The Use of E‐mail in the Therapy Process

The therapeutic letter has a long history, with roots in psychoanalytic work and continuing application in family therapy. The advent of e‐mail has allowed another form for therapeutic written communication which, while incorporating the benefits of therapeutic letters, adds to these. It has also opened up some potential risks. This article incorporates a brief review of the literature covering therapeutic written communication and offers a case example where e‐mail was used as an adjunct in face‐to‐face therapy with a client who experienced attachment difficulties. This therapy was informed by systemic and psychoanalytic traditions. The authors explore a variety of technical matters including the timing and crafting of e‐mail responses, the integration of written communication with face‐to‐face therapy, impact on the therapeutic relationship and management of crisis. Ethical issues such as confidentiality and duty of care are also considered.     

Family Therapy is Just One Option

I trace my development as a family therapist from being a single model worker in systemic family therapy to a more eclectic approach. The context of my work is children's services and private practice. Failure to appreciate when one method of therapy is more suitable than another can lead to family therapy being applied when it is not indicated. The dangers in such mistakes and a lack of careful assessment that includes the ‘feeling state’ of the therapist are illustrated by case vignettes. A possible effect of some therapy techniques is to create a ‘distance’ from clients and to shield the therapist from their emotional distress. I outline situations where I would not use family therapy.     

Practice with Transgendered Children

SUMMARY

Utilizing an ecological framework and based on the existing literature and research, as well as my own 24 years of clinical practice with children, youth, and families, this paper examines gender variant childhood development from a holistic viewpoint where children and en-vironments are understood as a unit, in the context of their relationship to one another. This chapter is limited to a discussion regarding the recogni-tion of gender identity; an examination of the adaptation process through which gender variant children deal with the stress of an environment where there is not a “goodness of fit” and a discussion of the overall de-velopmental tasks of a transgendered childhood. Recommendations for social work practice with gender variant children are presented in the con-clusion of the paper.     

On Teaching as Activism

This essay explores the relationship between teaching and activism by interrogating if teaching in higher education should be considered activism. Through a discussion of my commitment to data literacy and how participatory democracy, as practiced by Black Freedom Movement organizer Ella Baker, informs my pedagogy, I interrogate if activism and academic labor should be conflated. In the process I examine how my assessment is informed by my relationship to activism, the academy, my career trajectory, and racism as part of academic work conditions.     

Video Game Use as a Tool for Assessing and Intervening with Identity Formation and Social Development in Family Therapy

Because video games are becoming such an integral part of our culture, modern family therapists are more likely than ever to encounter families with members who play them. It is easy to overlook video game use in terms of its potential as a therapeutic tool, particularly if a therapist possesses only limited knowledge of the medium. Using existing literature and my experience as a lifelong gamer, I provide family therapists with a background of the major video game genres and explain how video games can aid in the assessment of factors such as identity formation and social development. I also provide a systemic case example, recommendations for practice, and a table for quick reference to highlight potential videogame‐based family therapy interventions.     

The Devil is in the Detail: Clinicians,Academics and Researchers Resolving the Problems of Clinical Research

The difficulties associated with conducting valid family therapy research within a clinical practice discourage many potential researchers. This article will describe collaboration between a group of academics, researchers and clinicians who decided to explore the process and efficacy of systemic family therapy conducted within a working private practice. The specific questions we are addressing are, whether the requests clients bring to their first session of therapy can be reliably classified by practitioners, whether these requests change over time, and whether the nature of the request is associated with therapist and client ratings of therapeutic outcome. Additional questions about the form and nature of the therapeutic alliance as experienced by both client and practitioner are also being explored. This paper will map the passage of the work from inception to its current state where over 140 clients are active participants. In doing so attention will be paid to the obstacles encountered: practical, financial and ethical, and the solutions devised to address these.     

Systemic Therapists' Experience of Powerlessness

In this article we explore and discuss the relevance of the concept of powerlessness in systemic practice. The views and concerns of systemic trainees' groups are compared with those of experienced therapists'. We interviewed 12 experienced systemic therapists and investigated what made them feel powerless and how they dealt with it. Extracts from interviews are quoted and summarised in the text. We argue that therapists' powerlessness is a marginalised subject in the systemic approach and that open discussion about the topic would enhance therapists' self‐reflexivity and contribute to a fuller understanding of the part that power and powerlessness play in the therapeutic relationship. We consider the place of gender, culture and wider sociopolitical contexts in the experience of therapists' powerlessness. Finally we discuss the implications of our findings for systemic therapy, training and supervision.     

THERAPEUTIC INTERVENTIONS IN LIFE-THREATENING SITUATIONS*

Therapists who encounter life-threatening behavior in their clinical practice are at risk in providing interventions which do not take into account the systemic effects of their interventions. Specifically, therapists are likely to engage in “more of the same” behavior with clients who present with suicidal or homicidal threats. This paper presents two case studies that employed therapeutic methods derived from the systemic therapy of the Palo Alto group. In these case studies, the author illustrates the importance of the therapist's ability to speak the client's language in formulating an intervention that has the potential for reducing the likelihood of actual violence. The first case illustrates the use of the client's world view about her situation to assist her in dealing with domestic violence. The second case presented describes the use of systemic interventions in the case of a young woman known to have made homicidal threats. The author discusses the appropriateness, as well as the ethical issues, of the techniques described. Also offered, is a discussion clarifying the theoretical underpinnings of the clinical work presented and an amplification of some of the ideas originally presented by the Palo Alto group.     

Family‐Focused Child Therapy in Marital Separation

When marriages and long‐term relationships break down, parents may refer their children and adolescents to therapy for a variety of reasons. While the systemic therapist's preference may be to work with the family system/s, high conflict separation may prohibit such an approach. This article discusses family‐focused child therapy that prioritises the needs of children while seeking to preserve a systemic approach. At a practice level this may involve: (a) individual child therapy, (b) engaging with smaller subsystems including siblings, (c) joint therapeutic work involving child/ren plus parent/s, and (d) any of these combinations; all while continuing to maintain a systemic understanding of the work. The article discusses the challenges of working with children from separated families, where there is restricted or no possibility of engaging with the broader family system.     

Thinking About the Emotional Interaction of Therapist and Family

The emotional interaction of therapist and family has been difficult to explore within the field of systemic family therapy. This paper looks at ways of thinking about this process. As a starting point, I take some feelings I had with three families in the course of therapy. These are used to illustrate some concepts from analytic therapy which address the emotional interaction of therapist and family. The kind of theoretical space and guidance offered within systemic family therapy is then explored, and it seems that the Milan frame gives some space for thinking about the process but offers little guidance as to exactly how this might be done. This is a paper about practice, though it's primarily a theoretical discussion. There is no aim of establishing a ‘correct’ way of understanding the emotional interaction of therapist and family.     

‘Riding the Wave’: Working Systemically with Traumatised Families

This paper draws on the authors’ clinical experience as family therapists, working predominantly with families who have experienced trauma such as sexual abuse, physical abuse and neglect, to demonstrate that taking a systemic trauma‐informed approach is a powerful therapeutic modality that can facilitate positive outcomes for all family members. The paper discusses the impact of trauma on relationships, and then outlines a rationale for a trauma‐informed, systemic approach with those traumatised families who are, at times, challenged by excessively heightened behaviour and emotional dysregulation. Drawing from parenting research, it includes a discussion of the place of parent work and how this can be integrated with systemic family work. Key constraints and considerations are highlighted followed by a discussion of key interventions the authors have found useful in building a clinical framework for this work, including what is critical for the therapeutic process. While working with traumatised families is complex and challenging, offering a safe place for families to be in the presence of each other's pain and ‘ride the wave’ of emotions can be a powerful path to recovery.     

Therapeutic Process as a Means to Navigate Impasse? Reflections on a Complex Case of Crosscultural Adolescent Family Therapy

This article explores the process of family therapy with a Turkish‐speaking single‐parent family with four children in which suicidal behaviour and family violence have become the norm. The following example describes a pivotal experience early within my career as a family therapist. The universality of first, being a beginner family therapist, and second, receiving a referral of a daunting, difficult case has led me to share my experience here. Central to this article is the focus on therapeutic process as a means to navigate beyond impasse. It is my hope that those who read this article will consider taking the risk to prioritise the therapeutic relationship, even when anxiety about ‘doing something’ to fix the problems is high.     

Teaching Sociology in Community College: Balancing Ideals with Institutional Constraints

Many professionals experience conflict between personal ideals about the meaning and importance of their work, and the structural limitations of the workplace. This conflict presents professionals with the challenge of how to hold true to their ideals within a non-supportive or even hostile environment. In this paper, I describe my experiences balancing my ideals about teaching, learning, and the purpose of a college education with the institutional constraints of a community college. There are three main sections in this paper. First is a discussion of the reasons I chose a career in community college teaching. The second section focuses on the institutional constraints I have encountered over the first 5 years of my career. In the third section, I explain how I have attempted to balance my ideals with the structural limitations of the college where I teach. Throughout the paper, I blend personal narrative with the relevant literature. In doing so, I intend to use my personal experience as a lens for discussing the challenges and possibilities that characterize community college teaching in general.     

Integrating Reflective Practice in Family Therapy Supervision

This paper discusses how to integrate reflective practice in the family therapy supervisory relationship. This enables family therapists to think creatively, be insightful, and develop a range of perspectives regarding systemic formulation and practice. It encourages review of the past and promotes understanding in the present with the aim to improve therapists work with families in the future. Reflective practice encourages independent thinking and learning and helps therapists to develop a systemic process of critical enquiry to investigate and critique their own practice. It encourages therapists to be self‐reflective and develop confidence to think hypothetically regarding change. This allows them to pose questions for exploration, construct a new lens to conceptualise therapy and the therapeutic relationship and develop awareness of the personal as well as the professional self.     

When Social Work and Psychoanalysis Meet

In this paper I share my personal journey from agency social worker to psychoanalyst. I show how I have brought to my psychoanalytic work the teachings of such well known social workers as Mary Richmond, Bertha Reynolds, Gordon Hamilton, and Florence Hollis as well those of such contemporary social workers as the late Gertrude and Rubin Blanck, Nancy Bridges, and Eda Goldstein, among others. In the presentation, I also consider how social work values, social work ethics and social work attitudes have influenced my approach to the practice of psychoanalysis. The attitudes which I refer to, include flexibility, beginning where the client is; an appreciation of the importance of understanding a patient’s cultural background and a recognition of the importance of the relationship in the therapeutic encounter. These were not standard for psychoanalysts at the time I began to practice. Today however psychoanalysis has largely caught up with social work, and this paper affirms how those of us who have had a social work background are well prepared for psychoanalysis in the 21st century.

The Theory Behind the Traps — Considerations for the Practice of Family Therapy in a Multi-frame Work Team*

Family systems theory as an approach to problem generation and change is practiced in many settings where other theoretical stances are also held. The issue of successful team work within a clinic where other therapists work from psychoanalytic and behavioural models is addressed. Structural, strategic and systemic approaches are compared with the psychoanalytic and behavioural. Particular attention is paid to apparent similarities between psychoanalytic and systemic family therapy theory. It is concluded that basic differences exist which make successful merging of the two views impossible. Practical examples of difficulties and attempted solutions are offered.     

Who Am I? And What Makes Me Hot and Bothered? Notes on Identity,Sexuality, Enigma,and Desire

ABSTRACT

This article explores the links among identity, sexuality, enigma, and desire in my work with 22-year-old Andrew as he explores his homosexuality. Sexuality is discussed as a developmental and relational construction simultaneously biological and social, inventive and defensive. Elaborating these vertices of sexuality in the treatment opened space to discuss Andrew’s sexual experience and fantasy. In this vein, the article questions the tendency to put aside frank discussion of sex in analytic practice and proposes case vignettes useful for clinically elaborating intimate fantasies rooted in the shared narration of patient and analyst as between psychoanalyst/writer and reader. In doing so, we turn from concrete definitions and explanations of sexuality that risk getting bogged down in details and use narrative to facilitate the uncanny experience of “finding” sexuality in clinical work.