From Universe to Multiverses—and Back Again

A number of concepts and ideas from constructivist and second-order cybernetic family therapy literature are presented and their implications for therapy are examined. I was inspired by and, in this article, refer to videotapes of consultations and therapy sessions shown at an international conference on constructivism and family therapy in Sulitjelma, Norway, June 1988, and to written material from the Tromsø group Andersen and Anna M. Flå), the Milan team (Luigi Boscolo and Gianfranco Cecchin), and the Galveston team (Harlene Anderson and Harold Goolishian). The article also represents an attempt to use constructivist concepts and ideas in a reflection on the author's own professional development as a psychologist and family therapist.     

Rebuilding family relationship bridges

This paper describes two techniques that the family therapist can use to help families in emotional crisis change and heal. They require the family therapist to persuade family members to view the therapy sessions as a project in building or rebuilding their family relationship bridges. An essential component of these approaches is the value placed by the family therapist on building rather than destroying family relationship bridges. Four themes are suggested as building blocks for healing dysfunctional family relationships: Love, Anger, Loss and Forgiveness. Vignettes of several family problems are presented accompanied by an intervention demonstrating an aspect of family bridge building.     

A systemic view of family therapy ethics

A critical review of the literature on family therapy ethics is used to develop the proposition that a more systemic analysis is needed, one that includes the levels of therapist and society as well as patient (family). These ideas are discussed through reexamining the issues of family secrets, therapist deceptiveness, and therapist advocacy of personal (feminist) values.     

Familientherapie

In the field of family therapy besides the emphasis on the autonomy of the different schools (behavioral, psychodynamic, systemic), partly motivated by professional politics, a growing openness for concepts developed in other approaches can be observed. Approaches and results of attachment and affect theory and research find their way into the conceptualization of family processes and family therapy. Processes in the “self” of the therapist are taken into the discussion of therapeutic processes in systemic therapies. Furthermore, new fields of application of family therapy approaches have developed: parents-infant therapy and counseling, therapy of the elder, family medicine and coping with the consequences of the “human genome project”. New research on the empirical validation of relational dynamic concepts and on the evaluation of family therapies show a trend to see the claim for making treatments as short as possible in very relative terms. It is assumed that the family therapeutic approach will become more important in the future.     

Network therapy for addiction: bringing family and peer support into office practice

Network therapy was developed as a specialized type of combined individual and group therapy to ensure greater success in the office-based treatment of addicted patients by using both psychodynamic and cognitive-behavioral approaches to individual therapy while engaging the patient in a group support network composed of family members and peers. This article outlines the role of group cohesiveness as a vehicle for engaging patients in this treatment; the patient's family and peers are used as a therapeutic network, joining the patient and therapist at intervals in therapy sessions. This network is managed by the therapist to provide cohesiveness and support, to undermine denial, and to promote compliance with treatment. The author presents applications of the network technique designed to sustain abstinence and describes means of stabilizing the patient's involvement. Some specific techniques discussed include ambulatory detoxification, disulfiram and naltrexone administration, relapse prevention, and contingency contracting. Also discussed are recent research on the use of psychiatric residents and counselors for treatment, and use of the Internet in dissemination.     

Orthodoxy in family therapy practice as servant or tyrant

This paper considers some of the pitfalls of a single-model approach to family therapy. It does not argue a 'right' way of practising family therapy, but proposes that the therapist needs to have available a range of approaches on which to draw. This also raises certain problems for training in family therapy, which are highlighted. A case is discussed in the light of a number of perspectives, to demonstrate how approaches can be used in complementary fashion. Finally, reference is made to some of the agency constraints which also make it difficult to practise any one model in a 'pure' form.     

Child Participation in Family Therapy

The full involvement of children, particularly those of younger ages, in family therapy presents a personal and professional challenge to the therapist. Out of his own needs he may favor involvement with one or another generation rather than with the complete three generation family. This issue is discussed and suggestions for therapeutic use of younger children are presented.     

Employing the God-Family Relationship in Therapy with Religious Families

In many religious families, God functions as a crucial family member, stabilizing interpersonal relationships and engaging in daily family transactions. In the psychological role of a transitional object, God can be usefully employed by the family therapist in therapeutic interventions, when the therapist keeps the focus upon the interpersonal relationship with God rather than the specific content of religious beliefs. This approach can access a vital resource in the family, particularly when conditions for therapy are otherwise difficult, such as an isolated, enmeshed dyad presenting alone for therapy. Four case examples illustrate how one may use this approach in family therapy.     

Family members' perceptions of live observation/supervision: An exploratory study

This ex post facto survey examined 75 client family members' perceptions of live observation/supervision of family therapy at a university clinic. The results seem to reflect the subjects' general satisfaction with the process, although this general satisfaction did not significantly predict outcome on either family or therapist goal attainment scores. Family members whose therapists were female reported greater satisfaction with the process than those with male theapists, although no differences by therapist gender were found on either therapist or family goal attainment scale scores. Open-ended responses suggested that some family members were aware of the purposes of certain strategic team interventions. Implications of findings for the practice and research of live supervision and/or observation are discussed.The authors would like to acknowledge the aid of Judith Myers Avis, Marcia Brown Standridge, Cleveland Shields, Linda Stone Fish, and Joseph Wetchler in various aspects of this research project.     

Management of religious issues in family therapy

Social scientists have long emphasized the reciprocal relationship between family and religion in society. Yet the family therapy literature is virtually devoid of consideration of religious variables in family life and function. Four major psychosocial aspects of religion in family life are discussed: sacralization, coalitions with the supernatural, religious conflict as a projection of family conflict, and family conflict as a projection of religious conflict. Clinical issues presented include: family therapy in religious and secular contexts, family religious expectations and transference, therapist religious countertransferences, religious identification in family therapy, and family therapy in different degrees of congruence or difference in religious orientation between the family and the therapist. The family therapist must learn how to correctly interpret and appropriately respond to religious issues as they appear in family life and family therapy.     

Tales of the Absent Father: Applying the “Story” Metaphor in Family Therapy

Father-absent families often function with a lively father-presence conveyed by stories the family members share. The metaphor of “story” proposed by social constructionist and narrative approaches to therapy helps us to conceptualize the role these family stories play. The story metaphor draws attention to four issues: the rendition of what is said and unsaid about the father; the connections among past, present, and future ideas about father and family; the reciprocal influences of expression and experience, seen in the family's stories and interactions; and the impact on the family and the therapeutic process of dominant narratives about father-absence. Exploration of these issues demonstrates how client and therapist stories about the absent father mediate the impact of father-absence on the family.     

Transcending a Differend: Studying Therapeutic Processes Conversationally

Studies of actual conversational behaviours used to generate positive change in family therapy are relatively rare. In this study such conversational details were examined as they occurred in a single session of family therapy. With passages identified by family members as helpful, discursive methods of analysis (conversation analysis and critical discourse analysis) were used to examine an actual conversation between a renowned family therapist (Karl Tomm) and a family formerly at a conversational impasse. Conversational practices and sequences in talk used by the therapist and family members to bridge these differences in their ways of relating are discussed.     

The formalization of family therapy training—issues and implications

This paper highlights the emerging debate, particularly evident in the U.K. and Australasia, regarding the desirability of more formalized training programmes for family therapy. The professionalization of family therapy is under way. The implications of this process for training structures, the role of the family therapist, the nature of family therapy associations and thus the ultimate goals of family therapy are summarized. Alternative models of training structures, their ideological bases and the implications of these alternatives for the nature of an association and the family therapy process are then briefly discussed. In summary, some priorities for a desired model of family therapy training are listed for discussion.     

Attachment Versus Differentiation: The Contemporary Couple Therapy Debate

This paper reviews the current debate between differentiation and attachment in treating couples through exploring the tenets of crucible therapy (Schnarch, 1991) and emotionally focused couple therapy (Johnson, 2004). We provide a review of the two theories—as well as the two “pure form” example models—and explore the debate in light of the integrative movement in couple and family therapy (Lebow, 2014). We also examine points of convergence of the two theories and models, and provide clinicians and researchers with an enhanced understanding of their divergent positions. Both differentiation and attachment are developmental theories that highlight the human experience of balancing individuality and connection in adulthood. The two models converge in terms of metaconcepts that pervade their respective theories and approach. Both models capitalize on the depth and importance of the therapeutic relationship, and provide rich case conceptualization and processes of therapy. However, they substantially differ in terms of how they view the fundamental aspects of adult development, have vastly divergent approaches to how a therapist intervenes in the room, and different ideas of how a healthy couple should function. In light of the deep polarization of the two models, points of integration—particularly between the broader theories of attachment and differentiation—are offered for therapists to consider.     

Avoiding Colonizer Positions in the Therapy Room: Some Ideas About the Challenges of Dealing with the Dialectic of Misery and Resources in Families

Some authors have argued that certain acts of family therapists—despite their best intentions—may represent a form of colonizing the family. When acting as a colonizer, a therapist is understood as becoming overly responsible for the family and focusing too strongly on change. In so doing, the therapist disrespects the family's pace, and neglects their own resources for change. This paper aims to highlight the need for therapists to be hypersensitive both to the resources of families entering therapy as well as to the impact of prevailing ideologies on their own positioning in the session. The kind of sensitivity advocated here is dialectical in the sense that every family is understood as having potentials promoting dynamism, happiness, and well-being as well as potentials contributing to stagnation, unhappiness, and misery. In this article, using illustrations from clinical practice, we present some ideas for resisting the tendency by the therapist to assume a colonizing position as a professional solver of problems for families. Our main aim here is to redirect the therapist toward connecting with the family's suffering, as well as with the resource repertoire it has developed for navigating and negotiating its way through life.     

Reflections on Ways to Create a Safe Therapeutic Culture for Children in Family Therapy

Although a large number of publications in the family therapy field stress the importance of children in family therapy, some authors report that, in practice, many family therapists do not actively involve children in their therapies. In this article, I reflect on the experiential reasons for this exclusion of children. I will consider the importance of the use of the self of the therapist and of the creation of a safe therapeutic culture for the child. Practical suggestions are made of ways to involve children in family therapy. Finally, these ideas are illustrated in a case example of a family therapy with an adoptive family.     

Systemic Family Therapy Competences in Child and Adolescent Mental Health Care

This article is based on a doctoral research project aiming to identify a comprehensive and detailed outline of the systemic therapist competences in child and adolescent mental health care in Norway. Because of the growing demands to offer specialized services within child and adolescent mental health care, I intended the identified competences to target the psychosocial difficulties that are categorized as associated abnormal psychosocial situations (axis 5) in the multiaxial diagnostic system (WHO, Multiaxial classification of child and adolescent psychiatric disorders. The ICD-10 classification of mental and behavioural disorders in children and adolescents. Cambridge University Press, Cambridge, 1996). The project is based on twelve qualitative in-depth interviews with six experienced systemic family therapists, and fieldwork observations of the therapists (participants) in practice. The qualitative methodology is based on Grounded Theory and five overarching categories were identified through the analysis: (1): the importance of ethical and contextual awareness in systemic therapy; (2) the systemic therapist’s stance; (3) therapeutic processes; (4) therapeutic practices; and (5) session-specific features. Challenges, such as limiting the systemic approach to five overarching competences, are discussed alongside this strengths and limitations of the study. The detailed outline of systemic therapist competences is intended to offer a framework for delivering flexible, yet specialized systemic therapy in the context of child and adolescent mental health care. This research may therefore facilitate a “bridge-building process” between mental health’s biomedical focus and postmodern systemic ideas.     

The structure of interpretations in family therapy: a video-enhanced exploration

A method for assessing the structure of interpretations of family therapy events is described. Family sessions were videotaped; each participant then independently reviewed the tape, stopping it to indicate any significant events and describing the importance of each identified sequence. Qualitative approaches to analyzing the stop points are described, using data from six families and their therapist. This combination of direct session experience and reflective interpretation provides a much-needed perspective on the meaning of sessions and psychotherapeutic interaction. Research and clinical implications for scientifically examining the structure of shared interpretations in family therapy are discussed.     

An exploratory study into how a sample of a British South Asian population perceive the therapeutic alliances in family therapy

There is currently little research on the therapeutic alliances in family therapy, and even less on those from minority ethnic backgrounds. This paper reports on how British South Asians attending family therapy perceive the alliances, and compares this to the constructs of a newly developed tool – the System for Observing Family Therapy Alliances. Nine participants were interviewed and thematic analysis was employed to analyse the data. The results suggest that certain aspects of the alliances may need more attention when working with this ethnic group. These are safety in front of the therapist and emotional connection to the therapist (including feelings towards the reflecting team and consideration of ethnically matching therapist and client). In general, the quality of the alliance is seen as more important than employing culturally specific techniques. The implications for diversity and family therapy training are discussed.     

Paradox and polarity: the Tao of family therapy

Taoism is a Chinese spiritual tradition whose central metaphors concern polarity, paradox, and the natural process of change. Taoist ideas offer a particularly useful framework for understanding paradoxical interventions, the stance of the paradoxical therapist, and the new epistemology emerging in the field. The relevance of three Taoist metaphors for family therapists is discussed: polarity, cyclical change, and Wu Wei (noninterference).