐ and posttest suggesting that the intervention is promising. Suggestions for future research and practice are offered.     

The Uses of Emotion Maps in Research and Clinical Practice with Families and Couples: Methodological Innovation and Critical Inquiry

We explore how “emotion maps” can be productively used in clinical assessment and clinical practice with families and couples. This graphic participatory method was developed in sociological studies to examine everyday family relationships. Emotion maps enable us to effectively “see” the dynamic experience and emotional repertoires of family life. Through the use of a case example, in this article we illustrate how emotion maps can add to the systemic clinicians’ repertoire of visual methods. For clinicians working with families, couples, and young people, the importance of gaining insight into how lives are lived, at home, cannot be understated. Producing emotion maps can encourage critical personal reflection and expedite change in family practice. Hot spots in the household become visualized, facilitating dialogue on prevailing issues and how these events may be perceived differently by different family members. As emotion maps are not reliant on literacy or language skills they can be equally completed by parents and children alike, enabling children's perspective to be heard. Emotion maps can be used as assessment tools, to demonstrate the process of change within families. Furthermore, emotion maps can be extended to use through technology and hence are well suited particularly to working with young people. We end the article with a wider discussion of the place of emotions and emotion maps within systemic psychotherapy.     

The family empowerment program: an interdisciplinary approach to working with multi-stressed urban families

The family empowerment program (FEP) is a multi-systemic family therapy program that partners multi-stressed families with an interdisciplinary resource team while remaining attached to a "traditional" mental health clinic. The rationale for this model is that far too often, families presenting at community mental health centers struggle with multiple psychosocial forces, for example problems with housing, domestic violence, child care, entitlements, racism, substance abuse, and foster care, as well as chronic medical and psychiatric illnesses, that exacerbate symptoms and impact traditional service delivery and access to effective treatment. Thus, families often experience fragmented care and are involved with multiple systems with contradictory and competing agendas. As a result, services frequently fail to harness the family's inherent strengths. The FEP partners the family with a unified team that includes representatives from Entitlements Services, Family Support and Parent Advocacy, and Clinical Staff from the agency's Outpatient Mental Health Clinic practicing from a strength-based family therapy perspective. The goal of the FEP is to support the family in achieving their goals. This is accomplished through co-construction of a service plan that addresses the family's needs in an efficient and coherent manner-emphasizing family strengths and competencies and supporting family self-sufficiency.