Benefits to Children Who Participate in Family Therapy with their Substance‐Using Mother

It is rare that family members other than the identified patient are followed over time in studies of therapy effectiveness. Family therapy is believed to be effective because it targets processes within the system that maintain symptoms. If these processes are changed, then all family members can benefit. Using a sample of 183 mother–child dyads from a study comparing family therapy for adult substance use versus an attention control, change in child's substance use (tobacco, alcohol, and marijuana) was estimated. Children who participated in family therapy with their mothers showed greater decreases in alcohol and tobacco use and were less likely to begin using compared to children whose mothers participated in the attention control condition.     

Family Therapy and Lithium Deficiency*

Lithium carbonate's usefulness in relieving the more dramatic symptoms of bipolar-affective disorder can obscure the family systems components of this illness. A compromised form of family therapy results which may stabilize the marriage but cause troubles for the larger family system. This paper offers a partial modus operandi for keeping family therapy systems oriented and avoiding the infantilization of the identified patient which occurs when the importance of purely medical treatment is overplayed.     

The Effects of a Family Systems Intervention on Co‐Occurring Internalizing and Externalizing Behaviors of Children with Substance Abusing Mothers: A Latent Transition Analysis

Children of substance abusing parents are at heightened risk to develop problem behaviors, yet little is known about the co‐occurring patterns of internalizing and externalizing behaviors among this population. With 183 children (M age = 11.54 years, SD = 2.55, range 8–16) whose mothers were diagnosed with a substance use disorder, the current study identified subgroups/classes of children that were clinically distinct in their co‐occurring patterns of internalizing and externalizing behaviors, and examined how children in different clinical subgroups responded to a family systems intervention. Latent class analyses identified four classes of internalizing and externalizing behaviors: internalizing only, externalizing only, comorbid, and normative. Latent transition analyses showed that participation in family systems therapy resulted in an increased likelihood of transitioning from the externalizing class at baseline to the normative class at 18 months post‐baseline, and from the comorbid class at baseline to the internalizing class at 18 months post‐baseline as well. The findings support the effectiveness of family systems therapy in interrupting the stability of children's problem behaviors and improving children's behavioral outcomes.     

The Theory Behind the Traps — Considerations for the Practice of Family Therapy in a Multi-frame Work Team*

Family systems theory as an approach to problem generation and change is practiced in many settings where other theoretical stances are also held. The issue of successful team work within a clinic where other therapists work from psychoanalytic and behavioural models is addressed. Structural, strategic and systemic approaches are compared with the psychoanalytic and behavioural. Particular attention is paid to apparent similarities between psychoanalytic and systemic family therapy theory. It is concluded that basic differences exist which make successful merging of the two views impossible. Practical examples of difficulties and attempted solutions are offered.     

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.     

Compelling Family Processes

This article introduces the idea of family process research and asserts that the study of family processes is an indispensable component of any effort to conceptualize and measure family life. Within this article the family process approach is defined through the use of several domains that categorize core constructs. Further, several key assumptions are identified that form the foundation this family process approach. A related objective of this article advances the notion that family process–oriented research has grown increasingly sophisticated over the years, often in ways that have helped to shape and define the discipline of family science. This article instructs readers about using a family process approach, especially within the context of employing a large national data set such as the NLSY97.     

Psychotherapy dropouts: differences by modality, license, and DSM-IV diagnosis

Dropouts are frequent in mental health care. Several client factors have been identified as dropout predictors, including ethnic minority status, race, low SES, and more severe symptoms. Research on therapist and process variables is less common, and findings are inconsistent. This study used administrative data for 434,317 patients from CIGNA Behavioral Health (CIGNA) to examine dropout rates by profession of provider, therapy modality, and DSM-IV diagnosis. Results indicate that among the providers, MFTs have the lowest dropout rates in the CIGNA network. Of the therapy modalities, individual therapy is associated with lower dropout rates than family therapy. Mood and anxiety disorders have lower dropout rates than other diagnosis categories, while schizophrenia, psychotic, and substance use disorders have the highest dropout rates.     

Dsm-iii-R and the family therapist: ethical considerations

DSM-III-R has gained popularity in many segments of the mental health field. Family therapists have generally not found its approach to assessing problems to be helpful in the planning of therapy, yet, are often forced to use it due to the requirements of third-party payers. This raises several ethical and practical concerns, e.g., the incompatibility of orientations between DSM-III-R and family therapy, the stigma associated with diagnosing, being asked to misrepresent diagnoses to third-party payers, and the competency of some family therapists to make DSM-III-R diagnoses. Short- and long-term strategies to deal with these ethical dilemmas are also presented.     

Navigating post-trauma realities in family systems: Applying social constructivism and systems theory to youth and family trauma

Trauma affecting youth and families takes a variety of forms, from random one-time events such as accidents and natural disasters to chronic and highly personal trauma from child abuse or intimate partner violence. Though trauma has received increasing attention in theory and intervention research over the last several decades, the prevailing theories and treatments have limitations due to a linear perspective focused on the trauma problems of the individual. This is particularly concerning given the high dropout rates for trauma-focused treatments and the complexities of intergenerational trauma that cannot be adequately conceptualised at the level of the individual. To inform and improve family-based treatment of youth and family trauma, this paper proposes a theoretical framework informed by social constructivism and systems theory. Social constructivism upholds that reality is constructed through communication as an adaptive process for survival, with multiple potential realities possible. Systems theory promotes a non-linear view of causality within a system, such that the structure and properties of a system determine outcomes more than the inputs that go into the system. Together, the principles of these meta-theories contradict the orthodox focus on traumatic events causing trauma symptoms, and instead imply that family-based treatment should focus on helping families shift assumptions and dynamics that sustain the problem in the present. The joint application of a social constructivism–systems theory framework for trauma introduces several new principles to inform family-based treatment: (a) post-trauma realities; (b) mutual survival; (c) power–justice balance; and (d) adaptive reorganisation. The implications of these principles for youth and family trauma treatment will be discussed. Future intervention development and research should consider these principles in the ongoing effort to improve family therapy for youth and family trauma.     

Studying Individual and Family Development: Linking Theory and Research

The predominant theoretical orientation of the majority of scientists studying human behavioral development and family functioning is derived from systems models. These theories are dynamic in their conceptualization and emphasize process and context. To a large extent, the analytic strategies we employ are not consistent with our theoretical assumptions. Analytic methods that focus on moderating and mediating processes rather than main effects, on within‐group variability and the sources of that variability, and on the identification of interrelated patterns of change in individuals, families, and environments are needed for our research results to mirror the complexity of our theories.     

ORGANIZATION OF EXPERIENCE AMONG FAMILY MEMBERS IN THE IMMEDIATE PRESENT: A GESTALT/SYSTEMS INTEGRATION

How processes of family functioning are conceptualized influences a therapist's understanding and use of immediate experiential phenomena in the therapy setting. This article outlines two basic formulations that generate different conceptual perspectives of immediate phenomena. One recognizes that the family system has a time-enduring stability, while the second postulates that the family system has an immediate and temporary organization. The latter position is developed as an appropriate and useful application of systems thinking. Integrating systems thinking and Gestalt Therapy provides a framework for this application, one that recognizes individual experience as organized and as embedded in a mutual causal, self-maintaining system of the whole. The nature of such wholes, how they maintain their stability, their potential for change, and implications for therapy are described.     

THE FAMILY CRISIS INTERVENTION LITERATURE: WHAT IS MEANT BY “FAMILY”?*

Family crisis intervention is a rapidly growing area of clinical care in family therapy which lacks clear conceptualization, especially with respect to how “family” fits into crisis intervention theory. This paper integrates recent concepts from the family therapy literature into three views: family as background, family as context, and family as a unit. The family crisis intervention literature (56 publications) is reviewed and categorized according to these three views. Clarity in how “family” is viewed and consistency between theory and practice are examined. Recommendations for improving the conceptualization of “family” in family crisis intervention theory and practice are made.     

Considering justice: an exploratory study of family therapy with adolescents

Feminist approaches to therapy with adolescents emphasize an empowering focus on the strengths of adolescents while simultaneously insisting that therapists become aware of their own biases toward today's adolescents. However, a review of the family therapy literature finds little mention of feminist approaches for addressing injustices (e.g., family scapegoating, negative societal views of adolescents, and gender oppression) that arise in family therapy with adolescents. Therefore, this study explores clinical approaches and resources suggested by a surveyed group of self-identified feminist family therapists. In addition, we also recommend several approaches and resources that will aid family therapists in creating a more just climate for family therapy with youth.     

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.     

The limbic model of systemic trauma

Psychological symptoms, i.e. compassion fatigue, burnout and vicarious trauma, have been found to be associated with working with clients who are experiencing trauma. The literature on the brain and neuropsychological processes that accompany trauma indicate that physiological changes also arise in the person. This paper argues that psychological and physiological changes can be transferred from the traumatised clients to those working with the traumatised person. In an organisation where there is insufficient support and high case loads this can result in physiological changes occurring in the worker that lead to three main flawed decision-making processes. Clinical practice that supports reflective supervision can help workers to process their client's trauma and prevent a traumatised professional system arising.     

PARADOX AND ORTHODOX: FOLIE À DEUX?*

In the recent family therapy literature, therapists have been cautioned to use paradoxical looking techniques as either a last resort, or else not to use such actions at all with specific problems. The paper argues that these stances arise from a rigid adherence to a set of orthodox views from which these actions appear contradictory. Similar to family systems, when such orthodox therapy systems do not question or alter their own premises in the face of contradiction, they tend to attribute either badness or madness to the action and either try to exorcise the badness, or banish the action. The literature which either prescribes “paradox as a last resort,” or which proscribes it altogether is reviewed and critiqued. Walter Buckley's process/adaptive system model is recommended as a positive alternative view from which such previously pardoxical actions may often be elected as a logical and effective first choice.     

Why more ‘quality time’ is not on the top of children's lists: the ‘qualities of time’ for children1

For many years the everyday reality of working parents and their children has been captured in notions of ‘quality time’ versus ‘quantity time’. On the one hand it is suggested that what families need is ‘more time’ for parents to spend together with their children and less time working. On the other hand this has been countered with arguments saying that attention has to be paid to how parents spend their time together with their children. As a result quality time is often presented through idealised images of ‘happy families’. Quality time is seen as parents engaging with their children in particular activities or outdoor excursions that create and maintain family enjoyment, care and togetherness. However, such debates are based on assumptions of what would be ‘good’ for today's children and neglect the perspective of children themselves. This paper draws on field research carried out with 10–11‐year‐old children on their understandings and use of time in an urban and a rural setting in the north of England. The paper points to five ‘qualities of time’ identified by children. These qualities suggest that children's views of time spent with their families cannot be seen as separate from the time they spend with friends, at school and on their own. The paper argues that the quality/quantity time conundrum needs replacing by fuller and more representative accounts of the varied aspects of time that matter for children. These need to be situated in the processes through which family, school and work life take place on a daily basis and in relation to children's life course. Copyright © 2002 John Wiley & Sons, Ltd.     

The feminist/emotionally focused therapy practice model: an integrated approach for couple therapy

Emotionally focused therapy (EFT) is a well-developed, empirically tested practice model for couple therapy that integrates systems, experiential, and attachment theories. Feminist family therapy theory has provided a critique of biased assumptions about gender at play in traditional family therapy practice and the historical absence of discussions of power in family therapy theory. This article presents an integrated feminist/EFT practice model for use in couple therapy, using a case from practice to illustrate key concepts. Broadly, the integrated model addresses gender roles and individual emotional experience using a systemic framework for understanding couple interaction. The model provides practitioners with a sophisticated, comprehensive, and relevant practice approach for working with the issues and challenges emerging for contemporary heterosexual couples.