Personal Reflections of A Family Therapist*

In this informal paper I discuss my personal evolution as a family therapist, developments in the field, the politics of a systems approach in conventional settings, resistances to family and marital therapy by other professionals, some still puzzling aspects of family therapy, whether family or marital therapy works and what do we mean by working, directions my own work has taken, some comments about the nature of family life, the satisfactions and frustrations and stresses of being a family therapist, some hidden agendas of family therapy practices, how one's own personal family relationships affect and are affected by this kind of work, the casualties among family and marital therapists, and, finally, whether family therapists should have family therapy for themselves and their own families.     

Shifting values in agriculture: the farm family and pollution regulation1

It has long been acknowledged that the notion of family continuity of farm occupation through succession is one of the central tenets of the ethos of ‘family’ farming, but recent evidence suggests that it is being called into question by family members. Farming practices are being pursued in a rapidly changing world, an important feature of which is a greater level of public and political concern for protecting the rural environment. This paper examines a range of new influences affecting farming practice and environmental consciousness and the implications these have for farming values, particularly that of family succession. Using evidence from a study of dairy farm families and pollution regulation in Devon in South West England, it suggests that rural social change is providing new routes through which environmental values can flow through farm households, influencing the ways farmers understand the environmental implications of their practices, and the ways they and their families think about their long-term futures.     

Being neither Pollyanna nor Henny Penny: Responding to McDonald and Jones

Abstract

This paper provides an account of the earliest contributions to family theory and practice by social workers, beginning in the late nineteenth century. The paper argues that the first widespread practice of ‘family work’ by the helping professions was carried out by social workers, primarily women, despite this being rarely acknowledged in the family therapy literature. An analysis of gender and its place in the development of professional status and the ownership of ideas is provided.

Summary

This paper has traced the place of the family in social work theory and practice since the beginnings of the profession, with a particular focus on theoretical developments in social work in the United States. A number of points have been argued. Firstly, there is significant historical evidence that social workers, most of them women, pioneered family work many decades before the term ‘family therapy’ was invented. This directly challenges the claim made by a number of family therapy historians that work with families was pioneered by psychiatrists in the 1950s and 1960s. It is argued here that this discrepancy is largely a result of differences in professional power and gender status.

Secondly, it is argued that the impact of psychoanalytic theory on social work was profound, not only in terms of how it might have distracted the profession from further developing its early family systems focus, but also in how its multidisciplinary practice tended to place social workers, again mostly women, in somewhat limited and prescribed positions.

In addition, it is argued that social work's emphasis on the family and family intervention has waxed and waned due to these concepts not appearing to fit neatly into divisions between fields of practice, such as casework, group work and Community development. While social work struggled with finding a place for the further development of family social work theory, the rapidly growing domain of family therapy quickly colonised this field of practice, giving little credit to the ground already laid by social workers.     

A Network Therapy Clinic for Clients with Intellectual Disability

Over the past 30 years a systemic approach has been applied to complex cases involving intellectual disability and behaviours of concern. This paper describes a model that draws on systemic family therapy and network therapy as well as the use of a reflective team. A single session intervention was provided for families of people with intellectual disability. A systemic consultation was used as a pre‐session meeting for professionals working with the family. The systemic consultation and single session therapy allowed the family and the professional network to gain insight. Involving the professionals in the therapy session also enhanced the alliance between professionals and family. This approach assists everyone involved in the case to find a way to progress.     

Family support in practice: voices from the field

This paper revisits core family support messages for social work practice in working with children and families, linking to findings from high-profile child protection cases in the UK and the Republic of Ireland. Drawing on a comparative study where these identified practice messages were explored through the lens of testimony of family support workers in the UK and Ireland, these core messages are examined. Operating with hard-to-engage children and parents, we hear how families and family support worker colleagues now view the core functions of child and family work across both jurisdictions (Ireland and England). The authors argue that by naming a more detailed set of practices that are deemed as most useful by families, based on the benefits and challenges of intensive family support work, key messages arise that have major resonance for social work and multiagency practice into the future. A basic message from this study is that valuable lessons on engagement and intervention with families can be drawn for professionals by examining the practice elements of this group of paraprofessionals in the child and family arena. This paper adds to debates on the role of support and intervention in social work and family support work.     

Object Relations Family Therapy: Articulating the Inchoate

In recent years there has been a renewed interest in psychodynamic ideas within the family therapy literature. While some authors have explored the usefulness of psychodynamic concepts in the systemic context (Byng-Hall, 1995; Flaskas, 1993, 1996; Luepnitz, 1988, 1997), others have argued that psychodynamic models of family therapy should be given more credence in systemic work with families (Guttman, 1991). This paper describes Object Relations Family Therapy (ORFT), a psychoanalytic model of family therapy, in plain English in order to minimise the obscurity of some of the existing terminology and to emphasise the utility of more contemporary formulations. ORFT addresses the interface between psychoanalytic and systemic theories. It offers a way of conceptualising complex family dynamics at both the interpersonal and intrapsychic levels. It also integrates an understanding of nonverbal, unstated and often implicit processes in its formulation of problem development. The unique contribution of ORFT is elaborated using a clinical example.     

‘Riding the Wave’: Working Systemically with Traumatised Families

This paper draws on the authors’ clinical experience as family therapists, working predominantly with families who have experienced trauma such as sexual abuse, physical abuse and neglect, to demonstrate that taking a systemic trauma‐informed approach is a powerful therapeutic modality that can facilitate positive outcomes for all family members. The paper discusses the impact of trauma on relationships, and then outlines a rationale for a trauma‐informed, systemic approach with those traumatised families who are, at times, challenged by excessively heightened behaviour and emotional dysregulation. Drawing from parenting research, it includes a discussion of the place of parent work and how this can be integrated with systemic family work. Key constraints and considerations are highlighted followed by a discussion of key interventions the authors have found useful in building a clinical framework for this work, including what is critical for the therapeutic process. While working with traumatised families is complex and challenging, offering a safe place for families to be in the presence of each other's pain and ‘ride the wave’ of emotions can be a powerful path to recovery.     

FAMILY THERAPY WITH INTELLECTUALLY AND CREATIVELY GIFTED CHILDREN

Few family therapists have expertise in the psychology of giftedness, and little research has been conducted to determine the effectiveness of family therapy with talented children and their families. The purposes of this paper are: (1) to provide family therapists with information on the unique psychosocial stressors associated with giftedness and (2) to stimulate further research and development on the efficacy of family therapy in alleviating distress and actualizing potential in gifted and talented children and their families. The paper provides a critical overview of the existing research literature on gifted children and their families. First, current conceptualizations of giftedness are described. Then the research literature on the characteristics of intellectually and creatively gifted children and their families is reviewed with an emphasis on the endogenous (individual) and exogenous (systemic) factors that can create or exacerbate psychosocial problems. Finally, we suggest an eclectic, eco-systemic approach to three common concerns that bring gifted children and their families to therapy.     

Transcultural Therapy with Aboriginal Families: Working with the Belief System*

A framework for conducting transcultural therapy with families is considered. This emphasises the importance of developing cultural sensitivity, competence, and the role of cultural consultants. The paper then applies this framework to Aboriginal families. The author explores the indigenous belief system about health and healing, demonstrating the importance of body, land and spirit to the Aboriginal people. Continuity and change in belief and health practices are then traced from the traditional setting to the mission or reserve and urban setting. A case study demonstrates how to work with this belief system and provides practical recommendations for family therapists. On a broader level the paper demonstrates the compatibility of systemic thinking to the Aboriginal world view and draws from the literature of transcultural psychiatry, geography, medical anthropology and family therapy.     

An Exploration of Family Environment,Adolescent Perceptions,and Home-Based Intervention

ABSTRACT

Home-based family intervention has become a successful approach to treatment in the field of social work and family therapy. Studies in this area have usually focused on the outcome of nonplacement as the measure of success; few studies have reported specifically on changes in family environment and adolescent perceptions following home-based intervention. Using the family life cycle as a theoretical framework, this study assessed changes in family environment and adolescent perceptions from pretest to post-test in families receiving home-based family intervention. Findings indicate that the family environment improved in cohesion, conflict, and independence; and adolescents improved in self-concept and peer security from pretest to posttest. Suggestions for aftercare are presented.     

Family‐Focused Child Therapy in Marital Separation

When marriages and long‐term relationships break down, parents may refer their children and adolescents to therapy for a variety of reasons. While the systemic therapist's preference may be to work with the family system/s, high conflict separation may prohibit such an approach. This article discusses family‐focused child therapy that prioritises the needs of children while seeking to preserve a systemic approach. At a practice level this may involve: (a) individual child therapy, (b) engaging with smaller subsystems including siblings, (c) joint therapeutic work involving child/ren plus parent/s, and (d) any of these combinations; all while continuing to maintain a systemic understanding of the work. The article discusses the challenges of working with children from separated families, where there is restricted or no possibility of engaging with the broader family system.     

Working systemically following abuse: exploring safe uncertainty

This paper explores systemic practice and ‘safe uncertainty’ in work with parents who do not accept responsibility following child abuse. The prevailing view has been that little positive work can be carried out with families where responsibility is denied. Our work is offered to add to the small yet growing number of publications which challenge the dominant discourse relating to child protection work. A case study is illustrated within which the issue of assessment versus therapy emerges. The Legal Department of the Local Authority Social Services requested an assessment from child and family psychiatry. Concern developed regarding the point at which assessment ended and therapy began. The authors offer a systemic model in exploring the importance of a safe multi‐disciplinary framework within which uncertainty can be tolerated and therapy/change work can be affected. A framework within which parents can be supported in developing skills to meet the needs of children is presented. These issues are central to the professional and legal systems relating to child protection in the UK. Copyright © 1999 John Wiley & Sons, Ltd.     

Work–home conflict and facilitation across four different family structures in Norway

The purpose of this study was to examine how work–home conflict and facilitation vary among people living in different family structures in Norway, here conceptualized as: two-parent families; single parents; childless couples; and singles. The study used data from a Norwegian study on occupational health (N=2414). We hypothesized that respondents living in two-parent families experience more work–home conflict and facilitation than others due to more complex role expectations. Similarly, we hypothesized that the effect of workload and autonomy on work–home conflict and facilitation would be stronger among this group. The results indicate that conflict between work and home life are more profound among those living in two-parent families and among single parents than among childless couples and singles. Work-to-home facilitation did not vary by family structure, whereas the childless couples reported more home-to-work facilitation. Furthermore, with a few exceptions the effects of workload and autonomy on work–home conflict and facilitation did not differ by family structure.     

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.     

Does a Perinatal Infant Mental Health Team Hold the Family in Mind? Opportunities and Challenges for Working Systemically in this Specialised Field

This paper considers whether systemic family therapy frameworks are used in current Perinatal Infant Mental Health (PIMH) practice. PIMH is a field that is, by nature, relational, focusing on enhancing the development of early parent–infant relationships. It is well accepted that the early years of an infant's life are crucial for brain development, and disturbances in early parent–infant relationships can impact negatively upon the child's development. Five clinicians from a PIMH service in a metropolitan area participated in a focus group related to key systemic concepts: genograms, family of origin, transitions, and morphogenesis. Findings suggest that the PIMH team does hold the family in mind, utilising systemic frameworks predominately in the engagement and assessment phase of intervention. They also highlight that PIMH clinicians focus on roles and boundaries occurring within the immediate and extended family unit and support families with the transition to family expansion phase. The application of working systemically differed significantly among participants, suggesting that the use of systemic frameworks in the PIMH field requires further exploration.     

Imagining the Good Place: Public Services and Family Strategies in Rural Ecuador

Recent scholarship seeks to lift up alternatives to neoliberalism that build community well‐being and a sense of place. This study follows three families in a rural highland Ecuadorean community and their investments in human capital, family businesses, and migration. It applies a human ecological model to show how complex ideologies around community well‐being, such as buen vivir (living well), are articulated at the macroscale and experienced at the meso‐ and microscales through investments in public services and their impact on rural families. Our collaborative ethnography elevates families’ voices to show how they both experience and envision community well‐being. We incorporate human capabilities and a community capitals framework to show how investments and ideologies flow across scales. We highlight the role of local social capital and regional territorial dynamics that support both economic growth and social inclusion. Our collaborative ethnography illustrates how rural residents imagine the good place (buen lugar), a resilient foundation from which they can build their family strategies. However, we find that lack of political and financial investment truncates active citizenship at the local scale, limiting the ability to achieve the full promise of buen vivir.     

Multi‐Family Therapy with a Reflecting Team: A Preliminary Study on Efficacy among Opiate Addicts in Methadone Maintenance Treatment

In this study, we evaluate the efficacy of multi‐family therapy at reducing the addiction severity and at improving the psychological and family dynamics of opiate addicts receiving methadone treatment at a public treatment center. The study compares multi‐family therapy with a reflecting team (MFT‐RT) and a standard treatment following a methadone maintenance treatment program. The results show that multi‐family therapy with a reflecting team effectively reduces the addiction severity in several of the areas evaluated and noted that this effect is superior to standard treatment. The psychotherapy patients showed improvement in the areas of employment and social support; their drug use diminished and their psychiatric condition improved. At the same time, they needed a lower daily dose of methadone. In addition, the group undergoing standard treatment showed a noteworthy deterioration in their medical condition. Both groups showed a significant increase in their alcohol use. When applied to family treatments, the systemic‐constructivist approach by the reflecting team offers combined techniques that can help improve care for the families of patients with addiction problems.     

Australian Family Therapy: Have We Lived Up To Our Mission Statement?

In 1983 the Fourth Australian Family Therapy Conference had the theme ‘Merging the Streams — Integrating Trends in Family Therapy’. In his keynote address Brian Stagoll outlined concerns regarding the nature of family therapy as it was then developing in Australia. This article revisits some of these themes to see where we have come from, where we are heading and which topics continue to be ignored. Evidence is drawn from articles that stood out for me in the Australian Journal of Family Therapy (later the Australian and New Zealand Journal of Family Therapy) and selected relevant papers from the 1983 conference itself. Finally, I speculate upon possible reasons for the absence of discussion on certain issues, most strikingly: systemic influences upon indigenous Australians, farm families, working with children in families, certain aspects of gender, the systemic implications of addiction; and environmental impacts on families now and for the future. The danger for family therapy is becoming stuck in a closed system that ignores the wider system.     

“It's Really Not Easy to Get Help”: Services to Drought-Affected Families

Abstract

The present paper details the results of research conducted with drought-affected farm families in New South Wales (NSW), Australia. The study reveals the significant health and welfare stresses experienced by families and the lack of access to services and support. The research was conducted in three sites in rural and remote areas of NSW in 2003. Farm family members, service providers, and other community key informants were interviewed. The paper outlines ways that the social work profession can respond to significant natural disasters.