Treating Inner-City Families of Homicide Victims: A Contextually Oriented Approach

Violence, including youth homicide, has assumed near epidemic proportions in US inner cities, with few signs that such violence is abating. Professionals working with families after the murder of a family member, are faced with the task of helping such families achieve a meaningful restoration of functioning. At the same time, there is a need to prevent retaliatory violence by surviving siblings and other family members. A treatment model will be discussed that uses the basic, theoretical principles of Boszormenyi-Nagy's Contextual Therapy (CT) while incorporating White and Epston's technique of “therapeutic certificates” in work with young people coping with loss via homicide. Case examples, drawn from the author's work at a unique, predominantly African American agency in an urban inner city will be used to illustrate applications of CT principles, and to show how therapeutic certificates can provide tools to clinicians working with this deeply troubling problem.     

Using video life reviews with older adults

Reminiscence by elderly people, known as life review (Butler, 1963), has been widely used as a therapeutic technique. This paper discusses a study with fifteen ageing families in which a therapist assisted the ageing member in producing a videotaped vignette from the life review. The resulting video life reviews were found to be an effective tool in helping the ageing family in 're-storying' the past events with new narrative and meaning. Three predominant themes were identified: (1) historical and evaluative reviews, (2) transition reviews, and (3) reviews dealing with emotional pain. Also discussed are the reactions of the ageing families to the video life reviews, the therapeutic uses of the technique, and format suggestions for therapists.     

Sculpting Present and Future: A Systemic Intervention Model Applied to Psychosomatic Families

We present a therapeutic intervention model for use with psychosomatic families. This method, the result of our extensive research on various psychosomatic disorders, uses family sculptures of the "present" and "future": each family member is requested to represent the family as it now "is," and how it "will be" in the future. We discuss the theoretical reasons for our choice of this method: (a) the opportunity to use a therapeutic language that is similar to the nonverbal language of the psychosomatic symptom, and (b) the usefulness of reinserting temporal dimensions into family systems that seem to have lost their evolutionary potential and to be in a sort of "time lock." Two clinical cases are discussed (a child with chronic asthma and an anorexic adolescent); the use of sculptures in both cases revealed the underlying problems and made positive therapeutic interventions possible. Finally, we point out how the use of sculpture as a therapeutic technique enables therapists to deal with multiple systemic levels.     

Using story as metaphor,legacy, and therapy

While stories have been a part of our lives for generations, we are becoming more aware of the power and variety of their uses. Stories can be used metaphorically within families or in therapy, as historical legacy to provide a confirmed existence, or as a part of the therapeutic technique. Stories can be found most easily in transitions or relationships, and humor should be kept as a part of storytelling.Jeanne R. Williams, MS, is a licensed marriage and family therapist who is in private practice with The Family Center, 607 Ingleside Ave., Athens, TN 37303. Reprints should be requested through this address.     

Should I give advice? A systemic view

Giving advice is considered from i he viewpoint of Milan systemic family therapy, and the possibility of its always being a therapeutic error is discussed. The beliefs of both professionals and clients concerning advice are examined. What can systemic therapists do if families ask for advice, and when is direct advice useful? Effects on therapists and families of giving advice are discussed as well as ways of limiting possible damage to the process of therapy. Questioning techniques are considered as an alternative that allows families to discover their own solutions.     

Medical family therapy: an emerging arena for family therapy

This paper describes an important recent development in American family therapy. Medical family therapy uses a biopsychosocial systems model to work with families who have a member with a chronic illness or disability. The authors maintain that family therapy has tended to embrace the mind–body split and to view itself too narrowly as a mental health specialty. Medical family therapists work collaboratively with physicians and other health professionals to help families achieve a sense of agency and communion in facing some of the greatest challenges that life brings.     

Using the Internet to assist family therapy

Possible uses of the internet to assist family therapy, especially in the treatment of families where members are geographically separated, are explored. The potential value of using e-mail and other Internet functions to facilitate family therapy is explained. The possible negative aspects of this new and experimental approach are evaluated. A case example is presented of a family that benefited from exposure to Internet resources. Ethical considerations in working with the new information and communication media are discussed. Analysis of a report on the use of the telephone to assist family therapy reveals many of the pros and cons that similar use of the Internet is likely to encounter. An evaluation of the use of the written word in recently developed family therapies lends support to the use of the Internet as a means of facilitating therapeutic family communications between remote members.     

Marital crisis and the trigenerational context: A model of short-term therapy

This article demonstrates a therapeutic technique used with dysfunctional couples or couples undergoing a divorce crisis which systematically incorporates both families of origin (FOS) in the treatment. The theoretical basis consists in seeing the perturbances of the conjugal couple as coming from a trigenerational context consisting of the confluence of both FOS with their set style of relating. The therapeutic aim is the definition of the relationship within the nuclear family system (NFS) and both FOSs. The technique consists of five scheduled sessions that incorporate alternatively both FOSs without the presence of the other spouse. The style of the intervention owes much to contributions of the systemic school of family therapy, especially those of strategic therapy and the Milan school. Ad hoc modifications are made for work with the FOSs.Adapted from an article published inTerapia Familiar (1986), volume 15, Buenos Aires, and reprinted by permission.     

Pictorially displayed family patterns as an assessment instrument

The performance of a pictorial assessment instrument and suggestions for clinical application are described. The stylized family illustrations include the following patterns: normal family, detouring, two-generational enmeshment, three-generational enmeshment, parental child, undermined mother and chaotic family. Ninety-eight individuals, five years or older, in twenty families selected depictions most like their own families. Siblings of patients alone or siblings combined with fathers chose the same pattern type as the family therapists 75 and 64% of the time, respectively. These concordances were significant statistically. Clinical uses include identifying promising therapeutic resources and facilitating transitions to systems and relationship issues.     

Pastoral counseling with alcoholics and their families

The pastor is often in contact with the alcoholic and his or her family. Providing help to alcoholics and their families is a spiritual, humanistic, and therapeutic challenge. Recent developments have favored a family systems orientation to working with alcoholic families. This orientation acknowledges the family as contributor to maintaining alcoholic behavior and includes the family in treatment. Specific family systems concepts are discussed and how they relate to the dysfunctional unit which houses an alcoholic. Implications for pastors and specific role definitions are explored. Krebs' therapeutic model is expanded to: 1) evaluate, 2) support, 3) refer, and 4) support, as appropriate for the pastor working with alcoholics and their families.     

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.     

Projective identification: Pros and cons. An essay review of Samuel Slipp,the technique and practice of Object Relations Family Therapy

This paper is a critical appraisal of Samuel Slipp's book on Object Relations Family Therapy (ORFT), which uses the concept of projective identification as a central thesis in explaining interpersonal influence. Slipp's book is praised for its excellent review of the literature of object relations theory and the major schools of family therapy, classification of families according to complementary projections, and revealing case material. Interpersonal-Systemic (I-S) theory and methodology with its use of the concepts of empathy, interpersonal influences, search for intimacy, maintenance of self-esteem, selective inattention, and reflected appraisals is offered as an alternative view to projective identification.     

Family Themes: Transmission and Transformation

This article describes a method for doing therapy that uses multisystemic themes that combine meaning and action to facilitate therapeutic change. By identifying central themes that operate at the individual, dyadic, triadic, whole family, inter-generational, and sociocultural levels, the therapist is able to develop effective interview questions and design useful interventions. In this method, behavioral symptoms are framed as a current manifestation of an overarching theme. This orientation enables family and therapist to de-pathologize symptoms and work collaboratively toward change. Case examples from a wide variety of families with differing presenting problems, interactional patterns, three-generational histories, and cultural backgrounds, illustrate the efficacy of the method.     

Effective functioning in dual-career families: an investigation

This study is concerned with the commonalities inherent in diverse psychotherapeutic strategies, despite seemingly discontinuous theoretical stances. Two approaches were evaluated with respect to effective family functioning, viz. Analytical Psychology and Systems Theory. Analytical Psychology posits the growth of conscious awareness in the individual as the source of therapeutic change. Problem centred systems therapy of the family emphasizes the importance of teaching clinically presenting families to negotiate collectively family rules and expectations and thus to allocate and monitor roles via clear and direct verbal communication. Both positions thus stress the reflective mode as a pivotal factor in effective problem solving. Analytical psychology maintains that conscious awareness expands to the extent that the individual integrates the contrasexual aspect of the personality, that is, the affective, expressive mode or 'feminine principle' in the male, or the instrumental, assertive 'masculine principle' in the female. Such individuals are said to be 'androgenous'. It was therefore hypothesized that such individuals would more readily be able to negotiate family rules and expectations in a manner consistent with a major therapeutic thrust of family therapy. These clinically derived hypotheses were subjected to an empirical test by assessing twenty, non-clinical, dual-career families where both parents pursued careers and were therefore presumably both required to share instrumental and affective roles on the basis of mutual agreement. Results indicated that negotiation contributed significantly to successful role fulfilment and effective family functioning, thus substantiating the focus of family therapy strategies upon clear and direct communication and role allocation.     

Reaction time measures of backward masking

We employed both simple and choice reaction time (RT) paradigms in which the subjects were required to respond to 3.0 cycles per degree (c/d) square-wave gratings presented to one eye, while checkerboard masks were presented at various stimulus-onset asynchronies to the other eye. No masking was evident using the simple RT paradigm, but with the choice RT task, checkerboard masks presented to the contralateral eye of three subjects resulted in substantial decreases in response speed when the test preceded the mask by stimulus-onset asynchronies of 25 to 75 ms. Masks that contained lower fundamental spatial frequencies (1.0 c/d) than the target were more effective than masks containing fundamental spatial frequencies (6.0 c/d) higher than the target, while masks that contained fundamental components identical to those in the target (3.0 c/d) produced maximum masking. The results offer support for the sustained-transient theory of visual processing and validate RT as a technique for examining spatio-temporal factors in masking.     

The function and role of forgiveness in working with couples and families: clearing the ground

Until recently, forgiveness has been a neglected concept in the family therapy literature. This is puzzling since conflict and its therapeutic management as it occurs in families and within couple relationships has been much discussed. On the other hand, forgiveness has been a foundational construct within religious and theological thought. This paper examines some of the dilemmas for the therapist about using forgiveness as a tool in family therapy. Definitions and meanings of forgiveness are discussed; a typology of different kinds of forgiveness is offered, and this is linked to an understanding of families in terms of their developmental progress as systems through a life cycle.     

Beneficial factors in family discussion groups of a psychiatric day clinic: perceptions by the therapeutic team and the families of the therapeutic process

This paper reports a pilot investigation of the perception of helpful events by the therapeutic team and the families in two family discussion groups (FDGs) of a psychiatric day clinic. All participants of the FDG, including therapists and observers, filled in questionnaires measuring events helpful for the individual, for the family and for the group after each FDG session. The results showed that the therapeutic team and the families diverged in their overall perception of which factors were important in family discussion group therapy. The therapeutic team saw the relational climate and the structural aspects of the group (including group involvement and support from the group), and specific therapeutic interventions as more helpful than the families. The process aspects in the group members (including the experiencing of communality and gaining insight) were, on the other hand, more frequently mentioned by the families than by the therapeutic team. The clinical implications of these findings and suggestions for future research are discussed.     

Implementing Family-Based Musical Interventions in Family Therapy: A Mixed-Methods Research

Although rarely used by family therapists, musical interventions have the potential to become a more common technique in family therapy. Music’s unique therapeutic properties engage families, including young children and adolescents, in a meaningful, therapeutic, “here-and-now” creative process. Musical interventions act as catalysts, enable direct communication, and augment authentic communication patterns in a playful atmosphere. The purpose of this explanatory mixed-methods research was to obtain a greater understanding of the clinical applicability, therapeutic value and future implementation of a musical intervention carried out by family therapists in a family therapy context. The study explored the outcomes of 35 participating family therapists who attended a designated workshop on a structured family-based musical intervention, 18 of whom then applied 38 family-based musical sessions focused on family roles in their clinical work. The results illustrate the family-based musical intervention is a noteworthy tool for family clinical assessment and treatment, easily applicable in a variety of private and public settings with diverse populations. Musical instruments used as intermediary objects are potent vehicles for growing family awareness, functioning, and congruence, as well as inducing opportunities for change. The family-based musical intervention manifests the potential of an interdisciplinary, holistic, biopsychosocial approach to promoting individual and family wellbeing. The article also addresses ethical considerations and implications for family therapy training and education programs.     

Children of victims of terrorist activities: A family approach to dealing with tragedy

Abstract

The present report deals with the treatment of families of victims of terrorist activities. Such families are subject to an initial crisis situation involving severe stress as well as disruption in family role structure and homeo-stasis. Much of the trauma precipitated by such events is a result of their suddenness, their salience in the public consciousness and the consequent stigma they produce towards survivors and/or relatives of victims. A number of specific issues were common in the two case studies presented in this report as well as in other families affected by terrorism. These included dealing with the need to be a superparent and correcting unrealistic expectations, teaching effective limit setting including giving permission to be a parent, giving permission to be an adult, dealing with guilt and phobic reactions as well as family and network reorganization. Therapy concentrated on promoting family strengths and coping and deemphasized individual pathology. Common to most families treated was the strong desire of the victim's children to be treated as normal and not as psychological casualties. Thus, family therapy proved to be an ideal treatment modality for dealing with the tragic loss. By focusing on the problems of day-to-day living, the mourning work evolved naturally in the course of therapy. Specific therapeutic modalities such as cotherapy and network intervention facilitated family adjustment considerably.