Child-Focused Family Therapy: Behavioural Family Therapy Versus Brief Family Therapy

We examined the effectiveness of behavioural family therapy (following the treatment agenda outlined in Fleischman, Horne and Arthur, 1983) and brief family therapy (following the procedures outlined in Fisch, Weakland and Segal, 1985), in the treatment of child psychological disorders. The parents of the 49 children referred to the outpatient unit of a children's hospital completed the Child Behavior Checklist (CBCL) (Achenbach and Edelbrock, 1983). Three scales of the CBCL were examined to assess the effectiveness of the two therapeutic approaches pre- to post-treatment. Significant pre- and post-treatment differences were found for behavioural family therapy on the Internalizing, Externalizing, and Sum T scales and for brief family therapy on the Internalizing and Sum T scales. Sum T scales represent the sum of scores across all sub-scales of the CBCL. Neither treatment was found to be more effective than the other.     

Therapeutic Alliance; A View Constructed by a Family Therapy Team

Therapeutic Alliance is a construct which may have value for a family therapy team and influence its day to day practice. This paper discusses whether family therapeutic alliance can be observed, described and measured, and gives an account of the development of the Family Therapeutic Alliance Scale (FTAS) by a brief strategic family therapy team. Our focus is on the use of statistical technique as a means of clarifying the team's construct of therapeutic alliance, informing the team process without being the final arbiter in development of the scale. The second stage outlines the investigation of the usefulness of the construct with a wider group of family therapists. In individual psychotherapies measures of therapeutic alliance have been shown to predict outcome. Our early work suggests this is also true for family therapies and the FTAS may be a predictor for outcome in family work.     

Brief Family Therapy: A Critique of Kinston and Bentovim

There has been a growing interest in the use of brief family therapy with children. Despite this increased interest, research into the effectiveness of this approach appears to have lagged behind clinical practice. The present paper critically reviews a study by Kinston and Bentovim (1978) which could be viewed as typical in the area of brief family therapy. Analysis of Kinston and Bentovim's investigation revealed serious methodological deficiencies and raised some important clinical issues in brief family therapy studies. These include the importance of training in family therapy, the use of a consistent theoretical framework, and flexibility in the application of techniques. On the basis of this review, recommendations are made that future investigations of brief family therapy follow the guidelines necessary for valid psychotherapy research.     

Cognitive-Behavioral Family Therapy with a Family in High-Conflict Divorce: A Case Study

Children who live in families with high-conflict divorce situations are increasingly coming to the attention of clinicians. This paper explains the nature of the impasse of high-conflict divorce. It presents a brief theoretical overview of cognitive-behavioral family therapy as an effective approach to treatment for high-conflict divorce families. A case study that successfully utilized a cognitive-behavioral approach to family therapy is presented. Specific techniques such as parent training, communication and empathy skills, problem-solving skills, assertiveness training, role-modeling on the part of the therapist and application of the concept of reciprocal inhibition were included in the cognitive-behavioral family treatment. An N=1 research design is graphically illustrated for evaluation purposes.     

Maintaining the Gains: What Worked in the Year after Brief Family Therapy

Brief family therapy, including single session therapy, is widely used to provide a timely and responsive service for children with emotional and behavioural problems. However, there is surprisingly little information about how these children and families fare in the longer term. The brief family therapy program described here was directed toward children with problems of moderate severity. Child Behaviour Checklists (CBCL) were completed by parents before, three months after, and twelve months after therapy; 110 parents also participated in semi‐structured telephone interviews twelve months after therapy. Parents' CBCL ratings showed a significant decrease in children's problems after therapy, which were maintained over the subsequent year, although some children continued to experience difficulties. Parents generally found brief therapy a helpful experience. Ways to strengthen the preventive possibilities of brief therapy work will be identified at both a practical and conceptual level.     

Evaluation of Family Therapy: A Comparison of Therapists' and Clients' Views**

In this evaluation of therapy experience for 82 families by brief therapy at Bouverie Clinic to 1976–1977, therapists' and clients' rating of outcome were obtained. After termination of therapy both therapists and clients reported high improvement rates in the presenting problem(s) as well as in the quality of family relationships and in the family's ability to deal with further problems. High agreement was found between therapist’ and clients' ratings of outcomes. Therapists were more favorable than clients in their ratings of change in the presenting problem and in their ratings of change in the quality of family relationships, but not in assessing the change in family's further problem solving ability. At follow-up clients were predominantly satisfied with their therapy experience. In addition, therapists' ability to predict outcome accurately, after the second of therapy, was strongly supported by our finding.     

Constructing a Focal Formulation and Hypothesis in Family Therapy

This paper is an account of the use of a focal formulation as part of a method of brief focal family therapy. The history of the focal approach is outlined and the concept of focal hypothesis examined. The theoretical basis of the approach is discussed by considering the way meaning in a family is expressed. Two forms of meaning are described: surface action, which is the current content of interaction, and depth structure, which is its context and is based in subjective history. A case example is provided to illustrate the application of the concepts, therapeutic implications, and the basis of outcome evaluation.     

Multiple Family Therapy Systems

This paper investigates multiple family therapy (MFT), a treatment method which includes several families in a series of sessions with the therapist(s). A brief historical development of MFT is included as well as reports of multiple family therapy groups found in the literature. The characteristics of this treatment method are delineated with special attention to the elements of change attributed to MFT and the stages of development in MFT groups. The role of the therapist and special problems in MFT are also explored. Some implications for research are outlined, indicating that MFT is lacking adequate validation as a treatment modality. Possible advantages inherent in multiple family therapy systems, which have been suggested by therapists' clinical findings, are also reported.     

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.     

Family Therapy in France: An Australian Perspective

This article is an exploration of family therapy in France by an Australian social worker and family therapist. It also reports on the 2010 European Family Therapy Conference and includes an interview with Dr Mony Elkaïm that provides an overview of his work. All this is discussed in terms of its relevance for family therapists in Australia. It is followed by a brief response from Dr Elkaïm.     

Family Therapy in a Psychiatric Hospital: A Case-Controlled Evaluation

Thirty-five patients (20 women) treated by a Family Therapy Unit based in a psychiatric hospital were compared with 35 matched control inpatients who were not treated by the Unit. Family Therapy averaged 4.5 one hour sessions and was cybernetic rather than behavioural or psychoeducational. The main outcome measure was days spent in the hospital in the year after family therapy. Women, but not men, showed a significant improvement after family therapy, reducing their days in hospital from a mean of 50 in the year before family therapy to 18 in the year after. The best response was shown by women with affective disorder. Control men and women showed a slight increase in days spent in hospital. Improvement after family therapy was associated with a markedly positive change in key relatives' attitudes to the patient, and a strongly positive attitude towards family therapy.     

Family Constellation — A Therapy Beyond Words

Family Constellation, a psychotherapeutic approach associated with the name Bert Hellinger, has become a popular yet also controversial form of systemic therapy in the German‐speaking therapy community. ‘Family Constellation’ (Familienstellen) means the individual client's physical‐emotional positioning and re‐positioning of substitute family members in relation to each other, with help of a therapeutic group. Family Constellation is a one‐session approach that addresses family‐of‐origin issues. The therapeutic process is highly experiential, utilising multiple sensory modalities. Hellinger locates his model within phenomenology, and his practice has roots in several therapy schools. His model offers complementary therapeutic techniques in our ‘languaged’ world of family therapy.     

Supervision in Family Therapy: A Developmental Perspective

A group model of supervision of family therapy was implemented by a team of three supervisors with doctoral students in counseling psychology. It was believed that such an approach would provide students with more opportunity to work as therapists with families and to observe a greater variety of families, therapists, and therapeutic styles than in other models. Interchange in supervisory sessions focused on co-therapy issues, observation skills, family dynamics, differing therapeutic techniques and approaches, and planning and goal setting in therapy. This experience contributed to the professional and personal growth and development of students.     

Family Context Therapy: A Model for Family Change*

Starting where family group therapy fails, this article breaks new territory in family context therapy. Consolidating the past 14 years of his work, Dr. Bell sets forth a conceptual program and methods to meet problems that earlier forms of family therapy could not reach. Here he provides a model drawn from studies, theories, and personal experience of organizational patterns, interrelations, and change among community institutions that provide settings for family functioning. His new methods are designed to modify the family environment so as to solve family problems and promote beneficial family growth—a framework that may bring together a broad variety of existing family development approaches.     

Ten Research Questions for Family Therapy

A growing evidence‐base shows that family therapy works, but many gaps in our knowledge remain about the conditions under which family therapy is effective and how it works. In this paper, ten critical research questions about family therapy that need to be addressed are considered. In short these are:

• 1 Is family therapy as effective in community settings as it is in specialist clinics?
• 2 For what problems is family therapy cost‐effective?
• 3 Does family therapy work for under‐researched problems and populations?
• 4 Do social‐constructionist and narrative approaches to family therapy work?
• 5 Can family therapy protocols be enhanced for non‐responders?
• 6 Can family therapy be combined with other psychotherapies to effectively treat specific problems?
• 7 Can family therapy be combined with pharmacotherapy to effectively treat specific problems?
• 8 What specific factors contribute to the effectiveness of family therapy with particular problems?
• 9 What common factors contribute to the effectiveness of family therapy?
• 10 What therapist and client factors contribute to the effectiveness of family therapy?

     

Single-case Design: The Neglected Alternative for the Evaluation of Family Therapy*

Family therapy (as with other treatment forms) needs to demonstrate its efficacy, but a major obstacle to the development and evaluation of therapeutic techniques in family therapy in particular, has been the almost total reliance on what is called classical group comparisons (e.g., treatment versus no-treatment groups). The focus on group comparisons, however, has meant a complete disregard for a methodology that is also highly appropriate; single-case design (or intrasubject replication) where the sample size is N = 1. In recent times, there has been an increasing disenchantment with classical group design for a number of reasons. For example, group comparisons are not always feasible in many clinical settings and tend to lack relevance for the practitioner's daily functioning. This paper elaborates these kinds of reasons and outlines the major advantages of using single-case design. There is little doubt that single-case methodology is becoming increasingly popular as an important research tool that can no longer be disregarded. Its specific applicability to evaluative research in family therapy is particularly appealing.     

Architecture: A Template For Generating Design And Construction Possibilities For Therapy

The architectural processes of design and construction can be adapted to the design and construct of human solutions. Architecture provides a generative metaphor for therapy as well as a coherent and comprehensive conceptualisation for developing an integrated therapeutic eclecticism. The notion of ‘therapy as architecture’ is general enough to encompass all models of therapy. However, the paper confines its application of the architectural metaphor to the field of family therapy, and in particular to the briefer approaches to family therapy. Also, the paper demonstrates the utility of this architectural template for providing specific guidance on how to design and construct a therapeutic form in keeping with the client's brief and context. A case vignette illustrates how an architectural therapy works.     

Do Personality Changes Occur in Parents Receiving Behavioral Family Therapy?

The present outcome study is a preliminary report on whether personality changes occur in parents receiving behavioral family therapy. Behavioral techniques for changing the identified patient's presenting problem were taught to the parents and each family member was given a weekly behavioral homework assignment intended to change the dysfunctional interactions assessed in the family.
An analysis of pre and post measures using Cattell's 16PF questionnaire showed a significant decrease in the parent's self-sufficiency index, indicating increased group dependence. The mean number of sessions was 12.6. The results of this study raise questions about the nature of the personality changes occurring in family therapy of this type. Family therapists, often-times assuming the role of the "expert" for the family, may be unwittingly fostering group dependence and losses in confidence for parents receiving such family guidance.     

Family Therapy and the Family Doctor − 1

The author shows that the family doctor's burden of responsibility in the area of psychological dysfunction in the community is immense. Traditionally he has little training, limited knowledge, and a paucity of skills, in the areas of counselling and psychotherapy. The author argues that structural and strategic family therapy skills may be applicable to family practice and of benefit to the family doctor. A brief introductory course and subsequent feedback are described.