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.     

Lesbian Therapists and Lesbian Clients

Abstract

The authors, on the basis of their own experience, explore issues specific to therapists working openly as lesbians with lesbian clients. Their discussion covers the structure of a private practice, the therapeutic relationship between lesbian therapist and lesbian client, and personal challenges for the lesbian therapist. Questions are raised and direction given with the aim of facilitating congruence among the therapist's personal capacities, the therapeutic setting, and the psychological intention of the therapeutic work. The authors note the therapist's need to tolerate the exposure of her personal life and the pressure toward fusion that are both entailed in work with lesbian clients, and they suggest that these special challenges, when the lesbian therapist's engagement with them is conscious, offer rich material that can deepen the therapeutic relationship and the therapeutic work.     

A Pilot Use of Letters to Clients before the Initial Session

This paper explores the nature of engagement in the therapy process, and proposes that engagement may be facilitated when both client and therapist are able to develop an appreciation of each other's position within the therapeutic relationship. Some ways that a therapist can assist in this process are explored. An experiment is described in which information letters are sent to clients before the initial therapy session, as a possible way to enhance the engagement process.     

Prescribing the Families Own Dysfunctional Rules as a Therapeutic Strategy*

The use of paradox-strategy in therapy is motivated by the fact that many families request help but at the same time seem to reject all offers of help. The therapist may be drawn into a game in which every effort on his part to act as an agent of change is nullified by the family group. In systemic terms these contradictory attitudes derive from the dynamic equilibrium existing between the tendency toward change, which is implicit in the request for help at one level, and the tendency toward homeostasis which at another level imposes the repetition of the family's habitual rules of interaction. The coexistence of these forces can entangle the therapist in the family's paradoxical logic of “help me to change, but without changing anything.” By accepting the contradiction facing him and by “uniting” himself with this within the family, the therapist puts himself into a position opposite to that which the family expects. His response to the family's paradoxical request is a paradox, or counterparadox, because it creates the contradictory communication typical of rigid family systems. By prescribing its own dysfunctional rules to the family, the therapist can stimulate the tendencies toward change present in the family system.     

We Don't Need Your Help,But Will You Please Fix Our Children

A Bowen Family Systems therapist employs concepts of triangles and the family projection process to view a child's symptoms as embedded in the broader family patterns. This article will examine the dynamics of two family therapy cases where parents anxiously asked for their children's symptoms to be fixed. These cases will be used to explore the common presentation in child and adolescent mental health, where the parents are concerned for their children but are also keen not to open their own ‘can of worms’. The presenting problem in the first case was violent hostility between adolescent sisters and in the second case was an adolescent's anorexia. Drawing on client feedback, I reflect on the therapy process behind the divergent outcomes. In case one, the parents were willing to address their own troubled relationship and family of origin, while in case two, the parents discontinued therapy when family of origin dynamics began to be explored. The article suggests how the therapist can evoke parents' curiosity about their role in anxious family patterns, without them feeling blamed.     

Vicarious resilience from attachment trauma: reflections of long-term therapy with marginalized young people

The concept of vicarious resilience captures the therapist's emotional growth occurring as a direct result of therapeutic engagement with traumatized clients. Three chronological case scenarios are presented for exploration of vicarious resilience in relation to attachment trauma. The purpose is to increase awareness and appreciation of the positive functions it serves for client mentalization, therapist skill and resilience factors for both parties. The reflective methodology considers the intrapsychic worlds of the client and the therapist and details how the therapist comes to experience the client's distressing projections. The potential for vicarious resilience begins from the outset of the therapist's actions of containment upon these projections. Advancing early ideas, it is advocated that vicarious resilience requires the therapist to have both the capacity and willingness to maintain a constant reflective stance.     

From action to reflection: New depths in psychotherapy with drug addicts

The continuously self-destructive behavior of some drug addicts may stir up in the therapist feelings of helplessness, hopelessness and anger. This article explores some of the dynamics of the addict's behavior and some of the pitfalls present in interventions on the part of the therapist which ignore the language of the acting out and which concentrate on crisis and behavior. Two case examples are presented to illustrate the therapist's dilemma and new depths of interventions.     

THE EVALUATION PHASE OF SYSTEMIC FAMILY THERAPY*

The initial, evaluation phase of family therapy is of decisive importance within the systemic perspective. Contacting a therapist is always a complex action for a family. The therapist's evaluation must include the possibility that continued contact may influence the family negatively and limit their potential for change. If there appears to be a logical context in which continued therapy can be justified, it will be necessary to use the first three or four sessions to collect essential data and to organize them meaningfully. It is essential to clarify the circular interaction that is maintaining the symptom, as well as the presence of specific family structures and traditions, and the kind of relationships the family attempts to establish with the therapist. On the basis of this information, the therapist can build models of the family's functioning. These models, according to general system theory, make possible logical intervention in complicated, living systems, without distorting them by artificially splitting them into their component parts. Two models that are important to our treatment perspective—the phenomenological and the mythical—are presented.     

Lessons my Clients have Taught Me†

The theme of the 1989 Family Therapy Conference Patterns of Experience provided an opportunity to consider the experiences in one's work as a therapist that shape and order our activity. A central concept is that clients perturb and alter the structure of the therapist such that our work is inevitably and permanently changed. A number of key cases are reviewed which illustrate one therapist learning from her clients.     

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.     

Genre as Tool in the Transmission of Practice Over Time and Across Professional Boundaries

In this article, we are concerned with the processes through which a central activity in the natural sciences—classification—is instantiated in the writing practices of psychotherapists. We examined several psychotherapists' grammatical, lexical, and rhetorical strategies for writing their initial evaluations of their clients' problems. Using membership categorization device analysis from ethnomethodology, we examined several therapists' written initial evaluations for their use of microlevel categories and categorizations derived both from clients' own (oral) representations and the therapists' professional repertoire. The resulting analysis suggests that clients' emic, contextually grounded expressions are absorbed into a monological account reflecting the therapist' s professional interpretive framework. The therapist thus translates the client' s concerns into a set of meanings compatible with the classifications of psychopathology of the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The resulting written account supports a billable diagnosis thereby fulfilling its institutional purpose. It fails, however, to serve another important purpose to many therapists, which is helping the therapist to guide the therapy process by providing a record of the client's perspective of his or her lifeworld.     

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.     

Working With a Deadly Serious Problem — An Interview With Brian Cade

Brian Cade is an internationally respected family therapist, noted for his work with teams and the one-way screen, for the creative use of metaphor and humour, and strategic interventions. Yet our interview, squeezed into a lunch-break in the middle of a workshop held in Adelaide in September 1984, touched none of these. Instead we talked of the nuclear issue and beneath this discussion ran basic questions all therapists should ask of themselves — What is the appropriate role of the therapist? Should a therapist's own strong values have a place within therapy? And how can the therapist make an impact on society?     

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.     

Parallel process: Emotional and physical digestion in adolescents with eating disorders

Abstract

This paper explores the emotional processes involved in psychoanalytical psychotherapy with adolescents with eating disorders. The central discussion is of two clinical examples, both of whom were seen by the author at the initial point of engagement with the therapeutic process. Through paying attention to the qualities of transference and countertransference, the idea of parallel physical and emotional processes is seen to emerge as central to the understanding of these two young people and their difficulties. The second half of the paper goes on to develop a comparison between the characteristics of the object relations of the two adolescent patients and the quality of early object relations in babies who have feeding difficulties. The latter is discussed with reference to infant observation, particularly the author's study of 'Five infants at potential risk'. The conclusions drawn are, first, that the therapist needs to take into account, in the countertransference, the 'pull' towards responding to the patient collusively, or through repeating an invasive experience and, second, that the patterns of object relations which are seen in the adolescents and experienced by the therapist in the countertransference relate to prototypes of specific defensive configurations that can be described, through observation, as occurring in early infancy.     

Marital Therapy — The Therapist

This article applies systems principles to an appreciation of the couple therapist. It offers an overview of the changing role of therapists and addresses the philosophical debate of the therapist as scientist or artist. It demonstrates how the worldviews, beliefs and values of clients and therapists are influenced by, and in turn influence, the therapeutic and wider social contexts to which they belong. The question of how a therapist simultaneously maintains personal values and neutrality is considered. The implications of examining the therapist's role from a systems framework are discussed. It is concluded that research needs to adopt a more holistic methodology and that impasses need to be analysed by examining beliefs at different levels within the systems involved. Finally, a personal account of the effect that therapy has on the therapist is offered.     

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     

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.     

Coming of Age: An Individual Perspective*

This paper attempts to examine some of the broader system constraints to family therapy's ‘Coming of Age’ and to relate these constraints to more personal issues that arise for the presenter as a recently qualified family therapist. These issues and constraints are clustered around the question of hierarchy, and it is the presenter's belief that, although family therapy has much to offer as a direct service method, it has less to offer as a tool for analysing phenomena of a structural nature.     

An Overview of Three Models of Marital Therapy

In this article three models of Marital or Couples Therapy are described. Framo's approch to working with couples illustrates Psychoanalytic Theory, Stuart — Social Learning Theory, and White — Systems Theory. For each model, the theory and the ensuing practice are discussed, with attention to the factors that lead to change, assessment, interventions, the role of the therapist. Each is placed within the Bernal and Baker (1979) level of intervention framework. Strengths of each model are highlighted. Each therapist's own style in session is described.