‘Somebody Else's Roadmap’: Lived Experience of Maudsley and Family‐based Therapy for Adolescent Anorexia Nervosa

The Maudsley and more recent family‐based therapy manualised approaches are positioned by some as the gold standard, evidence‐based therapy for adolescent anorexia nervosa (AN). However, a significant proportion of adolescents and their families either discontinue this therapy and/or find that it simply does not work for them. These adolescents and families are under‐represented in the literature on therapeutic interventions for adolescent AN. This paper begins to address this gap with an in‐depth qualitative case study that explores the lived experience of Maudsley family therapy (MFT)/family‐based therapy (FBT) for one female adolescent (age 14 years) and her family over the period of 3 years (ages 11–14). Although initially handing over the responsibility for her eating was comforting and reinstated a sense of control in the family system, these experiences were not maintained. When she did not progress past the first phase of FBT, she and her family experienced the approach as blaming. She felt silenced and family alliances were weakened. This paper analyses how the family members negotiated and preserved their identities within this disabling context.     

Patients' Perspective on Family Therapy for Anorexia Nervosa: A Qualitative Inquiry in a Chinese Context

This article presents a qualitative study of the subjective experiences of 24 Chinese adolescents and young women who have been suffering from anorexia nervosa and who have received family treatment from a university‐based family treatment centre in Hong Kong. In‐depth post‐treatment interviews were conducted and have been transcribed and thematised using content analysis. The narratives that have emerged have facilitated hearing the clients' and their family members' voices, especially in the areas of (a) perceived concepts of family therapy, (b) the perceived therapeutic relationship and its linkage to positive change, (c) perceived intervention strategies as employed in family treatment, and (d) the participants' own role in problem‐solving. The study has enabled the author to refine the family treatment model, which has been adapted from the Micucci's (1998) model, with additional components introduced by the author to enhance family treatment in a Chinese context.     

Parents' Involvement in Adolescents' Peer Relationships: A Comparison of Mothers' and Fathers' Roles

The goals of this study were to compare mothers' and fathers' direct involvement in adolescent girls' versus boys' peer relationships and to examine the links between parents' involvement and the qualities of adolescents' friendship and peer experiences. Participants were mothers, fathers, and firstborn adolescents (mean age = 15 years) in 187 working‐ and middle‐class families. Data were collected during home visits and a series of seven nightly telephone interviews. Parents' direct involvement was measured by parents' reports of their peer‐oriented activities, parents' knowledge about adolescents' peer experiences, and parents' time spent with adolescents and their peers. Findings revealed that mothers were more knowledgeable about adolescents' peer relationships than were fathers, that mothers with daughters reported the most peer‐oriented activities, and that both mothers and fathers spent more time with same‐sex adolescents and their peers. Parents' direct involvement was differentially related to girls' versus boys' peer experiences. Discussion highlights the role of parents' and adolescents' gender in shaping this dimension of family life in adolescence.     

Cognitive-Behavioral Family Therapy with a Family in High-Conflict Divorce: A Case Study

Children who live in families with high-conflict divorce situations are increasingly coming to the attention of clinicians. This paper explains the nature of the impasse of high-conflict divorce. It presents a brief theoretical overview of cognitive-behavioral family therapy as an effective approach to treatment for high-conflict divorce families. A case study that successfully utilized a cognitive-behavioral approach to family therapy is presented. Specific techniques such as parent training, communication and empathy skills, problem-solving skills, assertiveness training, role-modeling on the part of the therapist and application of the concept of reciprocal inhibition were included in the cognitive-behavioral family treatment. An N=1 research design is graphically illustrated for evaluation purposes.     

City of One: A Qualitative Study Examining the Participation of Young People in Care in a Theatre and Music Initiative

Young people's engagement with the arts can facilitate skills development, improve mental health and strengthen resilience. This article reports on a qualitative study exploring the experiences and involvement of ten young people in care in the development of a musical play exploring life in the care system. The project was viewed as successful in a number of ways: involving young people who had not previously taken part in drama; developing skills, confidence and resilience, and improving feelings of social connectedness. Extending work on participatory arts approaches, this study identifies factors that influence young people's ability to maintain involvement and the implications for carers and professionals supporting them.     

The Safety First Assessment Intervention: A Whole Family Approach for Young People with High Risk Mental Health Presentations

The following article provides a comprehensive guide to the clinical implementation of the Safety First Assessment Intervention (SFAI). The SFAI is a systemised, whole family approach for young people with high‐risk issues presenting in a mental health crisis. It is underpinned by the Safety First Model (Bickerton et al., 2007 ) and promotes community‐based care. The SFAI operationalises the foundation levels of the Safety First Model (SFM) through a highly structured clinical process. It draws on family systems theory, predominantly the work of Bowen ( 1978 ), to conceptualise distress through a multi‐generational systems lens and to prioritise the young person's natural support system (their family, friends, school and community) as their key resource. The SFAI engages this natural support system and facilitates open communication about symptoms, distress, safety and risk. This promotes a shared understanding of the key issues in a relational context and forms the basis of collaborative risk management. Thus, a system of safety emerges prioritising the family's role in optimising the young person's community‐based recovery. The need for pharmacotherapy and hospitalisation is therefore minimised. The article includes background theory, an outline of the structured assessment intervention and clinical techniques, including strategies for complex family situations. Specific strategies are illustrated with fictional vignettes. The work is based on the authors' accumulated experiences of working with young people and their families and carers in an acute Child and Adolescent Mental Health Service (CAMHS) for over a decade.     

Using Family Attachment Narrative Therapy to Heal the Wounds of Twinship: A Case Study of an 11-Year-Old Boy

This paper describes the utilization of Family Attachment Narrative Therapy with an 11-year-old boy experiencing significant behavioral and developmental problems emerging from his experience of identical twinship and associated parental failure. This innovative treatment model is demonstrated to be a useful tool for changing the child’s faulty self narrative resulting in improved functioning. The critical element of the reworked schema is the perception of self as complete, adequate, worthy and cherished. Family Attachment Narrative Therapy is also shown to facilitate increased parental attunement to the child’s inner state and parent-child bonding. This study highlights the unique developmental challenges facing young twins and the related complexity of the parental role.     

The Impact of the Physical Home Environment for Family Carers of People with Dementia: A Qualitative Study

Background: The majority of people with dementia are cared for by their families at home. This study aimed to elicit family carers' perceptions on home environmental aspects and strategies with the view to identify barriers and facilitators when caring for a person with dementia at home.

Design and methods: Thirteen co-resident family carers were engaged in semi-structured in-depth walking interviews. Interviews were recorded, transcribed and analysed using thematic analysis.

Results: Home environments can pose a number of challenges and opportunities. Aspects of the architectural and interior environment (e.g. size, condition, layout and accessibility, familiarity) are perceived as important (Theme 1) as well as a plethora of environmental strategies that encourage independence and comfort at home (Theme 2). Carers' scepticism, timing, costs, property characteristics and mistrust to services are some barriers to implementing environmental strategies (Theme 3).

Conclusions: Carers improvised solutions via trial and error and need further education on strategies to create an enabling and comfortable home environment.     

A Postmodern Critique of Societal Discourses of Male Violence in Interpersonal Family Relationships: A Balancing Act for Social Work

In recent years, treatments of family violence have tended to be built around conventional discourses suggesting that men are major initiators in instances of interpersonal violence. Utilizing a postmodernist analysis, we assess societal discourses that continue to give life to this narrow conceptualization of interpersonal violence. We also examine literature suggesting that both men and women resort to violence to resolve relationship difficulties and suggest that a more holistic and inclusive approach to understanding interpersonal violence is critical for social workers committed to social justice and a balanced understanding of the contextual nature of human problems.     

Interparental Incongruence in Differential Treatment of Adolescent Siblings: Links With Marital Quality

This study examined longitudinal links between incongruence in mothers’ versus fathers’ differential treatment of adolescent‐age siblings and parents’ marital quality. Multilevel models including 200 families, over four waves, spaced across 6 years tested whether youth perceptions of incongruence in differential intimacy and conflict predicted trajectories of mothers’ and fathers’ reports of marital conflict and satisfaction and vice versa. Analyses showed that changes in interparental incongruence covaried longitudinally with changes in marital quality and that these linkages became stronger over time. These results extend previous cross‐sectional research with younger children and are consistent with theories regarding family alliances and coparenting. Discussion focuses on the reciprocal relations between incongruence in parenting and marital quality as an important aspect of family systems.     

How Do the Professional Lives of Family Therapists Affect their Private Relationships: A Qualitative Study

This article is based on a qualitative research project about how the professional lives of family therapists affect their private relationships. The overarching research question was: How does your professional work as a family therapist affect your private relationships? To answer this question, semi‐structured qualitative interviews were conducted with four therapists from two different Family Counseling Services. Through the use of interpretative phenomenological analysis, three main findings were identified: (1) family therapists’ knowledge and values are a basis for interpersonal encounters; (2) participants describe resonance in relation to clients’ stories; and (3) therapists can be challenged in managing confidential knowledge particularly where they belong to the same communities as clients. The study also explores societal expectations and discourses that accompany the role of therapist, which can affect therapists’ freedom of movement in their private lives. These issues are discussed in relation to family therapy theory and relevant research.     

The Child in the Family of a Drug-Using Father: Attachment Styles and Family Characteristics

SUMMARY

The study examined the impact of family characteristics and parental attachment styles on the children of drug-using (DU) fathers in fifty-six families (n = 168) in Israel. Of the DU fathers, 60.7% were characterized by avoidant attachment style. Among the non-DU mothers, 53.6% were characterized by secure attachment style, 42.9% by avoidant style, and 3.6% by anxious/ambivalent style. Surprisingly, family cohesion and adaptability scores were similar to the Israeli norm, perhaps because the DUs had completed detoxification treatment and participated in rehabilitation programs. Of the children, 61.8% were characterized by secure attachment style, 21.8% by avoidant style, and 16.4% by anxious/ambivalent style. Stepwise regression to predict children's attachment styles revealed that maternal security of attachment and paternal anxious/ambivalent style predict similar attachment styles among the children. The important combined effects of spousal attachment styles on the children are discussed.     

Focus Group Study to Examine Content of Family Meetings in Short-Term Substance Use Disorder Treatment

This study explores the content family members find helpful in family meetings that occur while patients are in short-term treatment for substance use disorders. Four focus groups were conducted: 3 with 23 family members and 1 with 10 patients who were asked to identify those topics that are helpful or unhelpful for families with and without prior treatment experiences. Families identified education about substance use disorders and an overview of treatment options as useful for family members new to treatment, and an emphasis on response to relapse and family supports as important for those with prior treatment experiences.     

Adults in Wilderness Treatment: A Unique Application of Attachment Theory and Research

Research shows how an understanding of adult attachment applies to clinical treatment, such as outpatient therapy, but no literature explores the application of adult attachment to wilderness therapy, a distinct type of residential treatment. This paper explores how an understanding of adult attachment applies to wilderness therapy clients, as the nature of wilderness therapy involves losses, separations, and reunions, all of which evoke attachment needs. Adult wilderness treatment exemplifies an effective method of treatment that provides a secure base and supports healthy attachment relationships.     

From Face-to-Face to Facebook: The Role of Technology and Social Media in Adoptive Family Relationships with Birth Family Members

ABSTRACT

This qualitative study of 77 individuals in 40 couples (same-sex and heterosexual), who had adopted publically, privately, or internationally, examined parents' engagement with their child's birth family via technology (e.g., texting, e-mail, social media) through the lens of the Couple and Family Technology frame-work (Hertlein & Blumer, 2014 Hertlein, K. M., & Blumer, M. L. C. (2014). The couple and family technology framework. New York, NY: Routledge. [Google Scholar]). Parents used three approaches to contact: active, passive, and no contact. Regardless of approach, some parents described concerns about boundaries. Couples were generally in agreement in their perspectives on engaging with birth family via technology. Practitioners must be know-ledgeable about management of relationships via technology and help adoptive families set healthy boundaries.     

Family Changes in the Context of Lowest-Low Fertility: The Case of Japan

Abstract: Japan has currently one of the lowest-low fertility rates in the world. Low fertility in Japan is due to the extreme postponement of marriage and childbearing, and their weak recuperation in women in their 30s, as well as very low levels of cohabitation and extra-marital fertility. Both changing and unchanged aspects of families are related to lowest-low fertility in Japan. Although premarital sexual activities have increased, women's contraceptive initiative is very weak: they may be connected with weak partnership formation. "Parasite singles", "freeters", or "NEETs", probably related to weak family formation, have increased, but they may be connected with strong filial bondage derived from the traditional family system, i.e. Women have been normatively, educationally, and occupationally emancipated, but gender norms are currently divided in half among Japanese people, which may deter the revising of working conditions for women with children, leading to delaying family formation among working women. Lowest-low fertility conversely brings about family changes. Its direct effect is the increase of lifetime celibacy and childless couples, which may jeopardize the universality of families. Its indirect effect is through policy response to low fertility as well as labor shortages and population aging: recently, both family and labor policies have been strengthened to make it easier for working women to continue their jobs after marriage and childbirth, which might in turn promote family formation in Japan.