Pathways of Risk and Resilience: Impact of a Family Resilience Program on Active‐Duty Military Parents

Over the past decade, studies into the impact of wartime deployment and related adversities on service members and their families have offered empirical support for systemic models of family functioning and a more nuanced understanding of the mechanisms by which stress and trauma reverberate across family and partner relationships. They have also advanced our understanding of the ways in which families may contribute to the resilience of children and parents contending with the stressors of serial deployments and parental physical and psychological injuries. This study is the latest in a series designed to further clarify the systemic functioning of military families and to explicate the role of resilient family processes in reducing symptoms of distress and poor adaptation among family members. Drawing upon the implementation of the Families Overcoming Under Stress (FOCUS) Family Resilience Program at 14 active‐duty military installations across the United States, structural equation modeling was conducted with data from 434 marine and navy active‐duty families who participated in the FOCUS program. The goal was to better understand the ways in which parental distress reverberates across military family systems and, through longitudinal path analytic modeling, determine the pathways of program impact on parental distress. The findings indicated significant cross‐influence of distress between the military and civilian parents within families, families with more distressed military parents were more likely to sustain participation in the program, and reductions in distress among both military and civilian parents were significantly mediated by improvements in resilient family processes. These results are consistent with family systemic and resilient models that support preventive interventions designed to enhance family resilient processes as an important part of comprehensive services for distressed military families.     

Relational Resilience in Māori,Pacific, and European Sole Parent Families: From Theory and Research to Social Policy

This study reports findings and policy recommendations from a research project that applied a relational resilience framework to a study of 60 sole parent families in New Zealand, with approximately equal numbers of Māori, Pacific, and European (White) participants. The sole parent families involved were already known to be resilient and the study focused on identifying the relationships and strategies underlying the achievement and maintenance of their resilience. The study was carried out to provide an evidence base for the development and implementation of policies and interventions to both support sole parent families who have achieved resilience and assist those who struggle to do so. The three populations shared many similarities in their pathways to becoming sole parents and the challenges they faced as sole parents. The coping strategies underlying their demonstrated resilience were also broadly similar, but the ways in which they were carried out did vary in a manner that particularly reflected cultural practices in terms of their reliance upon extended family‐based support or support from outside the family. The commonalities support the appropriateness of the common conceptual framework used, whereas the differences underline the importance of developing nuanced policy responses that take into account cultural differences between the various populations to which policy initiatives are directed.     

Applying a Family Resilience Framework in Training,Practice, and Research: Mastering the Art of the Possible

With growing interest in systemic views of human resilience, this article updates and clarifies our understanding of the concept of resilience as involving multilevel dynamic processes over time. Family resilience refers to the functioning of the family system in dealing with adversity: Assessment and intervention focus on the family impact of stressful life challenges and the family processes that foster positive adaptation for the family unit and all members. The application of a family resilience framework is discussed and illustrated in clinical and community‐based training and practice. Use of the author's research‐informed map of core processes in family resilience is briefly noted, highlighting the recursive and synergistic influences of transactional processes within families and with their social environment. Given the inherently contextual nature of the construct of resilience, varied process elements may be more or less useful, depending on different adverse situations over time, with a major crisis; disruptive transitions; or chronic multistress conditions. This perspective is attuned to the diversity of family cultures and structures, their resources and constraints, socio‐cultural and developmental influences, and the viability of varied pathways in resilience.     

Global Mental Health: A Call for Increased Awareness and Action for Family Therapists

Global mental health (GMH) is an emerging field that focuses on the need for culturally sensitive mental health services in low‐ and middle‐income countries (LMICs). While many new initiatives have been established worldwide to understand GMH needs and to provide care in LMICs, family therapists have primarily worked with families in high‐income countries. The few existing family‐based initiatives in GMH focus on psychoeducation and are typically not based on general systems theory. However, emerging trends in family therapy may enable family therapists to impact mental health issues in LMICs. These trends, which are shared interests of both family therapy and GMH, include collaborative care, a growing emphasis on the importance of culture in understanding and treating mental health issues, recognition of the ability of families to support or impede recovery from mental illness, and the use of strength‐based and evidence‐based treatments. This paper describes ways for family therapists to become active in the GMH community.     

Communication of Information about Genetic Risks: Putting Families at the Center

Genetic information is a family affair. With the expansion of genomic technologies, many new causal genes and variants have been established and the potential for molecular diagnoses increased, with implications not only for patients but also their relatives. The need for genetic counseling and intrafamilial circulation of information on genetic risks grew accordingly. Also, the amount and, particularly, the complexity of the information to convey multiplied. Sharing information about genetic risks with family members, however, has never been an easy matter and often becomes a source of personal and familial conflicts and distress. Ethical requisites generally prevent healthcare professionals from directly contacting their consultands' relatives (affected or still at risk), who often feel unsupported throughout that process. We discuss here the communication of genetic risks to family members. We first consider genomic testing as a basis for family‐centered health care, as opposed to a predominant focus on the individual. We reviewed the literature on sharing genetic risk information with family members, and the associated ethical issues for professionals. Some clinical cases are presented and discussed, and key issues for meeting the needs of individuals and families are addressed. We argue that genetic information is inextricably linked to the family and that communicating about genetic risks is a process grounded within the broader milieu of family relationships and functioning. We conclude for the need for a more family‐centered approach and interventions that can promote sensitive attitudes to the provision of genetic information to and within the family, as well as its inclusion in educational and training programmes for genetic healthcare professionals.     

Integrated,Family‐based,Partial Hospital Treatment for Complex Pediatric Illness

This paper describes a unique treatment program for complex pediatric illness. The Hasbro Children's Partial Hospital Program uses a family systems orientation, integrated care, and a partial hospital setting to treat children with a wide range of pediatric illnesses that have failed outpatient and inpatient treatments. We have treated more than 2000 children with at least 80 different ICD‐9 diagnoses. The multidisciplinary treatment team functions as a meta‐family for children and their families who present with illness and family beliefs that impede successful outcomes with standard care. The three features: family systems orientation, integrated care, and partial hospital setting, hopefully interact to create an environment that helps families expand and modify their explanatory models regarding participating in effective medical care. The goal of treatment is for both children and their parents to feel empowered to take control of the illness. Parents completing standardized measures at intake describe their children and families as experiencing significant emotional distress, low levels of general family functioning, and poor quality of life. Although the children are described as having distinct behavioral differences, the families are described as responding to the experience of a seriously ill child in similar ways. A treatment program that addresses the noncategorical aspects of how families respond to illness while addressing the specific diseases of the children can allow children and their families to respond favorably to treatment.     

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

This study aimed to compare therapists’ observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists’ contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients’ engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists’ alliance‐building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.     

Providing therapy to children and families in foster care: a systemic-relational approach

Foster care is a system created to protect children from an unsafe home environment yet multiple foster home placements, conflictual or nonexistent relationships between foster parents and birth parents, long, drawn out court battles, and living in an on-going state of not knowing when or if they will be going home are just some of the challenges many children in care are expected to manage. This paper presents a guide for therapists working with families involved in foster care. Utilizing ideas from the postmodern therapies and structural family therapy, suggestions will be provided about who needs to talk to whom about what, when to have these necessary conversations, and how to talk to people in a way that mobilizes adults to take action for the children, with the goal of minimizing postplacement trauma, strengthening and repairing relational bonds, and moving children out of foster care and into permanent homes as quickly as possible.     

Profession Differences in Family Focused Practice in the Adult Mental Health System

There is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This article sought to determine practice differences between the differing professions working in adult mental health services in terms of their family focused work. Three hundred and seven adult mental health professionals completed a cross‐sectional survey of family focused practices in adult mental health services. Findings highlight that social workers engaged in more family focused practice compared to psychiatric nurses, who performed consistently the lowest on direct family care, compared to both social workers and psychologists. Clear skill, knowledge, and confidence differences are indicated between the professions. The article concludes by offering direction for future profession education and training in family focused practices.     

Family therapy and systemic interventions for child‐focused problems: the current evidence base

This review updates previous similar papers published in JFT in 2000, 2009 and 2014. It presents evidence from meta‐analyses, systematic literature reviews, narrative literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with common mental health problems and other difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training, or parent implemented behavioural programmes. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; recovery from child abuse and neglect; conduct problems, emotional problems, eating disorders, somatic problems, and first episode psychosis.     

Family Management of Pediatric Cancer: Links with Parenting Satisfaction and Psychological Distress

Research has long acknowledged the disruptions posed by pediatric cancer diagnosis and treatment to family life. Nonetheless, the mechanisms through which the family response influences parents’ mental health in this adverse context are not fully understood. The main goal of the present study was to examine the direct and indirect links, via parenting satisfaction, between family condition management and psychological distress of parents of children with cancer. Participants were 201 parents (86.6% mothers) of children/adolescents diagnosed with cancer who completed self‐report questionnaires assessing family condition management (family life difficulty and parental mutuality), parenting satisfaction, and psychological distress (anxiety and depression). Structural equation modeling was used to test the proposed mediation model. The results showed that parenting satisfaction mediated the association between both the family condition management dimensions (family life difficulty and parental mutuality) and depression. Specifically, greater family life difficulties and lower parental mutuality were associated with lower parenting satisfaction, which, in turn, was associated with higher levels of depression. Additionally, greater family life difficulties and lower parental mutuality were directly linked to higher levels of anxiety. Multigroup analyses suggested that the model was valid across patient age groups (children vs. adolescents) and treatment status (on vs. off‐treatment). These findings reinforce the need for family‐ and parent‐based interventions in the pediatric oncology field. Interventions that target families’ difficulties and promote their resources are likely to foster parenting satisfaction and psychological adjustment.     

A Community‐Responsive Adaptation to Reach and Engage Latino Families Affected by Maternal Depression

As family researchers and practitioners seek to improve the quality and accessibility of mental health services for immigrant families, they have turned to culturally adapted interventions. Although many advancements have been made in adapting interventions for such families, we have yet to understand how the adaptation can ensure that the intervention is reaching families identified to be in greatest need within a local system of care and community. We argue that reaching, engaging, and understanding the needs of families entails a collaborative approach with multiple community partners to ensure that adaptations to intervention content and delivery are responsive to the sociocultural trajectory of families within a community. We describe a cultural adaptation framework that is responsive to the unique opportunities and challenges of identifying and recruiting vulnerable families through community partnerships, and of addressing the needs of families by incorporating multiple community perspectives. Specifically, we apply these principles to the cultural adaptation of an intervention originally developed for low‐income African American and White families facing maternal depression. The new intervention, Fortalezas Familiares (Family Strengths), was targeted to Latino immigrant families whose mothers were in treatment for depression in mental health and primary care clinics. We conclude with key recommendations and directions for how family researchers and practitioners can design the cultural adaptation of interventions to be responsive to the practices, preferences, and needs of underserved communities, including families and service providers.     

Diagnoses,Relational Processes and Resourceful Dialogs: Tensions for Families and Family Therapy

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5), given its psychiatric focus on mental disorders in individuals, presents families and family therapists with challenges. Despite considerable controversies over its adoption, the DSM‐5 extends a process of standardizing a language for human and relational concerns. No longer a diagnostic language of professionals alone, its use is medicalizing how mental health funders and administrators, as well as clients, respond to human concerns. For family therapists who practice systemically, particularly from poststructuralist and strengths‐based orientations, many tensions can follow when use of the DSM‐5 is expected by mental health administrators and funders, or by clients who present concerns about themselves or a diagnosed family member. In this paper, I explore how such DSM‐5 related tensions might be recognized, navigated, and negotiated in the practice of family therapy with clients, and with administrators and funders.     

The Effects of Parental Education and Family Income on Mother–Child Relationships,Father–Child Relationships,and Family Environments in the People's Republic of China

Using a cross‐sectional design with 407 Chinese children aged 3–5 years and their parents, this study examined the effects of socioeconomic status, specifically parents' education and family income, on the children's mother–child relationships, father–child relationships, and the social environment in their families. The results indicated that income negatively predicted conflict in father–child relationships and positively predicted family active‐recreational environments. Income also positively predicted family cohesion among girls but not boys. Maternal education negatively predicted conflict in mother–child relationships and positively predicted closeness in mother–child and father–child relationships, family cohesion, and the intellectual‐cultural and active‐recreational environments in the family. Paternal education positively predicted family cohesion and intellectual‐cultural and active‐recreational environments. Income was found to partially mediate the effects of both maternal and paternal education on family active‐recreational environments. Findings are discussed in the frameworks of the family stress model and the family investment model.     

COGNITIVE AND SOCIOEMOTIONAL FUNCTIONING AT 4½ YEARS IN CHILDREN BORN TO MOTHERS WHO HAVE RECEIVED TREATMENT FOR SUBSTANCE‐ABUSE PROBLEMS WHILE PREGNANT

Cognitive and socioemotional functioning at 4½ years of age were examined in children born to mothers with substance‐abuse problems (n = 22) recruited from residential treatment institutions while pregnant, and then compared to children born to mothers with mental health problems (n = 18) and children from a low‐risk group (n = 26). No significant group differences in cognitive functioning were found, but the children born to mothers with substance‐abuse problems showed more caregiver‐reported socioemotional problems than did the low‐risk children, like the children born to mothers with mental health problems. Birth weight had an effect on internalizing problems at 4½ years and mediated the relation between group and socioemotional problems, although not when controlling for caregiver education, single parenthood, and anxiety and depression. At 4½ years, 7 children born to mothers with substance‐abuse problems were placed in foster care. These children had lower birth weight and higher caregiver‐rated internalizing problems. In addition to emphasizing the importance of the quality of the prenatal environment, this study suggests that families with previous substance abuse are in need of long‐term follow‐up to address socioemotional problems and enhance further positive child cognitive development. The foster‐placed children may be in particular need of long‐term follow‐up.     

Attachment and Family Processes in Children's Psychological Adjustment in Middle Childhood

This study examined the links between parent–child attachment, whole family interaction patterns, and child emotional adjustment and adaptability in a sample of 86 community families with children between the ages of 8 and 11 years. Family interactions were observed and coded with the System for Coding Interactions and Family Functioning (SCIFF; Lindahl, 2001). Both parents and each target child completed the appropriate form of the Behavior Assessment System for Children‐2nd Edition (BASC‐2; Reynolds & Kamphaus, 2004). Target children also completed the Children's Coping Strategies Questionnaire (CCSQ; Yunger, Corby, & Perry, 2005). Hierarchical multiple regressions indicated that Secure mother–child attachment was a robust predictor of children's emotional symptoms, but father–child attachment strategies were not significant independent predictors. Positive Affect in family interactions significantly increased the amount of variance accounted for in children's emotional symptoms. In addition, Family Cohesion and Positive Affect moderated the relationship between father–child attachment and children's emotional symptoms. When data from all BASC‐2 informants (mother, father, child) were considered simultaneously and multidimensional constructs were modeled, mother–child security directly predicted children's adjustment and adaptive skills, but the influence of father–child security was fully mediated through positive family functioning. Results of the current study support the utility of considering dyadic attachment and family interaction patterns conjointly when conceptualizing and fostering positive emotional and behavioral outcomes in children.     

Evaluation of a statewide initiative to reduce expulsion of young children

This program evaluation study describes 3 years of implementation of Arkansas's BehaviorHelp (BH) system, a statewide expulsion prevention support system for early care and education (ECE). BH coordinates three tiers of supports to ECE professionals, including phone support, on‐site technical assistance (TA), and infant and early childhood mental health consultation (IECMHC). We examine differences in characteristics of those served across BH service tiers, describe short‐term case outcomes, and explore factors associated with expulsions. BH accepted referrals for 1,195 children in 488 ECE programs. The majority of referrals involved male children over the age of three, and most cases were assigned to the TA tier (68.5%). Cases assigned to receive IECMHC (28.4%) were more likely to involve children in foster care, receiving developmental therapies, and with higher rates of exposure to potentially traumatic events. The expulsion rate among referred children was 2.9%, and reported teacher engagement with the support process was high. Teachers receiving IECMHC services reported significant improvements in children's symptoms of emotional and behavioral problems. Exploratory analyses revealed that risk factors for expulsion included being a male, in foster care, in a lower quality ECE environment, and having a teacher with less training in social–emotional development.     

Healing Intergenerational Wounds: An Integrative Relational–Neurobiological Approach

Old resentments and unfinished business from the family of origin can constrain adults in current relationships with parents or siblings and negatively affect relationships with partners or children. This article explores how old wounds get reactivated in current relationships and contribute to the intergenerational transmission of painful legacies and trauma. Building on intergenerational family theory and interpersonal neurobiology, the dynamics of reactivity and pathways for growth are explored. While much of the time the human brain is on autopilot, driven by habits and emotional reactivity, we are capable of bringing prefrontal thoughtfulness and choice to close relationships. Rather than being victims of parents or our past, we can become authors of our own relational life. Interventions are offered to help adult clients “wake from the spell of childhood,” heal intergenerational wounds, and “grow up” relationships with family of origin. The damage caused by parent‐blaming in therapy is explored and contrasted with Ivan Boszormenyi‐Nagy's emphasis on rejunctive action and cultivating resources of trustworthiness in intergenerational relationships. The family is considered both in its cultural context—including stressors and resources for resilience—and in its life cycle context. Aging in the intergenerational family is discussed, focusing on ways adult children and their parents can grow and flourish with the challenges at this time of life. Throughout, the theme of relational ethics—how we can live according to our values and “reach for our best self” in intergenerational relationships—informs the discussion.     

Clinical Guidelines for Working With Stepfamilies: What Family,Couple, Individual,and Child Therapists Need to Know

This article draws on four decades of research and clinical practice to delineate guidelines for evidence‐informed, clinically sound work with stepfamilies for couple, family, individual adult, and child therapists. Few clinicians receive adequate training in working with the intense and often complex dynamics created by stepfamily structure and history. This is despite the fact that stepfamilies are a fundamentally different family form that occurs world‐wide. As a result many clinicians rely on their training in first‐time family models. This is not only often unhelpful, but all too often inadvertently destructive. The article integrates a large body of increasingly sophisticated research about stepfamilies with the author's four decades of clinical practice with stepfamily relationships. It describes the ways in which stepfamilies are different from first‐time families. It delineates the dynamics of five major challenges stepfamily structure creates: (1) Insider/outsider positions are intense and they are fixed. (2) Children struggle with losses, loyalty binds, and change. (3) Issues of parenting, stepparenting, and discipline often divide the couple. (4) Stepcouples must build a new family culture while navigating previously established family cultures. (5) Ex‐spouses (other parents outside the household) are part of the family. Some available data are shared on the impact of cultural and legal differences on these challenges. A three‐level model of clinical intervention is presented: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational Family‐of‐Origin. The article describes some “easy wrong turns” for well‐meaning therapists and lists some general clinical guidelines for working with stepfamily relationships.