Family Survivors of Homicide: II. Practical Therapeutic Strategies

As more and more mental health clinicians become involved in the criminal justice system, family therapists will see increasing numbers of crime victims in their caseloads, and some of these families will have lost loved ones to murder. Part I of this two-part article described the common and atypical symptoms, syndromes, and reaction patterns shown by families who have experienced the murder of a loved one. Part II presents a practical model for treating family survivors of homicide that incorporates cognitive-behavioral, psychodynamic, family systems, and existential components. Throughout, the emphasis is on therapists being equipped with a sufficiently broad range of clinical tools to treat these survivors flexibly, effectively, competently, and compassionately.     

Therapists Ratings of Fundamentalist and Nonfundamentalist Families in Therapy: An Empirical Comparison

Using the Family Health Scale, Part I of an instrument developed for this study, two randomly selected groups of certified family therapists rated either nonfundamentalist or fundamentalist families in therapy on eight recognized indicators of family health. Factor analysis yielded eight factors accounting for 66% of the variance between groups. Cannonical discriminant function analysis revealed that therapists rated fundamentalist families as significantly less healthy on three of the eight factors and more healthy on one factor. Part II of this instrument, the Religion Impact Scale assessed the effects of church community and church teachings upon families. For fundamentalists, the church and concomitant belief system had a significant impact upon family organization and functioning. Theoretical and clinical implications of these findings are discussed.     

Engaging “Resistant” Families in Treatment

Many families, when presented with the option of family therapy, are less than eager to participate. This paper comprises the second and third parts of a series on engaging “resistant” families. ¹ 1 The first paper in this series, authored by J. M. Van Deusen, M. D. Stanton, S. M. Scott, and T. C. Todd, is entitled “Engaging “Resistant” Families in Treatment: I. Getting the Drug Addict to Recruit His Family Members” and appeared in the International Journal of the Addictions 15 (7): 1069–1089, 1980. A revised and expanded version of Part II is presented in M.D. Stanton, T. C. Todd, and Associates, The Family Therapy of Drug Abuse and Addictions New York, Guilford, in press.
Part II presents 21 principles and a number of techniques and strategies that have been developed for successfuly recruiting such families. These techniques should be applicable for engaging resistant families with all types of presenting problems. Part III provides an analysis of the important variables involved, along with data on cost efficiency and administrative costs. It was found that when therapists had administrative control of their cases, serving in dual roles as both therapists and drug counselors, the recruitment effort was (a) more effective (i.e., complete families, including both parents or parent surrogates, were recruited in 77 per cent of the cases), and (b) twice as cost efficient. Two-thirds of the non-engaged families were not recruited because the index patient would not allow family members to be contacted. Black families were more difficult to recruit than whites. Data on cost efficiency and on the actual administrative costs of recruiting families are also provided. We conclude that the engagement process requires a revision in therapeutic philosophy, since such families are often desperately in need of help but are unavailable unless therapists make a special effort to reach them.     

Police Families: Stresses,Syndromes, and Solutions

Law enforcement families experience a variety of both commonplace and unique stressors. This article discusses the main forms of police family stresses and crises and offers a range of practical solutions that family therapists can use to help these families cope and thrive. Especially with this kind of population, the emphasis is on both direct clinical services and a coaching-style, self-empowerment model that therapists can productively utilize in helping officers and their families to help themselves.     

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.     

Difficulties in Family Therapy Evaluation I. A Comparison of Insight vs. Problem-Solving Approaches II. Design Critique and Recommendations

In Part 1, an outcome study comparing two methods of family treatment, is reported. Families were randomly assigned to one of two forms of conjoint therapy: an Insight-oriented treatment (N = 10 ) or a Problem-Solving intervention (N = 10 ). The results on self-report measures of family functioning indicate that the Problem-Solving intervention produced more favorable changes after three months. Experienced therapists did better than inexperienced therapists in the Insight-treatment condition but level of experience did not make a difference in the Problem-Solving therapy. A group of eight families who dropped out of the Insight-treatment group provided data on correlates of premature termination. In Part II, the study is critically reviewed. The practical obstacles to implementing an experimental design in a clinic setting are considered. Special attention is given to issues involving the selection of treatment and control conditions: sampling and the measurement of outcome. Alternatives to experimental designs are considered.     

"If I Don''t Get Simple, I Cry"

Poor families have taught us special lessons that are applicable to all families. They have instructed us about the problems, within families, of developing relationships adequate to the tasks of family life. One consequence is that therapists are attending more to the evolution of the structure of family relationships, particularly, the phenomenon of underorganization. Poor families have also provided insight into the dynamic relationship between families and their social context. As a result, a therapeutic perspective is emerging that focuses on the influence of the community on the individual and the family, a perspective that may be called an eco-structural approach to therapy.     

Adolescent Sexual Assault Disclosure: The Impact of Peers, Families, and Schools

Adolescent sexual assault survivors are more likely to seek support from peers and families than to formal help systems, such as the medical and legal systems. In this study, we conducted in-depth qualitative interviews with N = 20 adolescent sexual assault survivors aged 14–17 who obtained services from Sexual Assault Nurse Examiner Programs to understand the pathways that led them to seek formal help. Our goal was to examine how survivors’ initial disclosures to peers, families, and schools facilitated adolescents’ access to formal help systems. Additionally, we explored how peer, family and school systems interact as mesosystems to effect subsequent disclosures. Results show that the peer and family microsystems were decisive in survivors’ willingness to enter formal systems. Disclosure became more complex when peer, family, and school personnel all became aware of the assault. When these mesosystem interactions occurred with survivors’ consent and produced a helpful response, they were perceived as positive. Alternatively, mesosystem interactions in which survivors had minimal control resulted in greater reluctance to enter formal systems. These conclusions highlight the need educating informal support providers about community services in order to make the disclosure process easier and beneficial for survivors’ recovery and well-being.     

Critical incidents: Life events for experienced family therapists

Summary The results of this investigation suggest that therapists' professional style and clinical use of self patterns are impacted by critical life events occurring in their personal life. Many subjects reflected on how changes in their family constellations (both family of origin and family of procreation) were important to their professional development. They frequently mentioned that marriage, children, divorce, and illness or death of a loved one impacted their personal and, then, their professional lives. The important life events of becoming a parent or losing a significant loved one was specifically mentioned as strongly influencing changes in one's professional direction and therapeutic style.Becoming a parent caused the interviewees to reevaluate their expectations of their own parents, their client families and themselves. Changes in career aspirations, interactional patterns, and the capacity to be consistent and calm were explored and understood differently. Many subjects described how this transition in their own life shifted their primary focus and altered many of their existing relationships. In particular, female therapists with younger children related how their sense of being female changed. They sought out other women for intimate contact more frequently, they understood their own mothers better, and they frequently were less judgmental of mothers in their client families.Along with creating their own families, death of a parent was keynoted as having a strong impact on the subjects' personal and professional lives. They described questioning (and frequently changing) the amount of time they spent working and the type of work they did. Many began to push for more emotionally intense relationships personally and therapeutically. Detailing how their therapeutic goals for a family now included connection-making rather than just problem solving, they described being much more willing to share their vulnerabilities and personal needs with clients.     

Family therapy and outcome: Relationships between therapist and family styles

This study examined therapeutic outcome for a group of 175 clinic families divided into levels of family competence and style, and, later, into seven clinical groupings. The division into these groups was based on the level of rated Competence and Style determined by using the Beavers Systems Model. Therapists also rated their level of Openness/Sharing Strategy, Power Differential, and Partnership with the family at the third session. Results indicate that more competent families who fared well in therapy had therapists who formed a partnership, disclosed strategy, and employed a minimal power differential with the family. The most disturbed families, and those with a Centrifugal style, did better with therapists employing a high power differential and lower levels of openness and partnership. The study also presented the distribution of individual diagnoses by family groups. Implications for family therapists, including the value of family assessment, are provided.     

Power and influence in the environment of family therapy*

This paper explores some of the ways in which family therapy theory and practice limits an appreciation of the contexts of families and family therapists. It focuses particularly upon how the rules which underlie patterns of relationships in social systems are made and maintained more by one part of a system than by another, and considers this (a) within families, (b) within various aspects of the social environment of families, and (c) within the organizational contexts of family therapists. It then proposes that the systemic thinking which family therapists apply to families is potentially applicable to wider contexts including international relationships.     

Power and influence in the environment of family therapy

This paper explores some of the ways in which family therapy theory and practice limits an appreciation of the contexts of families and family therapists. It focuses particularly upon how the rules which underline patterns of relationships in social systems are made and maintained more by one part of a system than by another, and considers this (a) within families, (b) within various aspects of the social environment of families, and (c) within the organizational contexts of family therapists. It then proposes that the systemic thinking which family therapists apply to families is potentially applicable to wider contexts including international relationships.     

Healthcare Policy in the United States: A Primer for Medical Family Therapists

As family therapists increasingly practice in healthcare settings, they need to be aware of forthcoming changes in healthcare policy and the impact of these changes on their clinical work and the lives of their clients. In this paper, we provide a primer on healthcare policy for family therapists, which describes current and proposed changes in healthcare that will potentially revolutionize healthcare delivery for families. We describe three key initiatives: (1) Triple Aim; (2) the Accountable Care Organization; and (3) the Patient Centered Medical Home. We conclude with a discussion about future directions and healthcare policies that include families.     

EMOTIONAL MEMORIES OF FAMILY RELATIONSHIPS DURING THE HOLOCAUST

This article examines psychosocial aspects of family/parent-child relationships during the Holocaust by focusing on the emotional memories of such relationships. Global and thematic analyses were undertaken on 93 life story interviews and testimonies with Holocaust survivors. Results showed that survivors who lived through most of the war with parents/family and those who had lived approximately an equal time with loved ones and without them were able to recall and narrate more emotional memories, both positive and negative, than people who had experienced the traumatic period mostly on their own. However, going through the war with family did not guarantee the narration of emotional memories; close to half of these victims could not recall/narrate such memories. In general, when the survivor recalled relative emotional security, she or he felt safe, even when physical danger was imminent. However, this feeling did not always continue when the physical situation worsened or when the survivor was separated from loved ones. It was suggested that the ability to recall and narrate emotional memories highlights the heterogeneity in family relationships that existed during the Holocaust and the kinds of family relationships that developed after the Holocaust.     

Countertransference and the developing family therapist: Treatment and supervision issues

All therapists experience reactions toward clients, which have traditionally been called countertransference. Such reactions toward families pose special issues for beginning and developing family therapists. This clinically based and clinically oriented article describes some of the reactions, clues pointing to their existence, and indicates some of the ways beginning and developing family therapists and their supervisors and consultants can deal constructively with these reactions.     

Engaging refugee families in therapy: exploring the benefits of including referring professionals in first family interviews

The possible benefits of including referring professionals in the first family interviews are being explored as a way to engage refugee families in therapy. Families in exile confront a number of problems related both to premigration traumatic exposures and to present adaptation processes. Refugee clients and the referring professionals in the larger system frequently see the problems and their solutions quite differently. This situation may often result in unclear working alliances in a context of therapy. We will describe first family interviews in which referring professionals are interviewed about their reasons for referrals, and where the families are invited to discuss these considerations. The conversations permit families, referrers, and therapists to reflect upon differences in positions and perspectives. Their experiences suggest that agreements or contracts based on these joint interviews are less ambiguous and more clearly formulated than contracts based on interviews with families alone. Finally, these experiences are discussed as a potentially valuable approach in a cross-cultural context.     

The Challenges of COVID-19 for Divorcing and Post-divorce Families

COVID-19 and the accompanying procedures of shelter-in-place have had a powerful effect on all families but have additional special meanings in the context of families contemplating divorce, divorcing, or carrying out postdivorce arrangements. This paper explores those special meanings for these families. It also offers suggestions for couple and family therapists involved in helping these families during the time of COVID-19.     

Practising family therapy in India: how many people are there in a marital subsystem?

Systemic therapy would appear to be a viable form of treatment for people who exist in cultures that contain complex, extended family systems, such as those found in India. The practice of family therapy in India has evolved from Western concepts. These concepts appear to offer Indian therapists relevant and practical ways of working with families. However, some of these concepts need modifying before they can be used in an Indian context. Indian families may have very different worldviews and ideas of 'self' compared to families in the West, leading to different family organization. The situation can be further complicated by the cultural norms of therapists themselves. Therapists in India are often highly educated, come from upper-middle-class families and have been exposed to different cultures. They increasingly share many of the values of their counterparts in the West. At the same time, they retain aspects of their own cultural heritage, which is also the dominant culture for a large number of the families with whom they work. Thus, not only must Indian family therapists seek to work in culturally appropriate ways; they must also tolerate their own internalized conflicts regarding differing cultural norms. With the use of clinical data, this paper describes some of the personal and professional problems experienced by an Indian family therapist working with Western constructs of family organization.