Maps and mapmaking: Developing the systemic paradigm of family functioning

This paper presents the Systemic Paradigm of Family Functioning (SPFF) as an organizing framework for integrating models of family therapy. Therapists can use the SPFF to understand and integrate existing models of family therapy and to create their own personal models of family therapy. The SPFF framework highlights the interrelationships among the four generic models which dominate the field of family therapy. Personal models of family therapy are based on maps of family functioning derived from one of these more generic models.     

Understanding the family in multiple cultural contexts: Avoiding therapeutic traps

Developing a balanced picture of a family's functioning is difficult when the family is culturally different from the therapist. Open-minded family therapists often translate culturally different traits and behaviors as culturally appropriate and exclude them from clinical judgment, which can limit therapeutic range and effectiveness. The following case study about an Indian family with a mentally retarded child is especially illustrative of the dilemmas facing the therapist working with families of different backgrounds. Therapeutic traps were avoided by having the family assess its own differences, while the therapist held steadfast to social interconnectedness as essential to healthy family functioning.An earlier and somewhat different version of this material appeared under a different title in Families, published by the Family Institute of Philadelphia.     

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.     

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.     

Family processes,resourcefulness, coping,and stress: A prospective study

A review of the family therapy literature indicates that few studies have investigated the complex relationship among family processes, coping, and stress in understanding how people manage stressful events and conditions. The purpose of the present study was to utilize a prospective research design to systemically explore the impact of family processes on an individual's ability to use effective coping responses when faced with a stressful situation. The results did indicate that individuals experienced greater strain at Time 1 (awaiting exam). However, no differences were found between family process variables and an individual's coping responses between Time 1 and Time 2 (awaiting results). Suggestions for further research on intergenerational family systems theory and implications for family therapy practice are provided.     

Psychoeducation: A promising intervention strategy for families of children and adolescents with mood disorders

Mood disorders and suicide in youth represent major health concerns requiring effective intervention strategies. This paper briefly summarizes the literature on childhood mood disorders and discusses expressed emotion (EE) and the link between lowering EE and improved outcome for mood disordered individuals. Family psychoeducation is discussed as a means of reducing EE and similarities and differences between psychoeducation and other therapeutic interventions explored. The authors' adaptations that made psychoeducation developmentally appropriate for families of children and adolescents are reviewed. Psychoeducation for families of mood disordered youth is suggested as worthy of further clinical and empirical effort.     

A structured approach to disengagement in family therapy with child-focused problems

The aim of this paper is to describe a structured approach to managing the disengagement process. Six distinct disengagement scenarios are first outlined. Thereafter, phasing out therapy, dealing with family belief systems concerning the permanence of improvements and relapse management are discussed. Ways in which disengagement from specific episodes of therapy may be construed as part of an ongoing therapeutic relationship and the practicalities of recontracting for further episodes of therapy, handing over cases, and referring cases on to other professionals are considered. An approach to therapeutic failure analysis is presented. Finally, ways in which disengagement may lead to significant loss experiences are discussed.     

participating in a couples therapy outcome study: Participants' views

Discovering that participants who received therapy in a research project and were being debriefed in a therapy outcome study considered those assessment sessions therapeutic, the authors conclude that participants: (a) are aware of the research context, (b) have some idea about how it affected the treatment they got, and (c) see positive outcomes for taking part in the study. Assessment and treatment were not separated in the minds of some participants, as they had been in the mind of the researchers.This study was supported in part by National Institute on Drug Abuse grant #1R 18DA 1069232001.