Family therapy as a dialogue of living persons: a perspective inspired by Bakhtin, Voloshinov, and Shotter

There are not a lot of conceptual tools that can help a family therapy teacher to talk and teach about the importance of the therapeutic relationship in family therapy practice. The idea that family therapy can be conceived as a dialogue might offer a fresh and promising perspective. Mainly inspired by the work of Bakhtin, Voloshinov, and Shotter, the author considers if the concept of dialogue can help us to talk about something that is there all the time in our family therapeutic practices, although sometimes unnoticed, and that is hard to talk about because we lack the necessary conceptual tools. When we choose to conceptualize family therapy as dialogue, the focus of the therapist is not primarily on data collection, information processing or problem analysis. The therapist is not primarily concerned with knowing, or with not-knowing. Instead, the focus is on the idea that first and foremost therapy is a meeting of living persons, searching to find ways to share life together for a while. Clinical vignettes that feature children's drawings in family therapy are used as illustrations.     

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.     

Family Therapy: A Client-Centered Perspective

>This article first critiques therapist-directed approaches to family therapy in the light of research findings on therapist variables (empathy, warmth, genuineness) associated with positive outcomes in psychotherapy. Second, two polar opposite positions in family therapy — psychodynamic and family systems — are examined and found to have much in common. The two approaches are based on a pessimistic view of the family, which is seen as an intractable unit, resistant to its own growth. Third, an alternative, phenomenological view of the family is developed, which more optimistically assumes the family to be motivated for enhancement and growth. Finally, a client-centered approach to family therapy is described.     

FAMILY THERAPY AND IDEOLOGY*

Contemporary family therapy is examined in terms of its ideological content. The adoption of cybernetics and biological systems theory to the family has led to the erroneous belief that familytherapy is exclusively concerned with natural systems, is process oriented, content relative, and above ideology. This article argues that the family and the enterprise of family therapy are social systems and under the influence of the ideology particular to a given society. The strategic family therapy treatment of a family with a drug-addicted member serves as an example to clarify the ideological themes of contemporary family therapy. These themes are: (a) family reductionism and blaming; (b) the relabeling of personal injustice into communicational terminology; (c) the assumption that the nuclear family is optimal; (d) the conceptualization of therapy as a commodity; and (e) the model of human relatedness and intimacy supported by family therapy.     

PERSONAL AUTHORITY IN FAMILY EXPERIENCE VIA TERMINATION OF THE INTERGENERATIONAL HIERARCHICAL BOUNDARY: PART III—PERSONAL AUTHORITY DEFINED, AND THE POWER OF PLAY IN THE CHANGE PROCESS

Present transgenerational family therapy theory is analyzed, and it is suggested that individuation is on a continuum with fusion-triangulation (family systems theory), that relational ethics are on a continuum with invisible loyalties (contextual family therapy), and that there is in fact but one continuum, so that these terms are well-nigh interchangeable. Individuation-relational ethics is presented in a (Hegelian) dialectic with intimacy; and personal authority in family experience is offered as the synthesizing construct in this dialectic. The change process in transgenerational family therapy is briefly noted. It is suggested that playfulness, including paradox and absurdity, is an effective intervention into the intense emotionality of inter generational work. A framework for and sequence of playful interventions are described.     

Monitoring Family Therapy in Clinical Practice A Note on the Use of the Beavers-Timberlawn Family Evaluation Scale

This paper is based on a thesis completed for the degree of Master of Psychological Medicine at Monash University, Melbourne. The aim was to determine if an instrument could be used to determine changes in family dynamics quantitatively and objectively during the course of family therapy. A sample of six families was evaluated on several occasions during therapy using the Beavers-Timberlawn Family Evaluation Scale. The results are discussed in the light of the literature as it relates to outcome studies of family therapy. Certain conclusions are made regarding the process of therapy.     

The restructuring of family schemas: a cognitive-behavior perspective

Cognitive-behavior therapists define schemas as cognitive structures that organize thought and perception. Schemas are also viewed as having an integral influence on emotion and behavior In this article, I examine the role of schema in family conflict and the specific interventions used in restructuring them during the course of family therapy. Further discussion highlights the concepts of attributions, assumptions, and family standards, and the role they play in schemas, as well as the overall family dynamics. Finally, a series of steps are suggested for facilitating the process of schema analysis and thought restructuring during the process of family therapy.     

FAMILY RESEARCH AND FAMILY THERAPY: A REUNION?*

This decade is witnessing the re-establishment of research in family therapy as an intrinsic component of the field. It is instructive to recall that family therapy actually had its most significant beginnings in the context of family research in the 1950s and that, three decades ago, family therapy and family research were fundamentally fused. In this paper, several of the most important forms of recent and current family research and family therapy research that are important to clinicians are identified, and it is suggested that this reunion of clinical and research interests signifies a new phase in the growth of the family therapy field.     

Family Versus Individual Therapy: Impact On Discrepancies Between Parents’ And Adolescents’ Perceptions Over Time

This study examined the degree of disagreement between runaway adolescents and their primary caretakers, defined as informant discrepancies, on their view of their family. How these discrepancies changed over time and whether family therapy or individual therapy could impact that change were also explored. The current sample (N = 179 dyads) included adolescent substance abusers residing in a runaway shelter and their primary caretakers. Adolescent gender was examined as a correlate of change, and treatment attendance was controlled. The intraclass correlation coefficient was used to measure discrepancies between the individuals within a dyad. Results showed that among those receiving family therapy, but not individual therapy, informant discrepancies decreased significantly over time. Additionally, dyads with a male adolescent showed a significantly slower rate of improvement in discrepancy scores across time compared with dyads with a female adolescent. Previous research indicates that lower levels of discrepant perceptions are associated with better individual and relationship functioning. Therefore, this study’s findings support family therapy as superior to individual therapy for addressing parent–child discrepancies––possibly through its focus on improving family communication, perspective taking, and understanding.     

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.     

‘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.     

An Invitation to Openness‡

In reflecting on the content of the Adelaide conference, this closing address reviews three themes that have seemed implicit to the author in this and other recent conferences. The adoption of parental metaphors for therapy and the ethical demands that this overtly places on practitioners are discussed. The growing interest in psychoanalytic theories for family therapy is commented on in the light of family therapy theory's absence of a ‘body’, the soma. Lastly, the issue of the therapist's therapy (to have or not to have) is considered as recurring ‘corridor talk’ that may benefit from open discussion in family therapy forums.     

Personal Reflections of A Family Therapist*

In this informal paper I discuss my personal evolution as a family therapist, developments in the field, the politics of a systems approach in conventional settings, resistances to family and marital therapy by other professionals, some still puzzling aspects of family therapy, whether family or marital therapy works and what do we mean by working, directions my own work has taken, some comments about the nature of family life, the satisfactions and frustrations and stresses of being a family therapist, some hidden agendas of family therapy practices, how one's own personal family relationships affect and are affected by this kind of work, the casualties among family and marital therapists, and, finally, whether family therapists should have family therapy for themselves and their own families.     

Enhancing Family Therapy's Relationships With Research

The contention of this article is that systemic family therapy has much to gain from a realistic appraisal of its research base, which is as positive as possible. And that through such an appraisal we can find ways of developing the scope of family therapy to the benefit of the profession and thereby, of our clients. Family therapy will benefit if practitioners can present an informed view of research. As a preliminary approach to this objective, I review reasons why perceptions of family therapy underestimate its research base, and why therapists might resist involvement with research. The article then explores the reasons for regarding randomised controlled trials as a ‘gold standard’, and why they are not well fitted for the purpose of evaluating or developing a relational therapy. Next is a consideration of alternative approaches to research, including a consideration of what clients actually want from their therapy, then a brief review of the positive findings of outcome research. Greater emphasis on researching processes in therapy is proposed, and consideration of the ‘common factors’ debate is shown to support priorities that are specific to systemic therapies. The article concludes with suggestions for increasing the involvement of family therapists with research, both as consumers and as research practitioners.     

BASIC FAMILY THERAPY SKILLS, IV: TRANSGENERATIONAL THEORIES OF FAMILY THERAPY

This pape focuses on the basic skills and compentencies of transgenerational approaches to family therapy, the fourth report of a program of research surveys by the Basic Family Therapy Skills Project. In the first survey, a panel of family therapy educators listed the most critical or basic skills or compentencies of beginning family therapist with a transgenerational orientation. In the third survey, self-selected respondents rated these items according to degree of importance for beginning family therapists. Rankings of the items according to mean scores of the Likert responses indicate that transgenerational family therapy skills are founded in theory and can be identified behaviorally. The most important skills are those that use the self of the therapist to understand and utilize transgenerational family therapy skills for both therapist and client. Also listed are skills that many raters deemed "generic" rather than specifically related to transgenerational family therapy. Other findings and their implications for the future training of family therapists are discusses. Although the paper is intended for family therapy educators interested in their colleagues' ideas about critical skills in trans-generational family therapy, theorists and clinicians may also find it useful.     

THE INTEGRATIVE PSYCHOTHERAPY ALLIANCE: FAMILY,COUPLE AND INDIVIDUAL THERAPY SCALES*

The therapeutic alliance concept has been confined primarily to the literature on individual psychotherapy. This paper formally introduces the concept into the family and marital therapy domain and presents various clinical hypotheses about the nature of the alliance and its role in familyand marital therapy. A systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework. The implications of this integrative-alliance concept for family, couple and individual therapy research are examined. Three new system-ically oriented scales to measure the alliance in individual, couple and family therapy are presented along with some preliminary data on their methodological characteristics.     

South Australia's First Family Therapist — Jeff Gerrard Remembers: An Interview

Jeff Gerrard can claim the distinction of being the first family therapist in South Australia. Early on in his career as a psychiatrist he explored the growing field of psychotherapy overseas and observed, studied, and trained with some of the historical greats in the area. When he returned to South Australia in the early 70s, it seems to have been a natural step for him to begin practising family therapy and training other health professionals in the theory and practice of family therapy. The early training that Jeff led at the South Australian Children's Hospital enabled a cooperation between a number of early family therapists, such as Michael White and Anne Sved Williams, to train the first cohort of people who would later go on to become significant contributors to the family therapy field in Australia. In this interview, Lorraine Read invites Jeff to explore his early contributions to the field and to discuss the training and supervision experiences which were/are important in his development as a family therapist.     

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.     

On Learning and Teaching Family Therapy

This paper explores some ideas about the process of learning to be a family therapist. It considers the questions: how does one learn to think like a family therapist? How is family therapy best taught? How is it learned? The author's experiences in learning and teaching are described. It is argued that family therapy differs from other approaches to therapy in some fundamental respects, and that learning to ‘be’ a family therapist is a different kind of task than learning to be a practitioner of other therapeutic approaches. The paper examines some key theoretical constructs, especially the idea of ‘levels’ of thinking, which are seen as central to both the learning and practice of family therapy.