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.     

Public opinion about AIDS policies. The role of misinformation and attitudes toward homosexuals

In an effort to better understand the cognitive and attitudinal factors underlying public opinion on AIDS-related issues, this article proposes and empirically tests a model of the relationships between (1) knowledge of HIV transmission, specifically the misinformation that AIDS can be transmitted easily through casual contact with HIV-infected persons; (2) attitudes toward homosexuals, the most prominent of the social groups presently affected by the AIDS crisis; and (3) support for restrictive public policies aimed at HIV-infected persons. Data from two nationally representative surveys conducted in December of 1985 (N = 2,308) and in July of 1987 (N = 2,095) provide evidence that misinformation about AIDS transmission and negative attitudes toward homosexuals are strong predictors of support for stringent restrictions of persons with AIDS. The findings also suggest that several background factors, in particular, education and political liberalism, may also play decisive roles in influencing levels of support for restricting those infected with the AIDS virus.     

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.     

Motivational,ethical, and epistemological foundations in the treatment of unwanted homoerotic attraction

A recent special section of the Journal of Marital and Family Therapy (October, 2000) focusing on the mental health needs of gay, lesbian, and bisexual individuals neglected to address the clinical needs of homosexual persons who desire to increase their heterosexual potential. This article attempts to correct this omission by outlining common motivations for pursuing change, updating the current state of knowledge regarding the effectiveness of change efforts, and providing some ethical guidelines when therapists encounter clients who present with unwanted homoerotic attraction. Finally, to assist marriage and family therapists (MFTs) in more deeply understanding divergent perspectives about reorientation treatments, an examination of the role of moral epistemology is presented and some examples of its potential influence are described. MFTs are encouraged to recognize and accept, rather than ignore or deny the valid needs of clients who seek to modify their same-sex attraction.     

The Family Ties of Unmarried Cohabiting and Married Persons in the Netherlands

Using a nationally representative survey (N = 4,612), we analyze whether there is a difference in the Netherlands between cohabiting and married persons with regard to the frequency of contact with one’s own family as well as the parents of the partner. Clustered regression analyses show that, as expected, cohabiting persons have less contact with family members. Results are consistent with the selection perspective, which attributes the lower levels of contact to background characteristics, influencing the orientation of the cohabiting toward family. The uncertainty perspective, which attributes the lower levels of contact with the parents of the partner to the greater uncertainty regarding the stability of cohabiting relationships, is partially supported.     

Family Therapy with Substance Abusers: Legal Considerations Regarding Confidentiality*

This paper explores various problems in the area of confidentiality often confronted by family therapists working with substance abusers. The scope and intent of the Federal Regulations controlling the release of all alcohol and drug abuse patient records and information are examined. Also, the rules regarding the release of confidential information by family therapists to attorneys, other family members and third-party funding sources are explained. Suggestions regarding the release of information in questionable cases are made. Finally, the growing use of family therapy in treating substance abusers, and its impact on confidentiality law and policy, is noted.     

How to reduce the risk of HIV infection for the seriously mentally ill.

1. The professional literature increasingly indicates the need to educate persons with serious mental illness regarding HIV/AIDS. 2. Community-based organizations currently responding to the AIDS epidemic are poorly equipped to respond to the special needs of persons with serious mental illness. 3. Persons with serious mental illness are concerned by HIV/AIDS. Some, however, will incorporate education into their pathology via delusional systems or misunderstandings. 4. Effective programs for this population can be developed following community health nursing principles.     

Helping HIV-positive persons to negotiate the disclosure process to partners, family members, and friends

For people who have been diagnosed with a chronic illness, one inevitable issue to be addressed is whether and how to share this information with others. For persons who are HIV positive, disclosure presents an especially arduous task. The purpose of this article is to offer a strategy to assist marriage and family therapists in facilitating client disclosure of an HIV-positive status to partners, family members, and friends. In addition, suggestions for setting the stage for disclosure to occur and recommendations for client follow-up are proposed.     

Advocating for Community Services Coordination: An Empowerment Perspective for Planning AIDS Services

With the progression of the HIV pandemic and the unique challenges it brings to community-based health and social services, comprehensive service planning becomes essential for the well-being of those affected by AIDS. This article reports on an educational program using an empowerment-based community practice model in responding to the AIDS crisis. This was a service planning coordination effort tbat included compiling a comprehensive directory and profile of local services, measuring practitioner knowledge and attitudes toward working with persons affected by AIDS, and analyzing planning policies of HIV service agencies. This joint work included faculty, students, and community service providers.     

ETHICAL DILEMMAS IN FAMILY THERAPY

A review of the literature in the area of ethical dilemmas facing family therapists revealed that there were a number of issues facing family therapists which are not included in the Principles for Family Therapists (1984) of the American Association for Marriage and Family Therapy. Seventy-five family therapists from across the nation responded to a questionnaire which asked what ethical dilemmas they face and how helpful the ethical guidelines are with these dilemmas. Results indicate that family therapists are encountering dilemmas which are not included in the Principles, significantly more often than those that are included. The ethical principles were found to be helpful for those ethical dilemmas attended to by the Principles.     

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.     

AIDS: developing a primary health care task force

As the number of people with AIDS increases, the number of people impacted by the AIDS crisis will also increase. Larger metropolitan areas have already responded to the crisis with various services (Deuchar, 1984); but the disease has yet to fully impact on smaller cities and towns. The formation of community service groups to cope with the AIDS crisis is a virtual necessity in health care preparation for persons with AIDS. The experience of the Fort Wayne AIDS Task Force reflects the potential of any community to utilize the existing resources in the gay and lesbian community, health and social service professions, and among family and friends of persons with AIDS. Consultation and resources are available through local and state boards of health, as well as local social service and health personnel currently dealing with the AIDS crisis.     

Training Family Therapists: Creating a Learning Experience

This article describes the structure of a Three Day Residential Workshop for experienced therapists. We were concerned that workshops for family therapists often failed to provide a sense of continuity and movement from one interview to the next. We also felt that workshops, through their process, imply an expectation of uniformity in style that may inhibit the creativity and spontaneity of the therapists. We therefore chose the Growth Model of family therapy as we experimented with a format that: (a) used sequential interviews which broke some well established rules of role-playing, (b) utilized a team approach as a useful tool in furthering the learning experience, and (c) exposed the participants to a variety of therapy styles. In this article we seek to Illustrate those components of the workshop that proved successful and those areas which needed to be changed in order to make it a more effective learning experience. We conclude with specific recommendations regarding the structuring of such workshops.     

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.     

Ethics and family therapy: the case management of family violence*

All family therapists, and especially Milan-style systemic therapists, have been trained to take a neutral stance regarding family issues, based on a circular causality model of family interaction. Therefore, when therapists deal with family violence, their ability to perceive individual responsibility for unethical behavior is weakened or suppressed. In fact, this ability is the primary tool in developing effective treatment planning in cases of family violence: The actively physically abusive man needs to be in individual and/or group therapy, not conjoint or family therapy. The ethical judgment of the therapist is what determines the limits of family therapy.     

Living with the stigma of AIDS

This article uses interview data to explore how 23 gay and bisexual men who had AIDS were affected by and managed stigma. The article describes how stigma affects the relationships of persons with AIDS to their families, friends, lovers, colleagues, and health care providers. It explores how persons with AIDS avoid or reduce stigma by concealing their illnesses, learning when and to whom they should reveal their illnesses, changing their social networks, educating others about AIDS, developing nonstigmatizing theories of illness causation, and using bravado to convince others that they are still functioning social beings.     

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.     

BIOLOGICALLY BASED DEFICIT IN THE IDENTIFIED PATIENT: INDICATIONS FOR PSYCHOEDUCATIONAL STRATEGIES

The phrase "identified patient" has attracted a wide following among family therapists representing a variety of approaches to family therapy. It is based on the assumption that persons referred for psychotherapeutic treatment are often incorrectly labeled "patients" when, in fact, their symptoms are manifestations of family, not individual, dysfunction or pathology. It is the thesis of this article that when biologically based deficits in the identified patient are a salient determinant of interpersonal dysfunction, such reframing is inappropriate. Psycho-educational strategies for treating families of persons with such physically based conditions as learning disability, attention deficit disorder, epilepsy, autism, and various medical illnesses and handicaps, are recommended.     

Conceptualizing and Treating Problem Gambling as a Family Issue

Few family therapists have training in the identification, assessment, and treatment of problem gambling and its impact on couple and family relationships. The authors conceptualize problem gambling (PG) as a family issue and encourage clinicians and researchers to pay attention to the systemic antecedents and consequences of PG on family relationships. A review of the literature and clinicians' experiences regarding the impact of PG on couple and family relationships are presented and discussed. In light of the limited systemic-based treatments for PG, marriage and family therapists are urged to begin paying attention to this emerging issue that has significant couple and family ramifications.     

Training issues for supervisors of marriage and family therapists working with persons living with HIV

The purpose of this article is to address the special issues and considerations Martial and Family Therapy (MFT) supervisors might face with the increasing HIV/AIDS epidemic. Three primary issues will be addressed in this article. First, the importance of educating therapists regarding various aspects of the disease process and its transmission will be discussed, followed by educational strategies programs might adopt. Second, we will discuss the ethical and legal considerations that may need monitoring by supervisors and trainees. Third, special therapeutic considerations will be provided to supervisors of therapists working with stigmatized populations.