Victim's Response Cycle: A Model for Understanding the Incestuous Victim-Offender Relationship

ABSTRACT

The victim-response cycle is a theoretical and clinical model that can be utilized to assist victims in their healing from the trauma of sexual abuse. This model focuses on the specific aspects of the relationship that victims have with their offenders, particularly in incest cases, which contribute to the degree of trauma that victims experience. This relationship can also become the model for other relationships as the victim matures, and the victim-response cycle can be used to assist these adult survivors in understanding their difficulties with adult intimate relationships. This model addresses aspects of attachment and learned coping responses to assist clinicians in treating symptomatic behavior. While severe trauma is rarely treatable with a short-term approach, this model can assist in providing clients and clinicians with tools for symptomatic relief, which may be achievable in a short-term setting. This model has not been examined empirically, but it has been utilized in several outpatient practices in the Midwest with positive clinical results. A case example demonstrating the use of this model is also presented.     

What about the family in family therapy research?*

Family therapists are frequently criticised for not publishing any substantiation of the effectiveness of their therapeutic interventions. This paper discusses why clinicians do not evaluate their work through examining current recommendations for family therapy evaluation, and the effects of these recommendations on the family under study. We provide some criteria specific to the family which will assist clinicians in selecting measurement instruments to evaluate family therapy. These relate to ethics, parsimony and design features of the study. The complexity of family therapy evaluation must be addressed if more clinicians are to do evaluation.     

‘Riding the Wave’: Working Systemically with Traumatised Families

This paper draws on the authors’ clinical experience as family therapists, working predominantly with families who have experienced trauma such as sexual abuse, physical abuse and neglect, to demonstrate that taking a systemic trauma‐informed approach is a powerful therapeutic modality that can facilitate positive outcomes for all family members. The paper discusses the impact of trauma on relationships, and then outlines a rationale for a trauma‐informed, systemic approach with those traumatised families who are, at times, challenged by excessively heightened behaviour and emotional dysregulation. Drawing from parenting research, it includes a discussion of the place of parent work and how this can be integrated with systemic family work. Key constraints and considerations are highlighted followed by a discussion of key interventions the authors have found useful in building a clinical framework for this work, including what is critical for the therapeutic process. While working with traumatised families is complex and challenging, offering a safe place for families to be in the presence of each other's pain and ‘ride the wave’ of emotions can be a powerful path to recovery.     

Does a Perinatal Infant Mental Health Team Hold the Family in Mind? Opportunities and Challenges for Working Systemically in this Specialised Field

This paper considers whether systemic family therapy frameworks are used in current Perinatal Infant Mental Health (PIMH) practice. PIMH is a field that is, by nature, relational, focusing on enhancing the development of early parent–infant relationships. It is well accepted that the early years of an infant's life are crucial for brain development, and disturbances in early parent–infant relationships can impact negatively upon the child's development. Five clinicians from a PIMH service in a metropolitan area participated in a focus group related to key systemic concepts: genograms, family of origin, transitions, and morphogenesis. Findings suggest that the PIMH team does hold the family in mind, utilising systemic frameworks predominately in the engagement and assessment phase of intervention. They also highlight that PIMH clinicians focus on roles and boundaries occurring within the immediate and extended family unit and support families with the transition to family expansion phase. The application of working systemically differed significantly among participants, suggesting that the use of systemic frameworks in the PIMH field requires further exploration.     

Outcome Evaluation of Therapeutic Effectiveness

Evaluation need not be a boring exercise, carried out under sufferance simply to please the demands of administration. Nor need it be so complicated that a research officer is required to undertake it. This article reports on an evaluation of therapeutic outcomes conducted by the Manly Warringah Adolescent Service. Apart from offering general evidence of therapeutic effectiveness, an evaluation of this kind has the potential for answering some of the more interesting questions posed by clinicians. It was discovered, for example, that there was a significant, positive association between the therapist's assessment of problem resolution at termination of therapy, and client's independent assessment made three months later. Support was also found for the practice of involving the family in therapy, with such an approach offering favourable results in fewer sessions and carrying with it the additional benefits of improved family relationships.     

A feminist analysis of self-help bestsellers for improving relationships: a decade review

Self-help literature is pervasive and influential in the United States. A critical analysis of self-help books would help therapists to determine their utility for the therapeutic process and assist them in making reading recommendations to clients. In this study, a content analysis was conducted of the top 11 relationship self-help books on the New York Times Bestseller List over a period of 10 years (1988-1998) to determine the degree to which these books support a feminist approach to therapy. This study yielded three major findings. First, the number of feminist books, the number of nonfeminist books, and those falling in the middle across four components of feminist family therapy are about equal. However, the second major finding was that the top-selling books are more likely to be nonfeminist than feminist. The third finding is that most best-selling self-help books appear to have become less compatible with a feminist approach to relationships over time. This analysis encourages therapists to think critically about these best-selling books; it will also allow therapists to consider this methodology as a model for critically analyzing other books that they recommend to clients or use in their own professional development.     

Family Social Work/Family Therapy

The author responds to Witkin's (1993) comparison of family social work and family therapy. The author argues that family social work and family therapy share important commonalities. He challenges Witkin's characterization of family therapy as outdated. Instead, family therapy is characterized as having contributed important writings about gender and culture to its practitioners. The paper ends with reflections on the implications of social justice for clinicians.     

Two Case Studies on Family Work with Eating Disorders and Body Image Issues

This article highlights the need for clinicians who work with eating disorders and body image problems to address the deeper family issues underlying these symptoms. The authors propose an eclectic approach including family systems, structural and experiential family therapy theory as a guide. The paper begins with an overview of family therapy theories currently used in the treatment of eating disorders, and goes into greater detail about the three theories highlighted in the eclectic model proposed. The authors present two cases with actual case dialogue, demonstrating how they used this composite model. This article has both theoretical and practical implications for clinicians working in the field.     

BASIC FAMILY THERAPY SKILLS, IV: TRANSGENERATIONAL THEORIES OF FAMILY THERAPY

This pape focuses on the basic skills and compentencies of transgenerational approaches to family therapy, the fourth report of a program of research surveys by the Basic Family Therapy Skills Project. In the first survey, a panel of family therapy educators listed the most critical or basic skills or compentencies of beginning family therapist with a transgenerational orientation. In the third survey, self-selected respondents rated these items according to degree of importance for beginning family therapists. Rankings of the items according to mean scores of the Likert responses indicate that transgenerational family therapy skills are founded in theory and can be identified behaviorally. The most important skills are those that use the self of the therapist to understand and utilize transgenerational family therapy skills for both therapist and client. Also listed are skills that many raters deemed "generic" rather than specifically related to transgenerational family therapy. Other findings and their implications for the future training of family therapists are discusses. Although the paper is intended for family therapy educators interested in their colleagues' ideas about critical skills in trans-generational family therapy, theorists and clinicians may also find it useful.     

Adolescent Violence: A Systemic and Feminist Perspective

In writing this paper I want to locate adolescent violence toward family members firmly within the spectrum of family violence, including spouse abuse, child abuse, and elder abuse. To call violence of this sort ‘challenging behaviour’, or to see it as ‘delinquency’ is to locate it outside this spectrum, where it is less subject to scrutiny from a systemic and feminist perspective. This paper looks at the relevant literature on adolescent violence, and attempts to develop family therapy theory in this difficult area. It is a companion piece to Marni Sheehan's more practice-focused paper in this issue.     

Patterns of Change in Families Following Severe Head Injuries in Children

After severe head injuries, children can display behavioural problems for many years. Factors related to the individual have been discussed in other articles, and authors have also suggested that resulting behaviour problems may affect the family. This paper assesses the direct effect of the injury and events around it on the family. The reaction of the family may contribute to the persistence of the behavioural change, rather than just be a result of it. This paper describes the effect of the accident on family relationships and discusses the behaviour of the identified victim in terms of the stage of the family life cycle. The family as a whole, and not just the child, is a victim of the event, and therefore the use of family therapy is an important and appropriate part of treatment. A comparison of family and individual therapy is made, and the problem of assessing whether behavioural changes are related to organic brain injury is addressed.     

Measuring Walsh’s Family Resilience Framework: Reliability and Validity of the Family Resilience Assessment Among Women with a History of Breast Cancer

Walsh’s family resilience framework presents a comprehensive and inclusive lens of family process that may assist clinicians, family service professionals, and health care providers with understanding the functioning of individuals and families in their care. A mechanism for using this framework is needed, as is empirical evidence of its cogency. This article reports on the development of the Family Resilience Assessment, a 29-item survey intended to assess dimensions of Walsh’s framework. The Family Resilience Assessment is presented as a reliable and valid mechanism for assessing the family resilience framework. Results of the use of the survey with women with a history of breast cancer demonstrate that it is a reliable instrument with content and construct validity.     

A Mexico City-based immersion education program: training mental health clinicians for practice with Latino communities

This article describes the philosophical foundations and educational methods of a Spanish language and cultural immersion program based in Mexico City, Mexico. The program is designed to assist U.S. graduate students in marriage and family therapy and clinical psychology programs to improve clinical service delivery with Latino clients. Utilizing critical pedagogy, the program works with future clinicians to develop multicultural and international competencies; acquire increased Spanish language skills; engage in self-of-the-therapist work; and expand their understanding of the historical and cultural influences shaping the mental healthcare needs of Latin American clients. A report of the themes from postimmersion surveys is provided and the implications for training are discussed.     

Understanding a non-causality crisis response: Examining the Florida Panthers response to Hurricane Irma

Much of the crisis response literature focuses on an organization deemed to be responsible for the occurrence of the crisis. For a crisis without a singular organization causality, such as a natural disaster, any organization can proactively initiate actions to address the situation. This article contributes to the understanding of a non-causality crisis response by identifying the capabilities that an organization needs to effectively assist with the response. An organization must possess the requisite resources, have developed key stakeholder relationships, and be driven by its own values and sense of responsibility. A sports team is well-positioned to assist with a non-causality crisis response. A sports team creates a feeling of community identity, has a vast array of resources, and has many critical stakeholder relationships. This article examines the NHL’s Florida Panthers relief efforts in response to Hurricane Irma, a storm that created a complex community crisis with residents in need of essential supplies and assistance.     

Conceptualizing and Treating Problem Gambling as a Family Issue

Few family therapists have training in the identification, assessment, and treatment of problem gambling and its impact on couple and family relationships. The authors conceptualize problem gambling (PG) as a family issue and encourage clinicians and researchers to pay attention to the systemic antecedents and consequences of PG on family relationships. A review of the literature and clinicians' experiences regarding the impact of PG on couple and family relationships are presented and discussed. In light of the limited systemic-based treatments for PG, marriage and family therapists are urged to begin paying attention to this emerging issue that has significant couple and family ramifications.     

Developing Family Therapy Skills on a Shoe String Budget: A Peer Supervision and Training Approach

Family therapy skills are an essential tool when working with young children and their families, yet accessing family therapy training and supervision in workplace settings has become more difficult. Skills enhancement may be obtained through formal training in accredited courses, a costly undertaking, in which clinicians most often carry the entire cost for the training. In this paper, we propose that specific family therapy skills relevant to working with families of young children can be developed within a peer group format. The peer training described in this paper is extremely cost effective, easy to set up, specifically tailored to our unique training needs and the characteristics of the population of families we are working with. Further, the training allows us to develop fresh and creative ways of skills acquisition, our own ‘curriculum’, with flexible use of training techniques, depending on our particular needs at a given time. We conclude with some of the disadvantages of the model and propose ideas for future development.     

OBLIGATED CLINICAN SELF-DISCLOSURE: JONE THERAPITS'S INTERVENTIONS FOLLOWING A FAMILY MEMBERS'S PUBLICIZED MURDER*

This article describes a family therapist's management of the sudden collision between profesional and personal boundaries following the publicized murder of her spouse. Reasons are offered to explain why it is becoming difficult for all clinicians to control the process of self-disclosure in therapy. Strategies used to meet the demands of affirming professional distance while maintaining therapeutic effectiveness are described. Brief recommendations are proposed for therapists in group, medical, rural, inpatient, and underserved settings. It is hoped that this case study will generate further discussion and assist health care providers who may face this challenge in the future.