Response to commentary: is collaboration a viable target for family therapists?

In response to Zimmerman's commentary, ‘Is collaboration a viable target for family therapists?’ we explore more conventional perspectives of therapeutic collaboration featured in the family therapy literature, including Zimmerman's commentary. In particular, we critique essentialist and universal formulations that portray the client–therapist relationship to be inherently unequal as inconsistent and limiting. We conclude by addressing what appear to be some misunderstandings in Zimmerman's commentary and clarify what we see as differences between his ideas and our stance on collaboration and power in family therapy.     

A Case of Functional Urinary Retention: The Use of Family Play Therapy

This case presents a technique for doing family therapy in families with young children. In family play therapy, the entire family plays together, allowing full participation of even the youngest children in the therapeutic process. Standard family therapy interventions in the latter part of each session make use of family interaction patterns and unconscious processes revealed during the earlier play. In the case presented here, the technique was successfully applied to a family with a 3-year-old son who had functional urinary retention. This case also provided an opportunity for interdisciplinary collaboration between the separate Child and Family Services at a major teaching hospital.     

Family Therapy in the Forbidden City: A Review of Chinese Journals From 1978 to 2006

This article provides a glimpse into the development of family therapy in China, by reviewing family therapy articles written in Chinese and published in journals in China that are not, therefore, readily accessible to the international community. A content analysis of journals published between 1978 and 2006 revealed 199 family therapy articles in 109 Chinese journals. Most of the studies were conducted by psychiatry or medical professionals, and were based on general systems theory or a systemic family therapy model. The articles focused on the promotion of family therapy theories and interventions in China, but did not specify the application of theory to specific clientele or symptoms. After the year 2000, a threefold increase in the number of family therapy publications was noted. These papers included the introduction of additional theories, but did not include critical assessment of the applicability of Western family therapy models to Chinese families. The researchers noted an absence of articles that identified Chinese approaches to family therapy, and a paucity of papers on gender, professional reflection, and the therapy process. The article concludes that there is room for improvement in the quality of family therapy publications in China, and that gains may be made by interdisciplinary collaboration among academics and practitioners.     

Ethnocentrism and beyond: Letters between a family therapist and an advocate of alcoholics anonymous

Both family therapists and advocates of 12-step programs are vulnerable to ethnocentrism, a one-way zeal that can inhibit collaboration and make it difficult to appreciate other ways to help individuals with drug and alcohol problems. Included is a series of letters between a family therapist and an advocate of Alcoholics Anonymous which illustrates the problems inherent in such ethnocentrism. An alternative position is also discussed which involves professional collaboration and an appreciation of the strengths of both traditions.Fred P. Piercy, PhD, is professor of family therapy and director of training and research in the family therapy doctoral program, Department of Child Development and Family Studies, at Purdue University.The letter writer's name and identifying information have been changed to protect his identity. This paper is not about Jim but about certain issues his letters raise for all of us.     

Lessons in collaboration, four years post-Katrina

Four action researchers present a case study of a project conducted by members of a national family therapy organization and members of a local family therapy institute, which describes their efforts to collaborate with local disaster recovery workers 2 years after Hurricane Katrina. The aim of the collaboration was to create a local action research team to study best practices that strengthen resilience after disaster. The authors discuss choice points and dilemmas faced in finding collaborative partners and in clarifying what constitutes an invitation to work in a community. The case study illuminates tensions and understandings between outsiders and a community still facing the long-term effects of a disaster.     

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.     

Family therapy and anthropology: a case for emotions

The idea that emotions are socially constructed challenges traditional views in both family therapy and anthropology and also opens the possibility for further collaboration. This paper reviews the traditional position of orthodox family therapy theory with respect to motivation and emotions. It argues that a social constructionist position can build on original family therapy insights about the connectedness of family members and offer a view which transcends mind-body dualism. Bateson's concept of ethos is seen as a forerunner of this view and, with the increasing interest in meaning and cross-cultural issues, Bateson's ideas deserve renewed attention. Implications of a social constructionist view of emotions for family therapists are outlined.     

Commentary: is collaboration a viable target for family therapists?

It is hoped that this commentary might serve to begin a discussion regarding collaboration, what is meant by it and whether it is a worthy goal for family therapists. I present the varying and sometimes contradictory meanings of the word, ‘collaboration’, as it is used in the therapy literature. Many of these meanings incorrectly imply an equality of the therapist–client relationship that only obscures the power differential that exists in the therapeutic relationship. A linguistic analysis of the primary meaning of ‘collaboration’ as ‘work with’ is presented. It is argued that equality between therapist and client cannot be achieved and need not be strived for. Therapists are encouraged to focus on the quality rather than the equality of their relationships.     

Contemporary family therapy in the United States

Major issues in contemporary family therapy in the United States are described. Issues from outside the field impacting family therapy include health care reform, family 'values', multiple forms of 'family', and the growing aging population. Issues within the field include the challenge of social construction theory, the decline of the expert, the feminist critique, sensitivity to culture, rediscovering individuals within families, focus on strengths and resources, a both–and attitude toward collaboration with other professionals, emphasis upon the person of the therapist, and convergence of 'schools' of family therapy. Therapists in the United States are also opening up the private process of therapy through reflecting teams, including clients in therapist thinking, multi-family groups, and through psychoeducational groups. Finally, attempts to bridge the gap between research and practice are analyzed.     

A family-based approach to adult mental disorders

Recent research studies have provided strong support for a collaborative approach between families and mental health services in the clinical management of major mental disorders. A comprehensive approach to adult mental health care that employs cognitive-behavioural family therapy as the basis for clinical assessment and treatment is described. This model emphasizes home-based intervention, collaboration with primary care, targeted specific interventions, achievement of the personal goals of index patients and their family members, long-term rehabilitation, and assessment of benefits and costs.     

The Facilitation and Maintenance of the Therapeutic Alliance in Family Therapy

The formation and maintenance of the therapeutic alliance in family therapy involves complexities pertaining to the stabilizing tendency of family systems, and the necessity for negotiation of the goals and tasks of therapy with and among multiple individuals (i.e., the family members) in a context of systemic reciprocity and mutual influence. This article explores the complexities associated with the establishment and maintenance of the therapeutic alliance in family therapy. Alliance stances are presented as clinical applications designed to assist therapists in working with split alliances, establishing within family collaboration, and in negotiating homeostatic processes.     

Prise en charge orthophonique des dyslexiques : influence des représentations familiales

Speech therapy with certain dyslexic children does not always produce the desired results. Unfortunately, as adults, these children face serious obstacles in their socioprofessional insertion. This article attempts to identify certain causes of this failure and examines more specifically the family's attitude towards the child's reading disorder and reviews certain reading remediation. The results show that the family's attitudes towards dyslexia, associated with the system of shared family beliefs (family myth), determine the involvement of the parents and the children in the reading remediation and consequently its progression. Importantly, the efficiency of the remediation depends not only on the techniques used but also on the collaboration between the speech therapist and the family unit.     

Student Healthcare Clinicians' Illness Narratives: Professional Identity Development and Relational Practice

ABSTRACT

In this qualitative, grounded theory study we examine how the intersection of self-reflection, illness narratives and perceived messages of professional identity inform care provided by medical, nursing, and medical family therapy students to patients and families. We discovered four common challenges students faced navigating personal experiences of illness and connecting to patients: 1) discrepancies between ideal and lived experiences, 2) challenges of healthcare work and culture, 3) navigating power and hierarchy, and 4) developing a shell of privacy. Discussion and implications include interdisciplinary training and collaboration and the unique role of medical family therapists in healthcare.     

Engaging multiproblem families in treatment: lessons learned throughout the development of multisystemic therapy.

Multisystemic therapy (MST) is a family-based treatment model that has achieved high rates of treatment completion with youths who present serious clinical problems, and their families. The success of MST in engaging challenging families in treatment is due to programmatic commitments to family collaboration and partnership as well as to a conceptual process that delineates barriers to family engagement, develops and implements strategies to overcome these barriers, and evaluates the success of these strategies. This article provides an overview of the nonspecific/universal engagement strategies used by MST therapists, frequently observed barriers to achieving therapist-family engagement, and specific strategies to overcome a sampling of these barriers.     

The Field of Marital and Family Therapy

This article defines the emergence of marital and family therapy as a distinct clinical discipline and an area of clinical practice. Significant historical developments that shaped the field and the integrative aspects of family systems theory are described. The role of the American Association for Marriage and Family Therapy in professional credentialing and state and federal advocacy is reviewed, along with the contributions of the Commission on Accreditation for Marital and Family Therapy Education. These areas of development set the stage for recommendations for further interdisciplinary collaboration among the mental health disciplines.     

Observing the therapeutic alliance in family therapy: associations with participants' perceptions and therapeutic outcomes

Positive and negative alliance‐related behaviours of thirty‐seven families seen in brief family therapy were rated from videotapes using the System for Observing Family Therapy Alliances ( Friedlander et al., 2006b ). Positive associations were found between in‐session behaviour and participants' perceptions of the alliance and improvement so far both early (session 3) and later in therapy (session 6). Binary logistic regression showed that successful outcomes (defined as consensus by therapist and all family members on general improvement and reduced problem severity) were significantly predicted by positive individual behaviour (Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System) in session 3 and productive within‐family collaboration (Shared Sense of Purpose within the Family) in session 6. Shared Sense of Purpose was the alliance indicator most consistently associated with clients' and therapists' perceptions of therapeutic progress; moreover, it was the only alliance indicator to improve significantly over time in treatment.     

Better versus worse family therapy sessions as reflected in clients' alliance-related behavior

To be responsive to clients' evaluations of the unfolding therapy process, therapists must first accurately "read" client behavior, a particularly challenging task in conjoint family therapy. In this study, the authors compared client behavior in 28 sessions that one family member and the therapist concurred, on the Session Evaluation Questionnaire (W. B. Stiles & J. S. Snow, 1984), were relatively better or worse than their other sessions. Client behavior was rated from videotapes using the System for Observing Family Therapy Alliances (SOFTA-o; M. L. Friedlander et al., 2006). In contrast to the worse sessions, the better sessions were characterized by significantly greater client Engagement in the Therapeutic Process and Safety within the Therapeutic System. Notably, whereas only the worse sessions had exceptionally poor within-family collaboration, 40% of the better sessions were characterized by mild family conflict. Implications are discussed for building theory on therapist responsiveness and for future research that may benefit practice, training, and supervision.     

Evaluating Training Needs for Home-Based Family Therapy: A Focus Group Approach

Therapists and supervisors engaged in the delivery of home-based services participated in two rounds of focus groups. Participants discussed the challenges they face doing home-based therapy, and how an accredited family therapy program could modify its curriculum to better prepare trainees to meet these demands. Eight topic areas considered necessary for home-based practice were identified and the implications for training reviewed. The focus group methodology is described in detail and is recommended as a useful tool to assess training needs and as a way of promoting improved collaboration among training sites.