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.     

Beginning Struggles with Families*

Beginning treatment with families is marked by a sense of struggle between the family and the therapist. The family is seen as testing the therapist and as asking through their behavior questions about the therapeutic process. The therapist is advised to focus intently on the beginning interviews, working toward the point where the family relaxes and decides on an intuitive level to enter therapy. The major hurdle is in dealing with the family's anxiety as the therapist attempts to shift the focus from the individual patient to the family as a whole. Strategy in establishing this shift is outlined     

Multiple Family Therapy Systems

This paper investigates multiple family therapy (MFT), a treatment method which includes several families in a series of sessions with the therapist(s). A brief historical development of MFT is included as well as reports of multiple family therapy groups found in the literature. The characteristics of this treatment method are delineated with special attention to the elements of change attributed to MFT and the stages of development in MFT groups. The role of the therapist and special problems in MFT are also explored. Some implications for research are outlined, indicating that MFT is lacking adequate validation as a treatment modality. Possible advantages inherent in multiple family therapy systems, which have been suggested by therapists' clinical findings, are also reported.     

Responsive Persistence Part I: Therapist Influence in Postmodern Practice

Feminist and social constructionist developments in family therapy highlighted the importance of attending to therapist–client power relations and incorporating clients' understandings and preferences as a part of therapy. Significantly, less attention has been given to how postmodern therapists do use their power and influence. This is an important topic because it is therapists who have the major responsibility for guiding the interaction with clients and persisting in this so that change is facilitated. Therapist persistence in various forms and across dimensions of therapy process is examined to expand understanding of therapist influence in postmodern and collaborative work. An analysis of responsive persistence in a session with Karl Tomm as the therapist is presented to illustrate this conceptual framing.     

Family Therapy is Just One Option

I trace my development as a family therapist from being a single model worker in systemic family therapy to a more eclectic approach. The context of my work is children's services and private practice. Failure to appreciate when one method of therapy is more suitable than another can lead to family therapy being applied when it is not indicated. The dangers in such mistakes and a lack of careful assessment that includes the ‘feeling state’ of the therapist are illustrated by case vignettes. A possible effect of some therapy techniques is to create a ‘distance’ from clients and to shield the therapist from their emotional distress. I outline situations where I would not use family therapy.     

Using culture and the intersubjective perspective as a resource: A case study of an African-American couple

In this article a White Jewish-American therapist shares what she learned from her work with an African-American couple using a semi-structured protocol for planned short-term marital therapy. Twenty-eight months after the original treatment, the author met again with the couple for an audiotaped follow-up interview. Marital satisfaction for both partners was tracked with an Index of Marital Satisfaction over the course of the treatment and the follow-up process. The empirical findings augment the story of the couple and the therapist. During the middle phase, the therapy reached an impasse. With the goal of creating a cognitive shift, the therapist used the couple's culture as a resource for therapeutic change. The cultural metaphor is considered as the vital step in overcoming the treatment impasse. The major finding is that cultural responsiveness does not end with the engagement and assessment of clients. The culture of the clients and the culture of the therapist provide powerful metaphors and rich resources to introduce change possibilities. With this couple, when culture was combined with an appreciation of the intersubjective meanings for both clients and therapist, culturally responsive and effective therapy became possible.     

DO WE REALLY UNDERSTAND? AN EXPERIENTIAL EXERCISE FOR TRAINING FAMILY THERAPISTS

This paper presents an experiential exercise for training beginning marriage and family therapists, as well as several adaptations of the format. The basic exercise consists of role playing a therapy session in which the people playing the clients speak a language that is not understood by the therapist-in-training. Although the therapist cannot understand the clients, the clients can understand the therapist. This exercise assists students to become more cognizant of the need to be cautious and curious in the cocreation of meaning in therapy. In addition, this exercise builds confidence and clinical skills, such as learning about nonverbal communication while observing process.     

Thinking About the Emotional Interaction of Therapist and Family

The emotional interaction of therapist and family has been difficult to explore within the field of systemic family therapy. This paper looks at ways of thinking about this process. As a starting point, I take some feelings I had with three families in the course of therapy. These are used to illustrate some concepts from analytic therapy which address the emotional interaction of therapist and family. The kind of theoretical space and guidance offered within systemic family therapy is then explored, and it seems that the Milan frame gives some space for thinking about the process but offers little guidance as to exactly how this might be done. This is a paper about practice, though it's primarily a theoretical discussion. There is no aim of establishing a ‘correct’ way of understanding the emotional interaction of therapist and family.     

Towards a Multicultural Society: Family Therapy with Greek Families†

Language and cultural differences can pose barriers to effective intervention in migrant families in conflict. Family therapy approaches can provide some useful strategies for overcoming these obstacles. A family therapy approach can (1) emphasise the value of utilizing natural network support systems; (2) provide a model which helps clarify communication problems arising in the relay of information through a third person acting as an interpreter; (3) underline the importance of non-verbal and process aspects of family communication; (4) suggest techniques for negotiating, joining, and finding commonalities of family experience between a therapist and family of different ethnic background. The therapist needs to develop sensitivity to both the universal and specific ethno-cultural structures, norms and problems of families; when this sensitivity is achieved powerful and culturally syntonic healing forces can be released. Examples of successful family therapy interventions in some Greek families in conflict are given.     

Metaphor: Complete or Incomplete*

Using metaphor in therapy, both in the process of joining with a family and as a process in itself within which interventions are delivered, can lead to extraordinary and sometimes unexpected behavioural change. Yet for the therapist beginning to consider the use of therapeutic metaphor the prospect must be daunting when, with a few notable exceptions, the literature suggests the ideal as a complex, isomorphic and often elegant story. This paper attempts to broaden yet simplify technique using clinical example to examine the use of metaphor in language and action in family therapy.     

Co-evolving with Anorectic Families Difference is a Singular Moment

An individual practitioner's development as a family therapist occurs in the context of the family therapy movement, most manifestly present in its literature and in seminars and workshops offered by its leading exponents. The process by which the therapist interacts with the broader field and consequently incurs shifts in perspective is rarely decribed, or theoretically elucidated. In this current paper, the author's changing orientation to the treatment of anorexia nervosa is viewed via theoretical discussions and case illustrations. The concept of co-evolution, as defined by both Bateson and Jantsch, is invoked to explain how interaction with other practitioners and literature can produce changes in therapeutic emphasis, and Prigogine's concepts of dissipative structures and bifurcation points are utilised in locating both therapeutic and theoretical shifts in time. The discussion briefly considers how therapists can co-evolve with conservative work situations to produce broader contextual changes.     

On Learning and Teaching Family Therapy

This paper explores some ideas about the process of learning to be a family therapist. It considers the questions: how does one learn to think like a family therapist? How is family therapy best taught? How is it learned? The author's experiences in learning and teaching are described. It is argued that family therapy differs from other approaches to therapy in some fundamental respects, and that learning to ‘be’ a family therapist is a different kind of task than learning to be a practitioner of other therapeutic approaches. The paper examines some key theoretical constructs, especially the idea of ‘levels’ of thinking, which are seen as central to both the learning and practice of family therapy.     

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.     

Adapting enactments to couple reactivity: five developmental stages

Interest in change interventions that are common to different models of relationship therapy has spurred investigation of enactments as one such candidate. In change-focused enactments, therapists structure and coach couple/family interaction, as opposed to channeling interaction through the therapist. Still, varying levels of couple/family distress, volatility, and reactivity mean that readiness for enactment intervention varies along a broad continuum and changes over the course of therapy. This suggests the need for differentiated enactments. Currently, however, no model exists for adapting enactments to changing relationship conditions. We propose a five-stage developmental model of clinical operations in couple therapy that adapts the process and structure of enactments to changing levels of relationship distress, interactional volatility, and emotional reactivity. The model increases the possibility for therapists to use enactments successfully over the entire course of couple therapy. Issues to be considered in using the couple enactments model as a template for the development of enactment models for other relationship systems are noted.     

Therapist effects on dropout in couple therapy

Marriage and family therapy scholars have argued that therapists play a crucial role in successful couple therapy, yet little research has empirically documented that the therapist in couple therapy has a significant impact on outcomes. Known as the study of therapist effects, this study sought to assess the amount of variance attributed to the therapist in couple therapy outcomes. Using dropout as the outcome variable, this study analyzed data from 1,192 couples treated by 90 masters and doctoral student therapists at a university‐based training clinic. Results from multilevel analysis indicated that therapists in the sample accounted for 9.4% of the variance in couple dropout while controlling for initial couple impairment. Therapist gender and therapist experience did not significantly predict variability in therapist effects. These findings give promise to future research on therapist effects in couple therapy and encourage exploration into which therapist characteristics and behaviors contribute to successful clinical outcome.     

Relational Quandaries in the Treatment of Forensic Clients

This article examines the sources of relational difficulties inherent in clinical work with forensic clients. Left alone, common countertransference feelings, responses, and defense mechanisms can disrupt and ultimately derail treatment. Concepts relating to the management of countertransference offer a path with which to integrate therapists’ affective reactions as a mechanism of therapy. A relational framework utilizing the affective dynamics between client and therapist to develop and promote treatment goals is introduced and the process of formulating it is described. Practice examples are offered.     

The Go-Between — Strategic Therapy with Teenagers in Separated Families*

The adolescent's experience of divorce needs to be understood within a developmental and systemic framework. Problematic or symptomatic behaviour in teenagers from separated families often reflects on the family's difficulty in managing the transition to a new and different family organisation. The type of problem or symptom presented is shaped partly by the developmental characteristics of the adolescent period, as well as being indicative of unresolved problems within the broader family system. Problem resolution can often require the involvement of both separated parents and their children in a conjoint interview, in which case a strategic family therapy approach can be particularly useful. A strategic approach offers the therapist clear guidelines regarding the focus and process of the interview, and assists the therapist to be in charge whilst remaining neutral in the sense of not allying more with one side or another. Case illustrations are included of a strategic approach with teenagers and their separated families.     

THE POLITICS OF FUNCTIONAL FAMILY THERAPY: A FEMINIST CRITIQUE*

This paper examines the political processes inherent in Functional Family Therapy (FFT). It argues that this model of family therapy takes a covert political stance which reinforces traditional gender roles in both family and therapist. Of particular interest are FFT's affirmation of existing interpersonal functions in the family, as well as suggested therapist use of self. The implications of this stance are discussed, as well as recommendations for change.