Structural Family Therapy and Autism Spectrum Disorder: Bridging the Disciplinary Divide

ABSTRACT

Applied Behavior Analysis (ABA) is an evidence-based practice approach for the treatment of individuals with autism. The systemic effects of autism suggest that family therapy would considerably enhance the treatment of individuals with autism. Marriage and family therapy (MFT) training does not routinely include exposure to autism beyond the associated diagnostic criteria. Structural Family Therapy (SFT) is a systemic model that is familiar to those trained in family therapy and appropriate for the needs of families affected by autism. Therefore, the authors have used SFT as a foundation for supervising MFT trainees working in an autism treatment setting.     

Family psychology from an Israeli perspective

A perspective of family psychology in Israel is drawn against a background of evolving indigenous elaboration suited to Israel's unique circumstances (J. I. Good & A. Ben-David, 1995). Its development shows a progression from the original source of an enriching but dominant culture (J. J. Gergen, A. Gulerce, A. Lock, & G. Misra, 1996; E. Halpern, 1985) to a discipline growing within the Israeli geopolitical reality, constraints of academic infrastructures, and training resources. One can currently recognize a discipline that is increasingly congruent with its cultural texture as well as the histories and traditions of individual families in a multifaceted society. This evolution is thought to bear similarities to the course that family therapy originally took and to where the roots of family psychology can be found. To echo F. W. Kaslow's (1987, 1991) analysis of this evolution in the United States, the heritage of family psychology in Israel also basically lies in mainstream psychology.     

For the new family therapist: A glossary of terms

Abstract

Traditional psychodynamic terms used in describing, diagnosing, and treating individual patients have proven less than helpful in working with families. In an attempt to alleviate this difficulty, and as an aid to the newcomer in the field of family therapy, this glossary of terms is presented. This glossary is not meant to be all-inclusive. Rather, its purpose is to provide the new family therapist with an introduction to the language of the field, an armamentarium from which to work, and to provide a basis of knowledge that is usually not accumulated by the new family therapist until he or she has worked with a number of families over a period of time.     

A comparison of obese and normal-weight families' sychological characteristics

Abstract

The present study assessed obese and normal-weight family members' perceptions of their nuclear family's social and environmental characteristics. Preliminary results support previous correlational and case studies that suggest obese families are dysfunctional. Results from the Family Environment Scale indicate that obese families perceive their family characteristics differently compared to normal-weight families or to a representative sample of families. Specifically, obese families perceive their homes as less cohesive, more conflictual, less interested in social and cultural activities, and less organized compared to normal-weight families. Obese parents also perceive themselves as more controlling and their families as less independent compared to nonobese parents.     

Children of victims of terrorist activities: A family approach to dealing with tragedy

Abstract

The present report deals with the treatment of families of victims of terrorist activities. Such families are subject to an initial crisis situation involving severe stress as well as disruption in family role structure and homeo-stasis. Much of the trauma precipitated by such events is a result of their suddenness, their salience in the public consciousness and the consequent stigma they produce towards survivors and/or relatives of victims. A number of specific issues were common in the two case studies presented in this report as well as in other families affected by terrorism. These included dealing with the need to be a superparent and correcting unrealistic expectations, teaching effective limit setting including giving permission to be a parent, giving permission to be an adult, dealing with guilt and phobic reactions as well as family and network reorganization. Therapy concentrated on promoting family strengths and coping and deemphasized individual pathology. Common to most families treated was the strong desire of the victim's children to be treated as normal and not as psychological casualties. Thus, family therapy proved to be an ideal treatment modality for dealing with the tragic loss. By focusing on the problems of day-to-day living, the mourning work evolved naturally in the course of therapy. Specific therapeutic modalities such as cotherapy and network intervention facilitated family adjustment considerably.     

Couple Crises and the Trigenerational Family

ABSTRACT

A trigenerational approach to couple crises is presented. Key ideas are developed from the work of Bowen, Framo and Whitaker on families of origin; Bowen sends partners back to their own families; Framo invites the extended family into the session with the couple; Whitaker enlarges the unit of observation to include more family members, increasing family resources. For the author, the early phase of therapy is diagnostic, so extended family members are invited to provide information as consultants. One couple'S crisis is reviewed m detail. Issues arising from inviting the couple'S parents and siblings, their children, and the value of individual sessions for the partners are examined using the trigenerational framework.     

An evaluation of a partial training program in psychiatric residency on the later practice of marital and family therapy

Abstract

This paper reports on the results of a survey of psychiatrists and residents who received marital and family therapy training during their second year of residency. The data indicate that such training has an immediate positive effect on practice and is carried forward into later practice. Practicing psychiatrists trained in marital and family therapy during residency report spending 25% of their caseloads in marital and family therapy which was seen as producing positive change in patients. In line with previous training, practicing psychiatrists define the unit of treatment as more than an identified patient and treat marital and family therapy cases themselves or refer to others for such therapy. Variations in practice and techniques raise questions regarding the structure and content of marital and family therapy training in psychiatry residency programs and point out the importance of such training in the later practice of psychiatry.     

School Psychology: Training Individuals for One of the Best Kept Secrets in Professional Psychology

Abstract

School psychology training at the doctoral level is discussed. Given the increasing diversity in the schools as well as the varied education and mental health needs of the population, school psychology training is necessarily broad, involving traditional skills such as assessment, intervention, consultation, and counseling, all of which are taught within a context of a changing school population with changing needs. Because there is compulsory education, school psychologists’ interface with a broad cross-section of individual children, their parents, and their teachers. Moreover, school psychological practice is not limited to schools, as doctoral school psychologists are health service providers; many of these individuals work in other settings for which they are trained to provide services. The complexities and challenges of training school psychologists within this broad agenda effectively across domains are discussed.     

A Systemic Treatment of Families with a Child Diagnosed with Autism Spectrum Disorder Using a Narrative Lens

Abstract

Autism Spectrum Disorder (ASD) is a neurodevelopment disorder that now affects one in 59 children, a 15% increase from the 2012 report. Although there have been numerous studies on the treatment of ASD, interventions focus primarily on the individual diagnosed with ASD. Marriage and family therapists’ (MFT) are in a unique position to handle the systemic dynamics of ASD. As a result, many MFTs find it difficult and outside their scope of practice to work with these families. We will explore aspects of narrative family therapy, conceptualization, and interventions, giving the reader a base understanding of how to implement narrative therapy while working with this population.     

Training analysis in the dutch society for psychoanalytic psychotherapy: A survey of attitudes and feasibility

SUMMARY

As is the case in many training courses in psychoanalytic psychotherapy, one of the training requirements of the Dutch Society for Psychoanalytical Psychotherapy (NVPP) is a training analysis, currently a minimum duration of 700 hours. During the last few years, this requirement has become somewhat controversial. Because the NVPP does not have information about the current interest in NVPP membership, the Board of the NVPP decided to do a survey. Of 995 psychiatrists, clinical psychologists and psychotherapists, who had recently completed their training, or were still in training, 623 filled in a questionnaire. Of those who are interested in the NVPP training, 39 per cent judged the training analysis as not feasible in terms of time, and 61 per cent in terms of money. Forms of personal treatment thought desirable for anyone who wishes to become a psychoanalytic psychotherapist at a specialist level are, in descending order, psychoanalytic psychotherapy (63%), psychoanalysis (39%), psychoanalytic group psychotherapy (25%), and psychoanalytic marital or family therapy (6%). Respondents who judge personal analysis as not feasible, also tend to judge psychoanalysis to be equivalent to other forms of psychoanalytic psychotherapy, whereas those who judge personal analysis as feasible, tend to think that personal analysis is essential for a psychoanalytic psychotherapist at the specialist level.     

Social class tensions within families

Abstract

The upward or downward social class mobility of an individual family member can result in tensions between the individual and the rest of the family, tension which is heightened because it rarely is identified and named as a class issue. This article explores the issue of class, identifies common situations in which class tensions occur within families, and discusses clinical considerations.     

Family therapy with adolescent offenders: A collaborative treatment strategy

Abstract

An intervention strategy is presented which can be used with families of adolescents who continue breaking the law despite improvement of family functioning during therapy. The strategy emphasizes collaboration between the therapist and juvenile justice system in stopping the child's law-breaking behavior in the shortest amount of time. The treatment strategy is suggested as a specific intervention to be used only when conventional family therapy strategies have failed to promote the cessation of the adolescent's law-breaking behavior. As such, it is suggested as a strategy to be used in conjunction with family therapy rather than as a comprehensive treatment approach in itself.     

Culturally Competent Family Interventions: Review and Case Illustrations

Family therapy is often the treatment of choice for culturally diverse clients. This article provides a critical review of culturally competent assessment and intervention strategies for use with ethnic minority families in the U.S. A culturally informed view of the definition of family health and dysfunction is presented, basic structure and goals of family therapy are delineated, and family therapy process and techniques are addressed. Clinical vignettes are provided to illustrate critical points.     

Student Healthcare Clinicians' Illness Narratives: Professional Identity Development and Relational Practice

ABSTRACT

In this qualitative, grounded theory study we examine how the intersection of self-reflection, illness narratives and perceived messages of professional identity inform care provided by medical, nursing, and medical family therapy students to patients and families. We discovered four common challenges students faced navigating personal experiences of illness and connecting to patients: 1) discrepancies between ideal and lived experiences, 2) challenges of healthcare work and culture, 3) navigating power and hierarchy, and 4) developing a shell of privacy. Discussion and implications include interdisciplinary training and collaboration and the unique role of medical family therapists in healthcare.     

Family therapy vs. parent groups: Effects on adolescent drug abusers

Abstract

The families of adolescent drug abuse clients who were admitted to six outpatient drug-free (OPDF) treatment programs were randomly assigned to either a family therapy method or a parent group method. It was later found that in 93% of the family therapy families, one or both parents participated (N=85); but that in only 67% of the families assigned to a parent group did one or both parents participate (N=50). This is considered to be an important practical advantage for family therapy. At follow-up evaluation 15 months later (after a 6-month course of treatment and a 9-month follow-up period), the clients and their mothers in both groups reported significant improvement on numerous outcome criteria, including reduction in substance use. There was no significant difference between the two groups in degree of improvement.     

Evaluating Training Needs for Home-Based Family Therapy: A Focus Group Approach

Therapists and supervisors engaged in the delivery of home-based services participated in two rounds of focus groups. Participants discussed the challenges they face doing home-based therapy, and how an accredited family therapy program could modify its curriculum to better prepare trainees to meet these demands. Eight topic areas considered necessary for home-based practice were identified and the implications for training reviewed. The focus group methodology is described in detail and is recommended as a useful tool to assess training needs and as a way of promoting improved collaboration among training sites.     

Family Consulting: A New Role for Therapists

A new model for psychological practice entitled, "Family Consulting" is proposed. It is defined as a long-term, intermittent approach to working with families based on a developmental/non-pathological perspective. The specific format of intervention is described in detail. A brief review of the life-span perspective of development, the family life-cycle literature, and object relations family therapy, which serve as the building blocks of the model is provided. The role that family consulting can play in today's managed mental health care environment is discussed.