A RATIONALE FOR FAMILY THERAPY SPECIALIZATION IN EARLY INTERVENTION

Over the past two decades, professionals providing intervention to families with children with disabilities have witnessed a philosophical shift from individually oriented care to family-centered care. Although the relevance of family therapy to these families has been formally acknowledged through the Individuals with Disabilities Education Act (IDEA), the integration of the fields of family therapy and developmental disabilities has not yet occurred to any signigicant degree. Awareness of critical issues associated with developmental disabilities and the potential impact on the family system is vital to the process of family-centered intervention. In this paper we address the need for family specialists to become knowledgeable about early intervention considerations relevant to young children with disabilities and their families.     

THE FAMILY CRISIS INTERVENTION LITERATURE: WHAT IS MEANT BY “FAMILY”?*

Family crisis intervention is a rapidly growing area of clinical care in family therapy which lacks clear conceptualization, especially with respect to how “family” fits into crisis intervention theory. This paper integrates recent concepts from the family therapy literature into three views: family as background, family as context, and family as a unit. The family crisis intervention literature (56 publications) is reviewed and categorized according to these three views. Clarity in how “family” is viewed and consistency between theory and practice are examined. Recommendations for improving the conceptualization of “family” in family crisis intervention theory and practice are made.     

BRIEF FAMILY-FOCUSED INTERVENTION ON THE PEDIATRIC CANCER UNIT

Behavioral problems that frequently occur in pediatric cancer treatment settings, such as food refusal and the resistance to treatment, have been successfully treated utilizing family therapy techniques. The theoretical background that supports this mode of intervention and several case studies are presented.     

INTERVENTION STRATEGIES: PREDICTING FAMILY THERAPY OUTCOME*

A pre-defined list of family therapy intervention strategies was used to predict post-therapy perceived life happiness and marital happiness among husbands and wives. Clients presented with both child and marriage-focused problems. The data were analyzed separately for husbands and wives. In general, favorable outcome for husbands was associated with active restructuring operations on the part of the therapist. Prediction of outcome for wives was less clear. However, wives did appear to respond favorably to less active interventions such as actualizing transactional patterns and reframing.     

A "READER'S THEATER" INTERVENTION TO MANAGING GRIEF: POSTTHERAPY REFLECTIONS BY A FAMILY AND CLINICAL TEAM

The sudden and accidental death of a child can be one of the most devastating events in the life of a family. This paper describes one couple's reflections of their grief and mourning following the death of their adolescent son as well as the clinical team's reflections of therapy. The uniqueness of this paper is that it offers a "reader's theater" intervention that enabled further change to occur. The clinical team used a belief model, emphasizing that altering constraining beliefs is at the heart of healing from such tragedies as sudden death (Wright, Watson, & Bell, 1996). This approach is operationalized through therapeutic conversations between family members, clinician, and clinical team. Interventions such as reflecting teams, therapeutic letters, and "homework tasks" were used to modify or challenge constraining beliefs of both the family members and the clinical team members. However, the intent to co-author a paper with this couple provided the serendipity intervention of a "reader's theater" that further served to identify, affirm, and solidify facilitating beliefs.     

PARANOIA: INTERACTIONAL VIEWS ON EVOLUTION AND INTERVENTION*

An interactional basis for the evolution of a paranoid cycle is presented, followed by its implications for clinical intervention. Treatment strategies and tactics are delineated along with a set of clinical examples. The major therapeutic principle advocated is for the therapist to help to build new action based upon old labels and premises. The danger of using static labels of pathology is clarified through the example of the paranoid cycle. Finally, the interactional view of the paranoid cycle is briefly related to the paradigm shift within our field. True to strategic intervention tactics, the reframing of traditional labels used by the field in general is advocated as the best pathway to change.     

STRATEGY AND INTERVENTION VERSUS NONINTERVENTION: A MATTER OF THEORY?*

The question of whether or not intervention and strategy are necessary components of competent therapy is described and related to the metaphorical assumptions of underlying theory. Passive listening and expert interpretations are consequences of psychodynamic theory. Active manipulation of social structure and strategic intervention into feedback are described as consequences of the mechanical assumptions of structural and cybernetic theory. Conversational participation and non intervention are described as necessary consequences of hermeneutic and linguistic approaches to therapy. It is concluded that different theoretical assumptions yield different conclusions regarding the nature of therapy and human problems. From this perspective the question of Intervention Versus Non-Intervention is more a matter of the theory held than a question to be answered in terms of the “right” or “adequate” thing to do or not do.     

FAMILY INTERVENTION IN A CASE OF MULTIPLE PERSONALITY

The authors report a case of multiple personality in which therapy was directed at the marital couple, rather than focusing on the multiple personality per se. The symptoms of the individual are seen as a disturbance in the family homeostasis and were treated from that standpoint. The functions of the symptom in the areas of impulse discharge, superego operation, boundaries of closeness-distance, and self-object representations for the couple and family are discussed.     

CALGARY FAMILY INTERVENTION MODEL: ONE WAY TO THINK ABOUT CHANGE

This article defines and describes the Calgary Family Intervention Model (CFIM). CFIM is an organizing framework conceptualizing the intersect between a particular domain (i.e., cognitive, affective, or behavioral) of family functioning and a specific intervention offered by a health professional. Examples and discussion of interventions such as storying the illness experience, encouraging respite, and asking interventive questions are presented. CFIM is one way that health professionals can conceptualize about change.     

PARENTS' AND CHILDREN'S PERCEPTIONS OF A FAMILY SUPPORT INTERVENTION FOR CHILD BEHAVIOURAL PROBLEMS

The aim of this study was to establish the perceptions of children and their parents following a Family Support intervention for child behavioural and related difficulties. One hundred parents and 22 children aged 5–12 years participated in structured interviews, following the intervention. A framework approach to thematic content analysis was used. Themes, categories and subcategories were established. Parents discussed the usefulness of the intervention and the service in relation to therapeutic work (behavioural techniques and advice), support, practical help, and liaison with other agencies. They also identified service gaps. A number of factors were identified as responsible for improvement, both directly arising from and independently of the intervention. Despite their young age, children had good understanding of the interventions and their role in them, and expressed their wish for active involvement. The intervention was underpinned by a solution‐focused therapy model, combined with behavioural techniques. Families' perceptions indicate that they predominantly applied behavioural strategies, while some parents and children generated solutions in other areas of their lives. Family support has an important preventive role and should consist of an integral component of inter‐agency services for children with a broad range of behavioural and emotional difficulties and their families, and have close links with child mental health services.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

Integrating Family Therapy Training in a Clinical Psychology Course

Teaching family therapy to clinical psychology trainees is not common practice in Australian clinical psychology training programs. There is sparse discussion in the literature. Family therapy is an evidence based intervention that complements a diversity of established theories and psychotherapies and would complement the intervention skills of trainee clinical psychologists. The aim of this paper is to illustrate how family therapy training may be integrated into a postgraduate clinical psychology course. The literature on core family therapy knowledge, skills and training methods will form the backdrop to a review of specific family therapy training courses for clinical psychology trainees. This will then be mapped against a consideration of accreditation requirements of clinical psychology courses in Australia and suggestions made for integrating family therapy into their training curriculum. Anecdotal feedback from students provides an initial step toward evaluation.     

Selfobject functions of the family: Implications for family therapy

The application of Self-Psychology theory to family functioning adds to our models of understanding and intervention in family therapy. This article develops a theory of the family as a supraordinate selfobject and explores diverse clinical applications of the theory. The family as a selfobject matrix enhances the self development of the child by the provision of continuity through the maintenance of proximity over time, and by an enhanced quality and quantity of selfobject responsiveness for the individual. This application of Self Psychology theory has wide implications for family therapy with children in foster care, family therapy with elderly couples coping with dementia in one spouse, and family therapy as a component of treatment with suicidal adolescents.     

MOTIVATIONAL INTERVIEWING AS AN INTERVENTION FOR AT-RISK COUPLES

Thirty-one couples participated in a pilot, motivational interviewing, intervention for at-risk couples called the Marriage Checkup (MC). The MC consisted of thorough relationship assessment and individualized feedback. It attracted substantial numbers of at-risk couples who were not otherwise seeking treatment. Partners' marital satisfaction improved significantly from pre- to post-check-up and remained improved at 1-month follow up. Partners were no longer significantly different from a non-distressed comparison group following intervention. Although not addressing the efficacy of the MC, this study supports its viability as an indicated preventive intervention with couples at-risk for severe marital distress by addressing its attractiveness, tolerability, and safety.     

Alcoholics Anonymous and Family Therapy*

Alcoholism affects the family of the alcoholic as well as the individual problem drinker. Change in drinking behavior is often brought about by change in the alcoholic's family members. There has been a natural evolution in the alcoholism field of self-help groups for mates and children of alcoholics. This development has paralleled the recent growth and development of family therapy as a major mode of psychotherapeutic intervention. Yet, crossfertilization of ideas and intervention strategies between the two fields has been slow in occurring. Arguments over whether one uses family therapy or A.A. and Al-Anon persist. This paper focuses on ways in which family therapy and the A.A. self-help groups add to, rather than detract from, one another. A note of caution about the misuse of family therapy when alcoholism is present is also provided.¹     

EFFECTS OF SOLUTION FOCUSED THERAPY'S "FORMULA FIRST SESSION TASK" ON COMPLIANCE AND OUTCOME IN FAMILY THERAPY

This study investigated the immediate impact of a "solution focused" family therapy intervention on both the family and the therapist. Specifically, the study examined the differential effects of the formula first session task (FFST) recommended by de Shazer (1982, 1985), as well as the FFST plus solution focused therapy, as compared to a standard problem focused structural-strategic intervention. After one week, the groups receiving the FFST were significantly higher on measures of family compliance, clarity of treatment goals, and improvement in the presenting problem. However, there were no significant differences among groups on family optimism or on outcome after 10 sessions. The implications of these results are discussed.     

MULTI-LEVEL VULNERABILITY OF ADOLESCENT MARRIAGES: AN ECO-SYSTEM MODEL FOR CLINICAL ASSESSMENT AND INTERVENTION

This paper utilizes the Transitionally Unintegrated-Externally Open family system type derived from Wertheim (1973,1975) to address the multiple factors that may enhance or reduce the vulnerability of the adolescent marriage. Facilitating and constraining factors on the development of marital system autonomy and competence are identified at the individual, marital, familial and extra-familial levels. Guidelines for clinical assessment and intervention are presented.     

自闭症儿童家庭干预方法的研究

对自闭症儿童家庭的调查发现，自闭症儿童的家长获得干预方法的途径主要来源于咨询机构的老师；家长熟悉的干预方法包括行为治疗法、感统训练法、药物治疗法、游戏疗法等：家长认为有效的干预方法是行为治疗法与感统训练法，认为无效的干预方法为药物治疗法与功能分析法。建议家长在选择干预方法时综合考虑家庭环境、儿童的特点、自身的学历水平和职业特点等多方面因素；干预方法的使用要立足于自闭症儿童的实际感受，服务于儿童生活质量的提高．注意干预的生态效度以及学科跨领域的合作。     

Deactivating the Buttons: Integrating Radical Exposure Tapping with a Family Therapy Framework

The purpose of this paper is to describe and illustrate with case examples a brief intervention termed Radical Exposure Tapping (RET). RET can be integrated with family therapy to address stuck points where the therapy is hindered by a family member's affective block, an intense and unchangeable emotional reactivity to a specific trigger. RET draws from the methodology of Eye Movement Desensitization and Reprocessing (EMDR) and combines it with the tapping sequence of the Emotional Freedom Technique (EFT) to produce an intervention that is more flexible than EMDR, provides greater rigor than using the EFT technique alone and can be effective in a single session within the context of family therapy. The paper puts this work into context by first over viewing definitions of trauma and Post‐Traumatic Stress Disorder, arguing that family members' emotional reactivity may be a symptom of PTSD even when they would not qualify for the diagnosis because they had not experienced a life threatening event.     

‘The Family’ In The Undergraduate Social Work Curriculum.**,***

The growing popularity of family therapy raises the question as to whether material on family therapy should be included in basic professional courses, or left as a more specialised area of study at the post-professional level. This paper describes how concepts and techniques of intervention from family therapy have been used in a unit on ‘Social Work with Couples and Families’ in an undergraduate degree course in Social Work.