Child and family therapy: A collaborative approach

Abstract

When a child is the identified patient, people often expect individual sessions to be a part of treatment. Yet, family therapists routinely violate this expectation by working with children solely in the context of the family. This article discusses how the therapeutic process can be facilitated by conducting at least a small number of individual sessions with children. Such behavior by the therapist communicates to children, parents, and involved referral sources a respect for their opinions and lays the groundwork for cooperation. The advantages and disadvantages of such an approach are discussed.     

Sequential analysis as a method of feedback for family therapy process

Abstract

The purpose of this study was to examine the relationship between therapist verbal behavior and family cooperation and resistance during the second session of family therapy with juvenile delinquents. Sequential analysis was used to investigate the impact of one therapist's behavior on family resistance and cooperation in a sample of 12 families. The results of the sequential analysis revealed that therapist “support” and “teach” behaviors were associated with significant increases in the likelihood of family cooperation. The study provides an example of how sequential analysis can be used to inform family therapists about the impact of their behavior on families.     

Bulletin Board

Abstract

When psychotherapy is viewed as shared reconstruction, there are implications for both clients and therapists. My clients become sources of expectations, myths, thought, and feelings about themselves and their therapists. I, as therapist, become a source of intentions and reflections, with capacities for self-awareness and abilities to construe my clients and their constructs, languages, and metaphors. Both participants in psychotherapy can then be seen as involved in reconstruction through the sharing and rebuilding of narratives. It is the life stories of clients that are likely to be more changed in therapy, but my life stories and my stories about the therapeutic process are also open to change     

Creating therapeutic realities via responsibility messages

Abstract

This paper proposes that operating from an ecosystemic epistemology does not preclude a family therapist from focusing on the individual responsibility of each family member. Rather, a systemic therapist can examine the family's pattern of distributing responsibility and map how this perpetuates the presenting problem. Examples from early, middle, and late therapy illustrate how a clinician can design interventions to encourage responsible behavior on the part of each individual, while being mindful of typical transactional patterns in the system     

Sacrificing Value

ABSTRACT

When is sacrifice – and particularly self-sacrifice – called for? This question turns out to be difficult to answer, for it tends to arise when values conflict, and hence the answer to it depends on how conflicts of values are to be resolved. If values are constructed, and if there is no single right way to construct them or prioritize them when they conflict, though there are identifiable ways in which the construction of values can go wrong, we may be left in a position of ambivalence about what should be sacrificed. In cases of conflict in which self-sacrifice is one of the options, ambivalence may be particularly appropriate. In part this is because there may be in such cases special sources of plurality and incommensurability of values, because the conflict is likely to be between something that is valued by a social group, and something that is valued particularly by an individual who has to consider self-sacrificing. And in part it is because individuals may have trouble balancing self-regarding and other-regarding concerns in the process of value construction. This paper elaborates these complications, and presents cases in which we might suspect that someone has self-sacrificed too much or too little.     

'But they aren't motivated …' issues concerned with encouraging motivation for change in families

This article is an attempt to provide some frameworks for understanding aspects of the context of families which support or constrain motivation for change. A theme of the entire paper is that ambivalence is normal and that it is therefore useful to regard families both as motivated to change and motivated to maintain stability. Part I focuses particularly upon family–referrer– therapist relationships and Part II upon family–therapist relationships. Part I begins with an exploration of the idea of motivation as a process and outlines the usefulness of the concept of ambivalence. Its main focus however is upon the importance of considering referrers when attempting to assess the motivation of family members for change.
Part II considers the relationship between the family and the therapist and takes account of some important aspects of the contexts of both. It ends with a summary of some experiential exercises which enable one's personal understanding of motivation issues to develop.     

Looking at Systems as Process

This article proposes that the social systems family therapists are concerned with may usefully be conceived of as interactive processes. It discusses limitations to the organismic view, in which social systems are seen as autonomous entities with boundaries, internal structures, and self-perpetuating behaviors, and argues, from Maturana and Varela, that social systems are qualitatively different from organisms. It develops from chaos theory an alternative view in which social systems are seen as complex nonlinear processes. It proposes that this view can free the therapist from the notions of family dysfunction and the systemic function of symptoms, and from reifications in which the family is seen as having covert rules, keeping secrets, neutralizing the therapist, and the like. This view leads to a redefinition of the therapist's place in the system and to the conclusion that family therapists can only influence systemic process by working with individuals.     

Using Genograms Creatively to Promote Healthy Lifestyles

ABSTRACT

Family therapists have used Genograms as an assessment tool for years to examine the interactions and relationships of family members across generations. This article discusses how a therapist can use a genogram creatively to help clients examine the impact of family relationships on healthy and unhealthy lifestyle patterns and how those relationships may be influencing the manner in which clients are currently managing their lives. The integration of a creative genogram can assist clients in recognizing inherited health-disease risks, learned lifestyle patterns, and parental behavior modeling. This technique can assist clients in developing a healthier lifestyle.     

On the witness stand:

Abstract

The family therapist is frequently called upon to testify as an expert witness. For many family therapists, the courtroom is an unfamiliar environment with different ground rules and basic assumptions. Testifying can be a difficult experience as the mental health professional faces different situational role demands than those encountered in usual therapeutic settings. If the family therapist can transfer to the court context the art of influencing interpersonal situations, the effectiveness of his/her testimony will be enhanced. This paper describes predictable legal behaviors and suggests to the family therapist strategic responses to improve skills as an expert witness.     

Death in the Family: Adapting a Family Systems Framework to the Grief Process

This paper presents a framework for adapting a family systems approach to the grief process. The framework places the bereaved and therapist in the larger context. The therapist builds a relationship around each family member's unique experience with death, and uses the grief timeline to facilitate timely systemic interventions. This perspective helps the therapist navigate pitfalls and remainstrategically positioned to address grief sensitively and effectively in psychotherapy.     

Ambivalence and Alliance Ruptures in Cognitive Behavioral Therapy for Generalized Anxiety

Client ambivalence about change (or motivation) is regarded as central to outcomes in cognitive behavioral therapy (CBT). However, little research has been conducted to examine the impact of client ambivalence about change on therapy process variables such as the therapeutic alliance. Given the demonstrated limitations of self-report measures of key constructs such as ambivalence and motivation, the present study instead employed a newly adapted observational measure of client ambivalence. Client statements regarding change (change talk (CT) and counter-change talk (CCT)) were coded in early (session 1 or 2) therapy sessions of CBT for generalized anxiety disorder. The frequency of CT and CCT was then compared between clients who later experienced an alliance rupture with their therapist, and clients who did not. The results showed that clients in dyads who later experienced an alliance rupture expressed significantly more CCT at the outset of therapy than clients who did not later experience an alliance rupture. However, CT utterances did not significantly differ between alliance rupture and no-rupture groups. CCT may strain the alliance because clients expressing higher levels of CCT early in therapy may be less receptive to therapist direction in CBT. Consequently, it is recommended that clients and therapists work together to carefully address these key moments in therapy so as to prevent alliance rupture and preserve client engagement in therapy.     

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?     

Tales of a Therapist

ABSTRACT

Historically, theorists and clinicians from various schools of family therapy have discussed therapist self-disclosure in terms of either helping or inhibiting therapeutic progress. Although postmodern language-based theorists and therapists accept and encourage its use, few clinical examples of therapist self-disclosure exist in the family therapy literature. In this paper, a postmodern family therapist working within the language-based tradition describes the use of self-disclosures with a couple. The therapist then reviews the effects of those self-disclosures through the eyes of husband, wife, and therapist.     

Utilizing artistry in a therapeutic relationship

Abstract

In many humanistic approaches, therapeutic change involves utilizing the relationship between the client and therapist as a tool for personal growth. Like any relationship, the therapeutic relationship is one that is co‐created between those engaged in it, namely, the client and the therapist. Utilizing this co‐created relationship requires a sense of artistry on the part of the therapist. A therapist must be willing to engage in this meaningful relationship with the client. A therapist must also be aware of the personal values that he or she brings into therapy, and how they influence the therapeutic relationship. Finally, a therapist must acknowledge the power that the therapist and the client possess in the relationship, and understand how that power can be used to validate and invalidate the therapist's and the client's personal meanings. These aspects of therapeutic artistry are discussed and the use of therapeutic artistry in Eron and Lund's (1996) narrative solutions approach is presented.     

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.     

Engaging with change: a process study of family therapy

It is argued that current attempts to investigate the process of family therapy might benefit from the application of discursive and narrative analytic techniques. An example of such an analysis is given, taking the work of an experienced family therapist with one family seeking help in dealing with the aftermath of a marital separation.' The theme of how to deal with change'as it materializes in the discussions during therapy is selected for detailed examination in this paper. It is argued that there are two main discourses on this theme evident in the family's discussions, one being that the separation has occurred and its consequences should now he left to arise naturally; the other being that the effects of the separation need to be actively managed. It is suggested that this analytic procedure can dramatize the subtle changes in family discourses during therapy; its limitations in terms of generalizability, and the difficulties of dealing with huge amounts of complex material, are also noted.     

One-person family therapy? An analysis of family therapy schools

Abstract

In this article, eight schools of family therapy (psychodynamic, intergenerational, contextual, experiential, structural, strategic, functional, behavioral) are examined regarding participation policies. Differences in schools' participation policies are compared and contrasted using comparative and content analyses. Schools' theoretical rationales and how they effect therapy practice are explored. Implications for therapy practice are presented. The study's goal is to provide information to increase therapist flexibility in working with varying client populations.     

D.H. Lawrence's The daughter-in-law: Transforming a family system

Abstract

D.H. Lawrence's play The daughter-in-law, written in 1912, explores underlying, implicit conflict within a family. Set in a small mining town in England, the family consists of Mrs. Gascoyne, her sons Luther and Joe, and her daughter-in-law, Minnie, Luther's wife. The central conflict is between Mrs. Gascoyne and Minnie, who challenges her mother-in-law's control over her sons, who also compete with each other for the love and recognition of their mother. Joe, the youngest son, perturbs the family system and acts as a mediator, functioning as a family therapist. He sets a process in motion through which the rigid family alliances are challenged and ultimately realigned. Mrs. Gascoyne's self-image as a perfect, self-sacrificing, self-righteous mother ultimately is transformed, and she accepts Minnie as a family member. Brandchaft's concept of “pathological accommodation” explicates how enmeshed family members can collide, and thereby stultify their personal development. As Joe plays his role of “family therapist,” the family dynamic changes. Through the process of rupture and repair, each family member begins to recognize the needs of the other, and thereby a path for differentiation, individuation, and autonomy becomes possible for them.     

Case Report: Object Relations Family Therapy as a Model for Genetic Counseling

Object relations family therapy (ORFT) is a psychoanalytically based approach for the treatment of couples and families which stresses the importance of past relationships. The therapist assumes a parentlike role and provides a holding environment in which clients can explore unconscious motivations. This paper will discuss the applicability of this method to genetic counseling. The case of a couple seen for recurrent trisomies will be presented and used as an example to discuss how ORFT might serve as a framework in a genetic counseling session.