Two Case Studies on Family Work with Eating Disorders and Body Image Issues

This article highlights the need for clinicians who work with eating disorders and body image problems to address the deeper family issues underlying these symptoms. The authors propose an eclectic approach including family systems, structural and experiential family therapy theory as a guide. The paper begins with an overview of family therapy theories currently used in the treatment of eating disorders, and goes into greater detail about the three theories highlighted in the eclectic model proposed. The authors present two cases with actual case dialogue, demonstrating how they used this composite model. This article has both theoretical and practical implications for clinicians working in the field.     

A perfect fit: connecting family therapy skills to family business needs

The purpose of this article is to encourage family therapists to become more interested in family business practice. It does so in three ways: (a) highlighting the number of therapists already involved in family business issues; (b) showing the parallels between family business and family therapy by applying family business research findings to couples therapy; (c) discussing how family therapists already have the practice wisdom to be effective in working with family business clients. Limitations of this practice are also discussed along with suggestions for overcoming them.     

Habla Mi Idioma? An Exploratory Review of Working Systemically with People from Diverse Cultures: An Australian Perspective

This paper presents a review of the literature informed by both grounded theory and phenomenology, which explores how culture is addressed in the family therapy field with particular emphasis on Australia. The primary aim of the study is to identify the issues and relevant publications that can inform and guide Australian family therapists in working with clients from culturally and linguistically diverse backgrounds. The secondary aim is to provide recommendations that may inform research directions and clinical practice. The results indicate that this challenge is not unique to Australia; indeed the issue is ubiquitous across the Western world. This paper attempts to provide an impetus for future dialogue and to precipitate discussion around the development of a culturally sensitive approach in the Australian family therapy field.     

Uniqueness of family therapists as family business systems consultants: a cross-disciplinary investigation

The purpose of this study is to address how the consulting approaches of family therapists working with family businesses differ from those of business consultants. The logic of analytic induction was used to analyze qualitative data from family business consultants with and without training in family therapy. Consultants were asked to respond to two vignettes: one emphasized primarily family system problems, whereas the other emphasized business problems with influencing issues at the family/business intersection. Both similarities and differences were found in reference to problem assessment, consulting goal orientation, intervention strategy focus, consultant role and function, and consulting setting preference between consultants with and without family therapy training. Results indicate that consultants of each discipline provide a unique perspective and expertise that allow them to successfully address the spectrum of issues that family firms face. Further, findings highlight the unique contribution of family therapists to an interdisciplinary consulting team.     

Working with Stepfamilies

Stepfamilies are complex family systems that warrant a specific model to guide therapy practice. Once a stepfamily has formed it's easy to overlook the lack of an attachment history that is commonly embedded in a biologically connected nuclear family. This can result in stepparents picking up parental responsibility for their stepchildren, which often may not go well. This paper highlights the need for clarity concerning the different levels of connection within a stepfamily, and the importance of avoiding ‘nuclear family‐style’ solutions and assumed attachments. This is especially important in the early stages of the relationship when everyone is adjusting to changing circumstances, which is often a time when issues of loyalty and betrayal fuel many of the actions taken. A range of family therapy techniques can be helpfully adapted to working with stepfamilies, especially as relationships with children often bring them to therapy. In particular, therapists can utilise ideas from structural family therapy to help guide the stepfamily to navigate the complexities of everyday life.     

Adolescent Violence—Strategies,Outcomes and Dilemmas in Working with Young People and their Families

MATTERS is a program of Berry Street, and has been in existence since 1990. The service is funded to address parent/adolescent conflict and the service delivery model has developed over time in a direction which incorporates family therapy and conflict resolution techniques. Many families come to the service seeking assistance for problems regarding violence, and increasingly around a young person's violence to parents and other family members. In some instances, violence has been present over a long period and has become normalised within the family's experience. When working with families who present with problems of adolescent violence, the service aims to find a pathway for the young person/family to confront violent behaviour and move to a different position about the meaning of violence in their lives. This paper describes the team's approach to working with adolescent violence, utilising ideas from narrative family therapy and psychodynamic theory, and incorporating issues of power in society, culture and gender. Outcomes, dilemmas and future directions are also discussed.     

Improving Functioning of the Remarried Family System

This report presents salient issues for therapists in understanding and treating the remarried (Rem, second, blended, reconstituted or step) family. The structure of the remarried family is differentiated from that of the intact family. Specific treatment goals for Rem families are elaborated and various treatment modalities advocated. The need to include former spouses and to consider the meta family system are discussed. Common reactions and difficulties engendered in therapists when working with Rem systems are explicated.     

THE LEGACY OF AIDS: CHALLENGE FOR THE NEXT CENTURY

AIDS presents an unprecedented challenge for family therapists. A method of response is suggested involving three stages of therapy: (a) dealing with the crisis of disclosure; (b) interacting with larger systems; (c) working on family relationships and the grieving process. Countertransference issues which threaten to disrupt this three-stage therapeutic process are discussed.     

Working Therapeutically with Indian Families within a New Zealand Context

This article aims to raise awareness amongst non‐Indian therapists working with Indian people by highlighting some of the important aspects of Indian culture within the New Zealand context. Although there is a great deal of diversity amongst Indians, there are some fundamental issues that would have relevance for most Indians. Specific issues relating to immigrant families are discussed, such as the sacrifices made by families in the hope of providing a better future for their children and the difficulties encountered by new migrants. The cultural clash for young people caught between parental expectations and peer pressure can often lead to significant family conflict. Some of the common pitfalls for non‐Indian therapists working with Indian people are outlined and suggestions made in relation to the process of therapy.     

Spiritual issues in family therapy: a graduate-level course

With the advent of the biopsychosocial approach in family therapy, the domain of spiritual issues is increasingly being recognized as important to families. This article will describe a graduate-level seminar on Spiritual Issues in Family Therapy at the University of San Diego that offers family therapy students the opportunity to examine issues of spirituality, religion, and meaning and their place in therapy. One premise of the course is that research has demonstrated that most clients consider their spiritual life to be relevant to personal problems and would prefer a therapist who is comfortable with such topics. The goals of the course include (1) training in opening a dialogue with individuals and families about spiritual issues and discerning when referral may be appropriate; (2) expanding an awareness of wisdom traditions through use of comparative religions material; and (3) identifying from current practice many of the spiritual issues that may arise in the clinical setting.     

Family Therapy Training in Israel*

In Israel the difficulties met with in training social workers in family therapy arise from inherent resistance to change in social and other professional agencies and from insufficient experience in the methodology of training. The family in Israel—a developing country—is undergoing wide-reaching social and cultural changes, which make for additional difficulty in using training models developed in other countries. Nevertheless, graduates of the family therapy program of the Institute for Training and Continued Education of Social Workers in Tel-Aviv, Israel, have shown substantial improvement in several areas of working with problem families.     

The feminist/emotionally focused therapy practice model: an integrated approach for couple therapy

Emotionally focused therapy (EFT) is a well-developed, empirically tested practice model for couple therapy that integrates systems, experiential, and attachment theories. Feminist family therapy theory has provided a critique of biased assumptions about gender at play in traditional family therapy practice and the historical absence of discussions of power in family therapy theory. This article presents an integrated feminist/EFT practice model for use in couple therapy, using a case from practice to illustrate key concepts. Broadly, the integrated model addresses gender roles and individual emotional experience using a systemic framework for understanding couple interaction. The model provides practitioners with a sophisticated, comprehensive, and relevant practice approach for working with the issues and challenges emerging for contemporary heterosexual couples.     

WORKING WITH MEN IN FAMILY THERAPY: AN EXPLORATORY STUDY*

The results of this exploratory research provide a beginning formulation of a gender-sensitive approach to working with men in family therapy. A panel of 36 family therapists endorsed 131 interventions as appropriate and effective ways to work with men. The results suggest the importance of therapist awareness of gender issues and socialization in working with male clients. Interventions were highly endorsed in the areas of developing therapist perceptual and conceptual skills regarding gender, promoting mutual responsibility, and challenging stereo-typical behaviors and attitudes. Surprisingly few interventions pertaining to structuring treatment and encouraging affective expression in men had sufficient consensus to be included in the final results.     

Working with ‘The Welfare’ in Child-at-Risk Cases

This paper, the second in a series concerned with family therapy in cases involving children at risk of abuse, focuses on how to establish a workable relationship between therapists and child protection professionals and child protection professionals and parents. After overviewing the difficulties faced by therapists in working with ‘the Welfare', we propose guidelines to overcoming common obstacles to successful case management, concluding that therapy often fails when therapists attempt to deal with intrafamilial issues long before external relationships are resolved.     

Thomas Szasz' “critical reflections on child psychiatry”: An alternative view through a systemic lens

In “Critical Reflections on Child Psychiatry,” Thomas Szasz (1979) argues that children are without the rights afforded adults, that children are often coerced into therapy, and that most children do not appear to benefit from psychotherapy. Szasz raises many pertinent questions for mental health professionals working with children. However, his arguments appear to be based on literature limited to traditional psychodynamic approaches. His position also neglects to consider literature in the developmental psychology and legal fields. This paper, written from the cognitive developmental and the family systems perspective, provides another examination of the important issues raised by Thomas Szasz.     

Doing a good job badly Mind-sets in family therapy

This paper reports on a case in which family therapy was one of the approaches attempting to resolve an eating disorder in the second-born of twins, the youngest in an intact family of four children. The case is described in its referral, agency and chronological contexts. The initial referral suggested that there was no physical cause for the presenting problem, and advocated an investigation of family dynamics. Some evidence which seemed to support the dysfunctional family formulation was provided, and various hypotheses regarding family disturbance were pursued in therapy. These hypotheses were, on the surface, supported by systemic observations. When a rare pancreatic tumour which was underlying the eating disorder was diagnosed many months after the brief and unsuccessful interventions, ‘confirmation bias’, resistance and neutrality became important issues for the therapists to consider. The role of these processes in this case is discussed.     

Engaging Fathers in Family Therapy with Violent Adolescents

Violent behavior in adolescents can often signal profound distress or pain arising from family conflicts, hostile marital separations, sudden losses and other family turmoil. By circumventing blame the therapist engages the family in a constructive process that allows adolescents to change and grow and parents to share pain and sorrow about their own issues and responsibilities for their children. This re‐establishes healthy generational boundaries, produces a clearer co‐parenting alliance (e.g. after divorce) and creates sibling support. This paper describes an experiential approach, for working with violent adolescents in family therapy influenced by the pioneer work of Satir and Whitaker. It integrates systemic and developmental theories linking the presenting problem to relevant family events. The therapist: (1) explores adolescent development in the family and social context; (2) establishes a therapeutic alliance through understanding the interpersonal context for violent behavior, and (3) re‐directs negative actions into positive connections with family members. Segments of family therapy sessions with two adolescent boys and their families from different cultural backgrounds illustrate the impact of paternal absence for adolescent well‐being and the need to actively engage fathers in family therapy. Mario, the father's ‘tumor’, and Juan with his despairing violence are two problematic adolescents brought to therapy because of their aggressive behavior at home and/or in the school. The paper describes how to give them a different voice and build a therapeutic alliance with the family.     

Social Work and Family Dispute Resolution

Abstract

Social workers have a significant role to play in the development and provision of family dispute-resolution services. Recent legislative changes and new directions in mediator accreditation in Australia are influencing education and practices in family dispute resolution. Alongside lawyers and psychologists, social workers constitute one of the main professional groups working in this area. A major contribution of social work is the emphasis on reflexive practices that consider political, social, and economic contextual factors. This is underpinned by a commitment to social justice and practices that focus on issues of access and equity and antidiscriminatory practice.     

Organizational Consultation and the Teaching of Family Therapy: Contrasting Case Histories*

This paper describes the process of attempting to teach the principles and effective utilization of family therapy to the indigenous staff of two mental health institutions. Both interventions are conceptualized as entrees into entrenched organizational systems requiring shifts in power alignments, clarification of self and group goals, articulation of needs, reallocation of resources, and attention to group process in order to succeed. One case, where such issues were overlooked and neglected, resulted in failure in which apparently little learning of family therapy occurred. The second, where these issues were anticipated, addressed and resolved, resulted in successful learning of family therapy, implementation of therapy programs and lasting change in the organizational climate to support those programs. The teacher of family therapy, by functioning as an organizational consultant, can help create the kind of working conditions which are best suited to effectively treating families.