MARITAL PARADIGMS: COMPATIBILITY, TREATMENT, AND OUTCOME IN MARITAL THERAPY

Marital paradigms comprise the guiding images that serve as reference models for a couple's relationship. Such individualized images can be understood as variations on a small set of basic themes. An understanding of clients' marital paradigms can help foeus treatment on the most appropriategoals usingapproaches and techniques that are most effective for a particular couple. An unselected group of 103 couples seen in systems-oriented marital therapy were reviewed, to identify outcome and treatment issues as a function of marital paradigm. Based on outcome criteria that took marital paradigm into account, 92% of 38 cases where both partners identified with the same basic paradigm were judged to be treatment successes, while only 60% of the cases where the partners identified with different paradigms could be considered successful outcomes. Clinical approaches based on experience with marital therapy conducted within a paradigmatic framework are presented.     

BEYOND LINEARITY AND CIRCULARITY: DECONSTRUCTING SOCIAL SYSTEMS THEORY

This article attempts to clarify the concepts of linearity and circularity as applied to marital and family therapy, especially in light of the credible challenge to the concept of circular causality by feminist theorists. Distinct and theoretically legitimate meanings of linearity are defined-proportionality, unilaterality, and temporality. Circularity is redefined into two distinct meanings-recursivity and holicity. The two meanings of circularity are then subdivided in accord with Bateson's guiding distinction between "substance" and "form" (i.e., physical force and mental information). This reworking of systemic concepts is described as important as a means to justify reformulation of theory in the field. The article concludes with a call for continued deconstruction of social systems concepts as a means toward refinement of the systemic paradigm or as a means toward development of a new paradigm, which, in either case, should acknowledge individual and relational realities.     

BONDS OR BARGAINS: RELATIONSHIP PARADIGMS AND THEIR SIGNIFICANCE FOR MARITAL THERAPY

Contrasting conceptual paradigms describing the nature of intimate relationships are discussed. In particular, relationships may be viewed in terms of a rational bargain or as an emotional bond. The implications of each paradigm for the process of marital therapy are delineated, and the role of bonding and attachment in adult intimacy is considered. Some general conclusions are then drawn as to future directions for the marital therapy field.     

THE STRUCTURE OF FAMILY PARADIGMS: AN ANALYTICAL MODEL OF FAMILY VARIATION

The theory of family paradigms provides an integrative framework for under-standing and systematizing the diverse ways that families organize and make sense of family life. Using formal methods of analysis based on logical and geometrical arguments, the priecise implications of models of family types can be investigated and compared. The paradigmatic framework can thus be refined and extended to form a more rigorous theoretical grounding for family typologies is explored and a miltidimensional model is derived the geometry of which is equivalent to, but more succinctly captures, the underlying structure of uariation in family para-digms. In Part II, the resulting model is interpredtd and explored in terms of implications for family theory, theory construction, and family therapy. Clarifying the basic dimensions of the paradigmatic framework also permits more precise exploration of interrelationships among related models of family types, which can be understood as reduced models derivable from the complete geometry of the paradigmatic framework.     

THE INTEGRATIVE PSYCHOTHERAPY ALLIANCE: FAMILY,COUPLE AND INDIVIDUAL THERAPY SCALES*

The therapeutic alliance concept has been confined primarily to the literature on individual psychotherapy. This paper formally introduces the concept into the family and marital therapy domain and presents various clinical hypotheses about the nature of the alliance and its role in familyand marital therapy. A systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework. The implications of this integrative-alliance concept for family, couple and individual therapy research are examined. Three new system-ically oriented scales to measure the alliance in individual, couple and family therapy are presented along with some preliminary data on their methodological characteristics.     

Beyond Nation-State Paradigms: Globalization,Sociology, and the Challenge of Transnational Studies

Globalization has made it increasingly necessary to break with nation-state centered analysis in macrosociologies. Social structure is becoming transnationalized, and an epistemological shift is required in concurrence with this ontological change. A new interdisciplinary transnational studies should be predicated on a paradigmatic shift in the focus of social inquiry from the nation-state as the basic unit of analysis to the global system as the appropriate unit. Sociology's fundamental contribution to a transnational studies should be the study oftransnational social structure. This article does not establish a new transnational paradigm. Rather, it surveys and critiques nation-state-centrism in extant paradigms, provides a rationale for a new transnational approach, and proposes a research curriculum of a new transnational studies that may contribute to paradigmatic reconceptualization.     

THE MARGINALIZATION OF FAMILY THERAPY: A HISTORICAL AND CONTINUING PROBLEM

Family therapy, and marital and family problems, are mariginalized in the larger fields of mental and physical health care, which is a misfortune both for family therapy and for other mental health professions. The early family therapists, who had multidisciplinary backgrounds, attempted toestablish a new, nondisciplinary paradigm and also tried to expand the perspectives of the more traditional mental health disciplines. More recently, family therapists have exerted greater effortsto establish marriage and family therapy as a differentiated, autonomous profession. These alternatives each involve dilemmas for the family therapy field. The positive side of becoming a distinctive profession is greater internal strength and clear professional identy; the downside is the threat of increased marginalization in rlation to the other professions, a tendency toward intellectual isolation, and hence restricted opportunities for invigorating new challenges. Family therapy now needs to develop new modes of interchange, collaboration, and selective integration with otherhealth care professions. Such interchange will be beneficial both to family therapy and to other professions.     

Anxiety Disorders and Family Therapy

The role of family therapy in anxiety disorders is controversial. Empirical data exist only in relation to agoraphobia and obsessive compulsive disorders. Experienced clinicians, generally working with complex cases, regard marital and family conflict as central to many cases, which require a family approach for optimal therapy. In contrast, research workers generally regard marital and family factors as irrelevant to treatment. This is because complex cases are usually excluded from empirical research. This leaves mainly uncomplicated cases without significant family conflicts, for which a family approach is rarely necessary. Techniques for treating anxiety disorders in a marital/family setting are outlined.     

THE EFFICACY OF MARITAL AND FAMILY THERAPY: AN EMPIRICAL OVERVIEW, CONCLUSIONS, AND RECOMMENDATIONS

Based primarily on the contributions to this Special Issue of JMFT, this article provides an overview of the empirical research on the efficacy of marital and family therapy for the following disorders and problems: schizophrenia; affective (mood) disorders; slected externalizing, internalizing, and pervasive developmental disorders of childhood; adolescent conduct disorder; marital distress and the prevention of divorce; alcoholism; adult and adolescent drug abuse; and various chronic adult, adolescent, and childhood physical disorders. Convincing scientific evidence supports the efficacy of broadly defined marital and family therapy for the treatment of many disorders, as well as its superiority to standard and individual treatments for certain disorders and populations. We conclude with recommendations for future research as well as for collaborative initiatives between marital/family therapists and other professionals working in the marriage and family field.     

The influence of marital and family therapy on health care utilization in a health-maintenance organization

Research has shown that people reduce their use of health care after individual psychotherapy. However, little research has been done to learn if marital and family therapy has a similar effect. Subjects (n = 292) from a health-maintenance organization were randomly selected according to the type of therapy they had received. Subjects' medical records were examined for 6 months before, during, and after therapy. Those who received marital and family therapy significantly reduced their use of health care services by 21.5%. These results show an "offset effect" for marriage and family therapy.     

The Clinical Uses of Video Therapy in the Treatment of Childhood Sexual Trauma Survivors

The power of visual images, combined with the increased availability of video taping equipment, has dramatically expanded the use of recorded images in psychotherapy over the past three decades. However, it appears that earlier video feedback techniques may not have fully capitalized on this modality's potential for catalyzing therapeutic change. Further, we have found scant literature on the use of video therapy in the treatment of adult survivors of sexual trauma. Drawing conceptually from a trauma model, as well as from cognitive behavioral and systemic/cybernetic frameworks, this article describes the therapeutic use of video therapy in the treatment of childhood sexual abuse. In video therapy, the patient is directed to independently view video recordings of therapy sessions to help correct cognitive and affective distortions resulting from trauma. How these distortions develop within the context of an incest "family trance" and how they are connected with processes of conditioning and programming are discussed. Further, the use of video therapy for marital therapy, perpetrator confrontations, and addressing suicidal impulses is described. The need for further empirical research is highlighted.     

Reintegrating Theories,Methods, and Historical Analysis in Teaching Sociology

We discuss ways of bringing theory and methods into conversation with each other within courses and across the sociology curriculum. Theory is often taught completely separately from research methods, which in turn are simplistically divided into quantitative and qualitative. To counter this fragmented approach to the discipline we discuss two major paradigms, a social-forces paradigm often linked to quantitative research and an interpretive paradigm often linked to qualitative inquiry. But at a deeper level both paradigms require an understanding of historical context. The relationship between these two paradigms and more familiar categories of theory such as "functionalism" and "conflict theories" is not straightforward. We conclude the discussion by describing classroom-tested strategies that help students explore the complexity of the linkages between theories and empirical inquiry.     

BOOK REVIEWS

Book reviewed in this article:
Rugel, R. P. (1977). Husband-ocused marital therapy: An approach to dealing with marital distress .
Selekman, Mathew D. (1997). Solution-focused therapy with children: Harnessing family strengths for systemic Change .
Taibbi, R. (1996). Doing amily therapy: Crat and creativity in clinical practice .
Bagarozzi, D. A. (1996). The couple and family in managed care: Assessment, evaluation, and treatment .
Friedman, S. (Ed.). (1995). The reflecting team in action: Collaborative practice in amily therapy .     

AGAINST THE GRAIN: DECENTERING FAMILY THERAPY

This paper is an interpretive polemic. It has two aims: (a) to clarify the concept of "system" as it is employed in family therapy, and, by doing so, to undermine and call into question the practice that follows from, or is contained within, a systemic perspective,¹ (b) it will offer several suggestions towards the development of an alternative perspective which preserves the idea of system in a social network/diachronic framework. With respect to the first aim, an argument will be made that there are severe and insurmountable problems in attempting to maintain a systemic perspective, that the methodology of analysis is fatally flawed, and that the results of analysis imprisons the therapist in a framework, which though extremely powerful interpersonally, must be rejected as overly authoritarian and overly restrictive in the range of perceptions of social situations allowed. A position will be adopted advocating a move of decentering family therapy to a more peripheral space within a social network perspective. What immediately follows is a redefinition and repunctuation of what can only be considered as a highly problematic paradigm.     

The influence of individual,marital, and family therapy on high utilizers of health care

Research has shown that people reduce their use of health care after individual, marital, and family therapy, which is known as the "offset effect." However, little research has been done to learn if high utilizers of health care reduce health care usage after therapy. Medical records of research participants (n = 65) from a health maintenance organization (HMO) were randomly selected and examined for 6 months before, during, and after therapy. Persons who received individual, marital, or family therapy all reduced their health care use after therapy, with the largest reductions coming from those participants who had some form of conjoint therapy.     

BOOK REVIEWS

Book reviewed in this article:
Boszormenyi-Nagy, I. and Krasner, B. R. Between give and take: A clinical guide to contextual therapy.
Bepko, Claudia with Krestan, JoAnn. The responsibility trap: A blueprint for treating the alcoholic family.
Jacobson, Neil S. and Gurman, Alan S. Clinical handbook of marital therapy.
Wilkins, Robert and Loudon, Penny. (1987). The therapist's thesaurus: A cartoon guide.
Campbell, David and Draper, Rosalind (Eds.). Applications of systemic family therapy: The Milan approach.
Strean, Herbert S. Resolving marital conflicts: A psychodynamic perspective.     

From Conflict Theory to Conflict Methodology: An Emerging Paradigm for Sociology*

A brief paradigmatic history of American sociology is presented. Conflict methodology is defined and exemplified. It is held to be an essential adjunct to a complete conflict paradigm. A conflict paradigm is relevant to sociological analyses in Eastern and Western Countries in view of the proliferation and power and of the large scale organization.     

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.     

Integrative Family Therapy With Childhood Chronic Illness: An Ethics of Practice

A challenge for contemporary family therapists is negotiating differences between modern and postmodern frameworks in the practice context. Modernists espouse a systemic metaphor; use evidence‐based and interventive approaches, including strategic, structural‐ or solution‐focused techniques, and believe in the therapist's knowledge, expertise and power to influence individuals or families to change. On the other hand, postmodernists follow a social constructionist, dialogical or narrative paradigm, which identifies the main ingredient of therapy as language, conversation, understanding and the therapist's ‘not knowing’ stance in eliciting a person's expertise and story Yet many practitioners adopt a middle way between these paradigm polarities, one that is less theory‐driven and more pragmatic, flexible, integrative and practice‐based. This is consistent with evidence‐based practice and research demonstrating common factors across all therapies. The value of preserving systemic thinking in family therapy is recognised while reaching forward to a postmodern social constructionist and dialogical approach. The article describes this integrative stance in family therapy as paramodern based on an ethics of practice. This is illustrated by a detailed case study of integrative family therapy, which addresses anxiety, anger and sleeping issues associated with a chronic childhood illness called Perthe's disease.     

FAMILY ASSESSMENT IN CHILD CUSTODY DISPUTES*

This paper has operationalized family systems theory to explicate the interfacing dynamics between family dissolution and child custody disputes. The authors suggest that clinical assessment and intervention in these matters which focus solely on individual and marital, or child dimensions, fail to recognize the powerful influences of systemic family process. A family assessment model, evolved from clinical work with over 200 court-referred custody cases, is described. The model involves a cross-sex therapy team with each member responsible for a specific family subsystem. The role of each therapist and the functioning of the team is outlined. Specific criteria for determining custody recommendations are identified based on patterns of family process and dissolution.