Whole Family Theraplay: Integrating Family Systems Theory and Theraplay to Treat Adoptive Families

This article regarding the effectiveness of Theraplay for the clinical treatment of adoptive families both outlines a model for integrating family systems theory with Theraplay to create a new approach entitled Whole Family Theraplay (WFT), as well as provides a preliminary report of a pilot study demonstrating the efficacy of that model. WFT integrates Theraplay with family systems approaches (Structural and Experiential Family Therapies) to treat parents and all the siblings within adoptive families. The findings indicate that WFT treatment may lead to statistically significant benefits in regard to family communication, adults’ interpersonal relationships, and children's overall behavioral functioning.     

Some Reflections on the Legacies of Michael White: An Australian Perspective

This article, which appears in a special 30‐year anniversary edition of the Australian and New Zealand Journal of Family Therapy, reflects on the legacies of the work of Michael White. It begins by looking back on Michael's time as editor of the Australian Journal of Family Therapy. Of the many themes that were discussed in the Editorials and Letters to the Editor section of this journal in the early 1980s, this article focuses on three in particular to explore the legacies of the work of Michael White. The author describes how Michael has bequeathed not only a profound body of work, but also a distinctive spirit of originating, and ways of working that consider the effects of social issues and that examine the politics of experience. It is the author's hope that this approach to considering Michael White's legacies honours his work and also honours the contributions of the Australian and New Zealand Journal of Family Therapy in its 30th year.     

Exploring changes in family functioning when a child participates in a School-Based Filial Therapy program

Child focus is a central construct within Bowen family systems theory (Bowen theory). A clinical implication is that mental health treatment focusing on a child may unwittingly reinforce the operation of child-focused processes, which undermine rather than enhance child well-being. The concept of child focus in Bowen theory presents significant implications for professionals working in school settings and in fields such as children's mental health, which are inherently child-focused. Bowen theory is the guiding theoretical framework for School-Based Filial Therapy (SBFT). SBFT is a play therapy intervention that was initially established in remote and outer-regional New South Wales, Australia in response to the low availability of children's mental health services and the significant barriers associated with caregiver engagement in children's mental health treatment. It involves trained school personnel facilitating therapeutic play sessions with children experiencing emotional–behavioural problems. The intervention occurs on school grounds, during school hours, and children's family members do not participate in the intervention. This mixed-methods study examines the impact of children's participation in SBFT upon family functioning. Interviews with caregivers (n = 10) of children who participated in 10 SBFT sessions were analysed using content analysis. Quantitative data were collected using the Differentiation of Self Inventory – Short Form and Visual Analogue Scale – Family Functioning. A Wilcoxon signed rank test was used to analyse the pre- and post-data. Qualitative outcomes indicated changes in the categories of child functioning, caregiver functioning, and extended family functioning, whilst child-focused processes remained dominant but changed in intensity and valence following SBFT.     

Preadoption Risks,Family Functioning,and Adoption Secrecy as Predictors of the Adjustment of Filipino Adopted Children

Using a correlational multivariate research design, partial least squares (PLS) was applied to examine the direct and indirect influence of pre-adoption risks, family functioning, and adoption secrecy on the adjustment (which is defined in this study as the internalizing and externalizing behaviors) of Filipino adopted children. Thirty-two sets of Filipino adoptees and their respective adoptive mothers participated in the study. Family functioning was found to predict the adjustment of Filipino adopted children while adoption secrecy predicted family functioning. Adopted children's perception of their family functioning and adoption openness buffer the impact of the early adversity experienced by the adopted children. Implications on the clinical practice and adoption practices in the Philippines are discussed.     

Family Communication as a Mediator of Child Adjustment to Divorce

Abstract

Reduced family conflict, consistency in roles and parenting, and limited negative life changes seem to be particularly important variables in promoting children's adjustment to divorce.

The impact of family functioning on child adjustment was investigated in a sample of 22 recently separated or divorced families with a total of 32 children. A series of multiple regression analyses using factors on the Family Assessment Device to predict Child Behavior Checklist scores indicated that family functioning is a significant predictor of children's Externalizing behavior problems. The Communication factor accounted for a significant portion of unique variance in the externalizing scores that was unaccounted for by the other factors. When separated parents can communicate with each other to co-parent their children, as well as communicate affective limit-setting messages to their children, the children exhibit less behavioral problems.     

Reflections and Learning From an Agency‐Wide Implementation of Single Session Work in Family Therapy

In November 2009, the Bouverie Centre, a centre for training, research, and clinical family therapy in Melbourne, Australia, embarked on a 12‐month trial involving the implementation of single session work as our main model of service provision for all new family appointments. We were interested in evaluating clients' and therapists' experiences of this change in our clinical service delivery. This article discusses some clinical dilemmas that arose for staff in this process, and how they were addressed. Clients' responses to single session work are outlined, followed by a discussion of outcomes of the implementation for our organisation.     

Nothing is as Practical as a Good Theory: Bowen Theory and the Workplace — a Personal Application

Bowen Family Systems Theory is most commonly used to understand and predict family process. It is also applied to other potentially intense relationship systems, especially the workplace. It has been used by workplace consultants and by individuals to understand, and to manage, their own workplace functioning. This paper will draw from several key Bowen concepts to analyse common workplace dilemmas and to suggest responses that may assist the functioning of the individual and the system. The author's own experience as a manager in a child and adolescent mental health programme will be used as the case study to illustrate the theory's application.     

Questioning the Suitability of Traditional Self-Report Family Functioning Measures for Single-Parent Families with Young Children

Family functioning is a common interest of social science and health researchers. Most often, well-established self-report instruments are used to measure family functioning. Although these instruments have been used with families of diverse compositions, our experiences using one of the commonly used instruments, the McMaster Family Assessment Device (FAD), suggest that it is not appropriate for single-parent families with young children. In addition to describing the difficulties we encountered with the FAD, we discuss our experiences in relation to current research findings about the processes and effectiveness of family functioning in single-parent families. As well, we examine other frequently used self-report family functioning instruments, the results of which lead us to question the suitability of any of the commonly used self-report family functioning instruments for single-parent families with young children. We conclude by arguing for the development of family functioning instruments that are appropriate for diverse family structures and compositions.     

SUPERVISION IN FAMILY THERAPY: A DECADE RESTUDY*1

This paper reports on a 10-year replication of Everett's (1980) survey of Approved Supervisors of the American Association for Marriage and Family Therapy (AAMFT). Significant differences were found between today's supervisors and supervision, including an increase in female supervisors, a shift toward a systemic theoretical orientation, greater concentration of supervisors in formal training settings, a great increase in the use of video recordings, a decline in the popularity of personal psychotherapy as part of training, a greater inclination of supervisors to identify themselves as Marital and Family Therapists (MFTs) regardless of original education, and others. The Approved Supervisor system appears to be fulfilling AAMFT organizational goals; other results will be reported elsewhere.     

Systemic Consultation in Intellectual Disability Case Management

Systemic consultation is a form of tertiary case supervision derived from the principles of systemic family therapy. The present study defines the process and outcomes of systemic consultation through the experiences of case managers (CMs) working with people who have an intellectual disability. CMs were invited to present and discuss one of their complex cases with a team of consultants and attend a follow up session 4 to 6 weeks later. Measures of levels of stress, perception of workplace functioning, and workflow information were completed pre and post‐intervention and compared to measures completed by a second group of CMs receiving regular supervision only. After participation in systemic consultation, the networks of people CMs consulted about the case were significantly smaller and they scored significantly higher on a network measure of efficiency of information flow. The CMs experienced lower levels of stress and higher perception of workplace functioning, these differences approached significance. After attending the consultation outcome, themes included a reduced sense of being stuck and stressed, becoming an agent of change and taking perspective. The approach allows CMs space for reflection on practice and new perspectives to be heard. Case management has been under‐represented in documented research and evidence‐based training and supervision models, and is an area in which professional theory appears to be lacking.     

Family Contingencies Across the Generations: Grandparent‐Grandchild Relationships in Holistic Perspective

Family relationships do not occur in isolation but rather are embedded within greater systems of family ties. In recognition of the need to study families holistically, we explore how relations between grandparents and grandchildren are contingent upon a matrix of intergenerational relationships. Using data from the Iowa Youth and Families Project, our analyses focus on person‐centered types of grandparent‐grandchild relationships and the legacy of social ties across the generations, as mediated by other family relationships. We find multiple dimensions of grandparents' involvement with their grandchildren to be associated with (a) whether the grandparents knew their own grandparents when they were young, (b) the grandparent's perceptions of contact and closeness with the target grandchild, and (c) nuances in the relationships of grandparents with the parent generation.     

Family Time Activities and Adolescents' Emotional Well‐being

The literature is divided on the issue of what matters for adolescents' well‐being, with one approach focusing on quality and the other on routine family time. Using the experience sampling method, a unique form of time diary, and survey data drawn from the 500 Family Study (N = 237 adolescents with 8,122 observations), this study examined the association between family time and adolescents' emotional well‐being as a function of the type of activities family members engaged in during their time together. Hierarchical linear model analyses revealed that eating meals together was beneficial to adolescents' emotional well‐being, especially when fathers were present. Family leisure was also beneficial to teens' well‐being. By contrast, productive family time (e.g., homework) was associated with lower emotional well‐being, as was maintenance family time (e.g., household chores), but only when adolescents engaged in it with both parents.     

Regression,Self-Disclosure,and the Teach or Treat Dilemma: Implications of a Relational Approach for Social Work Supervision

This paper presents a brief review of a relational approach to clinical supervision and argues for its application in social work settings. Although an integral and essential part of practice, clinical supervision is underrepresented in the practice literature. Given this paucity of writings on supervision, the recent book by Mary Gail Frawley-O'Dea and Joan Sarnat, The Supervisory Relationship: A Contemporary Psychodynamic Approach, stands out as a seminal contribution because the authors present a fully developed relational model of supervision that fills a major gap in the development of contemporary relational theory and practice. We selectively review the basic concepts and principles of Frawley-O'Dea and Sarnat's model and apply this supervisory approach to current social work practice. Our focus will be on exploring three controversial and much-debated topics: self-disclosure, regression, and the teach or treat dilemma. Case vignettes from two supervisory experiences will serve to illustrate how a relational approach enhances both the treatment and the supervisory relationship.     

Interview With Michael Kerr

The following article was written by Dr Michael Kerr in response to questions put to him by Barbara Fraser; Linda Mackay and Lu Pease when he visited Australia two years ago. These three family therapists took it upon themselves to prepare this interview in recognition of Dr Kerr's unique vantage point on Bowen Theory and family therapy. Michael Kerr was trained by Murray Bowen in the 1970s and subsequently went on to work as faculty at the Georgetown Family centre. He succeeded Bowen as director of the centre where he has devoted his professional life to the understanding, application and extension of theory. He is the co‐author with Dr Bowen of Family Evaluation: An Approach Based on Bowen Theory (Kerr & Bowen, 1988), which remains the most esteemed text on this theory. He is also the editor of Family Systems: A Journal of Natural Systems Thinking in Psychiatry and The Sciences. Bowen's Family Systems Theory grew out of years of research from the 1950s‐1970s, which included observations of inpatient families with a schizophrenic member and using data from Bowen's own interactions with his family of origin (Bowen, 1978). The theory continues to be influential in family therapy with its most well‐known contributions being the process of triangling, the intergenerational transmission of family patterns and the concept of differentiation of self. (Brown, 1999). The following discussion from Dr Kerr brings a fresh perspective on the current applications and developments of this systems theory     

Effectiveness of the Coral Tree Family Service family inpatient unit: a longitudinal study exploring change in family functioning

Child mental health disorders represent a major burden to public health in Australia due to high prevalence rates, the widespread impact across domains, and the potential for difficulties to persist into adolescence and adulthood. Extensive evidence exists for the use of parent management training and cognitive behavioural therapy to treat difficulties experienced by children; however, a proportion of children do not benefit as expected from these treatments. The use of complementary therapeutic approaches and variations to the mode and intensity of existing intervention is warranted; family inpatient units represent a unique example of this. The aim of this study is to evaluate the effectiveness of a well-established Australian inpatient unit that admits the whole family, for children aged 12 years and younger referred with mental health, behavioural, or emotional difficulties. This study's longitudinal within-subject study design utilised routinely collected outcome data from the systemic clinical outcome and routine evaluation, 15 item (SCORE-15)—a valid and reliable measure of family functioning—from a sample of 980 participants attending the Family Residential Program. This study reported significant improvement in family functioning across all outcome variables between baseline and post-intervention, with no variables returning to pre-intervention levels at follow-up. Clinically significant changes in overall family functioning showed that 37% of participant scores moved from the clinical range at baseline to the nonclinical range post-intervention. This study represents the first empirical evaluation of the Family Residential Program, and the reported results provide compelling evidence for the program to effect improvement in family functioning for families with long-standing and severe difficulties. Poor rates of questionnaire completion following intervention frequent the literature base of family inpatient units, with low post-intervention (56%) and follow-up (12%) rates evident in this study. This study uniquely contributes to the growing evidence base of family inpatient units using rigorous evaluation methods.     

Measuring Walsh’s Family Resilience Framework: Reliability and Validity of the Family Resilience Assessment Among Women with a History of Breast Cancer

Walsh’s family resilience framework presents a comprehensive and inclusive lens of family process that may assist clinicians, family service professionals, and health care providers with understanding the functioning of individuals and families in their care. A mechanism for using this framework is needed, as is empirical evidence of its cogency. This article reports on the development of the Family Resilience Assessment, a 29-item survey intended to assess dimensions of Walsh’s framework. The Family Resilience Assessment is presented as a reliable and valid mechanism for assessing the family resilience framework. Results of the use of the survey with women with a history of breast cancer demonstrate that it is a reliable instrument with content and construct validity.     

The Psychiatrist's Role in Implementing an Open Dialogue Model of Care

The Open Dialogue approach is a family‐oriented early intervention model for mental health problems developed in the health district of Western Lapland, Finland. Since the 1990s the psychiatric service system in Western Lapland Health Care District has been organised according to Open Dialogue principles and applied to the treatment of any mental health concerns. The Open Dialogue approach considers the client and their family as active participants rather than as objects of treatment in its planning and implementation with a psychotherapeutic focus. In daily work, the responsibility for the treatment process is shared with the case‐specific team. The model of care requires a dialogical orientation from all staff members, psychiatrists included, to interact with the team and the client's network. In this article I describe the role of the psychiatrist in implementing an Open Dialogue model of care in psychiatric services leaning on my experiences of clinical work in the adolescent psychiatric team in Western Lapland.