Depression,the Family,and Family Therapy

The potential contribution of family therapists to the treatment of depression remains underdeveloped. Family therapists need to articulate how changes in family functioning might benefit depressed persons, as well as how other problems in the families of depressed persons tend to go unrecognised. Furthermore, family therapists need to be alert to how undetected depression in adults and children may interfere with their ability to meet their goals with families who seek therapy for other persons. This article provides family therapists with (1) an overview of the nature and experience of depression; (2) an introduction to antidepressant medication; (3) a summary of research findings relating depression to its family context and (4) a brief overview of developments in the marital and family treatment of depression.     

A Note on Mourning an Adoptive Parent in an Orthodox Jewish Family

ABSTRACT

A sensitive and potentially problematic manifestation of family bereavement situations may occur when one of the mourners is an adopted child. Using an ecosystems perspective, this paper examines the nature of mourning in Orthodox Jewish adoptive families and the therapeutic use of religious ritual and dicta to assist with the maintenance of family homeostasis during the potentially destabilizing period following the death of a relative. A case example is presented, illustrating the value of cooperation between therapists and clergy to determine appropriate interventions. Suggestions are made for the use of analogous rituals to assist a broader range of families.     

INFLUENCES ON THEf INCLUSION OF CHILDREN IN FAMILY THERAPY BRIEF REPORT

This study examined factors that influence family therapists to include children in or exclude them from therapy sessions. We hypothesized that therapist comfort, child problem type (internalizing vs. externalizing), family composition (one- vs two-parent families), and presenting problem (child-oriented problem vs. adult-oriented problem) affect therapists' inclusion of children. A survey of clinical members of AAMFT found that half of the therapists excluded children on the basis of their comfort and that those who felt more comfortable were more likely to include children in sessions. Therapists included children more frequently in cases of an internalizing vs. an externalizing child, more with single-parent than two- parent families, and more often when the presenting problem focused on a child than on an adult. Implications of the findings are discussed.     

WHY FAMILY THERAPY SHOULD GO BEYOND HOMEOSTASIS: A KUHNIAN REPLY TO ARIEL,CAREL AND TYANO

The thesis of “Beyond Homeostasis” is (a) that the discourse of family therapists unquestionably shows that family therapists have tended to see homeostasis as a trait of families; and (b) that such a view of homeostasis is inconsistent with the systemic paradigm. Therefore, family therapy should go beyond such an understanding of homeostasis. Ariel et al. may have failed to grasp this argument; they have certainly chosen to ignore it. Ariel et al. have provided a logical empiricist explication of the nonsystemic version of homeostasis which is portrayed in the discourse of family therapists. I still argue that family therapy should go beyond such an understanding of homeostasis.     

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.     

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.     

Action-oriented evaluation of an in-home family therapy program for families at risk for foster care placement

The purpose of this study was to conduct an action-oriented evaluation of an in-home family therapy program serving families deemed at risk for the placement of children in foster care. In this study, feedback was solicited from both clients and therapists. Results indicate "duality" associated with several aspects of in-home family therapy, including the opportunity to observe families in their own homes versus the vulnerability some families feel when therapy is conducted in-home; therapists suggesting that sufficient training is required for in-home family therapy to be effective versus clients' opinions that therapists' lived experiences are more relevant; and the importance of the therapeutic alliance versus feelings of abandonment upon termination. Implications for researchers and practitioners are discussed.     

Families in the Time of the Pandemic: Breakdown or Breakthrough?

The COVID‐19 pandemic has taken a toll on all individuals and their families around the world. Some suffer more adversely than others depending on their unique developmental needs, resources, and resilience. However, instead of breaking down, many families and therapists have hunkered down to cope with this ‘wicked’ situation as it continues to evolve. This article examines the unique challenges and opportunities of COVID‐19 for families at different life developmental stages, as well as the challenges and opportunities for systemic therapists as they venture into unfamiliar territory. Through a case example and by integrating recent literature related to this pandemic, we apply three key and interconnected systemic themes (unsafe uncertainty, family life cycle, and social diversity) to discuss the challenges and opportunities for families and therapists, respectively. We are optimistic that there are many possibilities as families and therapists draw on, and often reinvent, currently available resources to navigate their course in this pandemic. We also find that while the pandemic continues to present unsafe and uncertain situations, there are new ways of being and behaving, especially when families and professionals work together collaboratively. Despite formidable challenges, there are many opportunities, both within families and communities that cut through different social contexts related to family, culture, economics, and even politics. Families and therapists could endure better when they are more cognisant of how and what these contexts may impact and offer them.     

Training family therapists to assess for and intervene in partner abuse: a curriculum for graduate courses, professional workshops, and self-study

Partner abuse is an epidemic with potentially dire consequences for individuals, families, and society. Family therapists must be able to competently assess for and intervene in abuse situations. This article presents a curriculum designed to provide family therapists with introductory knowledge and skills for the assessment and intervention of partner abuse. The curriculum, which is informed primarily by feminist and multicultural theories and practices, can be used in graduate courses, professional workshops, and for self-study.     

Treading the Path of Anticipatory Bereavement: Working with Families with a Dying Member in an Acute Care Medical Setting

The aim of this paper is to consider issues related to working with families with a dying member in an acute medical setting, using the framework of the Bower Place family therapy approach. The literature on individual and family anticipatory bereavement processes is reviewed and the Bower Place methodology of family therapy is outlined. A case example is used to illustrate the application of the methodology to a family facing the death of one of its members. The author highlights the need for therapists to consider second order cybernetic issues when working in this context.     

FAMILY THERAPISTS' RESPONSE TO AIDS: AN EXAMINATION OF ATTITUDES,KNOWLEDGE, AND CONTACT*

As the number of individuals and families impacted by AIDS continue to multiply, family therapists will increasingly be asked to become engaged in the challenge of caring for those affected. To date, little has been written in family therpy journals regarding the response of family therapists to this crisis. This paper represents an initial attempt to examine the atitudes of clinical members of the American Association for Marriage and Family Therapy toward AIDS and persons with AIDS. Included in the study are data regarding the therapists' contact with persons with AIDS, gays, and lesbians, and the impact of such contact on attitudes. Implications for future research, training, and treatment of those affected by AIDS are also provided.     

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.     

Healing loss, ambiguity, and trauma: a community-based intervention with families of union workers missing after the 9/11 attack in New York City

A team of therapists from Minnesota and New York worked with labor union families of workers gone missing on September 11, 2001, after the attack on the World Trade Center, where they were employed. The clinical team shares what they did, what was learned, the questions raised, and preliminary evaluations about the multiple family meetings that were the major intervention. Because of the vast diversity, training of therapists and interventions for families aimed for cultural competence. The community-based approach, preferred by union families, plus family therapy using the lens of ambiguous loss are proposed as necessary additions to disaster work.     

Marriage and family therapists working with couples who have children with autism

Current research about families and couples who have children with autism is discussed using the Double ABCX model as a guide. A case study is presented along with recommendations for therapists who work with couples who have children with autism. Marriage and family therapists are encouraged to use the Double ABCX model as both an assessment tool as well as for intervention. More research and effective therapists in this area are needed in order to keep up with the rising rates of families that include children diagnosed with autism.     

SUGAR AND SPICE, TOADS AND MICE: GENDER ISSUES IN FAMILY THERAPY TRAINING

Whereas family therapists have become increasingly aware of gender as a central organizing principle in how we think about families, few methods have been presented to help trainees and clinicians articulate how to adress gender. Four experiential exercises (including gender survival messages, gender framed circular questions, and process observation sheets) that can be used in training and adapted for use with clients are described. What we have learned about gender from our families of origin, the larger culture, and in the construction of family therapy models can be examined with these activities.     

SYSTEMIC TREATMENT OF SUBSTANCE ABUSE: A GRADUATE COURSE

Today, family therapists should have an understanding of the development and maintenance of substance abusing patterns in families. In this paper, the authors describe a graduate course for teaching therapists about the contributions that have been made to the understanding and treatment of substance abuse by family researchers, theorists and clinicians. Course purpose, student selection, instructional methods and course content are delineated.     

Therapeutic change in Colombian families dealing with violence: therapists, clients, and referring systems in conversation

There is a gap in the Marriage and Family Therapy literature regarding clients', therapists', and family judges' theories of change in relational therapy for family violence. We conducted in-depth interviews with eleven court-referred families, their therapists, and two family judges in Bogota, Colombia. Interviews focused on their expectations of therapy outcomes, their understanding of change, and their evaluation of individual and relational therapy outcomes. We followed a grounded theory approach to data analysis. Analyses showed that therapists, family judges, and clients hold different expectations and theories regarding therapeutic change. Findings are discussed based on existing research on clients' and therapists' ideas about change. Implications for future research and practice are presented.     

Developing culturally competent marriage and family therapists: guidelines for working with Hispanic families

As the Hispanic population of the United States continues to grow, so will the need for therapists who have been trained to work with Hispanic families. This content analysis of the available treatment literature generated several specific guidelines that can be used in training and evaluating culturally competent therapists. Guidelines included: Use family therapy, act as advocate for the family, assess immigration experience, assess acculturation, respect father, interview family subsystems separately, do not force changes, provide concrete suggestions, and warmly engage the family. Empirical and conceptual support for each guideline is discussed and several conclusions are made regarding culturally competent therapy with Hispanic families.     

MARRIAGE AND FAMILY THERAPISTS AND THE CLERGY: A NEED FOR CLINICAL COLLABORATION, TRAINING, AND RESEARCH

This article calls for greater collaboration between clergy and marriage and family therapists. It spells out the reasons for potenial collaboration and suggests some specific ways it can occur. Marriage and family therapists acknowledge the highest rates of religious involvement of any metntal health profession, placing them in a unique position to be involved in the continuing education of clergy. There is a clear need for research to understand how marriage and family therapists and clergy can more effectively work together. The dearth of research, training, and collaboration between the two vocations is all the more unfortunate given the clear evidence of the importance of religion in the personal lives of the clients we serve.