The "psychosomatic family" model: an empirical and theoretical analysis

Evolution of the Family Systems Paradigm has been constrained by the dichotomy between theory building and empirical research. This article integrates these two domains by presenting a theoretical analysis of the "psychosomatic family" model as it informs and is informed by an empirical research project. Forty families of children with Crohn's disease (CD), ulcerative colitis (UC), and functional recurrent abdominal pain syndrome (RAP) were rated during standard, videotaped family interaction tasks, lunch, and interview. Laboratory scores of disease activity were associated with triangulation, marital dysfunction, and total "psychosomatic family" scores. Disease activity was not significantly correlated with enmeshment, overprotection, rigidity, conflict avoidance, or poor conflict resolution. Thus, the marital/triangulation and enmeshment/overprotection/conflict clusters may be subcomplexes of the "psychosomatic family" complex. CD, UC, and RAP groups differed in the relations among particular family patterns and disease activity. A heuristic family-psycho-somatic model is presented to facilitate future research.     

No departure to "Pandora"? Using critical phenomenology to differentiate "naive" from "reflective" experience in psychiatry and psychosomatic medicine (A comment on Schwartz and Wiggins, 2010)

The mind-body problem lies at the heart of the clinical practice of both psychiatry and psychosomatic medicine. In their recent publication, Schwartz and Wiggins address the question of how to understand life as central to the mind-body problem. Drawing on their own use of the phenomenological method, we propose that the mind-body problem is not resolved by a general, evocative appeal to an all encompassing life-concept, but rather falters precisely at the insurmountable difference between "natural" and a "reflective" experience built into phenomenological method itself. Drawing on the works of phenomenologically oriented thinkers, we describe life as inherently "teleological" without collapsing life with our subjective perspective, or stepping over our epistemological limits. From the phenomenology it can be demonstrated that the hypothetical teleological qualities are a reflective reconstruction modelled on human behavioural structure.     

Story telling in families with children: A therapeutic approach to learning problems

Story telling can be used as an original method to restructure families with children. It actively involves parents in communicating with children in their own language, helping the family to switch from a rational language to an emotional/imaginary one, circumventing resistances and permitting its members to resume a natural path in parent-child communication. This paper illustrates how stories can be used in family interaction for treating problems of family origin. Selected stories were given to parents and children for them to read-listen/make comments/dramatize during the phase of family treatment which dealt specifically with learning problems. Three family cases in which story telling was useful in solving children's disabilities through promoting changes in the family structure and creating or enlightening parental functions of orientation and guidance are analyzed.This work was done at CERF, Buenos Aires, Argentina, and received the Margarita Ravioli Award from the Asociacion Argentina de Psiquiatria Infantil for the best paper in mental health and education, Buenos Aires, September, 1987. We wish to acknowledge psychologists Helen Lamuraglia, Julia Koremblit, and Susana Sola for their therapeutic cooperation with the family cases P and F respectively. We especially thank Harry Aponte, Alberto Gonzalez, and Helen Lamuraglia for their support, comments, and review of the paper, which enriched our scope and discussion.     

Psychosomatic disorders: the canalization of mind into matter

Psychosomatic disorders represent a therapeutic conundrum. Despite compelling evidence to suggest the integrity of mind and body, humans are famously prone to experiencing them as separate. This paper explores the scientific challenges posed by psychosomatic disorders and how changing cultural notions contribute to their perplexing presentations. Excerpts of cases from patients with chronic pelvic pain, chronic fatigue, and a factitious disorder are presented as examples of the challenges that these patients pose in analysis. An explanatory model of mind/body interaction based on early maternal-infant interactions and the placebo response complex is proposed as the basis for how psychosomatic pathologies may develop. Finally, therapeutic approaches to the psychological treatment of patients with psychosomatic issues are considered.     

Dilemmas in kinship care: negotiating entitlements in therapy

This paper considers how ideological dilemmas that arise in therapy can be analysed usefully for therapeutic practice. The focus is on the particular situation of kinship care families where family or friends are caring for children without birth parents being present. In the process of family members negotiating the entitlement to care and to be cared for, multiple possibilities about family constructions and authorities throw up many dilemmas for therapists and families. Based on the author's research study with kinship care families, a method for linking discourse theory and therapeutic practice through the use of discourse analysis and positioning theory is explored, with reference to the hierarchical method of the Co‐ordinated Management of Meaning model. The paper contends that a consideration of ideological dilemmas in conversation is a core part of any therapeutic encounter, which needs to be recognized and considered in order that those involved in therapy may reflect on several possible futures and so open up the space for future decision‐making.     

The structure of psychosomatic symptoms

1. According to our findings, a psychosomatic structure is not an alternative to neurosis. The syndrome of alexithymia appears to be, in our cases, a transitional phase, the dynamics of which can be understood and treated by psychotherapy. In the course of psychotherapeutic treatment, alexithymia always disappears. 2. However, a special psychotherapeutic technique is advisable, one different from that applied in classical neurosis. 3. For this reason the term psychosomatic structure can be used as a way of expressing a variation of neurosis. 4. Modern concepts of psychosomatic disease describe pathological personalities that are different from the classic pseudoneurotic type because of their narcissistic and pregenital structures. These structures can be concealed underneath a facade of genital and psychoneurotic defense. 5. The old relationship between psychosomatosis and psychosis can be better understood on the basis of our findings, which reveal a borderline structure and splitting mechanisms in many psychosomatic patients. 6. Psychosomatic pathology can be better understood today by relating it to the structure of the psychosomatic family. 7. It appears that if, on the one hand, psychosomatic diseases of a more hysterical picture are frequent among preindustrial cultures and in low-income classes, on the other hand psychosomatic syndromes of a narcissistic and borderline type are characteristic for our civilization.     

Wittgensteinian Semantics

Wittgenstein emphasizes two points concerning his notion of family resemblance. One is that the use of a family resemblance expression resists characterization by certain kinds of rules; the other is that due to the prevalence of family resemblance in the philosophical lexicon, philosophical inquiry must in many cases proceed differently from how it traditionally has. This paper develops an interpretation of family resemblance that seeks to do justice to these claims. I argue that what is characteristic about family resemblance expressions is not that they exhibit a basic semantic feature unique to themselves, but that they combine a number of semantic properties that happen not to be coinstantiated elsewhere. These features include (1) content variability (also a property of ambiguous expressions, polysemes, and standard indexicals), (2) a feature I call "topicality" (which is also a characteristic of polysemes), and (3) "semantic openness" (a feature of many ordinary indexicals). The notions of topicality and semantic openness are explained, and certain terms of natural language are shown to be family resemblance expressions. I conclude by indicating some of the potential philosophical ramifications of these results.     

Creating a Participant Text: Writing,Multiple Voices,Narrative Multiplicity

This article uses the ideas of social constructionism to explore how families change by investigating the way our perceptions of ourselves in relation to others are formed through language. The idea that language has the inherent potential to generate a reply has strongly influenced our thinking. We propose that the reply to others is shaped by our initial reply to ourselves in inner conversation. Interaction moves back and forth from inner conversation to conversation with others, from monologue to dialogue, becoming the “stuff” of new narratives. The particular focus on language in this article is on how adding writing to the session conversation produces a “participant text,” a therapeutic narrative that is composed of the voices of the family and the therapists. These voices, often newly discovered or invented, allow our narrative discourse to expand and multiply. Using this approach with individuals, couples, and families from different socioeconomic levels, we have worked with mourning, divorcing couples, recovery from abuse, marital conflict, parenting dilemmas, and physical illness.     

The Excitation-Adaptation Model of Pediatric Chronic Illness

This article examines the value of the psychosomatic family model for the study of chronically ill children. Four conceptual problems arise in the discussion of this model: the unidirectional causality of the model; the function of the sick child for the family system; the pathology of the family characteristics; and the disease type. In the present study, we propose (a) that a distinction be made between uncontrolled and controlled forms of disease, and (b) that the family characteristics of "cohesion" and "adaptation" be examined in relation to the parental capacity for problem solving and the acceptance or rejection of the child by the parents. This is shown by means of empirical research. In this empirical study, 20 families with a child suffering from controlled asthma are compared with 20 families with a child suffering from uncontrolled asthma. Contrary to the assumptions derived from the psychosomatic family model, the results show significantly more cohesion and structure in the group with a child suffering from controlled asthma. The findings from this study are integrated in a new model for the study of chronic childhood illness —"the excitation-adaptation model." In this model, two circular processes are emphasized involving (a) the progress of the illness and the way in which parents and child deal with medication and medical advice (therapy compliance), and (b) the factors influencing the therapy compliance on the part of the parents, the family, and the child. By studying these factors in connection with the management of the illness, it should become clear whether family characteristics are adaptive or pathological.     

Minuchin's psychosomatic family model revised: a concept-validation study using a multitrait-multimethod approach

The convergent and discriminant validity of three operationalizations of the psychosomatic family features--enmeshment, rigidity, overprotectiveness, and lack of conflict resolution, as described by Minuchin and colleagues--are tested in families that include patients with eating disorders, especially anorexia nervosa and bulimia. We redefined the family features as dimensions and measured them with two behavioral methods (direct observation and behavioral product) and a self-report method. The two behavioral methods showed convergent as well as discriminant validity for the intensity of intrafamilial boundaries, the degree of the family's adaptability, and the family's way of handling conflicts. The self-report method showed only convergent validity for the latter dimension and discriminant validity for none of them. Besides intrafamilial conflict, the self-report method seemed to measure other constructs. A factor analysis of the family questionnaire indeed yielded three more evaluative constructs: conflict, cohesion, and disorganization. We interpreted these findings according to two usually interwoven mechanisms: the different research context (insider/outsider evaluation) in self-report and behavioral observation, and the different level of specification (micro/global evaluation) of certain operationalizations. We draw some conclusions about the psychosomatic family model and discuss the clinical implications of our findings.     

Family Therapy Techniques in Residential Settings: Family Sculptures and Reflecting Teams

Outcome data has shown that family therapy is highly effective in the treatment of many disorders including addiction, mood, and other issues. In working to make treatment as effective as possible, many residential treatment and outdoor behavioral healthcare (OBH) programs have adopted family therapy techniques for use in individual and peer group therapy settings. Some have also incorporated family members by inviting them to visit the residential setting and participate in treatment exercises. An article by Faddis and Bettmann (J Ther Sch Program 1(1): 57–69, 2006) outlines an example of this integrated approach to family sculptures and reflecting teams in a wilderness therapy setting for adolescents. This integrated technique has since come to be known as the four phase Familial Sculpting and Reflecting intervention. Most recently these methods have been expanded for use with young men ages 18–30 in an adventure wilderness therapy program. This article will examine the theoretical basis for both of these approaches, discuss the application of these techniques to residential OBH programs and review how these methods have been most recently adapted for use in another program.     

道德外语效应及其调节变量：来自元分析的证据

同一个道德决策情景使用外语(相比母语)呈现时, 个体会表现出更强的功利性倾向, 即道德外语效应。随着研究的深入, 结论并不一致。本研究运用元分析方法首次探讨了语言类型(母语vs. 外语)对道德判断中功利性倾向的影响, 并分析了相关的调节变量。通过文献检索及梳理, 共有19篇文献46个独立样本97个效应量符合元分析标准(N = 9672)。结果显示存在较小但稳定的道德外语效应(g = 0.23); 调节效应分析表明, 道德外语效应受故事类型的影响, 在个人道德两难故事中存在较小但稳定的外语效应(g = 0.32), 但在非个人道德两难故事(g = 0.11)与日常道德评价故事中(g = 0.12)不存在外语效应; 非个人道德两难故事中的外语效应受记分方式的影响, 多点记分在该故事类型下存在效应(g = 0.27), 二点记分不存在效应(g = 0.05); 性别和语系类型没有显著的调节效应。这些结果表明语言类型对个体面对道德困境时的选择倾向有一定程度的影响, 道德故事类型和记分方式在未来的研究中需要加以考虑。     

FOXP2 in focus: what can genes tell us about speech and language?

The human capacity for acquiring speech and language must derive, at least in part, from the genome. In 2001, a study described the first case of a gene, FOXP2, which is thought to be implicated in our ability to acquire spoken language. In the present article, we discuss how this gene was discovered, what it might do, how it relates to other genes, and what it could tell us about the nature of speech and language development. We explain how FOXP2 could, without being specific to the brain or to our own species, still provide an invaluable entry-point into understanding the genetic cascades and neural pathways that contribute to our capacity for speech and language.     

Conversational perspective of therapeutic outcomes: The importance of preference in the development of discourse

Major theme: Evaluation of therapeutic outcome. Logical development of the theme: We suggest a way for practitioners and researchers to assess if they are on track in conversing towards client preferred goals. We offer a critique of more conventional approaches to studying therapeutic progress, suggesting how a discursive (i.e. focused on interaction and language use) lens can address these limitations. Through this lens we examine therapeutic progress evident in ‘preference work’, where clients demonstrably indicate, imply, agree and disagree with where the therapeutic conversation is heading. Such ‘preference work’ offers a form of evidence of within‐session outcomes in a process of reaching larger client preferred outcomes. Authors’ point of view: We present the results of conversation analysis – a qualitative approach to the study of therapy – to illustrate our discursive perspective on therapy progress and change. Implications: we suggest a way for practitioners to assess if they are on track in conversing towards client preferred goals. We propose that our interactional perspective may significantly contribute to bridging practice and research in therapy.     

How Cross‐Linguistic Differences in the Grammaticalization of Future Time Reference Influence Intertemporal Choices

According to Chen's (2013) Linguistic Savings Hypothesis (LSH), our native language affects our economic behavior. We present three studies investigating how cross‐linguistic differences in the grammaticalization of future‐time reference (FTR) affect intertemporal choices. In a series of decision scenarios about finance and health issues, we let speakers of altogether five languages that represent FTR with increasing strength, that is, Chinese, German, Danish, Spanish, and English, choose between hypothetical sooner‐smaller and later‐larger reward options. While the LSH predicts a present‐bias that increases with FTR‐strength, our decision makers preferred later‐larger options and this future‐bias increased with FTR‐strength. In multiple regressions, the FTR‐strength effect persisted when controlled for socioeconomic and cultural differences. We discuss why our findings deviate from the LSH and ask in how far the FTR‐strength effect represents a habitual constitution of linguistic relativity or an instance of online decision framing.     

Effekte regionaler Psychosomatiktherapiemodule

Psychosomatics from the perspective of medicine assumes that somatic, psychological, and social aspects must always be taken into consideration. By combining psychosomatic and psychiatric care in community psychiatric/psychosomatic networks, existing structures can be used and costs decreased due to synergies (best point of treatment). Using a 1?year pre-/postcatamnesis comparison of 106 patients, it was possible to determine the cost of the 3?week psychosomatic treatment with respect to the medical, sociotherapeutic, and psychotherapeutic treatment effects and how long it helped. Based on the results, inpatient intensive therapy of psychosomatic illnesses in regional psychiatric departments of general hospitals can be recommended as a future treatment option – taking into account that patient-related factors can predict treatment success.     

The reflexive loop of past, present, and future in systemic therapy and consultation.

Time is one of the most basic social constructions. There are several different "times" (individual, social, cultural). This article deals with the time variable in systemic therapy--a most important variable, but often underestimated by therapists--and seeks to illustrate, with clinical examples, the peculiar interplay of past, present, and future in the therapy session. The co-creation of the past and future in the therapeutic system is also considered, together with the different temporal horizons of the family therapist and the observation team. In our view, time is one of the key issues in successful therapy: consideration of time can open new perspectives in both therapy and research.