Clinical Guidelines for Working With Stepfamilies: What Family,Couple, Individual,and Child Therapists Need to Know

This article draws on four decades of research and clinical practice to delineate guidelines for evidence‐informed, clinically sound work with stepfamilies for couple, family, individual adult, and child therapists. Few clinicians receive adequate training in working with the intense and often complex dynamics created by stepfamily structure and history. This is despite the fact that stepfamilies are a fundamentally different family form that occurs world‐wide. As a result many clinicians rely on their training in first‐time family models. This is not only often unhelpful, but all too often inadvertently destructive. The article integrates a large body of increasingly sophisticated research about stepfamilies with the author's four decades of clinical practice with stepfamily relationships. It describes the ways in which stepfamilies are different from first‐time families. It delineates the dynamics of five major challenges stepfamily structure creates: (1) Insider/outsider positions are intense and they are fixed. (2) Children struggle with losses, loyalty binds, and change. (3) Issues of parenting, stepparenting, and discipline often divide the couple. (4) Stepcouples must build a new family culture while navigating previously established family cultures. (5) Ex‐spouses (other parents outside the household) are part of the family. Some available data are shared on the impact of cultural and legal differences on these challenges. A three‐level model of clinical intervention is presented: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational Family‐of‐Origin. The article describes some “easy wrong turns” for well‐meaning therapists and lists some general clinical guidelines for working with stepfamily relationships.     

Disrupted narrative and narrative symbol

In this article a specific type of narrative, which often appears in analytic sessions, is discussed. It is characterized by a seemingly ordinary, everyday topic and by a peculiar disruption of the narrative flow. The threefold structure of this type of narrative is described, along with its main characteristics. One element of this type of narrative is very similar to symbolic content or complex symbolic structures, e.g. dreams, the sort of material that can be used for the purpose of interpretation. The similarities as well as the differences are elaborated in the article. Thanks to the observed general structure and ‘symbolic’ nature of some parts of the narrative, it is easy to notice some of the unconscious elements, which are not familiar to the patient's ego, and to make an interpretation. Because these elements are close to the threshold of consciousness, the patient willingly accepts an interpretation based on them. This is especially true for patients whose dominant function is thinking. A temporary, working name for this type of narrative is proposed in the article: ‘disrupted narrative’ ? and for its disruptive part ‘narrative symbol’.     

On matters of mind and body: regarding Descartes

In this paper the author considers Descartes’ place in current thinking about the mind‐body dilemma. The premise here is that in the history of ideas, the questions posed can be as significant as the answers acquired. Descartes’ paramount question was ‘How do we determine certainty?’ and his pursuit of an answer led to cogito ergo sum. His discovery simultaneously raised the question whether mind is separate from or unified with the body. Some who currently hold that brain and subjectivity are unified contend that the philosopher ‘split’ mind from body and refer to ‘Descartes’ error’. This paper puts forward that Descartes’ detractors fail to recognise Descartes’ contribution to Western thought, which was to introduce the Enlightenment and to give a place to human subjectivity. Added to this, evidence from Descartes’ correspondence with Princess Elisabeth of Bohemia supports the conclusion that Descartes did in fact believe in the unity of mind and body although he could not reconcile this rationally with the certainty from personal experience that they were separate substances. In this Descartes was engaged in just the same dilemma as that of current thinkers and researchers, a conflict which still is yet to be resolved.     

Who is my Jung? Memories,Reflections, Prospects

The author describes his personal and professional journey in relation to the subject of the AJA 40^th anniversary conference, ‘Who is my Jung?’ The first part of the paper covers his early life and his attempt to bring together two opposing parts within him: valuation of a scientific approach, and an interest in the inner world, dreams and the paranormal. Discussion of his professional life follows, including his relationship with Gerhard Adler, past problems and splits within the Jungian community and the author's attempts to heal these. The value of both remembering and forgetting is questioned. This leads onto ideas that bring value and meaning to his work and life, and which bridge the inner divisions he felt in his early life: notably Jung's focus on applying scientific theory to the mystery of the psyche, his relational attitude (exemplified by the dialectical process and his interest in countertransference) and his theory of synchronicity. Recent discussion in Jungian writing has questioned the nature of synchronistic experiences and explored how they may emerge naturally from complex systems. The paper ends the author's continuing journey with two personal vignettes describing how meaning may emerge from the unconscious.     

Outside‐In: Jung's myth of interiority ambiguated. Or ‐ Knowing me,Knowing Jung – ahah!

Given his lifelong battle against one‐sidedness Jung's persistent prioritising of the ‘inner life’ over the ‘outer’ can seem problematic. The question is raised as to whether an approach that seems to verge uncomfortably close to solipsism can sometimes render Jung blind to the intuition that psychic life is constituted by an on‐going interplay between inner and outer, self and other (an intuition that he himself sometimes articulated so brilliantly). The ‘ambiguation’ of Jung's work offers an opportunity to confront this problem by utilising a critical dynamic that is consistent with Jung's psychological insights.     

Couple‐based Intervention for Depression: An Effectiveness Study in the National Health Service in England

This study represents an effectiveness study and service evaluation of a cognitive behavioral, couple‐based treatment for depression (BCT‐D) provided in London services that are part of the “Improving Access to Psychological Therapies” (IAPT) program in England. Twenty‐three therapists in community clinics were trained in BCT‐D during a 5‐day workshop, followed by monthly group supervision for 1 year. The BCT‐D treatment outcome findings are based on 63 couples in which at least one partner was depressed and elected to receive BCT‐D. Eighty‐five percent of couples also demonstrated relationship distress, and 49% of the nonclient partners also met caseness for depression or anxiety. Findings demonstrated a recovery rate of 57% with BCT‐D, compared to 41% for all IAPT treatments for depression in London. Nonclient partners who met caseness demonstrated a 48% recovery rate with BCT‐D, although they were not the focus of treatment. BCT‐D was equally effective for clients regardless of the clinical status of the nonclient partner, suggesting its effectiveness in assisting both members of the couple simultaneously. Likewise, treatment was equally effective whether or not both partners reported relationship distress. The findings are promising regarding the successful application of BCT‐D in routine clinical settings.     

Parent–Child Attunement Moderates the Prospective Link between Parental Overcontrol and Adolescent Adjustment

Parental overcontrol (OC), behavior that intrusively or dominantly restricts child autonomy, has been identified as a transdiagnostic risk factor for youth. However, it is as yet unknown whether the association between parental OC and child maladjustment remains even when OC is exerted infrequently or by attuned parents. Rather, the selective use of OC might steer children away from danger. Taking a developmental psychopathology approach, this study focuses on the larger parent–child relationship context, testing whether either the dose at which parents demonstrate OC or the degree to which children perceive their parents as attuned determines whether OC is risky or protective for adolescents’ adjustment. Among a community sample of 114 families of children followed from the ages of 12–18, we examine whether OC, behaviorally coded from triadic mother–father–child discussions in middle childhood, is associated with later risky behavior and anxiety symptoms in adolescence. Overcontrol exerted by either mothers or fathers had a curvilinear effect on adolescent risky behaviors, and this effect was moderated by children's perceived attunement. Although OC generally was associated with increased risky behaviors, low doses of OC or OC exerted by highly attuned parents protected against engagement in risky behaviors. No main effect of OC was observed on adolescent anxiety; however, mothers’ OC interacted with perceived parental attunement, such that OC exerted by less attuned parents predicted greater anxiety. Results underscore that the effect of parenting behaviors depends on the larger parent–child relationship context.     

The Partners for Change Outcome Management System: A Both/And System for Collaborative Practice

Systematic client feedback (SCF) is increasingly employed in mental health services worldwide. While research supports its efficacy over treatment as usual, clinicians, especially those who highly value relational practices, may be concerned that routine data collection detracts from clinical process. This article describes one SCF system, the Partners for Change Outcome Management System (PCOMS), along a normative (standardized measurement) to communicative (conversational) continuum, highlighting PCOMS’ origins in everyday clinical practice. The authors contend that PCOMS represents “both/and,” providing a valid signal of client progress while facilitating communicative process particularly prized by family therapists steeped in relational traditions. The article discusses application of PCOMS in systemic practice and describes how it actualizes time‐honored family therapy approaches. The importance of giving voice to individualized client experience is emphasized.     

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.