Emotionally Focused Family Therapy and Play Therapy Techniques

Emotionally Focused Family Therapy provides a framework for understanding children's behaviors in terms of attachment needs of comfort and support. However, when working with young children, play therapy is often developmentally preferred over “talk therapy.” By integrating play therapy techniques within an Emotionally Focused Family Therapy theoretical framework, therapists can help parents understand and meet their child's needs for affection and comfort. This article will discuss how play therapy techniques can be integrated with an Emotionally Focused Family Therapy theoretical framework for work with young children and their families.     

The experiences of transgender and non-binary children and young people and their parents in healthcare settings in England,UK: Interviews with members of a family support group

Abstract

Background: Transgender and non-binary children and young people and their parents in England, UK are poorly served across a range of healthcare settings. Whilst UK equalities legislation and international guidance on transgender healthcare pathways protects this group from discrimination and mandates an affirmative approach, services in England are not keeping pace.

Aims: This study aims to draw on the experiences of transgender and non-binary children, young people and their parents in a support group in England in order to investigate their experiences of healthcare provision, and to develop some ideas for improvement.

Method: Data was collected with participants in a family support group which offers a parent helpline service, social groups for children and parents, and training for schools and other organizations. 65 parents and children from 27 families from the family support group attended participatory workshops where they were given a range of briefs: “health,” “family,” “friends,” and “education.” Their participation involved being asked to define their own interview questions and collect data by interviewing each other. Their interview notes constituted the raw data. Data was coded inductively by the author with respondent checking as a second stage.

Results: Results constitute the views of a small group of people, so cannot be generalized. However, they do illustrate some of the issues which may arise. Participants’ experiences elicited five key themes: professionals’ perceived lack of clinical and therapeutic knowledge; mental distress caused by excessive waiting lists; professionals’ stereotyped gender assumptions; direct discrimination within healthcare settings; and a lack of attention to parent and child voice, especially in terms of school-based experiences and where a patient had a diagnosis of autism.     

Treating Parents and Children Together

SUMMARY

In this paper I look at two traditions of psychotherapy with children: family therapy {here considered in its common paradigm of systems theory and not in its diversity of approaches) and individual psychodynamically oriented child therapy. The author examines how, in these two modalities of treatment, the real world of the parent-child relationship, which remains mostly a world of women and children, tends to be left out in practice. Many family therapists “exclude” children from their sessions and concentrate on the marital relationship while child therapists “exclude” parents from the core of the therapeutic process. The issues for therapists and the consequences for adults and children in families in this com-partmentalization of services are examined within a feminist framework. The development which is advocated is for therapists to expose themselves fully to the world of the parent-child relationship as a fust step in reexamining their stereotypical views of motherhood and fatherhood which trap women in conflicted and potentially exploitative situations and do not consider that children actively construct their own relationships.     

The Family Cycle: Breaking the Intergenerational Transmission of Trauma through Mentalizing

ABSTRACT

In recent years, attachment and mentalization theory have been used to guide and inform clinical work with complex, vulnerable adults and children, who struggle to make sense of their own experience or to understand and reflect upon the thoughts and feelings of others. Traumatized parents often have difficulty reflecting upon their children’s thoughts and feelings, at great cost to the child’s sense of trust and safety in the world. In this paper we describe the use of the Family Cycle a clinical activity designed to promote mentalizing in high-risk parents and children with histories of significant and often chronic developmental trauma – with parents whose children are enrolled in an intensive home visiting program aimed at avoiding psychiatric hospitalization. Our aim is to both help them make meaning of their own histories, and understand how these have, in turn, impacted their children. We first present the Family Cycle activity generally, and then use case material to describe its use with a parent in our program.     

Examination of the Eyberg Child Behavior Inventory Discrepancy Hypothesis

ABSTRACT

This study examined the Eyberg Child Behavior Inventory (ECBI) discrepancy hypothesis, which asserts that a discrepancy in score elevations on the ECBI Intensity and Problem Scales is related to problematic parenting styles. The Intensity Scale measures the frequency of child disruptive behavior, and the Problem Scale measures parent perception of their child's behavior as problematic. In a sample of 216 female caregivers of 3-to7-year-old children, the magnitude of discrepancy between T scores on the two ECBI scales was found to predict parental tolerance for child misbehavior. A one-standard-deviation difference in ECBI T scores identified (a) parents intolerant of their child's misbehavior when the Problem score was highest and (b) overly permissive parents when the Intensity score was highest.     

Mothers' attributions and expectancies regarding their conduct-disordered children

As an extension of Patterson's family coercion model, we hypothesized that parental attributions about the causes of child misbehavior and parental expectancies concerning the effectiveness of parenting techniques are involved in the establishment and maintenance of coercive exchanges. Mothers of 40 conduct-disordered children and 40 matched control children completed questionnaires measuring their attributions regarding the causes of their children's misbehavior and their expectations concerning the general and personal effectiveness of parenting techniques. Results supported the hypotheses: parents of conduct-disordered children were more likely to regard their children's misbehavior as intentional and to attribute it to stable, global causes beyond the parents' control. They also were less likely to see their own parenting as effective. We speculate that these parents hold cognitive stances of blame and helplessness that contribute to aversive parent behavior as well as to parent withdrawal in the face of escalating child aggressiveness.This article is based on a doctoral dissertation conducted by Anne Davison Baden while at Peabody College of Vanderbilt University, and was presented in part at the annual meeting of the American Psychological Association, New Orleans, August 1989.     

Modifications des relations intrafamiliales dans les familles françaises de jeunes enfants pendant le premier confinement lié à la COVID-19

IntroductionIn the context of the COVID-19 pandemic, the French state implemented containment measures requiring parents to stay at home with their children, while ensuring, in addition to daily tasks and work, their schooling.ObjectiveThe objective of this publication is to present the modifications of parent-child and spousal relationships during this period and their main sources according to the parents.MethodAn online questionnaire from 28 April 2020 to 29 May 2020 collected data from 490 French families with at least one child from birth to six years old. A content analysis of the discursive corpus was carried out with NVivo software (version 10). Quantitative statistical processing (using STATA software, version 16.1) tested the relationships between socio-demographic variables, as well as those relating to the parents’ experiences, and “strained” and “strengthened” intrafamily relationships.ResultsWhile for 33.3% of the respondents, family relationships did not change, they became stronger for 42.5% and tense for almost a quarter (24.3%).ConclusionUnderstanding the sources of tension experienced by families of young children during lockdown, as well as what enabled other families to better cope with this situation, may enable measures to be implemented to deal with the consequences of the discomfort generated by the lockdown and to avoid further psychological problems during possible future ones.     

Attachment relationships within a family system

Insecurity in attachment relationships may promote family interactions that involve (1) “capturing” an attachment figure, (2) turning to an inappropriate attachment figure, (3) inappropriate responding to attachment behavior, and/or (4) anticipating loss, similar to past loss. In a family with two small children, family therapy over all the sessions involved reducing the need to “capture” (point l), with the therapist acting as a secure base for each family member (point 2) and exploring the anticipation of past losses (point 4), so that the parents could become a secure base for each other and their children (point 3). Coding from videotapes focused on a few minutes of intervention concerning the problem child. The interactions formed a pattern suggestive of a pattern of attachment with each parent. How the family contributed to the origins and maintenance of each pattern was illuminated by the above four influences of insecurity.     

Parental meta-emotion structure predicts family and child outcomes

Abstract

Fifty-six families with a preschool child whose parents varied widely in parental marital satisfaction were studied at two time points: at time-I when the children were 5 years old and again at time-2 when the children were 8 years old. At time-1 each parent was separately interviewed about their “meta-emotion structure”, that is, their feelings about their own emotions, and their attitudes, and responses to their children's anger and sadness. Their behaviour during this interview was coded with a meta-emotion coding system. Two meta-emotion variables were studied for each parent, awareness of the parent's own sadness, and parental “coaching” of the child's anger. We termed the high end of these variables an “emotion coaching” (EC) meta-emotion structure. Meta-emotion structure was found to relate to time-1 marital and parent-child interaction. EC-type parents had marriages that were less hostile and they were less negative and more positive during parent-child interaction. Their children showed less evidence of physiological stress, greater ability to focus attention, and had less negative play with their best friends. At time-2 those children showed higher academic achievement in mathematics and reading had fewer behaviour problems, and were physically healthier than non-EC parents. The relations between child outcome and parental meta-emotion structure were not explained by social class variables, emotional expressiveness, or the greater happiness and stability of parents with an EC-type meta-emotion structure.     

Playing Together: DIR and Child Psychodynamic Therapy

ABSTRACT

This article describes the integration of the developmental, individual difference, relationship model (DIR) and relational child psychodynamic therapy. DIR is an effective treatment for many children with uneven development, not only for those on the autistic spectrum. The importance for child psychodynamic therapists to understand individual differences, as delineated by occupational and speech/language therapists, and to include parents within the treatment will be discussed throughout this article and in a particular case. An understanding of individual differences makes psychoanalytic formulations, especially about the body, more accessible and actionable. Overlooking the contribution of individual differences to a child’s play and development has consequences for progress in treatment. Together, DIR and child psychodynamic therapy can most effectively integrate “psyche” and “soma” (Winnicott, 1949). The child psychodynamic therapist’s particular expertise, in such areas as countertransference enactments and unconscious meaning, crucially contributes to this integration.     

Family Stress and Adjustment as Perceived by Parents of Children with Autism or Down Syndrome: Implications for Intervention

ABSTRACT

This study examined stress and adjustment in parents of three groups of families: those with an autistic child, those with a Down syndrome child, and those with only developmentally normal children. A total of 54 families participated, with 18 representing each group. Parents of autistic children generally reported more family stress and adjustment problems than parents of children with Down Syndrome who, in turn, reported more stress and adjustment problems than parents of developmentally normal children. Although parents of disabled children reported more stress associated with caring for their child, they generally showed resilience in adjusting to the presence of a severely disabled family member. Implications for family intervention are discussed.     

Narrative Solutions: Using Preferred View of Self to Motivate Individual and Family Change

This article describes refinements of the Narrative Solutions approach to individual and family therapy we first presented in Family Process 22 years ago. The centerpiece of this integrative (narrative‐strategic) model is “preferred view of self,” or the constellation of qualities people would like to see in themselves and have others see in them. We assume that problems generally involve one or more people mismanaging discrepancies or “gaps” between preferred views of self and either their actual behavior or how they see others seeing them and their behavior. Because clients are motivated to resolve such discrepancies, we use specifiable conversational strategies to help people (a) be clear about their preferred view of self, (b) notice gaps or discrepancies, and (c) summon resources to manage these gaps more effectively. Positive clinical effects of these strategic conversations can be rapid and dramatic. Case examples highlight applications to child and family problems, and we discuss some challenges and future directions for the Narrative Solutions approach.     

The Development of Family Alliance From Pregnancy to Toddlerhood and Child Outcomes at 5 Years

This article presents a longitudinal study of the development of “family alliance” from pregnancy to toddlerhood in a community sample, as well as its links with the emotional and cognitive development of the child at age 5 years. Family alliance is defined as the quality of the interactive coordination between family members. We consider that the alliance constitutes a context for the child to learn emotion regulation and to develop an understanding of inner states. Family interactions (N = 38) were observed at the 5th month of pregnancy and at 3, 9, and 18 months after birth in a standardized situation of observation (Lausanne Trilogue Play). Marital satisfaction and child temperament were assessed through self‐reported questionnaires. Several outcomes of the child at age 5 years were measured: theory of mind performances, predominant emotional themes in pretend play, internalized and externalized symptoms. Results show that (a) three patterns of evolution of family alliance occur: “high stable” (n = 19), “high to low” (n = 10), and “low stable” (n = 9); (b) a high stable alliance is predictive of better outcomes in children at age 5 years, especially regarding theory of mind; (c) the temperament of the child is predictive of child outcomes; and (d) an interaction effect occurs between family alliance and temperament. These results highlight the importance of both family‐level and individual‐level variables for understanding individual differences in the social and cognitive development of children.     

ABSTRACTS OF LITERATURE

Schizophrenia is due to a combination of genetic and environmental factors. The author asserts that there has previously been an error in conceiving the patient as being molded completely by external circumstances. In fact, it is the patient's behavior, which is a transformation of family irrationality, that constitutes schizophrenia. In 75 per cent of cases of schizophrenia seen by the author in private practice, the mother did not fit the image of the so-called “schizophrenogenic mother.” In this technique for teaching family therapy, the students take the roles of the family. Procedures, selection of players, formulating the problem, the value of the experience, and ground rules are described. This is a case report and follow-up over nine years of an alcoholic woman. The patient and husband were treated for 35 sessions by cotherapists in conjoint marital therapy. Although there was improvement in the family patterns and in drinking behavior during the treatment, the improvement did not last after termination. The case suggests that marital therapy in the absence of other treatment interventions is ineffective in changing the long-run course of women alcoholics. Based on the author's practice on an inpatient unit that specializes in the study of aggressive behavior, he describes family dynamics and treatment when the identified patient suffers from “episodic violent behavior.” The sample focuses on adolescents, most of whom had episodes of suicidal behavior and who had some evidence of “organic involvement.” Typical family patterns include overly close alliances by the adolescent with one or both parents and transmission by parents of inconsistent values regarding aggression. Family therapy is seen as the preferred treatment approach and emphasizes family ways of handling dyscontrol episodes and the responsibility of the patient for his or her actions. No results are reported. This study attempts to link family variation and core relationships in types of families with the mental health of children. Sample was from a black, poor, urban community defined in terms of the adults present in the home. Eighty-six family types were found falling into ten major classes. Measures of mental health in children were done on psychological well-being of the children and on Social Adaptational Status. Results indicate that family type is strongly related over time to child's SAS and his or her psychological well-being. Mother-alone families entail the highest risk in terms of social maladaptation and psychological well-being of the child; the presence of certain second adults has important ameliorative functions—mother/grandmother families being nearly as effective as mother/father families, with mother/stepfather families similar to mother-alone in regard to risk. Inferences from this data and implications and interventions are discussed. This is a clinical essay on the role of family therapy for black families. In addition to the usual family stresses, black families are subject to the additional strain of discrimination. Support is achieved mostly from the family and from the kinship network, rather than the community. Treatment strategies for this situation are proposed. This essay reviews recent regulations concerning consent procedures and protection of privacy as they apply to children and their families. Rigorous sample selection, nearly complete follow-up, and objective assessment of outcome are virtually impossible at this point. It is concluded that compliance with current “subjects' rights” regulations sometimes seems potentially more harmful to the subjects than the research itself. One case example is presented in support of the hypothesis that brief family therapy has the potential to lead to individual personality changes that are long-lasting. The identified patient was a 15½ year old boy with the symptom of having a falsetto voice. Father, mother, and child were seen in twelve family therapy sessions with changes in the boy's self-image documented in “man-figure” drawings. Nine-month follow-up revealed no recurrence of the presenting symptom and an improvement in social and familial relationships of the identified patient. This is another in a series of papers from a divorce-counseling project. The focus in this paper is on preventive clinical interventions developed for children of various ages in divorcing families. Developmental assessment was achieved with a “brief” history from the parents, detailed information from school, and “direct observation” of the child. This paper covers treatment strategies, interventions, failures, therapist's role, and professional dilemmas in divorce counseling of 60 families with 131 children between the ages of 3 and 18 at the time of divorce. The technique of counseling was to see one parent and child separately by the same therapist three to six times over a three-month period. This is a research study to provide data on the question of whether the disturbed behavior of parents with a schizophrenic child preexists or is a response to an identified patient's pathology. Method was to administer a conceptual task called the Twenty Questions Task individually to each family member and to the family as a unit with a sample of 36 schizophrenic families, 13 non-schizophrenic controls, and 38 normal controls. Results “indicated that far more schizophrenic sons than control sons were much more efficient individually than with their families.” A number of schizophrenic sons performed competently as individuals, but the subsequent performance of parents and sons together on the same task was generally inferior to that of the son alone. Results suggest that the parental behavior plays a part in the etiology of schizophrenia.     

Research & clinical exchange

Abstract

Question: Family therapists are often called upon to do consultations to schools about children having social and educational difficulties. In what ways is the family therapist's role different when he or she is called in to consult as an “outsider’ to the school system about a particular child whom he or she does not know, compared to being called upon by the school for advice about a child who is already being seen in treatment by that therapist?     

Parents of Adults with Intellectual and Developmental Disabilities (IDD) and Compound Caregiving Responsibilities

In some cases, parents caring for an adult child with an intellectual and/or developmental disability (IDD) must balance this with caregiving for another family member. This dual responsibility, referred to as “compound caregiving”, may contribute to increased feelings of distress, or change their perceived ability to care for their child. The current study examined how compound caregivers differ from other parents of adults with IDD, and whether compound caregiving is significantly associated with family distress. Data was available for 199 parents aged 38 to 91 years who were seeking adult services for their son or daughter with IDD. Parents completed a mailed questionnaire and telephone interview in which they indicated compound caregiver responsibilities. Parents identified as compound caregivers were then compared to those who were not in terms of family characteristics, as well as parental perceptions of burden and mastery, and family distress as measured by the Revised Caregiver Appraisal Scale and the Brief Family Distress Scale, respectively. Nearly half of the parents reported being compound caregivers. The demographic profile of these parents was no different from that of the other parents but their children were slightly younger. Compound caregiving was significantly associated with parental perceptions of burden and mastery and family distress. Demands outside of caring for an adult child with IDD can negatively influence family functioning and must be included as part of caregiving assessments.     

The child abusing family: I. Methodological issues and parent-related characteristics of abusing families

Abstract

The physical abuse of children by their parents is a family matter and should be viewed within the context of the family unit. Unfortunately, few child abuse studies have directly examined the family unit. Rather, most studies focus on characteristics of individual members of abusing families or on dyadic relationships within abusing families. Therefore, the present paper examines the family-related variables that might contribute to child abuse. This review is divided into two parts. Part I discusses methodological considerations and parent-related aspects of abusing families, including: characteristics of abusing parents, childhood experiences of abusing parents, marital relationships of abusing parents and the perceptions and expectations that abusing parents have of their abused children. Part II of this review, which will appear in a later issue, will cover child-related aspects of abusing families, parent-child interactions in these families, environmental conditions associated with child abuse and typologies of abusing families.     

Maternal fatigue and burnout: From self-forgetfulness to environmental expectations

ObjectiveThe main objective of this study is to explore, through a qualitative approach, maternal and family expectations that could be related to maternal fatigue and exhaustion. The secondary objective is to identify aspects that could be specific to a specific age group.MethodA total of fourteen French mothers aged 28 to 42 (mean age 32 ± 4.3 years), with at least one child under 10 years of age, participated in a Focus Group. Mothers were grouped into two groups according to the age of their child(ren): 1) with children between 0 and 1 year of age; 2) with children between 1 and 10 years of age. Several themes were discussed: mothers’ sacrifices and efforts, maternal fatigue and exhaustion, maternal, family and social expectations, and means of prevention. A thematic analysis and a classification analysis were carried out.ResultsThe thematic analysis revealed that exhaustion is partly related to expectations and family and social remarks. The classification analyses showed that mothers’ discourse can be classified into three classes: the first class called “Self-forgetfulness and its consequences” (38.1%); the second class called “The mother as the main manager of the family's daily life” (39.2%) and the third “Social pressure” (22.7%).DiscussionThis exploratory study shows that maternal exhaustion has its origin in the tasks and responsibilities often associated with maternal role as well as in the pressure exerted by family and friends. Although differences exist between mothers in the two groups, several factors appear to be independent of the age of the children. Prevention strategies are discussed in this article.     

Family process and child anxiety and aggression: An observational analysis

Barrett, Rapee, Dadds, and Ryan (1996) described a phenomenon whereby family discussions magnified the style of children's problem solving in a way characteristic of their particular clinical diagnosis. That is, anxious children became more avoidant, aggressive children more aggressive, and nonclinic children more prosocial, after discussing ambiguous hypothetical situations with their parents. This study examined specific sequences of communications exchanged between parents and children hypothesized to underlie this family exacerbation of child cognitive style. Family discussions were videotaped and categorized for groups of anxious, aggressive, and nonclinic children and their parents. Results revealed differences between groups of parents in frequency of agreeing with and listening to their child and the frequency of pointing out positive consequences. Conditional probability analyses showed that parents of anxious children were more likely to reciprocate avoidance, while parents of nonclinic children were more likely to agree with and listen to prosocial plans from their child. Differences in parent behaviors observed during the family discussions were reliably associated with the child's response to the ambiguous situation proposed after the family discussion. Results support a model of developmental anxiety and aggression that emphasizes the interaction of family processes and social-cognitive development in the child.This research was supported by grants from The National Health and Medical Research Council of Australia, The University of Queensland, and The Myer Foundation of Australia.     

Children of Nazi Germany 60 years on

Abstract

Defence against shock, feelings of guilt, and shame about German atrocities during National Socialism (NS) have dominated the public discourse in Germany for decades. Mitscherlich and Mitscherlich have talked about the inability to mourn due to the involvement of most German families in Nazi terror. The research projects “Childhood in War” at the University of Munich and “War Children and their Flight” at the Hamburg DPG Institute are studying the long-term implications of a childhood during World War II and the Nazi period. In most cases, the personal development of the “war children” was affected – in the case of psychoanalysts, their psychoanalytic socialisation and current professional practice as well. The transgenerational transmission forms an NS introject in the personality. Due to their parents’ lack of empathy, war children are unconsciously looking for a containment of their unbearable feelings in their childhood. Psychoanalysis (including training analysis) becomes a stage where the analysee's childhood loneliness, the taboo-forming, the inhibition to ask and the protection of the parents, as well as feelings of guilt and embarrassment in the family, not talking about matters, and silence, occur once more in transference.