Integrative Family Therapy for Child Behavioural Problems in a Parenting Support Agency

This paper describes family therapy for behavioural problems in a parenting support agency. It discusses the literature on the effectiveness of family therapy with child behaviour problems within a community support environment. The paper presents a detailed family case study, which is discussed from an integrative family therapy framework. Narrative therapy is used as an overarching framework for integrating systemic therapy and parenting skills to help a family with a mixed cultural Aboriginal and Australian background. This allows sessions that are meaningful for the family and encourages a connection to their own resources and to their community, besides creating a safe space for a dialogue that hears and values all voices.     

Internalising and externalising children's behaviour problems in Britain and the US: relationships to family resources1

A large sample of British children (n=994) of varying ages (7–18 years) and a large sample of American children (n=886) of varying ages (7–16 years) were rated by their mothers using respectively the Rutter Child Scale A and the Behaviour Problems Index both of which cover a variety of behavioural problems. Factor analysis of the behavioural scales distinguished externalising and internalising dimensions of behaviour in both countries. We examined whether children's experiences of family change, cognitive ability and family adversity including economic deprivation were associated with differences in the prevalence of the behavioural dimensions. Mean cognitive scores decreased significantly with increasing level of externalising behavioural problems in British and American children but showed no significant relationship to levels of internalising behaviour problems in either sample. Among American children internalising and externalising behavioural problems were related to experience of non‐intact family structures and measures of family adversity. Externalising behavioural problems were related to measures of family adversity among British boys and girls but were only related to experience of non‐intact family structures in the sample of British girls. Among British girls, internalising behavioural problems were also related to non‐intact family structures. The associations between non‐intact family structures and behavioural problems were independent of measures of economic deprivation in both samples of children. This study documents some of the background factors which affect children's behavioural and cognitive outcomes. Unlike children's family structure economic deprivation can be influenced through policy intervention, and the analysis supports the view that relieving economic deprivation would help improve children's behavioural outcomes. Copyright © 2000 John Wiley & Sons, Ltd.     

Can community-based interventions prevent child maltreatment?

Despite the many efforts taken to prevent child maltreatment, this continues to be a significant worldwide problem. Interventions predominantly focus on ‘at risk’ populations and individual characteristics of the victim or abuser, but is that enough? The present review was designed to examine the potential of community-based programmes, those that target the problem solving and helping processes in the community, and thereby aim to prevent child maltreatment. We searched for theoretical and empirical indications and for available programmes that focus on neighbourhood processes, based on the assumption that positive outcomes may not just be changes in individual behaviours, but may also include changes in community capacity. We found strong theoretical evidence that for stable and long-term behavioural changes it seems necessary to also develop activities aimed at changing distal social contexts surrounding the family, including neighbourhood and school factors, that is, the public domain. We argue that a strong social environment is a necessary condition for the prevention of child maltreatment. Community-based interventions can strengthen the socialising quality of the social environment. Since the high prevalence of child maltreatment remains a significant problem, despite the availability of effective family interventions, preventive interventions should target the wider social context of the family, in particular neighbourhood factors. Scientific literature generally showed that community-based interventions targeting neighbourhood processes are promising, although effectiveness should still be established. Empirical evidence is necessary to further develop promising community-based approaches for the prevention of child maltreatment.     

Beyond Behaviour — The Importance of Communication and Connection in Parenting ‘Defiant’ Children: Pilot Study and Program

Parents of children with defiant behaviour are frequently encouraged to establish clear behavioural expectations and consistency. Yet parental exhaustion, the constancy of the child's demands, and the child's push for control may compromise the success of the behavioural approach, leaving the family and therapist to search for other methods. This paper introduces parenting strategies developed as part of the ‘C Plus C — K Program’ for parents of primary school aged children (age range 5–12 years) with major behavioural problems. The program encourages parents to utilise relationship‐building parenting strategies. It is anticipated that over time, the child will develop self‐regulatory ability in situations of stress, leading to a reduction in problem behaviour. Preliminary data suggests that the program may be effective in achieving this aim. C Plus C strategies are illustrated with a fictional vignette based on common parenting situations.     

Utility and the individual: An analysis of internal conflicts

Herbert Simon has argued that economic agents do not maximise a transitive ordering but rather adopt what he calls satisficing behaviour. He argues that such behaviour is rational. This paper aims to provide a theory to support Simon's viewpoint. Because of social choice problems an individual with multiple objectives may find it impossible to construct a transitive ordering and hence may have to adopt satisficing type behaviour. We show that whether or not an individual adopts satisficing behaviour depends on the information available.I would like to thank Amartya Sen, the members of a seminar in Oxford, and an anonymous referee for their comments on previous drafts of this paper.     

Cognitive behavioural therapy for violent behaviour in children and adolescents: A meta-analysis

Aggressive behaviours often co-occur with other emotional, behavioural, academic, and social relationship problems. During adolescence, these children often exhibit increased rates of school dropout, depression, juvenile delinquency, substance abuse, and poor peer relationships. Some definitions focus on aggression as an emotion; according to this framework, aggressive behaviours stem from anger. Other definitions emphasise the motivational aspect of aggression, wherein intentions are thought to indicate the behavioural characteristics. Cognitive–behavioural therapy (CBT) is one of the most extensively researched forms of psychotherapy. This paper aims to review the literature on the use of CBT for treating children and adolescents who demonstrate high levels of violence. Studies were searched for using several methods. First, we used large database of literature on psychological treatments of violence in general. Studies were traced by means of several methods. A large database of 240 papers on the psychological treatment of aggression and violence in general were used. This database was developed through a comprehensive literature search (from 1997 to March 2009) in which we examined abstracts in ERIC (19 abstracts), Psycinfo (30), and Medline (23). Keywords used in computer searches were: Aggression, Violence, CBT, cognitive–behavioural therapy, cognitive therapy, behaviour therapy, and behavioural activation. The options were used in computer searches so that all relevant topics within the broader categories were searched as well. Six studies met the inclusion criteria, all of which indicated beneficial results of using CBT. A meta-analysis suggested an effect size of − 0.094 for reduced violence as a result of CBT treatment; this is considered to be a medium effect. The differential effects of cognitive–behavioural therapy and affective education were variable, although they were also generally in the medium range. In this meta-analytic study, CBT treatment proved less effective in reducing aggressive behaviour. This review tentatively suggests potential for using CBT to reduce violence in children and adolescents. However, there is only a small body of research exploring this relationship at present. Further research is needed before any solid conclusions can be drawn.     

Intervening in the School-Family-Clinic Triangle*

Ideas from family therapy have recently been applied to school and learning problems. A systems view has been advocated rather than the more traditional individual one long used by teachers, parents and school psychologists. This paper describes a model that enables school problems to be formulated systematically and details the implications of this model for designing interventions. A new project in Perth that combines simultaneous interventions in family, social and educational systems is described and its work is illustrated with a case example.     

Transitions to Systemic Practice for a Clinical Psychology Trainee

This article provides an individual perspective on encounters with systemic and family therapy ideas during the transition from university training to professional practice as a Clinical Psychology Registrar. Clinical psychology training provides a solid grounding in individually focussed, cognitive and behavioural models of psychotherapy. What may be less developed on entry to practice are the knowledge, procedural skills and reflective competencies needed to understand and respond to challenges in family‐based therapy and in working within complex caregiving systems. Systemic ideas can provide important resources for facilitating these transitions. Trainees may need support not only in gaining knowledge of family therapy models, but also in making a challenging ‘epistemological shift’ (Cullin, 2014) from internalised models of psychopathology to systemic ways of thinking about problems and change. Systemic concepts and support in developing a position of ‘hospitality’ (Larner, 2003) towards competing therapeutic models can also help the trainee be more effective in complex caregiving environments. This article provides examples from my learning as well as reflections on what may help trainees make the transition to professional practice and make use of systemic ideas.     

Are income poverty and perceptions of financial difficulties dynamically interrelated?

An individual’s economic ill fare can be assessed both objectively, looking at one’s income with reference to a poverty line, or subjectively, on the basis of the individual’s perceived experience of financial difficulties. Although these are distinct perspectives, income poverty and perceptions of financial difficulties are likely to be interrelated. Low income (especially if it persists) is likely to negatively affect perceptions of financial difficulties and, as recently suggested by the behavioural economics literature, (past) subjective sentiment may in return influence individual’s income generating ability and poverty status. The aim of this paper is to determine the extent of these dynamic cross-effects between both processes. Using Luxembourg survey data, our main result highlights the existence of a feedback effect from past perceived financial difficulties on current income poverty suggesting that subjective perceptions can have objective effects on an individual’s behaviour and outcomes.     

Child abuse prevention: Blending research and practice

For over two decades, child abuse interventions have been plagued by poor definitions of what (or who) exactly is being treated, what constitutes ‘success’, and how services can be delivered in such a way as to minimize the harm to the child and to his/her family. Most recently, intervention/prevention programmes reflect the growing recognition that child maltreatment is the product of the interaction between the parent's abilities and resources and the child's emerging behavioural and emotional characteristics (i.e. the parent–child relationship), and place less emphasis on individual psychopathology. Accordingly, ways to strengthen this relationship offer considerably more promise than those aimed at correcting only one component (i.e. the parent) or treating only the visible symptoms of conflict. In an attempt to focus greater effort on prevention and early intervention, this paper reviews prominent risk factors that have been linked to physical abuse and neglect of children and their consequences. Major intervention targets are identified from this literature and discussed in reference to: (a) problems related to the family context; (b) child treatment needs; and (c) parent/caregiver treatment needs. The paper concludes with a discussion of promising developments in early intervention that are beginning to address problems in the early formation of the parent–child relationship (i.e. the pre-natal and infancy periods of development) and problems associated with parental competency and family support. Most notably, preventive efforts have been associated with more positive parenting knowledge, attitudes, skills, and behaviour, as well as fewer child injuries, emergency room visits, and reports to protective agencies among at-risk parents and children. Further evaluation and expansion of these programmes appears to be warranted by these data.     

Player account-based gambling: potentials for behaviour-based research methodologies

The emergence of player account-based gambling is a result of escalating technological sophistication and the incorporation of these developments into gambling. This term refers to gambling from a centralized account that is linked to an identified individual. Player account-based gambling is increasingly being utilized for multiple forms of Internet, mobile and land-based gambling through player cards and user-names. Player accounts track and store a wealth of data on gambling behaviour and related activities. Gambling research has been justifiably criticized for its reliance on self-report rather than behavioural measures. Research analysing player account data may advance conceptual models, identify behavioural risk factors for problem gambling and evaluate and guide effective policy and responsible gambling programmes. Although research utilizing player account data has unique limitations, it offers considerable benefits for researchers, operators and regulators. Research methodology incorporating the use of player account data stands to make significant contributions to the gambling field.     

Absenteeism and peer interaction effects: Evidence from an Italian Public Institute

Using microdata for a sample of about 350 workers employed by an Italian public institute, we explain individual absence rates considering both variables that may be related to health conditions and variables that may suggest shirking behaviour. Among these variables we especially focus our attention on the influence produced by the behaviour of randomly assigned peers. In order to handle reflection problems, we combine random assignment with the use of instrumental variables. The proportion of females in the peer group is used as an instrument of peer absence behaviour. From Two-Stage Least Square estimates it emerges that social and group interaction plays an important role in shaping individual absence behaviour.     

ARE TRUSTWORTHINESS AND FAIRNESS ENOUGH? CONTEXTUAL FAMILY THERAPY AND THE GOOD FAMILY

The moral dimension of family therapy theory and practice has received increasing attention in recent years. Boszormenyi-Nagy was among the first to see that family therapy and moral questions are inseparable. His focus on relational ethics has helped us to reappropriate individual responsibility and accountability within a systemic context. Although contextual therapy has clearly enriched the field, we argue that its emphasis on trustworthiness and fairness provides a limited view of the good in family life and leads to three related problems. First, Boszormenyi-Nagy offers a compelling ethical vision of the family and then denies that he has done so, which undermines some of his key moral claims. Second, because fairness is defined subjectively, contextual therapy may not have the resources to deal with legitimate differences in family ideals. Third, the reliance on self-interest as the primary motive for trustworthy relating appears to be self-defeating. We offer a hermeneutic perspective that takes a broader approach to the good. It places greater emphasis on the social and historical context, deals squarely with different understandings of the good in family life, and recommends an approach to resolving these differences.     

Stable sets and standards of behaviour

In this paper we present a constructive, behavioural and axiomatic approach to the notion of a stable set as a model of the standard of behaviour of a social organisation. The socially stable set we introduce is a generalisation of the von Neumann-Morgenstern stable set. In contrast with the original version, our stability concept is always solvable. The standard of behaviour, reflecting the established conceptual order of a society or organisation, emerges from a dominance relation on alternative conceptions that are relevant with regard to a certain issue. This common social choice phenomenon, that permeates our societies and organisations, we have tried to clarify. Two axiomatic characterisations as well as a construction algorithm for socially stable sets are presented. These characterisations are based on behavioural postulates regarding the individual or collective strategic behaviour of effective sets. Relations between socially stable sets and other notions of stability are discussed. Received: 4 May 1998/13 March 2000     

Children placed in long-term family foster care: A longitudinal study into the development of problem behavior and associated factors

Due to prior experiences of trauma and abuse, many foster children have behavioral problems. The placement of the child in a family foster home is expected to reduce the behavioral problems. However, this expectation is seldom met and mostly behavioral problems increase or remain stable during placement. Research on the development of behavioral problems in foster children is scarce. Moreover, most of the research results are situated on a group level, which obscures the development of problem behavior on a case level. This study investigated the development of problem behavior of 49 foster children on a case level and the association of global, contextual, familial and child factors with the increase or decrease of problem behavior. Over a two year period 18 foster children had more, 23 just as much and 8 less problem behavior. An increase was associated with the use of more negative parenting strategies by the foster mothers. A decrease was related to the use of supportive parenting. Support of foster parents aiming at reducing the use of negative discipline practices and promoting the use of supportive parenting may have a positive effect on the development of foster children.     

The prediction of learning in family therapy training programs*

Research on family therapy training has produced very little data regarding the kinds of trainees that do best in family therapy training programs. This study attempts to provide some rough and preliminary data on that issue. One hundred and seventy trainees, drawn from seven different structural!strategic training experiences, were evaluated as to how much they learned by taking the Family Therapy Assessment Exercise pre- and posttraining. Their performance was correlated using a hierarchical regression analysis with a number of trainee variables such as amount of conjugal family experience, amount of experience doing family or individual therapy, or prior knowledge of family therapy. The results indicate that, as predicted, conjugal family experience was positively related, and prior knowledge was negatively related to performance. Prior experience doing individual therapy was also positively related to performance.     

A comparison of two programmes for victims of child sexual abuse: a treatment outcome study

This study aimed to evaluate the comparative effectiveness of individual therapy and combined individual and group therapy in the treatment of the psychological sequelae of child sexual abuse. The Child Behaviour Checklist (CBCL), the Youth Self Report form (YSR), the Children's Depression Inventory (CDI) and the Trauma Symptom Checklist for Children (TSCC) were administered before treatment and 6 months later to a group of 20 young people who participated in individual therapy (IT) programmes and to a group of 18 young people who participated in programmes that involved combined individual and group therapy (IGT). For both types of programmes, statistically significant improvement occurred on the following scales: the total problems, internalizing problems, externalizing problems, withdrawn, somatic complaints, anxious/depressed, social problems, attention problems and aggressive behaviour problems CBCL scales; the total depression, interpersonal problems and anhedonia CDI scales; and the depression and anger TSCC scales. The only scale for which one therapy programme led to greater improvement than another was the CDI ineffectiveness scale. The IGT programme led to a reduction in the mean CDI ineffectiveness score, whereas a slight increase in the mean ineffectiveness score occurred in the IT group. There were no significant differences in the rates of clinically significant improvement associated with the two treatments and no major differences between cases who improved and those that did not improve over the course of therapy. From this study, it may be concluded that after 6 months, individual therapy and combined individual and group therapy were equally effective in the treatment of the psychological sequelae of child sexual abuse. Copyright © 2002 John Wiley & Sons, Ltd.     

Intimacy,Gender and Self Psychology: Considerations for Relationship Counselling

This paper reviews major conceptualisations of intimacy and the blocks, frequently attributed to gender, which are thought to contribute to problems in couple relationships. The paper concludes that gender is often not the limiting factor that inhibits intimacy in heterosexual couples. It may be more productive to consider individual rather than couple therapy to deal with impasses that appear to be associated with gender. Ideas from self psychology provide insights into how some requests for intimacy may be related to immature self‐object needs, which may better be handled through individual rather than couple therapy. A range of therapeutic goals and strategies that focus directly on intimacy are then outlined.     

Therapeutic Alliance; A View Constructed by a Family Therapy Team

Therapeutic Alliance is a construct which may have value for a family therapy team and influence its day to day practice. This paper discusses whether family therapeutic alliance can be observed, described and measured, and gives an account of the development of the Family Therapeutic Alliance Scale (FTAS) by a brief strategic family therapy team. Our focus is on the use of statistical technique as a means of clarifying the team's construct of therapeutic alliance, informing the team process without being the final arbiter in development of the scale. The second stage outlines the investigation of the usefulness of the construct with a wider group of family therapists. In individual psychotherapies measures of therapeutic alliance have been shown to predict outcome. Our early work suggests this is also true for family therapies and the FTAS may be a predictor for outcome in family work.