Live Consultation Without A One-Way Screen†

This article is about a method of teamwork in which both the therapist and the consultant are present in the same room as the family. It distinguishes between the therapeutic team of consultant and therapist and the therapeutic system of consultant, therapist and family. It outlines some particular advantages and disadvantages which are present when working in the same room as the family and emphasises the importance of the careful preparation and maintenance of the therapeutic team if its creative potential for the family is to be fulfilled.     

Therapeutic Alliance; A View Constructed by a Family Therapy Team

Therapeutic Alliance is a construct which may have value for a family therapy team and influence its day to day practice. This paper discusses whether family therapeutic alliance can be observed, described and measured, and gives an account of the development of the Family Therapeutic Alliance Scale (FTAS) by a brief strategic family therapy team. Our focus is on the use of statistical technique as a means of clarifying the team's construct of therapeutic alliance, informing the team process without being the final arbiter in development of the scale. The second stage outlines the investigation of the usefulness of the construct with a wider group of family therapists. In individual psychotherapies measures of therapeutic alliance have been shown to predict outcome. Our early work suggests this is also true for family therapies and the FTAS may be a predictor for outcome in family work.     

A "READER'S THEATER" INTERVENTION TO MANAGING GRIEF: POSTTHERAPY REFLECTIONS BY A FAMILY AND CLINICAL TEAM

The sudden and accidental death of a child can be one of the most devastating events in the life of a family. This paper describes one couple's reflections of their grief and mourning following the death of their adolescent son as well as the clinical team's reflections of therapy. The uniqueness of this paper is that it offers a "reader's theater" intervention that enabled further change to occur. The clinical team used a belief model, emphasizing that altering constraining beliefs is at the heart of healing from such tragedies as sudden death (Wright, Watson, & Bell, 1996). This approach is operationalized through therapeutic conversations between family members, clinician, and clinical team. Interventions such as reflecting teams, therapeutic letters, and "homework tasks" were used to modify or challenge constraining beliefs of both the family members and the clinical team members. However, the intent to co-author a paper with this couple provided the serendipity intervention of a "reader's theater" that further served to identify, affirm, and solidify facilitating beliefs.     

Supervision in Family Therapy: A Developmental Perspective

A group model of supervision of family therapy was implemented by a team of three supervisors with doctoral students in counseling psychology. It was believed that such an approach would provide students with more opportunity to work as therapists with families and to observe a greater variety of families, therapists, and therapeutic styles than in other models. Interchange in supervisory sessions focused on co-therapy issues, observation skills, family dynamics, differing therapeutic techniques and approaches, and planning and goal setting in therapy. This experience contributed to the professional and personal growth and development of students.     

A REFLECTING TEAM APPROACH TO FAMILY THERAPY: A DELPHI STUDY

Due to different conceptualizations and unclear theoretical guidelines, a reflecting team approach to family therapy has lacked conceptual and practical clarity. The purpose of this exploratory study was to outline the theory and practice of a reflecting team approach to family therapy. A Delphi technique was employed for panelists to consider the theoretical assumptions, techniques, how change occurs, major goals, when to use, and contraindications of a reflecting team approach. Analysis of data revealed where consensus was reached and a profile was formed to aid in further clarifying this approach.     

The Psychiatrist's Role in Implementing an Open Dialogue Model of Care

The Open Dialogue approach is a family‐oriented early intervention model for mental health problems developed in the health district of Western Lapland, Finland. Since the 1990s the psychiatric service system in Western Lapland Health Care District has been organised according to Open Dialogue principles and applied to the treatment of any mental health concerns. The Open Dialogue approach considers the client and their family as active participants rather than as objects of treatment in its planning and implementation with a psychotherapeutic focus. In daily work, the responsibility for the treatment process is shared with the case‐specific team. The model of care requires a dialogical orientation from all staff members, psychiatrists included, to interact with the team and the client's network. In this article I describe the role of the psychiatrist in implementing an Open Dialogue model of care in psychiatric services leaning on my experiences of clinical work in the adolescent psychiatric team in Western Lapland.     

The influence of the Milan approach—Part 2. The legacy of Boscolo and Cecchin and their Paduan connection: A conversation with Andrea Mosconi

The Milan approach, pioneered by Selvini-Palazzoli, Boscolo, Cecchin, and Prata, has significantly contributed to the field of psychotherapy, particularly in the realm of systemic and family psychotherapy. While rooted in systemic principles and concepts, over time the original Milan group demonstrated differences in their clinical orientations and practices which led to their regrouping into two teams. The paper explores the divergences in their views and directions on family dynamics and the role of symptoms within the system. It delves into the influence of Boscolo and Cecchin, two of the ‘Milan Four’ on the Centro Padovano di Terapia della Famiglia. Drawing from a conversation with Andrea Mosconi, a mentee and collaborator of Boscolo and Cecchin, the paper examines the reconfiguration of the original ‘Milan Four’ team and its impact on their clinical approach. Key Milan principles and concepts such as hypothesising, circularity, and neutrality are examined with particular emphasis on the work of Boscolo and Cecchin's systemic work. These principles, intertwined and interconnected, provide a fertile ground for the construction of multiple hypotheses and circular questioning. The paper also highlights the concept of reflexivity, which originates from Bateson's work and plays a crucial role in family relations and communication while explaining the birthplace of paradox taking place when two levels of meaning are ‘confused.’ The Milan approach continues to be highly regarded, as its early concepts and ideas have evolved and left a lasting impact on the field of family therapy. By reflecting on the distinct contributions of Boscolo and Cecchin, and using examples, Mosconi offers valuable insights into the rich legacy and ongoing relevance of the Milan approach to contemporary therapeutic practice.     

Surviving the swamp: Using cognitive behavioural therapy in a social work setting

This paper explores the attempts of an adolescent support team working for South Gloucestershire Social Services, to integrate Cognitive Behavioural Therapy (CBT) into its practice. We explain how we, as a team, undertook a year-long course of study in CBT and discuss the advantages and difficulties we encountered. Then, beginning with a case study, we draw out the limitations of trying to use CBT in a social work setting. We focus specifically on how the complications of wider family systems will often compromise individual therapeutic work with young people and conclude that a more pragmatic approach to CBT is required in social work, rather than attempts to replicate work carried out in the clinical setting.     

Non-Equilibrium, Chance and Change in Family Therapy

The model of the systemic approach that we commonly use in family therapy is mainly an homeostatic model insisting essentially on negative feedback and allowing little room for amplification phenomena and for abrupt changes that may occur. Our approach, called “systemic,” is related principally to models applying in cases of processes occurring at thermodynamic equilibrium or at stationary states close to equilibrium. In those instances, stability is maintained no matter what external or internal perturbations are exerted on the system. But our practice shows that a modification limited to one part of the family system extends quickly to the whole system. How are those changes brought about? How is an open system, such as the family in which feedback loops exist, pulled away from a stationary state? It was partly to answer such questions that we started to give attention to organizational forms likely to appear away from thermodynamic equilibrium and particularly to the work done in this field by the team ofllya Prigogine. Starting with a few examples of “dissipative structures” some concepts will be introduced which seem likely to be fruitful in our field.     

FamilyLive: Parental Skill Building for Caregivers with Interpersonal Trauma Exposures

Mental health treatments for emotionally traumatized children incorporate family and caregiver-child therapy sessions to promote child recovery and minimize developmental disruption. Such sessions require that caregivers regulate their emotions to remain productively engaged in the therapeutic process. However, caregivers with histories of unresolved interpersonal trauma have difficulty with emotional regulation. Interpersonal trauma also negatively affects the ability to reflect on one’s own and others’ feelings and intentions. This limitation interferes with caregiver engagement in psychotherapy relationships aimed at supporting child trauma work. FamilyLive is an innovative caregiver-focused family therapy model that uses a one-way mirror, a specially trained reflecting team, structured routines and individualized verbalizations to address this complex clinical phenomenon. Guided by the literature on attachment and trauma, FamilyLive has yielded anecdotal successes and positive pilot results. FamilyLive is a viable approach to engaging caregivers with histories of interpersonal trauma in trauma-focused child and family therapy relationships.     

ADVANCES IN COACHING: FAMILY THERAPY WITH ONE PERSON

This paper describes the process of "coaching" individuals in their efforts to change themselves in the context of their nuclear and parental family systems. Although this approach is regarded as one of the major modes of intervention in family therapy, the actual methods and techniques for intervention are not widely understood. Moreover, we have expanded the Bowen approach to address powerful cultural and family life cycle influences. The goal of coaching is to help clients define themselves proactively in relationship to others in their families without emotionally cutting off or giving in. Coaching begins by training clients to become observers and researchers of their own role in the family and of family patterns of behavior. Coaching then moves to help them bring their behavior more in line with their deepest beliefs, even if this means upsetting family members by disobeying family "rules."     

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.     

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.     

Intervention with Families in Extreme Distress (FED)

The FED (Families in Extreme Distress) Project described in this article was developed as an intervention model for families in extreme distress. The concept of families in extreme distress includes not only those families which have been widely regarded as multi-problem families for decades, but also those which may appear to be like any other middle class family. The dis- organization in family functioning that is created by an interaction of many problems results in a durable distress which is repeated throughout successive generations. The intervention design of this project was structured and short- term, and each family in the group met once a week in their own home for ten sessions with a therapeutic team composed of three workers. The target of the intervention was the functioning of the entire family as a unit; and goals included clarifying boundaries, strengthening roles, and developing a communication system. Analysis of the therapeutic sessions revealed several techniques which are useful for intervention with the FED population. The intervention process with these families should be multilevel and case management should not only include providing family therapy, but also advocating and mediating with various institutions in the community, as well as making connections for financial assistance.While some major policy changes may be required to meet the finan- cial and manpower needs involved in such a model, this demonstra- tion project indicates that investing the right resources is worthwhile for effecting change within the FED population.     

The reflecting team as a reflection of second order therapeutic ideals

The reflecting (R.T.) team is examined within its theoretical, therapeutic and training contexts. A distinction is made between the reflecting team technique (R.T.T.) and the reflecting team process (R.T.P.), in order to explore whether or not the practice of team reflection is consistent with the requirements of the second order family therapies, the theoretical development which supported the R.T.'s emergence and subsequent popularity. The critique of the R.T.P. suggests that although this therapeutic process does represent attempts towards increasing acceptance of complexity, reduced attempts to control, collaboration, interconnectedness and contextual respect, there is little room for complacency either theoretically or practically.     

Three Journeys Toward The Reflecting Team

The experience of familiestrainee and supervisory therapists involved in reflecting team work are explored through the metaphor of ‘journey’ and by asking a small number of our colleagues and clients about their experiences. Ideas gained from this approach are tentatively used to raise some questions about the reflecting team specifically and the current direction of family therapy. More rigorous research into this area is invited.     

Creating a bridge to healing: a professional/paraprofessional team approach

This paper describes a therapeutic model in which an English-speaking licensed clinician and a bilingual paraprofessional provide psychotherapy using a team approach in working with Cambodian refugee survivors of the Khmer Rouge. The team approach model differs from professionals who use interpreters in psychotherapy. The strengths and challenges of this approach are discussed. Agencies that serve refugees may not have professionally trained mental health providers who are from the country of origin of their clients. This model holds promise to provide culturally sensitive treatment. However, it is a model that is in its infancy in terms of knowing what works and how to duplicate that to other agencies and populations. This paper shares some of the benefits as well as some of the drawbacks.     

Training with o (observing) and T (treatment) teams in live supervision: reflections in the looking glass*

Working with a treatment and observing team at the same time, behind the oneway mirror, offers a variety of ways to: (a) generate multiple realities; (b) work with two different models of family therapy simultaneously; and (c) provide feedback on the teams' own roles, rules and group process. The process that 6 trainees and two supervisors used with T and O teams to examine their own coevolution as a therapeutic system using the Milan model of family therapy and Ericksonian hypnotherapy is described. The article concludes with a discussion of the advantages and pitfalls of this type of dual supervision.     

A Child and Adolescent Mental Health Day Program Working at the Edge of Chaos: What Complexity Science May Tell Us About Team,Family and Group Systems

The purpose of this article was to explore the potential application of the science of complexity to aspects of team, family and group systems. A child and adolescent mental health Day Program as a tightly knit multidisciplinary team closely interacting with family systems, provides an opportunity to illustrate concepts of this general scientific framework and offer potentially unique insights. In particular, the relevance of diversity and interconnectivity between parts of a system are highlighted. Ideas explored include team functioning, how change occurs in families and new ways of looking at groups. Furthermore, complexity provides support for intensive multisystemic interventions such as the Day Program to assist families with severe and chronic child mental health issues.     

Healing loss, ambiguity, and trauma: a community-based intervention with families of union workers missing after the 9/11 attack in New York City

A team of therapists from Minnesota and New York worked with labor union families of workers gone missing on September 11, 2001, after the attack on the World Trade Center, where they were employed. The clinical team shares what they did, what was learned, the questions raised, and preliminary evaluations about the multiple family meetings that were the major intervention. Because of the vast diversity, training of therapists and interventions for families aimed for cultural competence. The community-based approach, preferred by union families, plus family therapy using the lens of ambiguous loss are proposed as necessary additions to disaster work.