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.     

TEACHING PROFESSIONAL WRITING TO FAMILY THERAPISTS: THREE APPROACHES

The authors present three educational approaches designed to demystify the writing process and to support better writing skills among family therapists. One framework is an academic course in professional writing, another is a writing seminar for family therapy and physician trainees within a medical school setting, and the third is a 2-hour continuing education writing workshop for family therapists. Each is replicable within a variety of settings.     

Expanding Systems Thinking: Incorporating Tools from Medical Sociology into MFT Education and Research

The field of marriage and family therapy has historically focused on dynamics within family systems, and at times the role of social and cultural factors external to the family. To date, however, little scholarship has examined how therapists themselves are embedded within a mental healthcare system. The purpose of this article is to demonstrate how structural components of the mental healthcare system shape the practice of therapy. We draw from the field of medical sociology to illustrate how three dominant structures—managed care, diagnosis, and evidence‐based models—are intertwining and mutually reinforcing systems that have significant and long‐term implications for systemic therapists and researchers. We recommend incorporating a sociological understanding of such structures into MFT education and research.     

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.     

Mindful of the Intersession Break in Family Therapy: The Time to Think Experiment

The Time to Think Experiment researches the experience of clinicians, consumers, and families of an intersession break, which has been used historically in various models of family therapy training. This qualitative pilot study explores the experiences of 21 clinicians, 19 consumers, and six family members using this break for reflection, across the domains of family and couple therapy, individual therapy, group work, and supervision in a mental health service covering the whole age range. Using a phenomenological design, the analysis included narrative, thematic, content, and comparative techniques. The paper considers the impact of privileging reflection in the therapy process, in a climate where models, work cultures, and general lifestyles may not encourage it. Using the intersession break to create space to ‘be’ in the therapy process is one way to integrate mindful and family therapy practice. The emerging themes of an intersession break to promote a richer and deeper therapy experience, and the apparent shift of responsibility for change from clinicians to consumers is discussed.     

Brief Family Therapies

A modified version of Guerin's (1976) classification was used to categorise the principal models of brief family therapy according to theoretical and technical dimensions. While all models stemmed from common origins, either psychodynamic or systems theory, they differed in three particular areas: the premises regarding the origin of symptoms, the aims of therapy, and the major strategies employed. Nevertheless, all models were in agreement on several aspects, including the principles underlying brief family therapy techniques, the focus on the family's current level of functioning, the importance of clearly defining the problem (but not necessarily in terms of traditional psychiatric diagnoses), and other family variables. A survey of the literature indicated that there was a paucity of scientifically acceptable investigations of brief family therapy, and thus, a lack of valid evidence that any model provided an effective approach to therapy.     

Family Therapy … What's in a Name?*

The 2nd Australian and New Zealand Family Therapy Conference, held in Melbourne in July 1992, invited those making presentations to address the Conference theme Family Therapy … what's in a name? In a closing address to a plenary session of the Conference, I used the metaphor of first names (family) and surnames (therapy) to suggest that names are central to issues of identity. Our first name of “family” differentiates us within the larger group who share the surname “therapy”; but what does it mean to belong to the larger group sharing the name “therapy”? Historically, much of family therapy's energy has gone into issues concerned with establishing difference — difference within family therapy in terms of models and approaches, and difference from other approaches to therapy. Yet now perhaps family therapy would benefit from exploring what it shares in common with others who hold the same surname of “therapy”, with the possibility such dialogue could lead to mutual enrichment.     

How and Why Do Family and Systemic Therapies Work?

My reviews of the evidence base for family therapy conducted over the past 15 years have been guided by four key questions. Does systemic therapy work? What sorts of systemic therapy work for specific problems? What processes occur in effective systemic therapy? Is systemic therapy cost‐effective? In this paper answers to these questions are given. Systemic interventions are effective for about two out of three cases. Specific models of effective systemic therapy have been developed for most common mental health problems. There are many processes shared by evidence‐based models of practice that can be incorporated into the routine practice of research‐informed family therapy. Systemic therapy is cost‐effective and in many cases leads to medical cost‐offsets. Available evidence indicates that family therapy can make a very significant contribution to alleviating suffering and making the world a better place to be.     

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.     

Transitions to Systemic Practice for a Clinical Psychology Trainee

This article provides an individual perspective on encounters with systemic and family therapy ideas during the transition from university training to professional practice as a Clinical Psychology Registrar. Clinical psychology training provides a solid grounding in individually focussed, cognitive and behavioural models of psychotherapy. What may be less developed on entry to practice are the knowledge, procedural skills and reflective competencies needed to understand and respond to challenges in family‐based therapy and in working within complex caregiving systems. Systemic ideas can provide important resources for facilitating these transitions. Trainees may need support not only in gaining knowledge of family therapy models, but also in making a challenging ‘epistemological shift’ (Cullin, 2014) from internalised models of psychopathology to systemic ways of thinking about problems and change. Systemic concepts and support in developing a position of ‘hospitality’ (Larner, 2003) towards competing therapeutic models can also help the trainee be more effective in complex caregiving environments. This article provides examples from my learning as well as reflections on what may help trainees make the transition to professional practice and make use of systemic ideas.     

Bringing It All Back Home: Individual and Group Supervision in Family Therapy Training*

Literature in family therapy training neglects to address the usefulness of individual supervision. Just as family members struggle to integrate needs for autonomy with needs for family membership, so the individual family therapy trainee has individual concerns. Psychoanalytic literature fully recognises the power of the emotional responses of the psychotherapist, but is uncertain how to handle these reactions, especially in terms of the parallel process between psychotherapy and supervision. The integration of individual process-centred supervision with live group supervision and training provides a structure within which to maximize the supervisory experience.     

Family Therapy in Child and Adolescent Mental Health Practice: Integrating Family Therapy in Child and Adolescent Mental Health Practice: An Ethic of Hospitality

This article integrates family therapy in contemporary child and adolescent mental health services as an evidence‐based practice. An integrative practice model is proposed where contextual approaches like systemic and narrative therapy complement and enrich individual problem‐focused models such as biological psychiatry and cognitive therapy. This is based on an ethic of hospitality towards all therapy discourses and the following best practice guideline: ‘To make optimum space for a systemic and narrative understanding contributes to evidence‐based practice in a contemporary mental health service.’ After discussing some dilemmas of integrative practice, I illustrate the therapeutic process by a detailed example of integrative family therapy with a depressed suicidal adolescent.     

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.     

Challenge and Urgency in Defining Doctoral Education in Marriage and Family Therapy: Valuing Complementary Models

In this overview, I comment on the strong theme of the need to define and improve the quality of doctoral education in marriage and family therapy that pervades the three essays. Deficits in research training are the central concern, although the essayists take different perspectives on the nature of the research training needed. The different perspectives can be understood in terms of three different models of doctoral education. The institutional model focuses on professional training with little financial support for students and lower expectations for faculty research. The community of scholars model emphasizes a balance of research and practice with students required to attend full-time and financial support provided. Research is a mix of faculty- and student-driven and is often focused on professional issues. The star researcher model often held out as the ideal, although not yet represented in marital and family therapy (MFT), emphasizes faculty externally funded programmatic research with students working on and supported by faculty grant funding. The value and role of all three models in MFT doctoral education are described and discussed.     

PROBLEM MAINTENANCE IN FAMILY SYSTEMS: AN INTEGRATIVE MODEL*

Cybernetic theory, social learning theory and psychodynamic theory often have been put forth as competing models of the maintenance of family problems. It is argued here that the relative absence in the field of attempts to integrate these perspectives has restricted severely the development of family assessment and therapy. After highlighting the essential features of these three models, an integrative model of family problem maintenance is proposed, and the model's applicability is demonstrated in an illustrative discussion of three major types of clinical problems: symptomatic spouse, symptomatic child, and conflictual couple. Implications of the model for clinical practice are also discussed.     

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.     

Object Relations Family Therapy: Articulating the Inchoate

In recent years there has been a renewed interest in psychodynamic ideas within the family therapy literature. While some authors have explored the usefulness of psychodynamic concepts in the systemic context (Byng-Hall, 1995; Flaskas, 1993, 1996; Luepnitz, 1988, 1997), others have argued that psychodynamic models of family therapy should be given more credence in systemic work with families (Guttman, 1991). This paper describes Object Relations Family Therapy (ORFT), a psychoanalytic model of family therapy, in plain English in order to minimise the obscurity of some of the existing terminology and to emphasise the utility of more contemporary formulations. ORFT addresses the interface between psychoanalytic and systemic theories. It offers a way of conceptualising complex family dynamics at both the interpersonal and intrapsychic levels. It also integrates an understanding of nonverbal, unstated and often implicit processes in its formulation of problem development. The unique contribution of ORFT is elaborated using a clinical example.