The child's participation in family therapy: A review and a model

A major gap in family therapy, the treatment of children and adults together, is addressed. The literature on the children's participation is reviewed and a model which systematizes their involvement is presented. The full participation of the child necessitates the use of play. To create a context of play without alienating the rest of the family, action-promoting methods are used. These methods are implemented through family activities and role playing, which are followed by discussion. The advantages, the indications, and the contraindications to the use of action in family therapy are presented.     

A cross-cultural study of family functioning

The Family Assessment Device (FAD) was used to compare patterns of family functioning in two cultural settings, North America and Hungary. The sample size consisted of 95 nonclinical North American families and 58 nonclinical Hungarian families. No cross-cultural differences were found in the families' general functioning nor in their affective involvement or affective responsiveness as measured by the FAD. Hungarian families, however, perceived their functioning as significantly better than the North American families in problem-solving and in communication. North American families rated themselves significantly better than the Hungarians in setting family rules and boundaries and in meeting their family responsibilities. Results from this study suggest that cultural values can affect a family's functioning and that differences in areas of family functioning can be captured using the FAD. A discussion of broad societal values of the two cultures was used to interpret the contrasting patterns of family functioning.Cross-cultural studies serve many purposes. In general they provide knowledge about the different cultures under investigation. As such, they broaden and enrich our perspectives of ourselves and the world around us. More specifically they highlight similarities and differences across cultures, information that can be helpful in further refining our understanding of the impact of diverse and varying socio-political forces.A topic of particular interest to family therapists and researchers is family functioning in different cultural settings. In spite of continuing research in this area, few studies examine cross-cultural patterns of family interactions and even fewer do so with instruments specifically designed to assess family functioning.From a family perspective, particularly looking at pathology in family functioning, cross-cultural comparisons can be used to highlight areas of dysfunction common to families irrespective of the cultural context. From a cross-cultural perspective, family comparisons can be used to point out the cultural effects and emphases given to different dimensions of functioning within a common system (i.e., the family unit).Both conceptual and methodological problems have contributed to shortcomings in previous cross-cultural studies (Fabrega, 1974; Kleinman, 1987; Flaherty et al., 1988; Rogler, 1989). A basic criticism of such studies has been the assumption that meanings and values in one culture are equivalent to those in another.Another issue, which is particularly pertinent to our study, is the use of an instrument which is developed in one culture and administered in another cultural setting. A potential problem this raises is inferring cultural differences between groups when the translated and the original instruments are not actually comparable in meaning. In fact, one objective of the study was to see whether our own self-report measure of family functioning, the Family Assessment Device (FAD, Epstein et al., 1978, 1983), could be successfully used in another cultural setting.The following report is part of a larger research project, conducted in 1986–87, that compared depressed and nonclinical families across two cultures. The findings presented here are comparisons between nonclinical Hungarian and nonclinical North American families. In our earlier study differences in family interactions between clinically depressed and nonclinical families were evident in both cultural settings (Keitner et al., in press). It was not clear, however, if significant cross-cultural differences in family functioning would be found for the normal group of families and, if so, how these would differ from their ill counterparts. Inclusion of the normal families thus served two purposes, as controls in the larger study to test within cultural differences and as comparison groups in a separate analysis to test between cultural differences.A specific objective of this study was to contrast patterns of perceived family functioning in nonclinical Hungarian families and North American families. Another objective was to determine if the Family Assessment Device (FAD), a self-report measure of family functioning, could be successfully used in different cultural contexts. Hungary was chosen as an appropriate country of study for several reasons. It is at the crossroads of East and West, sharing enough similarities with western culture to validate comparisons, yet different enough in both its cultural and sociopolitical system that some differences could be expected to emerge. Because it is likely that the Hungarian social system is less familiar to readers than that of North American, the results are discussed with particular reference to Hungary.We would like to thank Drs. J. Furedi and T. Kurimay for help in translating the Family Assessment Device and Professors J. Szilard and Muszong-Kovacs for their support of this study. This work was supported in part by the Firan Foundation.     

Couple therapy and the developmental phase of couple relations with students

The aim of this research project has been, in terms of couple evaluation and therapy, to study structural couplings between individual development and the epigenesis of couple relationships. The epigenesis of couple relations was studied according to the model developed by Wynne in which the epigenetic stages are attachment/ caregiving, communicating, joint problem-solving, mutuality, and intimacy. Attachment/caregiving is crucial for the success of couple therapy. The research on 57 couples makes possible a new paradigm for theoretically understanding interconnections between individual development and development of the couple relation; valuable information for planning integrated and need-specific treatment of the couple relation; and evaluation of the course and prognosis of couple relationship with student.This study was carried out at the Health Care Center for Students, in Turku, Finland, and was financially supported by the Pro Sanitate Studiosorum Institute, Helsinki, Finland. We have been in cooperation with and received invaluable constructive criticism from Lyman C. Wynne, MD, PhD, whose theoretical model we applied in this study. Ms. Birgitta Nolvi's secretarial work was greatly appreciated.     

Need-adapted treatment of schizophrenic processes: The essential role of family-centered therapy meetings

Need-adapted treatment is a psychotherapeutically oriented approach to psychoses that has been planned and is implemented individually in each case, combining different activities so that they meet the needs of each patient as well as the people making up her or his personal interactional network (usually the family). A systemic initial intervention, carried out as a conjoint session of the patient, the family members, and a team of 3–4 staff members is an essential part of this approach. The name therapy meeting was given to these sessions because of their notable therapeutic significance. Therapy meetings are often continued during the later phases of treatment to follow up the course of treatment and to reassess the therapeutic plans.     

Effectiveness of short-term seminars in four different cultures

The authors examine the knowledge, attitudes, and suppositions concerning family therapy among specialists from four professionally and politically quite different cultures. The results of the survey, which was carried out among participants in workshops and specialists' training courses, have shown that: attitudes toward and the place of psychotherapy in a given culture serve as a relevant point of reference for finding out about attitudes toward family therapy; the value of the family as a sociological unit has a formative effect on views regarding family therapy; and professional and political isolation may be a hindrance to the formation of a healthy family therapy approach, but the basic attitude toward psychotherapy is not significantly influenced by ideological factors.     

Family therapists and family business: A view of the future

The family business is a unique entity that has recently come to the attention of business consultants and family therapists. The unique processes of family business are amendable to the applications of family systems theory, organizational development theory, and various theories that focus on individual growth and development. In this paper we review some of the basic concepts relative to understanding family businesses and briefly outline our approach to consultation with family businesses.     

Community engagement,greening, and violent crime: A test of the greening hypothesis and Busy Streets

Researchers have documented that vacant lot greening can reduce community-level crime and violence. Busy Streets Theory (BST) suggests that residents who are involved in the greening process can help to improve physical environments and build social connections that deter crime and violence. Yet few researchers have explored how community engagement in the greening process may affect crime and violence outcomes. We applied BST to test the effects of community-engaged vacant lot greening compared to vacant lots that received either professional mowing or no treatment, on the density of violent crime around study lots. Using mixed effects regression models, we analyzed trends in violent crime density over the summer months from 2016 to 2018 at 2102 street segments in Youngstown, OH. These street segments fell within 150 meters of an intervention parcel that was classified as one of three conditions: community-engaged maintenance, professional mowing, or no treatment (control). We found that street segments in areas receiving community-engaged maintenance or professional mowing experienced greater declines in violent crime density than street segments in areas receiving no treatment, and more decline occurred in the community-engaged condition compared to the professional mow condition. Our findings support BST and suggest that community-engaged greening of vacant lots in postindustrial cities with a concentrated vacancy can reduce crime and violence.     

HOW PSYCHIATRIC TREATMENTS CAN ENHANCE PSYCHOLOGICAL DEFENSE MECHANISMS

Psychological defense mechanisms are a powerful and often unappreciated force safeguarding mental health. Although rarely directed in this way, the most common forms of psychiatric treatment—psychotherapy and antidepressants—can enhance psychological defense mechanisms. Psychotherapy, through both specific and nonspecific factors, induces positive perspective shifts favoring positive cognitive distortions, including adaptive classical defense mechanisms and healthy attribution biases. Antidepressants, by altering very basic emotional information processing, such as facial expression recognition and emotional memories, also foster positive cognitive distortions. By shifting perceptions and thoughts in a positive direction, psychotherapy and antidepressants improve the capacity to dissociate from negative emotional stimuli.Brad Bowins, M.D., FRCP(C), is a staff psychiatrist at the University of Toronto Health Service and he is in private practice.     

Authors and publication practices

Although authors are usually considered to be the main perpetrators of research and publication misconduct, any person involved in the process has the potential to offend. Editors may breach ethical standards particularly with respect to conflicts of interest. In the same way that authors are now required to declare competing interests, notably commercial affiliations, financial interests and personal connections, so must editors. Editors can influence the chances of acceptance or rejection of a paper by reviewer selection. Reviewers should also be ready to disclose conflicts of interest. They must ensure that their reviews are evidence based and free from destructive criticism driven by self interest. It seems likely that ultimately we will progressively move towards 'open' peer review in which both the authors and the reviewers are known to each other. There is an urgent need for increased transparency of the relationship between editors and owners. The events of the last few years indicate that unless this interface is fully understood by all parties, conflicts may arise. There is also a need for a radical overhaul in the relationship between journals, journal editors and the biomedical industry. It is now increasingly accepted that all clinical trials should be registered in a centrally held database and that protocols should include the primary and secondary outcome measures and the intended approach to data analysis thereby avoiding opportunistic post hoc analyses. However, the even more radical proposal that journals should cease to publish clinical trials sponsored by industry deserves wider debate.