Rationale and directions for an increased emphasis on the therapeutic relationship in family therapy

This paper argues the need for an increased emphasis on the therapeutic relationship in family therapy. The ways in which the field of family therapy has eschewed the importance of the therapeutic relationship are discussed. Therapeutic alliance research from the field of individual psychotherapy and research on the importance of relationship factors to family therapy are reviewed. Suggestions for family therapy theory, practice, and research are presented.An earlier version of this article was presented at the 1992 Western Canadian Conference on Family Practice.     

Using masks as therapeutic aids in family therapy

'Man is least himself when he talks in his own person, give him a mask and he will tell the truth' (Oscar Wilde).
This paper describes an innovative technique which uses masks as therapeutic aids in treating families in conflict. Structured within the framework of interpersonal perception, this technique uses play, humour, and the power and 'magic' of masks paradoxically to 'unmask' family members and facilitate reality-testing of perceptions distorted by the emotional masks individuals create and project onto each other. Mask usage is suggested as an adjunct to other therapeutic approaches currently used with families. Caveats and contradictions for the technique are presented. A case study illustrates the use of the technique with a reconstituted family.     

'Holding' as a therapeutic manoeuvre in family therapy

This paper describes the use of planned parental physical 'holding' as part of family therapy in a Child and Family Guidance Clinic. It is used when the child is overactive or out of parental control, or is not attached to its parents. Direct or indirect suggestions that parents hold their children are made by the therapist.     

Observing the therapeutic alliance in family therapy: associations with participants' perceptions and therapeutic outcomes

Positive and negative alliance‐related behaviours of thirty‐seven families seen in brief family therapy were rated from videotapes using the System for Observing Family Therapy Alliances ( Friedlander et al., 2006b ). Positive associations were found between in‐session behaviour and participants' perceptions of the alliance and improvement so far both early (session 3) and later in therapy (session 6). Binary logistic regression showed that successful outcomes (defined as consensus by therapist and all family members on general improvement and reduced problem severity) were significantly predicted by positive individual behaviour (Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System) in session 3 and productive within‐family collaboration (Shared Sense of Purpose within the Family) in session 6. Shared Sense of Purpose was the alliance indicator most consistently associated with clients' and therapists' perceptions of therapeutic progress; moreover, it was the only alliance indicator to improve significantly over time in treatment.     

Essay on feminist family therapy: A review ofWomen in families: A framework for family therapy andThe invisible web: Gender patterns in family relationships

Monica McGoldrick, Carol M. Anderson, and Froma Walsh (Eds.). (1989).Women in families: A framework for family therapy. New York: W. W. Norton.     

Experiential personal construct therapeutic artistry: The therapy relationship and the timing of interventions

Abstract

Experiential personal construct psychotherapy focuses on the intimate, interconnected, and evolving relationship between the therapist and the client as vital to therapeutic growth. Great creativity is demanded of the therapist who aspires to connect with clients in life‐changing psychotherapy. This article first describes the essential nature of the therapy relationship with its implicit and explicit demands for therapist creativity. These principles then are illustrated through a discussion of the critical issue of timing therapeutic interventions.     

The therapeutic object relationship

This paper introduces the concept of the therapeutic object relationship in order to clarify our understanding of the nature of fully analytic work with the more regressive patient, which has unsystematically developed over the last 30 or 40 years. The need for such a clarifying concept seems to arise from several sources. Our analytic work with the more regressed patient appears to entail a relationship demand factor which cannot be usefully treated only as resistance to the development of the transference. These are patients with what may be described as object hunger emanating from faulted ego development and a disordered internal object world. This object hunger cannot be adequately met within the framework of the tacit, ordinary, good-enough environment of the concerned and nonjudgmental analyst. In addition, the literature on this subject still dichotomizes the relationship factor of treatment from the transference. The concept of the therapeutic object relationship appears to offer the possibility of a clinical and theoretical unification between transference and relationship. The major point of the paper may be described in terms of the manner in which we have progressed from Eissler's parameter paper of 1953 to the widened scope of analytic work made possible by object relations theory, developmental theory and observation of infant and child development. The face of analysis seems to have undergone profound modification from the early classical model to one in which developmental maturation, in addition to making unconscious conflict conscious, has become a matter for our concern. This change seems to require seeing the analyst as a special form of real object with whom the patient passes through a revised version of certain developmental pathways. The therapeutic object relationship is viewed as a potentially unifying concept which may make possible higher degrees of generalization about the variously unsystematized approaches to analyzing the more regressive, but nonpsychotic patient. Some history of definition of the analytic relationship in terms of transference or relationship is presented. In the course of the paper the therapeutic object relationship is gradually defined as one of: primal intimacy; increased permeability of boundaries between self and other; intensive empathic interaction; the evolution of self and object definition in a context of intimate relation with an object that is instrumental in this process; and the activation of transcendant forms of symbolic-creative intercommunication.(ABSTRACT TRUNCATED AT 400 WORDS)     

A family therapy perspective on mediation

Many times, family therapists are both the first to learn that a couple may separate and the last to see them in the same consultation room, still relating to each other and the same professional before the adversarial system takes over. Mediation offers a viable alternative to that system because clients are helped to speak directly and craft the decisions that will delineate their move toward separate lives. Mediation is defined and the divorce process demystified, and the similarities and differences between mediation and therapy are discussed. Brief examples and a longer case discussion are provided to illustrate the mediation process. A familiarity with this process will enable therapists to hold more informed discussions about mediation with their clients and invite them to consider a process that is congruent with many of the values of family therapy.     

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.     

Intuition in family therapy: A short manual on post-modern witchcraft

Intuition is an important part of a mature clinician's work. Yet, it is a component of clinical work which is looked upon with suspicion, due in part to the Middle-Age's association between intuition and the work of witches. This paper describes a tenuous link between intuition, witches, and Carl Whitaker. Patterns for including intuition in family therapy are discussed.     

Evaluation of family therapy trainees: acquisition of cognitive and therapeutic behavior skills

In this study, which describes the evaluation of a structural family therapy training program, we developed an evaluation procedure that can be used with other similar training programs. Trainees were evaluated before and after training as to their improvement in cognitive, case-planning and in-therapy intervention skills. Results suggest a progression of skill learning, beginning with cognitive understanding, followed by case planning, and then intervention skills. Though trainees made significant progress in cognitive and planning skills, this was not the case with intervention skills. Trainees' self-evaluations were similar to their results on other measures.     

Long-term family therapy: A developmental approach

The emphasis in family therapy literature on brief therapy has given a false sense of what family therapy can accomplish. While it has helped to develop different theories of change and refine techniques to deal with resistance, it has caused many clinicians to mistake technique for treatment. A long term developmental approach is advocated in which the family therapist is the general practitioner rather than the specialist. This paper is the result of a 30-year caseload in which there was a group of multi-therapy families.     

A developmental view of therapeutic bonding in the family: treatment of the disconnected family

Data from an ongoing research study have been used to identify a subgroup of families of severely ill, young adults who present formidable treatment challenges to the family therapist. The disconnected family is characterized by disturbances in attachment between one or both parents and the patient. In many cases, disturbances in attachment and caretaking in the family of origin are reported for the parents in these families. Disconnected families that also have intense emotional styles of relating are particularly difficult to treat. A treatment model that focuses on intergenerational attachment issues is described.