Family-level impact of the CHAMP Family Program: a community collaborative effort to support urban families and reduce youth HIV risk exposure

This article presents family-level results from an ongoing study examining the impact of the CHAMP (Chicago HIV prevention and Adolescent Mental health Project) Family Program, a family-based HIV preventative intervention meant to reduce the amount of time spent in situations of sexual possibility and delay initiation of sexual activity for urban youth in the 4th and 5th grades living in neighborhoods with high rates of HIV infection. The CHAMP Family Program has been developed, delivered, and overseen by a collaborative partnership, consisting of community parents, school staff, community-based agency representatives, and university-based researchers. Design of the program was informed by input from this collaborative partnership, child developmental theory of sexual risk, and empirical data gathered from the targeted community. This article presents findings that suggest CHAMP Family Program impact on family communication, family decision-making, and family-level influences hypothesized to be related to later adolescent HIV risk. Implications for future family-based HIV prevention research are discussed here.     

The family check-up: a pilot study of a brief intervention to improve family functioning in adults

Many barriers exist for families seeking appropriate treatment for family problems. In an effort to minimize some of these barriers, we developed the Family Check-Up, a brief two-session family intervention. The Family Check-Up is based on the Drinker's Check-Up and consists of assessment, feedback, discussion, and goal setting. The purpose of the intervention is to help families identify and become motivated to make needed changes in any aspect of their family functioning. We conducted an open pilot trial of the Family Check-Up with 32 families. Our data suggest that the Family Check-Up (1) is sought out by the target audience, namely those with family problems; (2) is sought out by people with elevated depression symptoms or a history of treatment for depression or anxiety; (3) is feasible to conduct; (4) is acceptable to families; and (5) may be associated with changes in family functioning and depression symptoms over time. These results suggest that further research, particularly a randomized clinical trial, is warranted.     

Relationship of Attachment Style to Personality Factors and Family Interaction Patterns

This study investigated the relationships among attachment, personality style, and family interaction patterns. The results revealed that avoidant attachment style was associated with indirect affect expression as measured by somatic complaints, social isolation, family disengagement, and family conflict avoidance. Anxious/ambivalent style was associated with more overt expression of depression and anxiety. Family factors were not significantly related to either the anxious/ambivalent or secure styles. The implications and potential therapy benefits for use of attachment theory in family therapy and directions for future research are also addressed. Marci Leveridge, PhD, is a Licensed Health Service Provider and private practitioner in Oklahoma City. Cal Stoltenberg, PhD, is Professor, Counseling Psychology Program, University of Oklahoma, Department of Educational Psychology, 820 Van Vleet Oval, Room 321, Norman, OK 73019-2041 (cstoltenberg@ou.edu). Denise Beesley, PhD, is an Assistant Professor in the Counseling Psychology Program at the University of Oklahoma.     

Wilderness family therapy: An innovative treatment approach for problem youth

We present a treatment program (The Family Wheel) designed to integrate wilderness therapy interventions with family therapy for the treatment of troubled adolescents. The Family Wheel program was conducted in the high desert of southern Idaho. Participation in this four-day program required parents and their adolescent children to engage in an intensive experiential family therapy while camping and trekking in the wilderness. An evaluation of the program revealed positive outcomes for the programs' participants. The theory, research, and pragmatics of conducting such an innovative program are discussed.     

Family psychopathology: Cross training graduate marital and family therapy students in family assessment and psychiatric nosology

The structure of a course entitled Family Therapy with Major Psychopathology taught annually in the Mercer University Graduate Marriage and Family Therapy Program is presented. An epistemological presentation regarding the interface of psychiatric nosology and family systems assessment is discussed. Methods of diagnosing and assessing dysfunctional family systems are presented and training in individual psychiatric nosology is discussed, with particular attention given to family systems dysfunction as an etiological factor in the development of individual psychopathology. Learning techniques are discussed including lecture, discussion, case presentations, readings, and testing methods.     

Outcomes of an Intensive Couple Relationship Education Program with Fragile Families

Couple relationship education (CRE) has been proposed as one means to help fragile families stabilize their relationships. The current research is one of the first studies to look at the outcomes of a CRE program with fragile families in the areas of couple stability and marriage formation. Data were from the Family Formation Project, a federal and state funded program working with fragile family couples (n = 96) in a metropolitan area. A historical cohort control group quasi‐experimental research design was used with a matched control group from the Fragile Family and Child Well‐being Study. The intervention consisted of in‐home education and support, group educational events, and social service referrals. Findings showed that couples had the same rate of couple stability as the control group but an increased rate of marriage. These findings suggest that CRE can help fragile families achieve marriage when that is their goal, but that some fragile families may need more than CRE to help them stabilize their relationship, or they may be better off separating.     

An Overview of Primary Care Family Psychology

This paper describes the application of family psychology to the primary care setting—in service, education and training, and scholarship. Primary care family psychology integrates family systems with biopsychosocial theory, yielding an approach that is uniquely suited to the generalist demands of primary care. This approach attends especially to the effects of relationships on health and healthcare, using the family as a potential resource to the patient just as the healthcare team is a resource to the clinician. Training opportunities in primary care family psychology are growing. The University of Rochester School of Medicine and Dentistry fellowship is described as an example, with core primary care family psychology training in four different clinical sites: Family Medicine, Internal Medicine, Pediatrics, and Obstetrics/Gynecology. Susan H. McDaniel is Professor of Psychiatry & Family Medicine, Director of Family Programs & the Wynne Center for Family Research in Psychiatry, and Associate Chair of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York. Dr McDaniel also directs the Primary Care Family Psychology Fellowship. Picter LeRoux is Associate Professor of Psychiatry & Pediatrics, and Director of the Family Therapy Training Program in Psychiatry, University of Rochester School Medicine and Dentistry, Rochester, New York. Dr. LeRoux also heads the Pediatric Track of the Primary Care Family Psychology Fellowship.     

DRUG ABUSE AND THE FAMILY

The Family and Drug Abuse Symposium held on July 10–12, 1975, brought together individuals who possess clinical and/or research expertise in the area of family research and substance abuse. The purpose of the symposium was directed toward assessing the current state of knowledge in the field and delineating directions for future work. The role of family interaction in causing or maintaining a drug abuse problem has only recently become the focus of research and innovative treatment efforts. This special section is intended to acquaint therapists and researchers with recent work in the field; the papers are revised versions of materials originally prepared for the symposium. This first paper offers a brief overview of the symposium and summarizes issues that arose from each of the four workshops: I. Psychosocial Research; II. Clinical Observations; III. Clinical Programs; and IV. Recommendations Made to the National Institute on Drug Abuse. The next paper is a review of recent studies in research and treatment that have approached substance abuse from a family viewpoint. Other research methods that appear relevant to the study of families with a drug-abusing member are discussed. Three commentaries on this review follow. The last paper describes an extensive effort to implement and evaluate family therapy within an existing drug treatment facility.     

Anomic depression and the migrating family

Anomic family depression is a form of depression which occurs in reaction to a disruption in a family's ability to discover a sense of meaning and purpose in life. Anomic depression often occurs during times of family migration where there is an increased danger of a disruption in the family's traditional methods of discovering and experiencing meaning. Existential family therapy utilizing network intervention, social skills training, and existential reflection is frequently a useful form of treatment in this kind of practice situation.James Lantz, PhD, and Karen Harper, PhD, are assistant professors at The Ohio State University College of Social Work and serve as family therapy practitioners and consultants at The Midwest Institute for Advanced Study in Existential Family Study.     

The Influence of Family and Experimental Context on Cognition in Anxious Children

Examined the influence of family on anxious children's cognition. Research by Barrett, Rapee, Dadds, and Ryan (1996) found anxious children reported increased avoidance after interacting with their parents. They labelled this finding the FEAR effect—Family Enhancement of Avoidant Responses. Whilst some subsequent studies have found similar results, others have not. These contradictory findings question whether the direction of parental influence on anxious children is determined by the perceived demands of the experimental context. Anxious children (N = 101) and their parents were asked to interpret seven ambiguous situations and to discuss what their child would do if the scenario actually occurred. Study 1 found that children in the anxious group and an externalizing control group were more likely to interpret ambiguous situations as threatening than nonclinic children were. Study 2 sought to examine changes in the children's responses from pre- to postfamily discussion, and to identify variables associated with the FEAR effect in anxious families. Interestingly, anxious children whose families completed the discussion task after they (children) had been offered treatment were more likely to show a FEAR effect than anxious families who completed the task as part of assessment. Study 3 examined predictors of enhanced avoidance in anxious families. Treatment context and maternal distress were correlated with the child's increased avoidance following family discussion. Limitations of these studies and directions for future research are discussed.     

Treating emotionally disturbed youth: A comparison of home-based and outpatient interventions

The purpose of this study was to compare home-based and outpatient treatment for families with an emotionally disturbed child. Following treatment, both groups reported improvement in child and family functioning. Guidelines are offered to therapists working with families-at-risk of having a child removed from the home.John J. Zarski, PhD, is coordinator of the Marriage and Family Therapy Training Program and Leslie Barnes Fluharty, MS, is a doctoral student in counseling psychology at the University of Akron, Akron, OH.     

The McMaster Approach to Families: theory, assessment, treatment and research

The McMaster Approach to Families is a comprehensive model of family assessment and treatment. This paper provides an overview of the McMaster Approach and consists of five major sections. First, the under-lying theoretical model (McMaster Model of Family Functioning) is described. Second, the three assessment instruments of the approach (Family Assessment Device, McMaster Clinical Rating Scale, McMaster Structured Interview of Family Functioning) and their psychometric properties are summarized. Third, the family treatment model (Problem Centered Systems Therapy of the Family) is presented. Fourth, the research conducted using the McMaster Approach is reviewed. Finally, the clinical uses and advantages of the McMaster Approach are discussed.     

A Conceptual and Empirical Basis for Including Medical Family Therapy Services in Cancer Care Settings

Psychosocial interventions in oncology settings have largely been individually and group-based despite evidence that a family-based approach fills a treatment gap in the cancer care experience. Medical Family Therapists are trained to address the family as the unit of treatment and provide services that consider family dynamics, reorganization of couple and family roles, and broader systemic issues. This article describes the conceptual bases for Medical Family Therapy services provided in cancer care settings, and reviews research on their implementation and effectiveness. Following a review of the literature, recommendations for studying the effectiveness and efficacy of MedFT in cancer care treatment are detailed.     

Addressing Family Violence Within Juvenile Courts

Summary

Whether as overt or underlying issues, family violence is prevalent within juvenile court caseloads, yet often is not identified within intake and disposition. Focusing on juvenile victimization of parents, and to a lesser extent teen dating partners, this article discusses model programs emerging in juvenile courts specifically addressing these issues. A comparative analysis of the drug court trend is explored in the context of its applicability for specialized family violence applications in the Juvenile Court. An overview of the King County (Washington) Juvenile Court's Step-Up Program and the Santa Clara County (California) Juvenile Court's Family Violence program is offered, followed by the process by which the Travis County (Texas) Juvenile Court has implemented a program similar to these models. Effective interventions with violent families must be informed by the domestic violence community's treatment expertise, building on the paradigm of youth resilience.     

An Index for Measuring Agency Involvement in Family Therapy

The Progress Index for Family Therapy Programs, an instrument for measuring the relative level of involvement in family therapy by treatment programs, is presented. It was developed as part of a national survey on the use of family therapy for treating drug abuse and includes data from 500 agencies, 76 of which were Community Mental Health Centers. The Index may be useful for assessing extent of family therapy involvement for differing agencies treating different populations.     

Population growth--a challenge to psychologists

This article briefly reviews research conducted in the U.S. on fertility behavior and the characteristics associated with it. The Indianapolis Study (1941), the Family Growth in America Study (1957, 1969), the Growth of American Family Studies (1955, 1960), and the National Fertility Study (1965) are cited. Working wives are associated with lower fertility while Catholics are more often associated with slightly higher fertility. More study is needed to determine the interactions between the number of children desired and intended before and after families are completed, and between the relationship between knowledge and practice of family planning. Motivations for childbearing are discussed in relation to role definitions especially for women. Research into the value systems that are the bases for motivation is proposed.     

The Family Cycle: An Activity to Enhance Parents’ Mentalization in Children’s Mental Health Treatment

This article introduces the Family Cycle, a therapeutic activity informed by attachment theory, family systems theory, and current literature on reflective functioning. The Family Cycle helps clinicians and families create a narrative about a child’s psychopathology that considers complex trauma and/or adverse childhood experiences. It reframes observable dysfunctional phenomena as behavioral sequelae of more deeply rooted emotional loss. After the theoretical underpinnings of the Family Cycle are laid out, we describe the implementation of the Family Cycle within the context of an intensive home-based, family-focused intervention created at the Yale Child Study Center, the Intensive In-Home Child and Adolescent Psychiatric Service (IICAPS). The Family Cycle provides a teachable clinical framework to facilitate the treatment of families with complex, multigenerational trauma.     

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis

As evidence‐based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural‐strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off‐model, nonsystemic formulations/interventions). Of these, “failure to think in threes” appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.     

Gender, Power, and Relationship Ethics In Family Therapy Education

Awareness and sensitivity about gender issues have central positions in family therapy education. Traditionally gender relationships have been treated as either a reflection of cultural values and norms or as a dynamic of the way that men and women deal with the other sex. This paper presents the findings of a qualitative study that examines the meaning and enactment of gender issues in the supervisory process in family therapy. Based on that study, the authors developed a strategy for raising issues of gender equity in clinical training and describe the effects of that strategy on one practicum.Professor of Family and Child Sciences and the director of the Interdivisional Program in Marriage and Family Therapy at Florida State UniversityAn associate professor of Family and Child Sciences and the co-director of the Family Policy and Research Unit in the Family Institute at Florida State University