‘Somebody Else's Roadmap’: Lived Experience of Maudsley and Family‐based Therapy for Adolescent Anorexia Nervosa

The Maudsley and more recent family‐based therapy manualised approaches are positioned by some as the gold standard, evidence‐based therapy for adolescent anorexia nervosa (AN). However, a significant proportion of adolescents and their families either discontinue this therapy and/or find that it simply does not work for them. These adolescents and families are under‐represented in the literature on therapeutic interventions for adolescent AN. This paper begins to address this gap with an in‐depth qualitative case study that explores the lived experience of Maudsley family therapy (MFT)/family‐based therapy (FBT) for one female adolescent (age 14 years) and her family over the period of 3 years (ages 11–14). Although initially handing over the responsibility for her eating was comforting and reinstated a sense of control in the family system, these experiences were not maintained. When she did not progress past the first phase of FBT, she and her family experienced the approach as blaming. She felt silenced and family alliances were weakened. This paper analyses how the family members negotiated and preserved their identities within this disabling context.     

The Family Context of Relational Aggression in “Difficult to Treat” Female Juvenile Offenders

Female juvenile offenders often engage in socially aggressive behaviors that make them more difficult to treat than male juvenile offenders. This social (i.e., relational) aggression may be developed or maintained through transactions with family members. To investigate this issue, we measured relational aggression in the family interactions of 140 adolescents divided by gender and offender status into four equal‐sized groups (female juvenile offenders, male juvenile offenders, female nonoffenders, and male nonoffenders). Adolescents and caregivers completed a family discussion task, and raters coded relationally aggressive behaviors at the dyadic level. Results showed that female juvenile offenders and their mothers directed more relational aggression toward each other than did mother–adolescent dyads in the other groups. Implications of these results for treatment and research are discussed.     

An integrated treatment approach to child sexual abuse in the family

SUMMARY. In responding to the increasing professional recognition of child sexual abuse within the family, this paper, relating data from a clinical sample to epidemiological studies, is the first of a number devoted to experimental approaches being taken to identify and treat this problem. The author goes on to describe the multi-disciplinary approach taken at the Tavistock Clinic and other treatment centres. The need for close cooperation and coordination of all professionals concerned and for the involvement of all family members in different forms of treatment is particularly emphasised. This paper was given at the 11th International Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions, Paris, July 1986     

Exploring the Role of the Internet in Juvenile Prostitution Cases Coming to the Attention of Law Enforcement

This exploratory analysis examines the role of the Internet in juvenile prostitution cases coming to the attention of law enforcement. The National Juvenile Prostitution Study (N-JPS) collected information from a national sample of law enforcement agencies about the characteristics of juvenile prostitution cases. In comparison to non-Internet juvenile prostitution cases, Internet juvenile prostitution cases involved younger juveniles and police were more likely to treat juveniles as victims rather than offenders. In addition, these cases were significantly more likely to involve a family or acquaintance exploiter. This analysis suggests that the role of the Internet may impact legal and social service response to juveniles involved in prostitution. In addition, it highlights the need for interventions that acknowledge the vulnerabilities of youth involved in this type of commercial sexual exploitation.     

Exploring the role of the internet in juvenile prostitution cases coming to the attention of law enforcement

This exploratory analysis examines the role of the Internet in juvenile prostitution cases coming to the attention of law enforcement. The National Juvenile Prostitution Study (N-JPS) collected information from a national sample of law enforcement agencies about the characteristics of juvenile prostitution cases. In comparison to non-Internet juvenile prostitution cases, Internet juvenile prostitution cases involved younger juveniles and police were more likely to treat juveniles as victims rather than offenders. In addition, these cases were significantly more likely to involve a family or acquaintance exploiter. This analysis suggests that the role of the Internet may impact legal and social service response to juveniles involved in prostitution. In addition, it highlights the need for interventions that acknowledge the vulnerabilities of youth involved in this type of commercial sexual exploitation.     

Treatment of Juvenile Sex Offenders: A Review of the Literature

This article reviews the literature concerning the treatment of juvenile sex offenders, an area that has only recently begun to receive attention by researchers. This review considers the types and modalities of treatment methods available as well as the research supporting their efficacy. Special issues for therapists who work with juvenile sex offenders are also discussed. This review found that although there is a wide variety of treatment techniques available to treat juvenile sex offenders, very little research has been done to validate their efficacy. The need for controlled systematic research is noted.     

The Different Meanings of Food in Chinese Patients Suffering from Anorexia Nervosa

Abstract

The metaphoric meanings of food have cast new lights on Social Work intervention with Chinese patients suffering from anorexia nervosa (AN) and their families. Hitherto, there is inadequate documentation on the different meanings of food in families with a daughter suffering from AN in a Chinese context. To fill this knowledge gap, this article reports the 3-year clinical observations of a sample of 34 adolescents and young women suffering from AN, as well as their families under family treatment. These observations show that food can be conceptualized in the following ways: (1) eating as an expression of filial piety; (2) food preparation as part of the woman's nurturing role; (3) self-starvation as refusal to grow up; (4) self-starvation as struggle for autonomy; (5) assignment of food as part of the family hierarchy; and (6) assignment of food as part of parental control. Its implications for clinical social work practice and the roles of social workers in helping are discussed.     

Teasing Out the Lessons of the 1960s: Family Diversity and Family Privilege

The tumult of the 1960s brought new strains of cultural relativism. I survey the continuing impact of some of these strains on family studies, focusing especially on the study of family diversity as an offshoot of the relativistic project. A dominant discourse still drives much of our work, however, and I illustrate it with some recent examples. The diversity agenda is hampered too often by unintended erasures of large categories of people in nondominant family arrangements. As a corrective to this tendency, I propose an agenda to study family privilege and entitlement, that is, to treat it as a “social problem” much as we treat poverty or juvenile delinquency. I illustrate with my own narrative of how I learned privilege and entitlement growing up male in a White, Jewish, upper‐middle‐class family. I end with some recommendations about how we might bring this agenda into our research and writing.     

Whole Family Theraplay: Integrating Family Systems Theory and Theraplay to Treat Adoptive Families

This article regarding the effectiveness of Theraplay for the clinical treatment of adoptive families both outlines a model for integrating family systems theory with Theraplay to create a new approach entitled Whole Family Theraplay (WFT), as well as provides a preliminary report of a pilot study demonstrating the efficacy of that model. WFT integrates Theraplay with family systems approaches (Structural and Experiential Family Therapies) to treat parents and all the siblings within adoptive families. The findings indicate that WFT treatment may lead to statistically significant benefits in regard to family communication, adults’ interpersonal relationships, and children's overall behavioral functioning.     

Effective components of interventions in juvenile justice facilities: How to take care of delinquent youths?

Therapeutic interventions support change in delinquent youths rather than rely on surveillance and deterrence. This article describes successful and concrete components for therapeutic interventions in juvenile justice facilities. The effectiveness of remedial measures to best address the sources of youths' delinquent behaviors and the performance of juvenile justice system are discussed first, and then two theoretical frameworks of rehabilitative models are described that are commonly used with delinquent youths. Finally, specific recommendations for enhancing treatment in juvenile justice facilities with regard to the content of interventions, social climate, and youth motivation to engage in treatment are described and explained in a way intended to help caregivers and practitioners, supervisors of juvenile justice facilities, and policy makers improve the daily life of youths placed in this kind of environment.     

Co-evolving with Anorectic Families Difference is a Singular Moment

An individual practitioner's development as a family therapist occurs in the context of the family therapy movement, most manifestly present in its literature and in seminars and workshops offered by its leading exponents. The process by which the therapist interacts with the broader field and consequently incurs shifts in perspective is rarely decribed, or theoretically elucidated. In this current paper, the author's changing orientation to the treatment of anorexia nervosa is viewed via theoretical discussions and case illustrations. The concept of co-evolution, as defined by both Bateson and Jantsch, is invoked to explain how interaction with other practitioners and literature can produce changes in therapeutic emphasis, and Prigogine's concepts of dissipative structures and bifurcation points are utilised in locating both therapeutic and theoretical shifts in time. The discussion briefly considers how therapists can co-evolve with conservative work situations to produce broader contextual changes.     

Change and Paradox in Family Therapy

This paper shows that when the interpersonal context in a family alters, solutions which have previously been successful may paradoxically increase the family's difficulties rather than resolve them. Therapy minors this process, in that when the family system is flexible, “commonsense” interventions may be effective, whereas with a rigid dysfunctional family system therapeutic interventions may be necessary which, among other things, paradoxically imply that no change is required. Some concepts derived from Watzlawick, Weakland and Fish are redefined and the mathematical group theory used by these authors is replaced by system theory in combination with the theory of logical types. A “behaviour disorder” family is used to illustrate the paradoxical mode of symptom development and also the use of a number of paradoxical therapeutic interventions. Possible reasons for the therapeutic power of these interventions are discussed; the concept of first and second order therapeutic paradoxes is introduced.     

Patients' Perspective on Family Therapy for Anorexia Nervosa: A Qualitative Inquiry in a Chinese Context

This article presents a qualitative study of the subjective experiences of 24 Chinese adolescents and young women who have been suffering from anorexia nervosa and who have received family treatment from a university‐based family treatment centre in Hong Kong. In‐depth post‐treatment interviews were conducted and have been transcribed and thematised using content analysis. The narratives that have emerged have facilitated hearing the clients' and their family members' voices, especially in the areas of (a) perceived concepts of family therapy, (b) the perceived therapeutic relationship and its linkage to positive change, (c) perceived intervention strategies as employed in family treatment, and (d) the participants' own role in problem‐solving. The study has enabled the author to refine the family treatment model, which has been adapted from the Micucci's (1998) model, with additional components introduced by the author to enhance family treatment in a Chinese context.     

Death in the Family Implications for Family Development

This article attempts to integrate concepts from psychoanalytic literature on parent loss with concepts from family literature in order to demonstrate their compatibility. A case is described that suggests that family treatment for this patient population provides the optimal opportunity for comprehensive diagnosis and treatment planning. The patient and family were treated by one of the authors. The other author served as supervisor and consultant.     

An integrated experimental approach to treating young people who sexually abuse

This article promotes the use of an integrated (holistic) approach to treating juvenile sexual offenders. An integrated model takes into account the fact that: (a) youth are resilient, (b) youth progress through various stages of development, (c) these stages are often arrested as a result of trauma, child abuse and neglect, and attachment disorders, (d) humanistic approaches and the therapeutic relationship are essential to the healing and recovery process, (e) youth learn and work with a variety of learning styles and multiple intelligences, (f) many traditional assessment and treatment approaches can be modified and blended with an integrated approach, and (g) the use of experiential treatments can have a positive and profound impact in treating youth with sexual behavior problems.     

Exploring the Therapeutic Relationship A Case Study

This paper is focused on the topic of the therapeutic relationship in systemic therapy. It is structured around the discussion of my experience of work with a particular family where the engagement issues were complex, and where there was the potential for a negative therapy sequence. The psychoanalytic concepts of transference, countertransference and projective identification are chosen to discuss my dilemmas — however, the differences between the analytic and systemic contexts of work are noted. Through the discussion of this case study, the potential benefits of using these analytic ideas to understand the therapeutic relationship in specific situations in systemic therapy are identified.     

The mental health recovery movement and family therapy, part II: a collaborative, appreciative approach for supporting mental health recovery

A continuation of Part I, which introduced mental health recovery concepts to family therapists, Part II of this article outlines a collaborative, appreciative approach for working in recovery-oriented contexts. This approach draws primarily upon postmodern therapies, which have numerous social justice and strength-based practices that are easily adapted in recovery-oriented contexts. The model outlined in this article includes an overview of the recovery partnership (i.e., therapeutic relationship), mapping recovery (i.e., assessment and case conceptualization), recovery planning (i.e., treatment planning), facilitating recovery (i.e., intervention), accessing resources (i.e., case management), recovery maintenance, and service contexts as well as a case study.     

Multidimensional Family Therapy: A Science‐Based Treatment System

MDFT is a family‐based intervention for adolescent substance abuse and associated mental health and behavioural problems (Liddle, 2010). Integrative in several ways, MDFT uses an ecological or contextual conceptual framework to understand the developmental tasks of teens and their families. Research‐derived knowledge about risk and protective factors, and proximal causes, correlates and contributors to adolescent drug and related problems inform clinical thinking and interventions with every case. A multisystems approach, MDFT assesses and intervenes in four areas: (1) the adolescent as an individual and a member of a family and peer network; (2) the parent(s), both as individual adults and in his or her role as mother; father or caregiver; (3) the family environment and family relationships, as manifested in day‐to‐day family transactional patterns; and (4) extrafamilial sources of influence such as peers, school and juvenile justice. Interventions are made within and coordinated across domains. Progress in one area or with one person has implications for and use in others. Individual meetings with parent(s) and teen set the stage for family sessions, and family meetings may offer content and new outcomes that need to be brought to extrafamily meetings with juvenile justice or school personnel. MDFT was developed and tested as a treatment system rather than a one‐size‐fits‐all approach. A treatment system offers different versions of a clinical model that vary according to factors such as clinical sample characteristics (older versus younger adolescents, juvenile justice involved versus no involvement in juvenile justice systems), and treatment parameters (type of clinical setting and treatment dose).