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.     

Making sense of the parenting ‘soft/hard split’

This paper explores the common parenting style tension around nurture versus limit-setting often evident when working with families with a symptomatic child. Firstly it will delve into the parenting ‘soft/hard split’ with an overview of the literature on parenting styles. Next, it summarises the appearance of this phenomenon in the family therapy literature during its formative days, noting how Bowen, Minuchin, Haley, MRI (Bateson), and the Milan associates respond to this parent presentation in their approaches. Next, the paper outlines recent iterations of these family therapy interventions. An expanded discussion follows on Bowen theory's understanding of the parenting tension triangle. The article then outlines elements of the author's qualitative research study of parents' experience of adolescents' mental health treatment where the ‘soft/hard split’ emerged as a repeating theme. Finally, a clinical intervention based on Bowen theory, the Parent Hope Project, is outlined for how it addresses the parenting ‘soft/hard split.’ The goal is to contribute to understanding this phenomenon and its implications for clinical practice.     

Why a universal population‐level approach to the prevention of child abuse is essential

This paper argues for the importance of adopting a population‐level approach to promote more effective parenting and to reduce the risk of child maltreatment. Family‐based interventions based on social learning principles have been shown to make a useful contribution in the treatment of child maltreatment. However, typically such programmes have been used to treat parents who have already become involved in the child protection system. We argue that the creation of community‐wide support structures to support positive parenting is needed to reduce the prevalence of child maltreatment. Such an approach requires several criteria to be met. These include having knowledge about the prevalence rates for the targeted child outcomes sought, knowledge about the prevalence of various parenting and family risk factors, evidence that changing family risk factors reduces the prevalence of targeted problems, having culturally appropriate, cost‐effective, evidence‐based interventions available and making these widely accessible. Copyright © 2003 John Wiley & Sons, Ltd.     

Affective disorders

Unipolar depressive disorders are especially common among persons presenting with marital and family problems, rendering their impact on the treatment of marital and family problems of interest to every marriage and family therapist. The current paper describes empirically based decision making rules for determining who may benefit most from marital and family therapy interventions. Using well-controlled outcome research, it is concluded that both marital therapy and parenting interventions can play an important role in the treatment of many but not all depressed persons. Predictors of treatment response are discussed and recent epidemiological research is used to examine the size of the population that may respond especially well to marital therapy. Future directions for research are suggested and public policy implications are discussed.     

Achieving Competent Family Practice with Same-Sex Parents

Abstract

Due to the increasing recognition of same-sex marriage in different jurisdictions and growing numbers of parents raising children in the context of a same-sex relationship, it is becoming ever more important for family therapists to attain clinical competence in working with families headed by same-sex parents. This paper takes as its premise that good intentions and general acceptance of diversity are not sufficient in working with this population of families. Rather, clinical competence rests on experience working with lesbian and gay clients and knowledge of the impact of heterosexism on parenting in the context of same-sex relationships. Equally critical to competent family therapy practice is a theoretical framework that pulls together complementary concepts from different bodies of theory to analyze family structures and functions in the social context of heterosexism. To this end, this paper reviews family systems theory, structural social work, ecological systems theory and queer theory with an eye to culling complementary constructs relevant to working with same-sex parents. Specific aspects of family functioning such as maintenance of boundaries around and within families and role differentiation between parents are then explored using this theoretical framework. Finally, implications for the clinician working with families led by same-sex parents are reviewed.     

Walk-in Together: A pilot study of a walk-in online family therapy intervention

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk-in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof-of-concept study investigating the acceptability and short-term effectiveness of an online walk-in family therapy service, Walk-in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk-in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre-session, post-session, and at 6 weeks follow-up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi-structured interview data. Post-session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post-session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well-received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk-in delivery model. This proof-of-concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk-in, telehealth model to meet the rising demand for therapeutic support for families in distress.     

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?

     

Lesbian-Headed Stepfamilies

Abstract

This paper examines the lesbian stepfamily. It considers the family structure, parenting roles, gender composition of the couple, the distribution of family labor, and the impact of familial and community support. It discusses some of the challenges facing lesbian-headed stepfamilies, their strengths, capacities and competencies, and the strategies these families use for coping with stigma and intolerance. The paper concludes with implications for policy and practice with lesbian stepfamilies.     

Complex inequality: A contextual parenting framework for Latino infants

Latino infants and toddlers are rapidly becoming the most represented ethnic group within the overall U.S. child population, underscoring the importance of a comprehensive conceptual framework informed by the factors that affect their well-being, including their lived environments. Research that explores parenting among Latino families is limited or tends to portray a homogenized Latino experience, without accounting for within-group differences. This paper presents a contextual parenting framework for Latino infants that incorporates a more nuanced understanding of culture as well as its complex and reciprocal relationship with environment. It highlights the multi-level, multisystemic, contexts affecting these families on the present day. This framework hypothesizes that cultural beliefs around family and child rearing, as well as the environment — constituted of physical environment and social opportunities — influence parenting. Further, institutional and structural inequalities can significantly affect the environmental conditions that Latino families experience and are therefore examined in the model. The way parenting behaviors are understood and interpreted by researchers and practitioners has serious consequences for parents engaged in the child welfare system. This paper explores how vulnerable Latino families with young children engaged in this complicated system experience the factors described by the parenting framework.     

Family Mediation: A Guide for Family Therapists

Family therapists often see separating parents who need to agree on co‐parenting arrangements. This article provides a guide to current research and practice in family mediation. The limited available research suggests mediation is a useful approach for some separated parents and their children, but often is not successful with highly conflicted parents, parents with mental health problems, parents struggling to accept the separation from their partner, or parents with unrealistic co‐parenting expectations. We analyse ways in which mediation might be enhanced, and discuss the potential roles of family therapists to support separating families to negotiate positive co‐parenting.     

Sometimes Words Just Ain't Enough – Enhancing the Contribution of Children in Therapy through Creative Expression

The meaningful inclusion of children in family therapy is an ideal that therapists readily align with and yet struggle to implement effectively. Within a practice that relies heavily on verbal expression, young children provide a unique challenge for therapists, who require developmentally appropriate opportunities for the child to express, document, and share his or her experience in all its richness and colour. In this paper the author utilises art therapy to support greater inclusion of children in family therapy by capitalising on their creative talents and facilitating the child's visual story within the family dialogue. This can assist in the formulation and treatment of systemic issues.     

Is There a Place for Biopsychosocial Formulation in a Systemic Practice?

There is a long history of literature concerning integrative practice and how a systemic practice can fit with other models of therapy Much of this literature has focused on establishing a space for systemic therapy within the dominant medical paradigm, and exploring how the medical model can be enhanced by systemic ideas. The outcome has been better practice, especially in child and adolescent mental health. Interestingly, however, there has been less discussion of the converse: the family therapy literature has rarely considered whether or not systemic practice itself can be enhanced by ideas from the dominant medical model. This article proposes that a biopsychosocial formulation can enhance systemic practice by: (I) holding clinicians accountable for their thinking; (2) facilitating a rigour and attention to detail that may prove useful when therapy falters; (3) opening up other possibilities for intervention; and (4) providing a way to engage with the dominant medical paradigm and support clients in negotiating their way through this system. Potential problems nevertheless arise when integrating a biopsychosocial formulation into a systemic framework. This article identifies these problems and presents ideas for how they can be managed in practice.     

Psychotherapy with Gay and Lesbian Families: Opportunities for Cultural Inclusion and Clinical Challenge

Many gay men and lesbians are making decisions to have children, either through pregnancy, adoption, or by blending their families. These families may seek psychotherapy for help with dynamic issues which confront all families from time to time. This article presents a context for clinicians to deepen their understanding of cultural and clinical aspects of gay and lesbian parenting. This context will be discussed through the application of concepts frm self psychology within the framework of narrative theory in order to validate gay and lesbian family experiences by through the creation and understanding of their family narratives.     

The Incarcerated Parent: Examining Mother-Child Conflict at the Margins through a Bio-Ecological Lens

ABSTRACT

This study examined conflict, parenting communication style, and attitudes regarding the parent-child relationship for a marginalized special population: incarcerated mothers and their children. Bronfenbrenner’s bio-ecological perspective served as a guiding framework, based on its ability to consider family interactions across ecological contexts, both proximal and distal to the developing child’s home setting. Fifty incarcerated mothers in the central U.S. provided in-depth interviews and individual self-report surveys. Findings indicate that incarcerated mothers most frequently used an authoritative parenting communication style in conflict situations that ended positively, and authoritarian style in conflict that ended negatively. Authoritative parenting was associated with incarcerated mothers’ reports of greater satisfaction with parenting. Study findings suggest that parenting communication style can help support efforts to reduce recidivism. Contextualizing these findings within Bronfenbrenner’s model, the present study affirms the role of proximal as well as distal factors governing relational communication between incarcerated mothers and their children.     

Integrating a Trauma Lens into a Family Therapy Framework: Ten Principles for Family Therapists

This paper aims to show how a trauma lens can be incorporated into existing family therapy practices, changing how therapists perceive presenting problems and therefore the issues and sites of intervention. After reviewing the family therapy literature concerning trauma and defining different types of trauma, the paper discusses how traumatic memories differ from ordinary memories. Ten principles for practice are described to guide therapists in integrating the trauma lens into their family therapy practice. Three case studies are used to illustrate these principles.     

Mental Health and HIV Risk Among African American Adolescents

Summary

The family system is integral to adolescent mental health and HIV risk. However, few studies have addressed family variables and adolescent outcomes among African American families. This study tested a longitudinal model of parenting, adolescent mental health, and adolescent HIV risk, among a community sample of low-income, urban African American families from the Collaborative HIV prevention and AdolescentMental Health Project (CHAMP). Consistent with general adolescent population data, we expected less parental monitoring, greater psychological control and less positive parenting to increase risk for adolescent depression and conduct problems. We hypothesized that these variables would in turn increase rates of HIV risk. We followed one hundred and thirty-four African American youth and theirmaternal caregivers as part of the CHAMP project. Study variables included: positive parenting, parental monitoring, psychological control, adolescent distress, conduct problems, and recent HIV risk. We examined the relationship among these variables via longitudinal path analysis. Age was strongly associated with increased adolescent HIV risk. Contrary to hypotheses, more parental psychological control was marginally associated with less HIV risk, while positive parenting was marginally associated with greater HIV risk. Adolescent depression was associated with more conduct problems, but unrelated to HIV risk. Thus, parenting practices generally considered negative might actually be protective among some lower SES African American families. This underscores the importance of extending studies of family context and adolescent risk behaviors to diverse social and ethnic groups. Designing prevention programs for diverse groups will require articulating culturally specific effects for different parenting practice.     

Family Socialization and Chinese Youth Children’s Development: Does psychosocial Maturity Matter?

The present study examined the effects of family socialization in the form of family processes and parenting practices on youth children’s internalizing and externalizing problems concomitantly in a sample of Chinese parent–child dyads. The results generally support that (1) family socialization is crucially influential on the youth outcomes, in which parenting is a function of family processes; (2) youth’s psychosocial maturity significantly mediates the effects of family socialization on their outcomes; (3) effects of family processes are observed more pronounced as compared with parenting practices; and (4) more complicatedly varying effects of family processes and parenting practices on the youth outcomes appear when setting free the mediations of psychosocial maturity across different structural models. Service implications of the findings and future research directions are briefly discussed.     

The warrants of parenting: emotionality and reflexivity in economically disadvantaged families

Despite the popularity of the education model in parenting work, parents' capacity for reflexive inner dialogue is becoming a newly sought virtue for handling parent–child difficulties. Based on a study of parenting experiences among Chinese parents in Hong Kong, this paper argues for a departure from the education model to incorporate reflexive parenting in the parental role. Reflexive parenting promises idiosyncratic solutions for the dynamic problems that parenting in contemporary society must address. Warrants of reflexive parenting are proposed as a framework with which helping professionals can adjust their strategies to help parents better handle the challenge of contemporary parenting.