Integrative family therapy for high-conflict divorce with disputes over child custody and visitation

A growing number of divorcing families become locked in intractable disputes over child custody and visitation. This article describes an integrative family therapy approach targeted toward such families. Aspects of this treatment include negotiating a clear therapy contract, creating a multipartial alliance with all parties, assessing through the lens of specific understandings about these cases, incorporating multiple therapy session formats, holding both systemic and individual focused perspectives, incorporating a solution-oriented focus, and drawing upon a wide range of intervention techniques. The treatment aims to create a good-enough postdivorce climate in which a new family structure can be constituted in which parents maintain distance from one another, and conflict and triangulation can be minimized.     

A family system perspective on custody and adoption

This paper will define the conceptual models of an internalized family image and an external psychological family as derived from psychoanalytic and family therapy studies, and relate these models to several issues impinging on custody, adoption, and foster care. Several suggestions based on these models and illustrated by clinical material will be presented which, if applied by families, and mental health, social, and legal authorities, can facilitate the creation of a psychological family, or at least an ambiance imbued with the concepts of a psychological family, for use in the construction of a family image by unrooted children.Dr. Sonne is Clinical Professor of Psychiatry and Human Behavior, Jefferson Medical College; Visiting Clinical Professor of Psychiatry, Hahnemann Medical College; Emeritus Director Clinical School, Family Institute of Philadelphia; Senior Attending, Institute of the Pennsylvania Hospital.     

Re-editing family mythology during family therapy

Family mythology includes false or edited beliefs about the present which may be coupled with family legends which support those beliefs. Families are particularly likely to use their histories dys-functionally if they either see the present as an exact replication of the past or, in contrast, deny that the past has any relevance whatever. Re-editing myths involves enabling families to alter their relationships and their self perceptions. This allows a fresh exploration of the past; a process which can support and encourage further change. Case material is used to illustrate this.     

Medical family therapy: an emerging arena for family therapy

This paper describes an important recent development in American family therapy. Medical family therapy uses a biopsychosocial systems model to work with families who have a member with a chronic illness or disability. The authors maintain that family therapy has tended to embrace the mind–body split and to view itself too narrowly as a mental health specialty. Medical family therapists work collaboratively with physicians and other health professionals to help families achieve a sense of agency and communion in facing some of the greatest challenges that life brings.     

Restorying family therapy

This article describes a multi-systemic model of therapy developed by the author over the past decade and summarizes the main products of this project: Explication of key family systems notions, strategic family play therapy, multi-systemic therapy, and culturally-competent family therapy. The model incorporates beyond the family system, culture, wider ecosystems, psychodynamics, and the individual's neuropsychological, cognitive, and socio-emotional development. The model enables the therapist to design flexible multimodal interventions.     

Transcultural family therapy

Conventional family therapies such as Structural, Systemic, Satirian, Adlerian and Dreikursion seem to be marked by cultural biases and give an indication of one single culture orientation. These seem to represent the cultural majority norms and values in acting as oppressive tools in a multi cultural society. Most of these therapies are derived from theories reflecting intrapsychic factors that are white middle class concepts, neglecting the multi culturaUsocia1 contexts in family therapy. “Ethnic minority families” from non Western Countries often experience more problems than families from Western Countries in the areas of education, immigration, employment and health. The cultural expectations are full of contradictions and ethnic minorities feel handicapped both socially and culturally in the task of growth and development. Western family therapy has failed to address these issues.     

Fairy-tales and teaching family therapy

This paper sets out to illustrate how well-known fairy-tales can be adapted to serve as a useful teaching tool in family therapy. Familiarity with fairy stories means they can be used as a ready access to common family constellations and dynamics. This may be particularly useful when asked to present an introductory workshop or single lecture to participants unsophisticated in family therapy conceptualizations or practice. Potential clinical applications are also briefly mentioned.     

Ibsen's truth, family secrets, and family therapy

In certain Ibsen plays a character (would-be family therapist) enters during a crisis revolving around family secrets. Taking two such plays as models, this paper examines family processes and clinical issues surrounding secrets and myths. In Ghosts, Ibsen demonstrates the tragic foreclosure visited upon the Alvings' lives by a generation of secrecy. For contrast, in The Wild Duck the would-be reformer Gregers brings out the truth, to expose and correct consequences of his father's past machinations. The biographical roots of Ibsen's obsession with truth and illusion are explored. Lastly, the notion that Ibsen and early family therapist were reformers is viewed in historical perspective.     

Structural family therapy with Mexican-American family systems

Characteristics of traditional Mexican-American families with consequent family rules that affect these family systems are discussed along with selected clinical cases. The specific cases discussed involve: (1) interactions with family of origin in intercultural marriages, (2) intracultural differences in levels of acculturation and traditional family rules, and (3) extended family impact in response to severe life crisis. The development of therapeutic processes from structural and strategic family therapy approaches, which reflect appreciation for cultural differences and strengths, is suggested.This material was presented at the annual meeting of the Texas Association for Marriage and Family Therapy, January, 1994, San Antonio, TX.     

Art therapy in transcultural family therapy

The increased existence of foreign culture patterns in the child population calls for transcultural comprehension in child psychiatry. This case report describes transcultural aspects in the therapy of an 11 year-old Moslem girl admitted to a child psychiatric department. Her symptoms were abdominal pain, headache, anxiety, and pretended fever. A family therapeutic approach was used together with elements of art therapy and individual therapy in a successful treatment. The family therapeutic approach was based on art therapy as a part of the communication where cultural symbols were an important part. An interpreter was not used. The cultural context where it is acceptable to overstep the borderline between reality and fantasy is seen as an important healing capacity.I would like to acknowledge my debt and my appreciation to Ebba Ernst, psychologist of the department and supervisor in the therapy of the S. family. I would also like to thank professor Kai Tolstrup and child psychiatrist Torben Marner for stimulating support in the process of writing the article. A grant from Enkefrue Hermansens Mindelegat made the participation in the Krakow Congress possible.     

A follow-up of families disputing child custody/access: Assessment,settlement, and family relationship outcomes

In this pilot study, 49 parents who had been involved in a custody and/or access assessment several years previously responded to a structured telephone survey. Information about eventual settlement processes, custody and access arrangements, satisfaction with the clinical assessment, children's adjustment, family relationships, and ongoing family problems was gathered an average of two and one half years after the assessment. Sole custody arrangements evidenced the greatest degree of stability from assessment to follow-up, while joint custody arrangements were more unstable. Visitation was not occurring for a substantial number of children (35%) at follow-up, even when it was recommended on a regular and frequent basis. Although parents reported little or no ongoing contact with their ex-spouse, they also reported continuing concerns and new problems with respect to the other parent or their children. The impact of this form of “parallel parenting” is discussed within the context of high-conflict, multiproblem families.     

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.