How and Why Do Family and Systemic Therapies Work?

My reviews of the evidence base for family therapy conducted over the past 15 years have been guided by four key questions. Does systemic therapy work? What sorts of systemic therapy work for specific problems? What processes occur in effective systemic therapy? Is systemic therapy cost‐effective? In this paper answers to these questions are given. Systemic interventions are effective for about two out of three cases. Specific models of effective systemic therapy have been developed for most common mental health problems. There are many processes shared by evidence‐based models of practice that can be incorporated into the routine practice of research‐informed family therapy. Systemic therapy is cost‐effective and in many cases leads to medical cost‐offsets. Available evidence indicates that family therapy can make a very significant contribution to alleviating suffering and making the world a better place to be.     

Working Relationally with Youth in Child Protection Institutions: A Milieu‐Therapy Perspective

Children and youth who have shown serious difficulties or if it is surmised that parents over time will not be able to care for the child or youth, could be placed in a child protection institution. The therapeutic work in such institutions is often described as milieu therapy. There has been little focus on the milieu therapist's relational work in child protection institutions. The research question for this study was: What factors are described by milieu therapists as significant for relational work with youth placed in institutions? To answer this question, we collected data from qualitative semi‐structured interviews with four milieu therapists working in child protection institutions. Interpretative phenomenological analysis helped us identify three overarching categories: (1) structural and personal factors as a basis for relational work; (2) various forms of communication in relational work; and (3) relational work with a starting point in everyday events.     

When Less is More: Lessons from 25 Years of Attempting to Maximize the Effect of Each (and Often Only) Therapeutic Encounter

The three main findings of studies conducted by Hoyt, Rosenbaum, and myself during the years 1986–1990 at the Kaiser Permanente Medical Group, were

• 1 . Single session is the most common length of psychotherapy.
• 2 . The first session in psychotherapy is potentially the most therapeutic and often has the greatest influence on the outcome of therapy.
• 3 . Single session therapy (SST) is the most cost‐effective mode of therapy.

The fact that less is very often better in psychotherapy is by now one of the most validated and consistent findings in evidence‐based psychotherapy research. We now think of it as a very common, very useful way of conducting therapy, employing many different approaches and methods to address a wide range of presenting problems. In retrospect, 25 years later, I believe that the essence of single session therapy is still about being present in each and every session as a whole. The goal has always been to make the most of every therapeutic session, whether seeing a client only once or over a long period of time. In a personal communication in 1978, Haley (in Talmon, 1990) predicted that a ‘single interview could become the standard for estimating how long and how successful therapy should be.’ This article explains why it didn't happen.     

The Multiple Relationships Between Neutrality And Therapeutic Influence

The term ‘neutrality’ has multiple meanings within the literature and practice of family therapy. The first section of this paper identifies and discusses these uses. A second and more heuristic section developes linkages between neutrality and what is seen to possess professional authority. We believe these linkages tend to be obscure, only becoming accessible if the multiple, interlacing contexts within which therapists participate are examined. These contexts include:

• (i) the place given to neutrality in Western culture
• (ii) the organisations employing therapists and how these bodies view professional neutrality, and
• (iii) the expectations and experience of clients in relation to professional neutrality.

Because neutrality is so entwined with questions of professional effectiveness and power, the authors believe it is not possible to declare neutrality good or bad, possible or impossible. Rather the question should be: within what local circumstances, and in what particular senses of the term, can neutrality be effectively and ethically employed?     

Five artists' valuations of the visual

Abstract

This paper comprises interviews with five practising artists: Terry Atkinson, Torie Begg, Rebecca Fortnum, Lubaina Himid, and James Hugonin. The aim is to gauge the ways in which ‘the visual’ features in contemporary fine art practice, not only at the end of a century in which the visual ‐ at least for much of the first half of that century ‐ was often accorded special status, but also, more recently, after Conceptualism and radical egalitarian interventions have challenged the status of and assumptions about the value of the visual. All five artists were asked the same questions: What/who are the formative influences on your work?; What role does the visual play in your work ‐ to what extent do you value the visual?; Can you say something about (i) aesthetic and (ii) pleasure ‐ however you define them?; How does a work evolve?; How do you define quality ‐ what makes you think one of your works is better than another?; What is the spectator's relationship to your work? ‐ what role does the spectator have? The responses bear witness to significantly different ways in which contemporary artists value the visual.     

La sociologie clinique comme science rigoureuse et comme pratique sociale

How can clinical sociology be considered from an epistemological point of view, since it deals with social problems not in their overall dimension, but seen as specific situations where concrete people are suffering? This paper is concerned with a two-fold epistemological difficulty: from the one side, studying such problems could involve a therapeutic intervention that exceeds a purely scientific approach; then, has a clinical sociologist to deal with a social therapy? And how far does that (not) involve any political involvement? From the other side, under which conditions could he (she) generalize information coming from his (her) experience as to contribute to social theory (according to Merton's suggestions about theory and research)? An effective contribution to answer such questions can come from the concept of ‘cultural pattern’, as pointed out in this paper.     

Disturbing the AcademicConferenceMachine: Post‐qualitative re‐turnings

Author 1:

They say they want to disturb the AcademicConferenceMachine.

Author 34:

What is an AcademicConferenceMachine?

Author 2:

Please do not go in that direction. Ask, for example, what does an AcademicConferenceMachine do?

Author 51:

Ok, so what does it do?

Author 6:

AcademicConferenceMachines are becoming so regulated and standardized that they might lose the possibility to produce different knowledge and to produce knowledge differently.

Author 227:

Do you think they succeeded?

Author 9999:

I do not know.

     

Becoming Resilient: Overturning Common Sense — Part 1

How might we engage with the concept resilience in a world obsessed with the measurement and cataloguing of deficits and virtues alike; with predicting outcomes, producing certainty and the reification of stable identity? This article is based on a plenary address presented to the Australian Family Therapy Conference in 2009 and takes Deleuze's paraphrase of the 17th century philosopher, Spinoza as a point of departure from common sense views of identity. Can resilience be possessed by some as a personal quality enhancing their coping skills or might resilience be a vital aspect of living which passes through us? Perhaps resilience bounces back towards us and enables the unsettling of dogmatic beliefs and a stable sense of identity Enquiry might then shift from the moral; What kind of person am I? How should I live? towards an ethical position of wonder; What else might there be? What might I be capable of?This article invites an ethical exploration of desire, its capture and of resistance and explores the politics of identity; illustrated with men's journeys of struggle with violence, sexuality and belonging and the discovery of ethics and generous forms of love in the face of adversity.     

Social Work Student Learning Experiences of Family Therapy: Improving Competency in Pedagogy Through Qualitative Research

The purpose of this qualitative study is to evaluate graduate social work student experiences of pedagogy intended to improve competency in family therapy practice. Students from two classes (N = 37) completed open‐ended surveys assessing: perceptions of most helpful pedagogical practices; understanding of needed competencies; and perceived opportunities offered to them during their graduate training for learning about work with couples and families. Results, analysed using grounded theory methodology, revealed that students: (1) believed that experiential activities were especially critical for learning how to do clinical practice with couples and families; (2) understood important competencies related to professional development, therapeutic engagement with the family, and how to approach family practice; and (3) believed they were ‘somewhat prepared’ for practice. Implications include improving understanding of abstract skills in practice with couples and families, and emphasising relationship dynamics more in graduate social work education and training.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

Multisystemic Therapy for Disruptive Behavior Problems in Youths With Autism Spectrum Disorders: A Progress Report

Youths with autism spectrum disorders (ASD) often engage in serious disruptive behaviors that interfere with their ability to successfully manage day‐to‐day responsibilities and contribute to relationship problems with caregivers, peers, and teachers. Effective treatments are needed to address the factors linked with disruptive behavior problems in this population of youths. Multisystemic therapy (MST) is a comprehensive family‐ and community‐based treatment approach that has been effective with other difficult‐to‐treat populations of youths and holds promise for youths with ASD. In this article, we review the broad range of factors associated with disruptive behaviors among youths with ASD and discuss how MST interventions can be adapted to address those factors. We also present a framework for our adaptation of the MST model for youths with ASD. This framework includes a recently completed pilot study as well as an ongoing efficacy trial that together have served to identify key interventions for our adaptation of the MST model.     

Teaching and Learning Guide for “Gender In/equality in Worker‐owned Businesses”

This teaching and learning guide accompanies the article, “Gender In/equality in Worker‐owned Businesses,” which reviews existing literature on gender in businesses with employee stock ownership plans, worker cooperatives, and communes. Worker ownership has attracted renewed interest as a possible solution to the social and economic problems confronting our society. In worker‐owned businesses, workers have greater control over what they produce, how they produce it, and how they are compensated. If workers ran things themselves, so the story goes, jobs would be better and workplaces would be more equal. What do we actually know about work in alternative organizations? Do women fare better? Can they offer alternatives or solutions to the gender inequality that permeates working life? This teaching and learning guide provides supplemental information to facilitate the use of this article in the classroom. This includes a list of recommended readings, online resources, a sample syllabus, focus questions, and project suggestions.     

Online Education in Social Work,Effectiveness, Benefits,and Challenges: A Scoping Review

ABSTRACT

Online education has long been a controversial issue within the Australian social work community. Although technological advances have improved the quality of teaching substantially, scepticism and disbelief continue to exist. Despite the growing evidence base as to the effectiveness of online teaching, this tends to be overlooked. A scoping review of the literature was conducted to synthesise research conducted on online social work education to identify its effectiveness, potential, and challenges and to show whether online social work education will effectively prepare qualified social workers. This revealed that online education enhanced diversity and equity among social work students and students’ performances and satisfaction were similar for both online and on-campus students. Nevertheless, communication and engagement continue to be a challenge.

IMPLICATIONS

• Decisions on online education should be based on evidence of effectiveness rather than on the assumption that face-to-face teaching is superior.

• Further research is needed to explore effectiveness of online education for different groups of students.

• Employers’ experiences with social work graduates from online courses need further research.

• Academics require support to tailor courses interactively and suitably for online education.

     

The Not-So-Flat World: Exploring the Meaning of Buying at the Intersection of the Global and the Local at a Starbucks in Singapore

Abstract

This essay pulls together two threads of literature on globalization and buying to explore how consumers constantly re-signify the global and national origins of products and deploy these global products to create local, even family and dinner table conversations about identity and self. Based on interviews, surveys, and ethnographic research, I look at the drinking of Starbucks coffee in Singapore by ex-pats and middle-class citizens, but especially by young Malays. What does it mean for these teens from the most economically and socially marginal community in this multicultural country to publicly consume oversized American products? What are they saying about themselves and their relationship to their tradition-bound community? What can we learn about globalization and how it works and how it is represented on the ground in local conversations by charting the consumption of this American product by a somewhat outsider community in this transnational place? I focus on this group of buyers, again, to explore in detail the very localized meanings of this very resonant and globalized product.     

Case‐Based Research in Family Therapy

Traditionally, case‐based research has not been considered as scientific by many in the field due to the lack of controlled conditions and objectivity. However, case‐study material may be more effective than once believed in educating family therapists. Future implications of the role of case studies in family therapy research are considered, including the manner in which case studies might be designed to be more rigorous so that they can serve as the basis for drawing causal inferences in clinical cases, and at the same time, provide family therapists with useful information to improve their skills. A discussion section highlights the future direction of case‐based research in the family therapy literature and how it may be used as an effective learning tool.     

Labour,Legality and shifts in the Public/Private divide

This article discusses the changing role that work performed in private homes has played, and continues to play, in migration law in the Netherlands and at the EU level. It explores to what degree work performed in the home is defined as (exploitative) contractual labour or as inherent to family life, and what this means for claims to residence rights as a precursor to citizenship. It does this by reviewing case law of the European Court of Justice (CJEU) and of the European Court of Human Rights (EctHR) against the background of the Dutch case. It reveals tension between how citizenship is constructed and reproduced at the national level and how it is constructed and reproduced at the EU level. Following Adam McKeown, this article concludes that different perspectives on (reproductive) labour as a qualification for citizenship may reflect different perspectives on (reproductive) labour and the quality of citizenship.

Policy Implications

• Third Country Nationals must be allowed to reside in the EU with their EU children, to ensure the latter's effective enjoyment of fundamental rights.
• Policies to combat trafficking of domestic workers must respect family life.
• Family migration policies must allow individual family members enough scope to resist exploitation within families.
• Policies concerning labour protection, social protection and migration should no longer take the breadwinner‐citizen as point of departure, but the current reality of flexible labour relations in which the distinctions between home and work, and between employment and self‐employment, are no longer sharply defined.

     

Deactivating the Buttons: Integrating Radical Exposure Tapping with a Family Therapy Framework

The purpose of this paper is to describe and illustrate with case examples a brief intervention termed Radical Exposure Tapping (RET). RET can be integrated with family therapy to address stuck points where the therapy is hindered by a family member's affective block, an intense and unchangeable emotional reactivity to a specific trigger. RET draws from the methodology of Eye Movement Desensitization and Reprocessing (EMDR) and combines it with the tapping sequence of the Emotional Freedom Technique (EFT) to produce an intervention that is more flexible than EMDR, provides greater rigor than using the EFT technique alone and can be effective in a single session within the context of family therapy. The paper puts this work into context by first over viewing definitions of trauma and Post‐Traumatic Stress Disorder, arguing that family members' emotional reactivity may be a symptom of PTSD even when they would not qualify for the diagnosis because they had not experienced a life threatening event.     

Drug trafficking and addiction among low-income urban youths: An ecological perspective

Drug addiction and drug trafficking continue to be a major problem during adolescence and a primary cause of significant problems in adulthood. For low-income, urban, African American youths, these problems are compounded by environmental factors-such as communities that are depleted of resources, schools that are inadequately funded, family members who are unemployed-and other physical, legal, spiritual, social and psychological factors. These ecological factors have the potential to impinge significantly on the lives of those who become involved with drug use and sales. The problems resulting from these issues not only affect the individual but also family members, communities and the nation.

This paper examines the patterns of drug addiction and trafficking among African American youths in poverty, with an eye toward answering the following questions: What is drug trafficking? What is the youths perception of drug addiction? What role does drug trafficking play in subsequent drug use? What is the nature and role of ecological factors, such as poverty, in the interaction between drug addiction and drug trafficking? How do these issues reflect on developmental theories of addiction?