TRAINING THE PERSON OF THE THERAPIST IN STRUCTURAL FAMILY THERAPY

Structural Family Therapy needs a training model that integrates the existential, human mutuality of the therapeutic relationship with its technical elements. This paper offers a theoretical foundation for training structural family therapists in the use of self, discusses a model for training, and gives a case example illustrating personal training in a clinical context.     

ADVANCES IN COACHING: FAMILY THERAPY WITH ONE PERSON

This paper describes the process of "coaching" individuals in their efforts to change themselves in the context of their nuclear and parental family systems. Although this approach is regarded as one of the major modes of intervention in family therapy, the actual methods and techniques for intervention are not widely understood. Moreover, we have expanded the Bowen approach to address powerful cultural and family life cycle influences. The goal of coaching is to help clients define themselves proactively in relationship to others in their families without emotionally cutting off or giving in. Coaching begins by training clients to become observers and researchers of their own role in the family and of family patterns of behavior. Coaching then moves to help them bring their behavior more in line with their deepest beliefs, even if this means upsetting family members by disobeying family "rules."     

ON THE NEED FOR CONVERSATION IN THE FAMILY THERAPY FIELD

It is argued that the field of family therapy has entered a period which is characterized by a considerable absence of conversation. Such a lack hinders the field's development and increasingly saps its vitality. It is proposed that there be an annual working conference, founded on conversation and dialogue, which would rigorously examine (one at a time) the core issues of the field. It is further proposed that the papers and discussions at each conference be published as an annual monograph.     

A BLUEPRINT FOR INCREASING THE RELEVANCE OF FAMILY THERAPY RESEARCH

Family therapy research and psychotherapy research in general have been criticized for their lack of relevance to clinical practice. This paper presents a fivestage model that family therapy researchers can follow to increase the relevance of their work for clinicians and other consumers of family therapy research. Using lessons derived from private industry, the research model is based on a marketing and developmental perspective.     

THE PROBLEM OF THE SIBLING AS THE REFERRING PERSON*

This paper is the first concerning observations gathered at our Center during studies of the treatment of families with a chronically psychotic member.' It draws the attention of family therapists to a danger not uncommon in such cases, one that arises when the person referring his family of origin is a sibling of the index patient and, in many ways, the most “competent” and prestigious family member. The theoretical part of the paper and the clinical example that follows are intended to demonstrate how this pitfall can be turned into a springboard for therapeutic success.     

TOWARD THE IDENTIFICATION OF VARIABLES FOR EVALUATING FAMILY THERAPY WORKSHOPS*

If the field of family therapy is to improve the quality of its continuing education, a useful measurement of workshop quality must be developed. In a preliminary step towards this goal, 14 expert subjects from the field of family therapy were interviewed to identify variables and relationships that can be hypothesized to influence the quality–as assessed by participants–of family therapy workshops. This paper reports the opinions of the subjects, using counts and quotations to convey as much of the raw information as space allows, and presents the methods through which the information was organized by the authors into four categories and 58 (assumed to be interdependent) variables.     

THE CULTURAL CONTEXT MODEL: THERAPY FOR COUPLES WITH DOMESTIC VIOLENCE

This article offers a brief analysis of heterosexual dominance within various cultures toward a larger understanding of domestic violence. It then describes the Cultural Context Model, developed over 15 years of experience treating domestic violence in its broader context, utilizing separate "culture circles" for men and women before and during couple therapy. It then identifies guidelines for assessment and intervention with a discussion of the special issues raised when substance abuse is involved.     

THE INTERPERSONAL CONTEXT OF OBJECT RELATIONS: IMPLICATIONS FOR FAMILY THERAPY*

Psychodynamic theory and family systems theories have come to represent competing orientations in the understanding of human behavior. This paper extends the quest for an integration of these perspectives. This is done by mapping ideas from one orientation onto constructs from the other. Case examples illustrate the ideas and demonstrate how inner dynamics and interactional behavior dovetail to create systemic and personal crises. Clinical implications highlight the need (a) for psychodynamic therapists to recognize the contextual forces that activate personality structures and (b) for systems therapists to recognize the idiosyncratic meanings of interactional behaviors.     

FAMILY THERAPY TREATMENT OUTCOMES FOR ALCOHOLISM

We conducted a meta-analysis of 21 studies of family-involved therapy for alcoholism, evaluating them for design adequacy, clinical significance, and effect size. The review is divided into studies of family involvement in three phases of treatement: (a) initiation of treatment, (b) primary treatment/rehabilitation, and and (c)aftercare. We conclude that family therapy is effective in motivating alcoholics to enter treatment. Once the drinker enters treatment, family-involved treatment is marginally more effective that individual alcoholism treatment. The data suggest that three factors may mediate the effect of treatment: gender, investment in the relationship, and perceived support from the spouse for abstinence. Modest benefits have been obtained in family-involved relapse prevention programs. The most recent studies are starting to address tese issues by developing treatment models specifically for women alcoholics and identifying factors that could be used to match appropriate treatments to alcoholics and their families. These efforts are just beginning, however, and we make a number of recommendations to support implementation of these and other efforts.     

SELF ISSUES FOR FAMILY THERAPY EDUCATORS

Family therapy educators frequently encourage self-reflection in their students and clients. However, little attention has been paid to the challanges and processes of the eudcators themselves. In this piece, four faculty members reflect individually and collectively on their lives and roles as educators. the describe family-of-origin influences, the intersections of their personal and academic lives, systemic factors in the professional setting, balancing work and family, hierarchy, gender, and coping strategies ot increase support and reduce competition. They recommend a deliberate process of self-reflection to other family therapy educators and offer suggestions for improving the organizational dynamic of family therapy training programs.     

HOME-BASED MARITAL THERAPY FOR MULTIPROBLEM FAMILIES*

This paper describes a project designed to reach low-income, multiproblem families, utilizing couples therapy in the home. By targeting a population of young couples under the age of 30 and with children no older than 7 years, the project aimed at prevention of severe family dysfunctioning and child disturbances. The major characteristics noted in the literature on multiproblem families are reviewed here, as are the treatment goals and techniques with such families. Most programs working with multiproblem families have focused primarily on the parental functioning in family therapy, and little has been reported on work with the couple in multiproblem families. The project described here used home visits by a male-female therapist team, including frequent individual and couple sessions. Therapeutic techniques based on modeling, role playing and demonstration were emphasized. In addition, tasks which increased the individual and couple functioning of the spouses were designed and successful completion was reinforced. An attempt was made to integrate the couple into the community and to create a network of support outside of the family, including friends and community services.     

CRITIQUING THE NEW EPISTEMOLOGIES: TOWARDMINIMUM REQUIREMENTS FOR A SCIENTIFIC THEORY OF FAMILY THERAPY*

The purpose of this paper is to critically analyze the structures of the new epistemologies. Epistemology is a technical term within the field of scientific philosophy. When it is used looselyby family therapists, confusion results. The central argument of the present author is that the new epistemologies are, in fact, weak theories. It is suggested that the practice of using the term “epistemology” to denote theory or paradigm, be discontinued. A more limited and narrowly defined use for the term “epistemology” is proposed. Specifically, this paper presents: (a) a discussion ofthree areas of philosophy that serve as foundations for the construction of scientific theory, (b)a critical analysis of the new epistemologies, (c) a logical structure for scientific family therapy theory, and (d) minimum requirements for a scientific theory of family therapy.     

USING THE TELEPHONE IN FAMILY THERAPY

This article explores use of the telephone as a communication medium for engaging families in the therapy process. A review of related literature is followed by an exploration of some of the challenges involves. The author offers suggestions for conducting phone sessions, provides a case example, examines some of the ethical issues involves, and ponders the possible future impact of advanced telephone-related communication technology on family therapy.     

CREATING HEALING RELATIONSHIPS FOR COUPLES DEALING WITH TRAUMA: THE USE OF EMOTIONALLY FOCUSED MARITAL THERAPY

Emotionally focused marital therapy (EFT), a marital therapy that particularly focuses on the creation of secure attachment, has proven in empirical studies to be effective for distressed couples. This paper discusses the application of EFT in couples where one or both of the partners have experienced significant trauma. EFT, in this context of trauma, incorporates the nine steps of conventional EFT and also encompasses the three stages of the "constructivist" self development theory of trauma treatment. This paper illustrates how the integration of EFT and trauma treatement can prove effective in treating not only relationsip distress but also the individual symptoms of posttraumatic stress disorder (PTSD).