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.     

Unlocking the family secret in family play therapy

Family play therapy combines play therapy with family systems therapy. When family secrets are revealed in a family setting, with play to cushion the family's anxiety, families have the opportunity to resolve long-standing intrapsychic and interpersonal difficulties that impede the psychological well-being of both children and parents. Family play therapy effectively reduces symptomatic behavior in children in an age-appropriate manner—an advantage over family therapy that may be geared to adult cognitive levels. It also gradually shifts the family to a systems perspective of its problems in a non-threatening way, thereby facilitating the child's connection to his or her primary caretakers.Ms. Eaker is a psychotherapist in private practice in Family Systems Theory, and therapist for the United Federation Teachers' Stress Management Program and various Employee Assistance Programs, and a PhD candidate.     

Abstracts

Gerson, M. J. & Barsky, M. For the new family therapist: A glossary of terms. American Journal of Family Therapy .
Gunderson, J. G., Kerr, J. & Englund, D. W. The families of borderlines. Archives of General Psychiatry .
Mandelbaum, A. Family characteristics of patients with borderline and narcissistic disorders. Bulletin of the Menninger Clinic .
Liddle, H. H. On teaching a contextual or systemic therapy: Training content, goals and methods. American Journal of Family Therapy .
Pope, K. S., Schover, L. R. & Levenson, H. Sexual behavior between clinical supervisors and trainees: Implications for professional standards. Professional Psychology .
Robinson, B. & Thurnher, M. Taking care of aged parents: A family cycle transition. The Gerontologist .
Watzlawick, P. & Coyne, J. C. Depression following stroke: Brief, problem-focused family treatment. Family Process .     

The Clinical Effects of Massive Psychic Trauma in Families of Holocaust Survivors*

For years we have been treating numerous concentration camp survivors in the psychiatric clinics and hospitals of Israel. In recent years we have been seeing increasing numbers of the second generation suffering from a wide spectrum of emotional disorders, personality disturbances, borderline and psychotic states which are clearly related to the long-term effects of massive traumatization in the survivor parents. These effects are manifest in four inter-related areas of disturbance within the family—the parents' mental state, the family atmosphere, inter-personal functioning in the family and specific distortions in the parent-child interaction. Excessive talking about holocaust experiences to children, or the opposite —lack of communication, avoidance and denial of these experiences—are patterns frequently found in the children of survivors who seem to be most affected by the massive traumatization of the parents. It is postulated that therapy of the survivor parents can modify the transmissions of affects to the children. Family therapy is indicated whenever possible.     

Family Mediation: A Guide for Family Therapists

Family therapists often see separating parents who need to agree on co‐parenting arrangements. This article provides a guide to current research and practice in family mediation. The limited available research suggests mediation is a useful approach for some separated parents and their children, but often is not successful with highly conflicted parents, parents with mental health problems, parents struggling to accept the separation from their partner, or parents with unrealistic co‐parenting expectations. We analyse ways in which mediation might be enhanced, and discuss the potential roles of family therapists to support separating families to negotiate positive co‐parenting.     

Separate But Not Alone: Separation-Individuation Issues in College Students with Eating Disorders

It sometimes seems that the college experience is tailor-made for the development of eating disorders. Overwhelmed and bombarded by their feelings, college students often turn to behavioral means, like eating disorders, to cope. Contemporary research (e.g., Christenson et al., 1994) has shown that good and bad emotions alike can be managed by starvation, bingeing, overeating, purging, and/or obsessive exercise. For college students, many of the overwhelming feelings that are titrated by eating disorders are directly linked to the separation process. Adolescence has been called a second individuation. While Mahler et al. (1975) viewed separation-individuation as both a developmental stage and a lifetime's work, contemporary therapists often concentrate on the importance of early separation experiences. A postmodern perspective, however, recognizes the importance of connection as well as separation. Our culture is so focused on independence that many parents of college students do not recognize the importance of maintaining active contact with their older adolescents. It can be very helpful to view an eating disorder as representing a college student's attempt to negotiate separation and connection, dependence and autonomy. This article examines some of these dynamics and the implications for therapy with this population.     

Family Dispute Resolution: Use,Timing, and Outcomes

The mandatory requirement for separating or separated parents to mediate disputes over children before filing an application for the courts represents one of the key changes introduced in the 2006 Australian family law reforms. The process is known legally as Family Dispute Resolution (FDR). Based on the reports of three cohorts of parents who had separated in different periods after these reforms were implemented, this paper examines: (1) the socio‐demographic characteristics and circumstances of parents who used FDR; (2) the extent to which parents who attended FDR at different periods after separation differ in characteristics and circumstances; (3) FDR outcomes and the extent to which these outcomes vary according to parents’ circumstances and their timing of FDR use. The analysis shows that use of FDR was quite common among separated parents. Parents who went to FDR were typically able to reach an agreement and this positive outcome appeared to have increased over time, which may reflect improving and refining practice. The data show that the quality of inter‐parental relationship and circumstances surrounding separation such as family violence and other issues are closely linked with FDR use and its outcomes. They also reveal that parents who used FDR typically did so in the early stage of separation with its use much less common after separation for three or four years. Typically, in these cases, s60I certificates, which are normally required before the courts can intervene, were issued.     

Family Therapy with the Elderly

This article outlines health and lifestyle challenges to elderly persons and associated changes in their family systems. Flexibility, related to attachment patterns, is considered central to healthy adaptation. Family therapy approaches and relevant systemic and cultural factors influencing psychotherapy with the elderly are discussed. Key family therapy concepts and strategies (genograms, transmission of family histories and circular patterns of interaction), are reviewed and exemplified. Four types of family therapy presentations are elucidated by composite case examples. Firstly, the elderly person can be the identified patient. Secondly, another family member can seek help for him/herself in relation to the elderly person. Thirdly, another family member can be the identified patient without direct reference to the elderly person. Finally, the wider health care system involved with the elderly person and family can be the focus of therapy. Family therapy offers important conceptual and strategic advantages in working with the elderly and their systems.     

Depression movement in family therapy with depressed adolescents

Family therapists presume, observe, and predict that depression can move from member to member in the family system depending upon the dynamics of the system as a whole. When an adolescent who is depressed begins to improve in family treatment, many family therapists have reported that the parents will often begin to experience an increase in their level of depression. This observation has been reported but has not been objectively measured. In this clinical study of four families, adolescent and parental depression during family therapy is measured to determine if depression movement does occur during family treatment. Results indicate that in three of the four families the parents did initially show depression level increases reactive to improvement in the adolescent. Such findings are supportive to the idea that some forms of adolescent depression often do serve a family system function.     

BOOK REVIEWS

Book reviewed in this article:
Commitee on the Family of the Group for the Advancement of Psychiatry. The family, the patient, and the psychiatric hospital: Toward a new model .
Segal, Lynn. The dream of reality: Heinz von Foerster's constructivism .
Combrinck-Graham, Lee (Vol. Ed.). Treating young children in family therapy
Hafner, R. Julian. Marriage and mental illness: A sex-roles perspective .
Schultz, Stephen J. Family systems therapy: An integration .
Nerin, William F. Family reconstruction: Long day's journey into light .
Wallas, Lee. Stories for the third ear .
Beavers, W. Robert. Successful marriage: A family systems approach to couples therapy .
Bornstein, Philip H. & Bornstein, Marcy T. Marital therapy: A behavioral-communications approach .
Slipp, Samuel. Object relations: A dynamic bridge between individual and family treatment .     

A Structural Approach to a Family with an Encopretic Child*

This article describes brief therapy using a structural approach. During the course of therapy the encopretic behavior of a pre-adolescent boy was observed in relation to the interactionand structure of the family system. The presenting problem was analyzed as a sign of family dysfunction and of the stress consequent to the parents separation. The success of the therapy didnot consist only of the disappearance of the encopretic behavior, but also in the discovery of different modalities of relating which produced a liberating effect on the identified patient and on other members of the family.     

Alone together: An application of separation-individuation theory to conjoint marital therapy

Mahler's principle of separation-individuation, widely recognized as a useful tool for understanding couples' difficulties, has been applied traditionally in one-to-one psychotherapy with individual partners. In this article, the author illustrates the use of Mahler's schema in conjoint marital therapy. Following a theoretical elaboration, the author uses excerpts from case process notes to trace a couple's development in treatment from a level dominated by symbiotic longings and related ambivalence to one reflective of increased object constancy and empathic mutuality.     

Whole Family Theraplay: Integrating Family Systems Theory and Theraplay to Treat Adoptive Families

This article regarding the effectiveness of Theraplay for the clinical treatment of adoptive families both outlines a model for integrating family systems theory with Theraplay to create a new approach entitled Whole Family Theraplay (WFT), as well as provides a preliminary report of a pilot study demonstrating the efficacy of that model. WFT integrates Theraplay with family systems approaches (Structural and Experiential Family Therapies) to treat parents and all the siblings within adoptive families. The findings indicate that WFT treatment may lead to statistically significant benefits in regard to family communication, adults’ interpersonal relationships, and children's overall behavioral functioning.     

Gay and Lesbian Adults' Relationship With Parents in Germany

Despite a rapid expansion of research on gay and lesbian family issues, a comprehensive account of intergenerational family relationships for a population‐based sample of adult homosexual children is still lacking. Using more than 7,500 baseline interviews from the German Family Panel (pairfam), this study aimed to fill this gap. The authors analyzed nationally representative data for 2 cohorts (born in 1971–1973 and 1981–1983, respectively) with regard to 5 outcome variables: (a) emotional closeness, (b) contacts, (c) geographic proximity, (d) conflicts, and (e) ambivalence. They found indications of modestly lower levels of emotional closeness to both parents as well as evidence for less frequent contacts of homosexual children with their fathers. Overall, however, the results suggest that adult gay and lesbian children's relations to parents do not differ substantially from those observed among their heterosexual counterparts. The article concludes with a discussion of limitations and potentials for future research.     

Family Experience of Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) struggle with unbearable emotions that arise out of interpersonal difficulties. Self‐harm and suicidal behaviours serve to regulate these emotions and to gain a sense of well‐being and control in a treatment context where hospital admissions are avoided by mental health services. Clinician engagement with families may be constrained by their knowing the accepted etiology of the disorder, which includes a causal link with the family environment. Other constraining factors include the negativity of those with BPD toward their family, and their clinicians' diagnostic uncertainty or confusion. This qualitative study explored the experience of families whose close relative with BPD has a long history of self‐harm and/or suicide attempts. Family members were found to have chronic and traumatic stress. Family roles and relationships were strained, as were relationships between the family and the mental health system. The findings of this study indicate that treatment for BPD needs to adopt a systemic approach that considers individuals and their significant family relationships, as well as relationships between the family and treatment providers.     

The loyalty bind and sacrifice of the self: Family treatment of adolescent schizophrenia and schizophreniform disorder from a psychodynamic-systemic perspective

This article reviews treatment of families with a schizophrenically functioning adolescent from a psychodynamic systemic perspective. Systemic and psychoanalytic conceptions of family binding and the sacrificial nature of schizophrenic dysfunction, both on an intrapsychic and interpersonal level, provide the theoretical foundation for a multi-dimensional approach to treatment. This treatment approach is predicated on reframing of the adolescent's behavior, a co-therapy model of reparenting and multi-family group therapy to resolve the separation-individuation impasse characteristic of such families. The case of a 16 year old boy and his family is used to illustrate the concepts discussed.At the time this was written the author was a family therapist with Child and Adolescent Services, Coliseum Psychiatric Hospital, Macon, Georgia. He wishes to express appreciation to Dennis Jones, Ph.D., Program Director: A. Allison Grant, M.D., Clinical Director, and the staff of the adolescent unit.     

Benefits to Children Who Participate in Family Therapy with their Substance‐Using Mother

It is rare that family members other than the identified patient are followed over time in studies of therapy effectiveness. Family therapy is believed to be effective because it targets processes within the system that maintain symptoms. If these processes are changed, then all family members can benefit. Using a sample of 183 mother–child dyads from a study comparing family therapy for adult substance use versus an attention control, change in child's substance use (tobacco, alcohol, and marijuana) was estimated. Children who participated in family therapy with their mothers showed greater decreases in alcohol and tobacco use and were less likely to begin using compared to children whose mothers participated in the attention control condition.     

Family Therapy with the Learning Disabled Child and His/Her Family

No therapist can come in contact with and treat children with minimal brain damage or specific learning disabilities without being struck by the fact that there are numerous intertwined factors that have contributed to and continue to perpetuate the problems. In addition to the helping approaches which have been utilized in recent years, such as tutoring, special education, and child therapy, this article elaborates the importance of utilizing family therapy as the treatment of choice sometime during the course of treating the child and helping the parents to understand and deal with their handicapped youngster.     

EFFICACY OF FAMILY THERAPY FOR DRUG ABUSE: PROMISING BUT NOT DEFINITIVE

Drug abuse is an enormous public health problem with consequences not only for individuals using drugs but also for families, communities, and society. Moreover, research evidence and clinical experience agree that drug abuse is one of the more difficult problems to treat. Despite considerable research on the connection between family factors and drug use, and the existence of family therapy models for drug abuse, comparatively few controlled efficacy studies have been conducted. This article presents a critical review of controlled treatment outcome research in the area of family therapy for drug abuse in both adults and adolescents. A number of studies from different clinical research groups demonstrate that different versions of family intevention can engage and retain drug users and their families in treatment, significantly reduce drug use and other related problem behaviors, and enhace particular domains of prosocial functioning. Moreover, a smaller number of comparative efficacy studies have shown family therapy to be more effective than nonfamily therapies. Family therapy of adolescent drug abuse is more developed at present than family therapy of adult drug abuse. Although the results of the reviewed studies are promising, a blanket confirmation of family therapy's efficacy for drug abuse cannot be made at this time because of the relatively small number of studies and the noted methodological limitations of the studies published to date. Nonetheless, substantial progress in this clinical research area has occurred, and if research and funding support continue or can expand, significant breakthroughs in the treamtment of drug abuse with family-based treatments are possible.     

Family-directed structural therapy

Family-Directed Structural Therapy (FDST) is an approach to family therapy built on traditional concepts of Structural Family Therapy, the Strengths Model, and Group Work Theory. The FDST approach is a goal-oriented, time limited approach that enables the family to identify strengths and areas of concern, as well as to enhance family functioning. This process is facilitated via the use of a common vocabulary and a concretely organized, easily administered FDST Assessment Tool that is completed by adult family members. This article presents the essential features of the FDST approach, including the use and scoring of the FDST Assessment Tool. It concludes with an extensive case example.