Abstracts

Ahrons, C. R. Divorce: A crisis of family transition and change. Family Relations ,
Elmer, E. Child abuse and family stress. Journal of Social Issues .
McCubbin, H. I. Integrating coping behavior in family stress theory. Journal of Marriage and the Family ,
Reiss, D. & Oliveri, M. E. Family paradigm and family coping: A proposal for linking the family's intrinsic adaptive capacities to its responses to stress. Family Relations ,
Richman, J. The family therapy of attempted suicide. Family Process ,
Stanton, M. D. Family treatment approaches to drug abuse problems: A review. Family Process ,
Unger, D. G. and Powell, D. R. Supporting families under stress: The role of social networks. Family Relations ,
Wiseman, J. P. The "home treatment": The first steps in trying to cope with an alcoholic husband. Family Relations ,     

Walk-in Together: A pilot study of a walk-in online family therapy intervention

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk-in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof-of-concept study investigating the acceptability and short-term effectiveness of an online walk-in family therapy service, Walk-in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk-in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre-session, post-session, and at 6 weeks follow-up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi-structured interview data. Post-session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post-session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well-received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk-in delivery model. This proof-of-concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk-in, telehealth model to meet the rising demand for therapeutic support for families in distress.     

Engaging Fathers in Family Therapy with Violent Adolescents

Violent behavior in adolescents can often signal profound distress or pain arising from family conflicts, hostile marital separations, sudden losses and other family turmoil. By circumventing blame the therapist engages the family in a constructive process that allows adolescents to change and grow and parents to share pain and sorrow about their own issues and responsibilities for their children. This re‐establishes healthy generational boundaries, produces a clearer co‐parenting alliance (e.g. after divorce) and creates sibling support. This paper describes an experiential approach, for working with violent adolescents in family therapy influenced by the pioneer work of Satir and Whitaker. It integrates systemic and developmental theories linking the presenting problem to relevant family events. The therapist: (1) explores adolescent development in the family and social context; (2) establishes a therapeutic alliance through understanding the interpersonal context for violent behavior, and (3) re‐directs negative actions into positive connections with family members. Segments of family therapy sessions with two adolescent boys and their families from different cultural backgrounds illustrate the impact of paternal absence for adolescent well‐being and the need to actively engage fathers in family therapy. Mario, the father's ‘tumor’, and Juan with his despairing violence are two problematic adolescents brought to therapy because of their aggressive behavior at home and/or in the school. The paper describes how to give them a different voice and build a therapeutic alliance with the family.     

Normative Family Development

Healthy, normal families pass through a sequentially developmental life cycle. Family therapists need a normative framework within which to test for dysfunction and pathology in family process. This paper provides an exposition of these developmental stages and forms, and therefore, hopefully some universal guidelines for the practice of family therapy.     

Negotiating Emotional Support: Sober Gay Latinos and Their Families

This study explores how sober gay Latino men obtain support from their families. Familial ties can be a protective health factor, yet many gay Latinos experience rejection from family members because of their sexuality. There are very few studies that examine the extent and quality of emotional support from kin for this population. Understanding family dynamics within the context of recovery and sexuality can increase our understanding of how to leverage family ties to develop alcohol abuse interventions. The study was conducted via semistructured interviews with 30 sober gay Latinos using a grounded theory approach. Analyses of the qualitative data identified the following themes: family values shaped the participants’ perception of their range of choices and emotional responses; participants reported feeling loved and supported even when sexuality was not discussed with parents; and family support for sobriety is essential. Findings suggest that familial ties shape perceptions of support and importance of disclosing sexual identity. Family support often results from agreements about sexual identity disclosure, and some families can overcome cultural and religious taboos on sexuality. Future studies should investigate families that negotiate acceptance with their gay members, and whether they exhibit heterosexual biases that may influence the psychological stress of gay Latino men who wish to be sober.     

An Educational Model of Family Consultation*

This approach to working with families under stress recognizes the family as a system interacting via communication patterns among its own members and within a larger context of peers, neighbors, school, work, and community agencies. The goal is to help the family become a support system for all its members, more capable of meeting both adult and child needs for ongoing socialization and personal growth. The model is educational in that the focus is on teaching the family to identify strengths as well as dysfunctional behavior, and to acquire some basic communication and problem-solving skills. Methods are both cognitive and experiential. The approach is useful in short-term therapy with single families or groups of families.     

Family Therapy for a Korean Son with Schizophrenia

In recent decades the treatment of schizophrenia has focused primarily on pharmacotherapy with an emphasis on respite for family caregivers, support groups, and compliance regimens to sustain and maintain the affected client and family members. The use of family therapy models to intervene effectively with families affected by a diagnosis of schizophrenia is less common in the professional literature. This case study draws on the Mental Research Institute's communication theory and Bowen Family Systems Theory in therapeutic work with a Korean family.     

Couple and family interventions in health problems

Intervention research for couples and families managing chronic health problems is in an early developmental stage. We reviewed randomized clinical trials of family interventions for common neurological diseases, cardiovascular diseases, cancer, and diabetes, which is similar to the content of previous reviews discussed later. One overriding theme of these studies is that patients with chronic illnesses and their families face a variety of challenges to which researchers have responded with an array of treatment modalities. Very few of the interventions reviewed, with the exception of treatment for adolescents with diabetes, tested family psychotherapy models. Most interventions were time-limited therapeutic interventions that trained families to improve their communication and problem-solving skills, individual and family coping skills, and medical management. Researchers more clearly described mechanisms of change in intervention studies with cancer and diabetes than with other diseases, and not surprisingly, they found greater empirical support for their interventions. Family interventions show promise to help patients and family members manage chronic illnesses. To develop an empirical base for family approaches to managing chronic illnesses, interventions must be based on theories that delineate mechanisms of change in family processes and skills in medical management necessary to maintain patients' and family members' health.     

Gambling and the family: From the stress‐coping‐support Perspective 1

Abstract

Aims: To apply the stress‐coping‐support perspective to the study of the effects of problem gambling in the family. Specifically, to examine the ways in which family members cope and the nature and sources of support they receive. To compare coping strategies of family members of gamblers with those of individuals living with other addictive behaviour in the family. Design: Cross‐sectional interview and questionnaire study of close relatives of problem gamblers. Participants: Sixteen close family members of gamblers from separate families, mainly parents and partners. Data: Semi‐structured interview; adapted version of the Coping Questionnaire (CQ). Findings: Data from the CQ and qualitative analysis of interview data suggested considerable use of ‘engaged’ (specifically controlling) ways of attempting to cope with such problems, comparable to the use of such strategies by relatives of people with alcohol or drug problems, but little use of ‘tolerant‐accepting’ and ‘withdrawal’ ways. Interview data on the support received (or not) by family members confirmed previous research showing that relatives of people with addiction problems often feel unsupported, but particularly appreciate positive emotional and practical support for themselves and their problem gambling relatives. Conclusions: The stress‐coping‐support perspective, previously applied to families with alcohol and drug problems, also offers an appropriate framework for understanding problem gambling and the family.     

Health-Promoting Influences of the Family on Late Adolescent Functioning

This study examined whether potentially modifiable health-promoting family factors during mid-adolescence (age 15) predicted adaptive functioning in late adolescence (age 18) among members of a working-class community cohort. Family factors included feeling valued in the family, cohesion, and social support. Late adolescent outcomes covered developmentally salient areas: academic functioning; mental health; suicidal behavior; and social, psychological, and behavioral functioning. Our findings demonstrate that a positive adolescent family milieu is related to both adaptive outcomes and a reduced likelihood of serious difficulties, including mental and behavior problems. Although each hypothesized health-promoting factor was significantly associated with multiple areas of age 18 functioning, the patterns of association differed by type of family factor. Taken together, results suggest that the family remains an important social context during mid-adolescence and that to be most effective programs designed by practitioners aimed at strengthening families should target multiple features of the family environment.     

Stages of Change Theory in Family Therapy for Sibling Sexual Assault

Family therapy understands the benefits of therapeutically supported dialogue amongst family members when there are challenging themes and topics that need to be discussed. This paper is an attempt to explore ways that family therapists can work with family members who are thrust into therapy rather than ‘voluntarily’ signing up for it. It applies ideas from the drug and alcohol field such as Stages of Change theory and Motivational Interviewing. The paper explores how these ideas and approaches might help family therapists to formulate a concept of resistance and to make helpful dialogue more likely. They are applied to families experiencing sibling sexual assault, where they become involved with a legal response that necessitates a therapeutic intervention.     

Towards a Multicultural Society: Family Therapy with Greek Families†

Language and cultural differences can pose barriers to effective intervention in migrant families in conflict. Family therapy approaches can provide some useful strategies for overcoming these obstacles. A family therapy approach can (1) emphasise the value of utilizing natural network support systems; (2) provide a model which helps clarify communication problems arising in the relay of information through a third person acting as an interpreter; (3) underline the importance of non-verbal and process aspects of family communication; (4) suggest techniques for negotiating, joining, and finding commonalities of family experience between a therapist and family of different ethnic background. The therapist needs to develop sensitivity to both the universal and specific ethno-cultural structures, norms and problems of families; when this sensitivity is achieved powerful and culturally syntonic healing forces can be released. Examples of successful family therapy interventions in some Greek families in conflict are given.     

Creating pathways to participation: a community-based developmental prevention project in Australia

Pathways to Prevention is a developmental prevention project focused on the transition to school in a disadvantaged multicultural urban area in Queensland. The project incorporates two elements: The Preschool Intervention Program (PIP) promotes communication and social skills related to school success; and the Family Independence Program (FIP) (parent training, facilitated playgroups, support groups, etc) promotes family capacity to foster child development. Using a quasi-experimental design (N= 597), improvements in boys' but not girls' behaviours over the preschool year were found. FIP reached more than a quarter of the target population, including many difficult-to-reach families experiencing high stress. Case studies and other qualitative data suggest positive outcomes.     

Socioeconomic status, neighborhood disadvantage, and poverty-related stress: Prospective effects on psychological syndromes among diverse low-income families

Living with persistent poverty is toxic for one’s psychological health. This study examined SES, income, neighborhood disadvantage, and poverty-related stress as predictors of a wide range of psychological problems including anxiety, depression, aggression, relationship problems, physical problems, and trouble with the law. Longitudinal analyses were conducted with a low-income multiethnic sample of 98 families recruited from the greater Denver, CO metropolitan area (300 family members: 136 adults, 82 preadolescents, 82 adolescents) using hierarchical linear modeling to predict all eight ASEBA narrow band syndromes. Analyses showed that poverty-related stress was directly related to anxious/depressed symptoms and social problems and interacted with prior symptoms, contributing to worsening symptoms for delinquency, attention problems, somatic complaints, and anxious/depressed symptoms. Hollingshead SES also had direct predictive effects for certain syndromes, though these effects were in the opposite direction predicted. In contrast, lower income-to-needs predicted more problems as expected. Neighborhood disadvantage also predicted psychological syndromes. Developmental differences are discussed. Our data show that parents are not the only family members who are affected by stress from living in poverty. SES, neighborhood disadvantage and poverty-related stress take a toll on children, adolescents, and adults.     

Maladaptive Coping as a Mediator of Family Stress

Family members of women substance users may be at risk for stress-related problems. Family coping responses may affect outcomes for both families and women in treatment. Eighty-two women in treatment for substance use disorders (56 with comorbid psychiatric conditions) and 82 family members were interviewed. Stressors related to women's disorders were significantly related to increased family member burden. Women's behavioral problems predicted greater family member Worry, Displeasure, and Impact. Extent of women's drug or alcohol use predicted greater family member Stigma and Impact. Family member maladaptive coping partially mediated relationships between family member stressors and family member Displeasure and Impact. Family member maladaptive coping also functioned as a moderator between the stressors and Impact.     

THE THERAPEUTIC ALLIANCE IN HOME‐BASED FAMILY THERAPY: IS IT PREDICTIVE OF OUTCOME?

This study examined the association between the therapeutic alliance in family therapy and changes in symptom distress, interpersonal relationships, and family coping. The participants (N = 81) were members of low socioeconomic status families referred to a university clinic for in-home family therapy. Participants completed the Outcome Questionnaire, Family Crisis Oriented Personal Evaluation, and the Family Therapy Alliance questionnaires. Regression analyses revealed that the therapeutic alliance explained 19% of the variance in symptom distress changes for mother, 55% for fathers, and 39% for adolescents. The implications of these findings for practicing and researching family therapy are presented.     

Ecologically defining the mistreatment of adolescents

Ecologically defined, the problem of adolescent/family conflict for otherwise “normal” families is a reaction to crisis in the life cycle of the family. A family's success in weathering the crisis is indicated by their successful maturation to the next stage of the cycle; we can assume that in such cases the ratio of stress to coping ability was such that the family could integrate that stress. When conflict escalates to abuse and neglect, however, the indication is that stress has outstripped coping ability, and the implication is for stress-reducing intervention quite unlike the standard existing interventions in either the juvenile justice or child welfare systems, which negatively label family members, make them adversaries, fragment their coping capabilities, and even subject them at times to situations worse than those for which they needed help originally. The interventions called for are those that support beleaguered families; that are based on conceptualizations of people as adaptable and capable of solving their own problems if they are given adequate supports.     

FAMILY ASSESSMENT DEVICE: REPORTS FROM MOTHERS, FATHERS, AND ADOLESCENTS IN COMMUNITY AND CLINIC FAMILIES

This study compared responses on the 60-item version of the Family Assessment Device (FAD) obtained from mothers, fathers, and adolescents in two groups of families. The clinic group consisted of 94 families in which the adolescent had been referred to a mental health service in metropolitan Adelaide, South Australia. The community group consisted of 94 families, also containing an adolescent, living in the Adelaide community. Members of the clinic families consistently rated their families as less healthy than did families in the community. Importantly however, adolescents in both groups of families rated their families as significantly less healthy than their parents. Thus, while the results of the study provide support for the discriminative validity of the FAD, they also emphasize the need to consider separately self-reports on family functioning obtained from different members of the same family.