Perceived Marital Problems in Taiwan

With the expansion of the practice of marriage and family therapy outside of the U.S. and Western Europe, it important to gain a better understanding of family interaction and processes in other cultures and countries. Several studies have examined the problems that couples experience in the United States, but little is understood about problems that couples in Asia experience. In this study, perceptions of relationship problems experienced by 213 married couples living in urban Taiwan were examined. Results indicated that raising children and communication were the two problems most frequently reported by both husbands and wives. Among eight relationship problem areas, the only gender difference was in the area of communication, with wives significantly more likely to report it as a problem. An examination of within-dyad agreement indicated that couples generally had high consensus regarding relationship problems. Implications of this research for culturally-sensitive MFT practice are discussed.     

The Effects of Strategic and Behavioral Family Therapies on Child Behavior and Depression

The efficacy of behavioral and strategic approaches to child-focused family therapy for child behavior and depressive symptomatology was investigated. Participants were 49 clinic-referred families who were randomly assigned to either behavioral or strategic family therapy for 8 to 12 weeks and assessed at pre- and post-test. Results showed that both forms of therapy were equally effective in reducing parent-reported behavior problems and depression in children. In addition, the relationship between child and maternal depression was explored. Significant relationships were found between pre-test levels of depression in children as reported by mothers and mothers' self-reported depression, psychological stress and level of interpersonal discomfort. The results support a relationship between child and maternal depression. The findings also suggest that child-focused family therapy can be effective for both behavioral and depressive symptoms.     

Stories we tell each other: A comparison of families' and their therapists' explanations of presenting problems

This study reports the explanations of presenting problems given by 10 mothers of children referred to a department of child and family psychiatry and their therapists. Video-recordings of therapists' pre-session meetings and the initial therapy sessions were searched for explanatory statements. These statements were then coded. It was found that therapists referred to past events, present circumstances, relationships, and possible future events in their explanations of presenting problems significantly more frequently than mothers. It was rare for mothers to speak in terms of past or future events at all. The mothers explained difficulties in terms of character traits significantly more often than did the therapists. The implications of these findings are discussed.Thanks to all of the child and family consultation team at 1 Wolverton Gardens for their participation in this research and particularly to Ruth Kossoff for her great help with organising data collection.     

The Poverty of Privilege:

Despite the seeming freedom from many of the economic and other pressures encumbering women in more palpably disadvantaged subgroups, women of the upper classes are faced with considerable numbers of psychological problems. Prevalent among the presenting problems include depression and other disorders related to powerlessness, relationship problems, alcohol and substance abuse, and eating disorders. While increasing numbers of women in lower socioeconomic groups work outside the home, the upper class wife represents the last vestige of the classic patriarchal family: her raison d'etre is to assist her husband and children in perpetuating the power and privilege of her family and class, often leaving her with nothing that is truly her own. She is most likely to present in therapy when widowed or confronted with "losing it all," finding herself with few marketable skills or even basic life competencies. Therapy issues include how to help her develop greater self-acceptance and begin to identify and pursue some of her own dreams; countertranferential issues, such as envy or impatience, may also need to be addressed. The conclusion is reached that ultimately gender transcends class as the major determinant of the quality of upper class women's lives, and that it is crucial that any therapy geared toward helping them become happier and more effective be informed by a strong feminist awareness.     

Moderators of the Relationship Between Maternal Substance Abuse Symptoms and Preschool Children’s Behavioral Outcomes

While maternal substance use problems increase the likelihood of behavior problems in children, child outcomes are varied, leading to interest in understanding additional family factors that contribute to the development of behavior problems in children impacted by maternal substance abuse. The purpose of this study is to examine harsh parenting and family conflict as potential moderators of the relationship between symptoms of maternal substance use problems and child externalizing behavior problems. The non-clinical sample for this study included 250 low-income parents whose preschool age children were enrolled in Head Start programs in a Southern state. This study utilized data collected during two home visits, an average of 10 months apart, with data on family functioning and maternal symptoms of substance use problems collected at the first time point and child externalizing behavior collected at the second time point. Over one-third of the children (38.1 %) had clinically elevated externalizing behavior scores. We used regression analysis to examine whether harsh parenting or family conflict moderated the relationship between maternal substance use symptoms and child externalizing behavior. In this community sample, we found that in the absence of family risks related to harsh parenting and family conflict, maternal symptoms of substance use problems did not have a significant impact on child externalizing behavior in preschool children. However, when high levels of family conflict or harsh parenting were present, symptoms of maternal substance use problems increased the risk of externalizing behavior problems in children.     

Follow-up evaluation of 55 child guidance cases

Parents coming to a child guidance clinic reported behaviour in their children which they (parents) viewed as problems or symptoms. The first 55 families coming to a new clinic were selected as part of a programme to evaluate the effects of the clinic's services on its total caseload. A follow-up inquiry was made about the presenting symptoms six months after the family ceased attending the Center. The parental reports of improvement in the child's symptoms appeared to be related to the extent to which both parents participated in coming to the clinic: the child's age also had some relationship to reported improvement. The kind of service provided, and the number of contacts with the Center appeared to be unrelated to reported improvement.     

Family Influences on the Long Term Post-Disaster Recovery of Puerto Rican Youth

This study focused on characteristics of the family environment that may mediate the relationship between disaster exposure and the presence of symptoms that met DSM-IV diagnostic criteria for symptom count and duration for an internalizing disorder in children and youth. We also explored how parental history of mental health problems may moderate this mediational model. Approximately 18 months after Hurricane Georges hit Puerto Rico in 1998, participants were randomly selected based on a probability household sample using 1990 US Census block groups. Caregivers and children (N?=?1,886 dyads) were interviewed with the Diagnostic Interview Schedule for Children and other questionnaires in Spanish. Areas of the family environment assessed include parent-child relationship quality, parent-child involvement, parental monitoring, discipline, parents’ relationship quality and parental mental health. SEM models were estimated for parents and children, and by age group. For children (4–10 years old), parenting variables were related to internalizing psychopathology, but did not mediate the exposure-psychopathology relationship. Exposure had a direct relationship to internalizing psychopathology. For youth (11–17 years old), some parenting variables attenuated the relation between exposure and internalizing psychopathology. Family environment factors may play a mediational role in psychopathology post-disaster among youth, compared to an additive role for children. Hurricane exposure had a significant relation to family environment for families without parental history of mental health problems, but no influence for families with a parental history of mental health problems.     

Siblings in family therapy

The participation of siblings in family therapy was studied from case records in 76 consecutive cases attending a child and adolescent psychiatric outpatient clinic. Siblings took part in family therapy in two thirds of the cases. Of these, 76 per cent attended only one or two sessions. A sub-sample of nine families with children below 13 years of age was interviewed. Seven out of 10 evaluated siblings had psychiatric symptoms of some severity at the onset of therapy compared to two after, and all had fewer symptoms after therapy compared to before (p<0.01). Most families thought it relevant for both parents and siblings to take discussing their children's behaviour in front of them and wanted the opportunity of also talking to the therapist without the children being present.     

Judged school problems and competencies of referred children with varying family background characteristics

The school adjustment problems and competencies of referred children with varying family background histories were compared. Children from homes characterized by low parent interest in education had more severe learning problems and fewer competencies than either matched referred controls without such a history or matched referred children under family pressure to succeed. The relationship of these findings to other studies of school adjustment and family background was considered.This research was done with grant support from the NIMH Experimental and Special Training Branch (MH 11820-06), which the authors acknowledge with gratitude.     

Thinking and Working Relationally: Interviewing and Constructing Hypotheses to Create Compassionate Understanding

In the initial interviews of family therapy sessions, the therapist faces the challenge of obtaining and organizing the information that is most relevant toward understanding the essential concerns that families and couples bring to therapy. This article describes the process of clinical interviewing and case conceptualization used in training family therapists at the Ackerman Institute for the Family. This approach helps the therapist bring forward, and organize, specific information into relational hypotheses, or systemic‐relational conceptualizations, that allow both family members and the therapist to understand presenting problems within their relational contexts. While always provisional, relational hypotheses help anchor the therapist in a systemic‐relational frame and provide a conceptual through‐line to guide the ongoing work of the therapy. The process of interviewing and the construction of clear and complex conceptualizations of presenting problems are illustrated through case examples.     

The Efficacy of Child Parent Relationship Therapy for Adopted Children With Attachment Disruptions

This pilot study examined the effectiveness of child parent relationship therapy (CPRT; Landreth & Bratton, 2006 ) with 61 adoptive families. Statistically significant findings and large treatment effects on all measures indicated the effectiveness of CPRT over the wait‐list control condition on reducing child behavior problems and increasing parental empathy. The results provide preliminary support for CPRT as a responsive intervention for adoptive families with children presenting with attachment difficulties.     

累积家庭风险与贫困儿童情绪问题的关系:有调节的中介模型

对468名贫困家庭儿童（平均年龄=13.76±2.88岁）进行问卷调查,探究累积家庭风险与贫困儿童情绪问题的关系以及学校联结的中介效应与自尊的调节效应。结果发现：（1）累积家庭风险能正向预测贫困儿童情绪问题;（2）学校联结在累积家庭风险和情绪问题之间起中介作用,即累积家庭风险可影响贫困儿童的学校联结,进而导致儿童情绪问题;（3）自尊在中介的前半路径“累积家庭风险→学校联结”路径上起调节作用。具体而言,自尊可以缓冲低累积家庭风险对学校联结的影响,但随着累积家庭风险水平的增高,自尊的缓冲作用也在逐渐减弱和丧失,符合“杯水车薪”调节模式。研究结果提示,累积家庭风险和学校联结均是贫困儿童情绪问题的重要预测因素。与此同时,对贫困儿童高自尊的保护作用可能不宜过分乐观。     

Multimodal Rehabilitation: A Mind-Body Family-Based Intervention for Children and Adolescents Impaired by Medically Unexplained Symptoms. Part 2: Case Studies and Outcomes

In Part 2, we describe three cases implementing our mind-body, family-based, multimodal rehabilitation approach for treating children and adolescents presenting with medically unexplained symptoms. For each child and family, treatment interventions were selected and implemented, simultaneously or sequentially. In a cohort of 100 consecutively referred children, 56 suffered from, and were treated for, significant physical or chronic school absenteeism. Thirty-five of these children (63%) recovered fully, 10 (18%) had a relapsing course, 7 (12.5%) had chronic symptoms, and 4 (7%) were lost to follow-up. These outcomes suggest that mind-body multimodal rehabilitation is a successful, cost-effective model of treatment.     

The EPPI family therapy outcome study

Information was evaluated from 1014 families seen in an eight-year period by therapists connected with the Department of Family Psychiatry at Eastern Pennsylvania Psychiatric Institute in Philadelphia. Statistical analysis revealed several factors that had some predictive value in relation to outcome of therapy; these were race, past psychiatric hospitalization, type of presenting family problem, and number of sessions held. There was a rather good chance of improvement being noted by the therapist if the family stayed in treatment for eight or more sessions. About 90% of the cases were seen for less than 20 interviews. Only about 3% were seen for longer than 35 interviews. The vast majority of EPPI cases were short-term. Black families tended to present different problems from white, and therapy was terminated with blacks sooner than for whites. About 35% of families terminated after one to two interviews, and another 30% after three to seven sessions. Since families tended to benefit most after eight or more sessions, the need for better methods or techniques to engage families is highlighted.The research was supported in part by a Career Development Award from the University of California, San Francisco, to the first author.     

A comparative study of family therapy in the treatment of opiate users in a London drug clinic

This study presents the results of a randomized treatment trial of family therapy and two control treatments for 119 outpatient opiate users. All treatments were combined with a methadone reduction programme. The control treatments were: (1) a 'standard' treatment (supportive psychotherapy) and (2) a 'low contact' intervention. Treatment outcome was evaluated six and twelve months after the initial assessment. Both the family therapy and minimal intervention groups had a significantly higher number of drug–free days at six and twelve months, compared to the standard treatment, despite receiving fewer treatment sessions. Across all treatments there was evidence for a gender difference in response to therapy in users who were in a couple relationship. In couples where both partners were using drugs women did significantly better than men. Men living with a non–drug–abusing partner fared better than men living with a drug–using partner. Across the treatment groups diminution in drug use was accompanied by improvements in psychosocial functioning. Unemployment, sharing needles and injecting drugs were predictive of poor outcome.     

ICTs and Family Functioning: A Study on Portuguese Families with Adolescents and Emerging Adults

Nowadays, information and communication technologies (ICTs) represent an integral part of contemporary family life, introducing changes in families’ functioning. Positive, negative, and mixed aspects of this influence were identified. The present study intends to understand the relationship between ICTs and family functioning among participants from two different family life cycle stages. A total of 157 Portuguese families (307 participants from 97 families with emerging adult children and 169 from 60 families with adolescents) completed measures about the use of ICTs (an adaptation of SEFT/ETEF©) and family functioning (SCORE-15). The number of ICTs and problems related to their use were higher in families with adolescent children. The use of a higher number of ICTs was related to a better level of family functioning in both family groups. However, according to the multiple regression model, the problematic situations related to ICTs use only seem to predict a worse level of family functioning in families with adolescent children. Also, parents and children of each group differed in the number of ICTs used. Some limitations, implications for family therapy, and future research directions are discussed.     

Narcissistic Vulnerability in Marriage

Many couples who seek therapy with issues around money, work, sex or children are actually dealing at a deeper level with problems of narcissistic entitlement, vulnerability to emotional injury, or defenses that protect against perceived attacks upon a fragile self. This paper considers the concept of narcissism as it relates to marriage and family issues and suggests some important ingredients in treating a narcissistically vulnerable relationship.     

Family Impact and Parenting Styles in Families of Children with ADHD

Attention deficit hyperactivity disorder (ADHD) begins in childhood and is characterized by attention deficits, hyperactivity, or impulsiveness that is inconsistent with a child’s developmental level. The effects of ADHD are not limited to the child alone but can affect their familial context, particularly parenting styles. Using data from 68 parents of 6–11-year-old ADHD-diagnosed children, we attempted to identify the predictive variables of two parenting styles: criticism-rejection and permissiveness-indulgence. We analyzed two complex predictive models using structural equation modeling. We hypothesized that family impact variables would mediate the relation between the child’s behavior and parenting. The data showed that the child’s ADHD was only indirectly related to parenting styles, whereas child’s behavior problems had a direct relationship. The results stressed the central role of the child’s behavior on family social life, parents’ marital relationship, and parents’ feelings about their children. These variables mediated the relationship between the children’s disorders and parenting styles. On the other hand, perceived social support had an inverse relationship with this negative family impact, and it even had relevant indirect effects on criticism and permissiveness.     

Family therapy in treatment of the deaf: a case report.

Deaf patients with psychological problems have developmental handicaps and clinical characteristics that reduce the effectiveness of traditional modes of psychotherapy. Attempts have been made to utilize individual and group therapy, but family therapy has been largely overlooked as a method of alleviating problems of the deaf. Clinical and research writings provide us with rich insights into the family dynamics of the deaf. These data suggest to the authors that the problems of deaf individuals are largely related to family problems, and therefore merit a family orientation as the focus for treatment. This paper describes an attempt to apply family therapy with a range of deaf patients over a period of two years. From a review of their work, the authors conclude that family therapy can be effective, particularly in the treatment of deaf adolescents and children.