The Nomothetic-Idiographic Debate in Family Therapy

This essay introduces the terms "nomothetic" and "idiographic" to characterize the current debate about whether the field of family therapy should accumulate and apply knowledge about patterns of adjustment that hold across different families, or whether the field should consider each family as utterly unique, and should tailor interventions solely on the basis of these unique qualities. Embedded in this debate are the arguments for and against quantitative research, disagreements about the value of clinical prediction and interobserver reliability, as well as the issue of whether therapists can rightfully claim to possess "expert knowledge." The essay begins with the personal-professional anecdote that stimulated me to explore this debate in greater depth. It continues with a brief discussion of the historical context of this debate, particularly noting the parallels between the methodological issues in personality research and those facing family therapy. The nomothetic-idiographic debate in family therapy theory, research, and practice is then described. The essay ends with the suggestion that family therapy view nomothetic and idiographic thinking as complementary, and that the field strive to develop an integrated, "idiothetic" approach to family therapy research and practice.     

Rationale and directions for an increased emphasis on the therapeutic relationship in family therapy

This paper argues the need for an increased emphasis on the therapeutic relationship in family therapy. The ways in which the field of family therapy has eschewed the importance of the therapeutic relationship are discussed. Therapeutic alliance research from the field of individual psychotherapy and research on the importance of relationship factors to family therapy are reviewed. Suggestions for family therapy theory, practice, and research are presented.An earlier version of this article was presented at the 1992 Western Canadian Conference on Family Practice.     

Reclaiming the Idea of Truth: Some Thoughts on Theory in Response to Practice

This paper examines the idea of truth, its place in therapy and in the history of systemic theory. Beginning with some practice fragments, the theory exploration considers the idea of truth in the modernist frame, the paradox of the modernist metaphor in describing the activity of therapy, and the peculiarities of the idea of truth in the earlier systemic therapies. Postmodernist and social constructionist ideas are then explored, and meaning is identified as the concept which currently occupies the place of an idea of truth in systemic discourse. It is argued that meaning as a concept is insufficiently attached to an idea of (external) reality or to an understanding of the relationship of the individual to knowledge of her/his experience of the world. Reclaiming the idea of truth as an emotional and social process has more potential to meet the complexities of human experience in thinking about the process of therapeutic change.     

The space of reflection: thirdness and triadic relationships in family therapy

This article explores ideas about threes and the triadic space of reflection. Early family therapy theory offered rich ideas about triadic relationship patterns. Contemporary practice frameworks have generated reflective therapeutic practices and an attention to reflexivity. Meanwhile, a contemporary theory constellation allied with psychoanalysis has studied the capacity for ‘thirdness’ in intersubjective relating, reflective functioning and mentalization, and the triadic space of thinking. The article reviews this psychoanalytic theory, explores symbolic thirdness alongside actual triadic relating, and maps an understanding of the space of reflection as triadic and relational. Thinking about the space of reflection as triadic and relational offers one way of orienting ourselves to reflective processes and an inclusive frame for valuing both the earlier family therapy attention to relationship patterns and the different, current contemporary family therapy practices of reflection.     

WHEN INFANTS GROW UP IN MULTIPERSON RELATIONSHIP SYSTEMS

Despite prompts from the field of family therapy since its inception, contemporary infant mental health theory and practice remain firmly rooted in and guided by dyadic-based models. Over the past 10 years, a groundswell of new empirical studies of triadic and family group dynamics during infancy have substantiated that which family theory has contended for decades: looking beyond mother-infant or father-infant dyads reveals a myriad of critically important socialization influences and dynamics that are missed altogether when relying on informant reports or dyad-based interactions. Such family-level dynamics emerge within months after infants are born, show coherence through time, and influence the social and emotional adjustment of children as early as the toddler and preschool years. This report summarizes key findings from the past decade of empirical family studies, highlights several areas in need of further conceptual development and empirical study by those who work with infants and their families, and outlines important implications of this body of work for all practicing infant mental health professionals.     

New branches on the Tree of Knowledge. Challenges for systemic family therapists

Faced with today's challenges, I question whether the framework for family therapy provided by systemic thinking is sufficient when working with children and teenagers. The aim of this paper is not to argue for an eclectic model for therapy, but rather to encourage a critical dialogue between various bodies of knowledge. The paper raises the discussion of how family therapists relate to knowledge external to the therapy field. Contemporary developmental psychology, neurobiology, behavioural genetics and group socialization theory are highlighted as useful bodies of knowledge for family therapists. Examples from clinical practice are used to illustrate this.     

The confusion about epistemology and "epistemology"--and what to do about it

The epistemology debates within the field of family therapy have become relatively infrequent in the last year or so, perhaps as a consequence of the confusion they have generated for many family therapists. This article maintains that the primary reason for the confusion is a failure to distinguish clearly between the conventional meaning of the term epistemology, which concerns the nature of knowledge, and the unconventional meaning given the term in family therapy, which concerns the nature of what we know. It is proposed that the confusion can be diminished by understanding the relationship between the two meanings, which are here distinguished as epistemology (meaning 1) and epistemology (meaning 2) respectively. Particular attention is given to the logical consequences of adopting a position on epistemology (meaning 1)—e.g, is the knower capable of knowing an independent reality, or does the act of knowing make its own reality?—or on epistemology (meaning 2)—e.g., is causality linear or nonlinear?. The relevance and implications of these problems for the theory and practice of family therapy are discussed.     

Development of Family Therapy in Hong Kong

This paper provides an insight into the development and growth of family therapy in Hong Kong. Family therapy was introduced in Hong Kong in the early 1980s and is now gaining ground. The authors give a historical account of the development of family therapy in Hong Kong, and report on its progress and achievement for the past three decades there. The field has gone through several stages of development. The 1980s were marked by an importation of Western family therapy models, during which overseas expertise was tapped to promote family therapy. The 1990s were characterized by a blossoming of different schools of family therapy on the local scene. Most schools established their own practice centers, and training packages were tailor-made for local use. The 2000s were an important era of family therapy development in Hong Kong. The field has nurtured a new generation of leaders (both academics and front-line practitioners and trainers) who play an essential role in advancing its development. The paper concludes by identifying problems in clinical practice, professional training, and research and knowledge development, and proposes ways of overcoming these difficulties.     

Systemic therapy and attachment narratives

In this paper we describe how we bring together three major systems of thought: attachment theory; family systems theories; and theories of narrative development, in an integrated approach to systemic practice that we call attachment narrative therapy (ANT). ANT provides a four‐stage framework for practice: creating a secure base; exploring narratives and attachment experiences within a systemic framework; considering alternatives and taking action; and the future and maintenance of the therapeutic base. Formulation, especially regarding the role of emotions and attachments in family dynamics and narratives, is at the heart of our approach and helps us hold ourselves accountable for our particular weave of theory and practice.     

Narrative process modes as a bridging concept for the theory, research and clinical practice of systemic therapy

This article is concerned with the relationships which hold between the clinical practice and the theory of family therapy; and between these and academic research. These relationships are seen as tenuous and thin because, in the first place, there is a lack of rigorous theoretical underpinning; and second, the research methods employed do not fit in with current family therapy practice, and with the theory that underlies this practice. The role of the concept of narrative process modes is proposed as a bridging and mediating one. The external, internal and reflective narrative process modes are seen as relevant from the point of view of family therapy process research, and the clinical practice of marital and family therapy.     

The Primacy of Discourse in the Study of Gender in Family Therapy

Family therapists and scholars increasingly adopt poststructural and postmodern conceptions of social reality, challenging the notion of stable, universal dynamics within family members and families and favoring a view of reality as produced through social interaction. In the study of gender and diversity, many envision differences as social constructed rather than as “residing” in people or groups. There is a growing interest in discourse or people's everyday use of language and how it may reflect and advance interests of dominant groups in a society. Despite this shift from structures to discourse, therapists struggle to locate the dynamics of power in concrete actions and interactions. By leaving undisturbed the social processes through which gendered and other subjectivities and relations of power are produced, therapists may inadvertently become complicit in the very dynamics of power they seek to undermine. In this article, we argue that discourse analysis can help family therapy scholars and practitioners clarify the link between language and power. We present published examples of discourse analytic studies of gender and sexism and examine the relevance of these ideas for family therapy practice and research.     

A Systems Approach to Sex Therapy with Gay Male Couples

SUMMARY

Sex therapy with gay male couples is difficult for many family and relationship therapists. Family therapists lack knowledge of the nature of sex therapy, gay male culture and sexuality, the dynamics of gay male couples, and the sexual issues gay male couples are likely to bring to sex therapy. Countertransference also makes sex therapy with gay male couples difficult for some family and relationship therapists. This paper addresses those issues and then explains a systems approach to sex therapy with gay male couples.     

Bilingualism and systemic psychotherapy: some formulations and explorations

Bilingualism has risen dramatically due to increased migration patterns all over the world. This paper offers an overview of the current literature dealing specifically with bi- and multilingualism, and identifies a gap in systemic and family therapy literature about the subject of bilingualism. In the light of this, the author proposes a working definition of bilingual families. Some case examples illustrate different aspects of working systemically with a bilingual family and highlight potential challenges for a therapist, such as the assumption of more knowledge and expertise. The tools suggested relate to a rethinking of some modernist ideas regarding hypothesizing, and both the use of a social constructionist perspective and of self of the (bilingual) family therapist. A case is made for the exploration of meanings of difference including the lingua-cultural one. The author ends with a plea to start including more specific cultural issues such as bilingualism in systemic therapy practice.     

Reflecting team processes in family therapy: a search for research

Tom Andersen's Reflecting Team approach is widely (and creatively) employed in family therapy. Despite continuing enthusiasm for the practice, however, there are few journal articles reporting empirical research and only one (now dated) review of the literature. After defining reflecting team processes through practices that are embedded in particular approaches to knowledge construction and theoretical interpretation, we offer an overview of the empirical research found in our search of the literature. In the second half of this article we ask why there is so little existing research in this area. Various possible explanations are explored and future directions proposed. We conclude that a dialogue around the complex interweaving of practice, theory and research (that is, praxis) would be a helpful overall stance to adopt in relation to future work in this area.     

Clinical Application of the Advantages of Technology in Couple and Family Therapy

While couples may be holding hands with one another, they are also holding their cell phones in the other hand. Technology is so woven into the fabric of our society that it is hard to separate it from the relationship itself. As such, the role of the marriage and family therapist demands that it attends to technology within the practice of couple therapy. This article describes strategies for couple and family therapists to use in the context of their treatment. The strategies are grounded in both theoretical and empirical knowledge and cover three categories of application: relationship initiation, relationship maintenance, and relationship enhancement.     

Instruction and Practice in Learning to use a Device

We explore the extent to which Anderson's (1987) theory of knowledge compilation can account for the relationship between instructions and practice in learning to use a simple device. Bibby and Payne (1993) reported experimental support for knowledge compilation in this domain. This article replicates the finding of a performance cross-over between instruction type and task type that disappears with practice on the tasks. The research is extended by using verbal protocols to model the strategies of novice and more experienced individuals. Production system models of these strategies suggest that knowledge compilation only provides an adequate account of practice for one of two Instruction groups. To model the strategy shifts for the second group, we employ a “procedure modification heuristic” (after Neches, 1987), which relies on access to a declarative model of the configuration of the device. This suggests that instructionally derived declarative knowledge may have a subtle ongoing effect on the changes in procedural knowledge with practice.     

‘The experiencing of experience’: a Pragmatic reassessment of Rogerian Phenomenology

This paper draws on a study that asked twenty family users about their first session of family therapy. Analyses of the interviews indicated that families entered therapy with a pre-existent knowledge about therapy, which did not always chime with those of professionals and which positioned speakers in ways which governed their expectations and perceptions of therapy. This paper, therefore, is concerned with the acquisition and deployment of knowledge: specifically, the knowledge involved in being a user of family therapy. Three key discourses were identified through this analysis: medical, counselling and consumerist. We aim to illustrate how these discourses served as a resource for members of the family in constructing therapists, therapy and themselves in relation to their experience. The examination of the rhetorical, ideological and practical effects of the positions chosen and the objects constructed, in terms of how speakers wanted to present themselves, with what enhanced or diminished status as patients, shows users actively engaging with the power of therapeutic institutions. Users’ accounts suggest that while most speakers felt anxious about the prospect of therapy, there were clear differences in overall satisfaction/dissatisfaction with the experience according to the synchrony between speakers’ construction of the therapist, and themselves as client/patients. Those who seemed to take a traditional view of therapy within a medical discourse valued therapists who offered diagnosis and a cure; those who sought and experienced a counselling relationship with the therapist found their experience to be constructive in terms of enhanced self-knowledge. We believe that the research findings discussed in this paper have implications for family therapists in accommodating to parental and child positions to maximise the effectiveness of therapy and so minimise drop-out.     

Deconstructing Agnes – externalization in systemic supervision

Externalization is seen in this paper as a valid and useful part of the process of clinical supervision in systemic family therapy training. We offer a discussion on the use of externalization based on an example from a supervision group on a London M.Sc. in Family Therapy. Externalizing practices are located in the context of a postmodern perspective and narrative ideas within systemic family therapy. We explore the use of narrative ideas and the recursive relationship between theory, practice and the subjective experience of the trainee, within the practice of systemic supervision.     

The Theory-Practice Gap in Cognitive-Behavior Therapy

This special series is devoted to understanding the theory-practice gap in cognitive-behavior therapy (CBT). Although CBT enjoys considerable empirical support, and is widely recognized as an efficacious approach to a diversity of psychiatric disorders and includes many different forms of treatment, it is unclear whether clinicians are familiar with the underlying theories of the treatments they are practicing. Moreover, it is unclear to what degree an understanding of the theory is necessary for effective practice. Gaining clarity on the role of understanding underlying theory and identifying potential disparities between theory and practice may have implications for the way graduate training programs are structured and current professionals approach continuing education. A brief exploration of these implications will be offered by introducing issues related to the scientist-practitioner model and dissemination of efficacious treatments, in addition to an outline of potential advantages and disadvantages of knowing underlying theory. This special series will then feature several major approaches to treatment wherein the role of theory and practice are discussed.