Training family therapists to work with children and families: a modified Delphi study

This study examined child inclusion issues and training marriage and family therapists (MFTs) to treat children. This modified Delphi study utilized a panel of experts, and gathered data through questionnaires and qualitative interviews. Panelists believe children should participate in family therapy sessions for both child and adult problems, except when parents are discussing sex or sensitive issues. Child-focused courses should emphasize developmental issues, engaging techniques, theoretical issues, play therapy theory, MFT treatment for child disorders, and specific child/family problems. Panelists suggest numerous child-focused references, but reached consensus for only one. Key therapist attributes and skills were identified. Deductive and inductive training methods and the role of supervision were highlighted. Although therapist playfulness and creativity were emphasized, few play techniques were included in the final profile.     

AN ETHNOGRAPHY OF COUPLE AND THERAPIST EXPERIENCES IN REFLECTING TEAM PRACTICE

Couple and therapist perspectives about the use and process of reflecting team practice were analyzed using ethnographic research. A domain analysis was performed on postession interviews from both couples and therapists, and on field notes from each therapist. Seven couples and five therapists were interviewed at least twice over a 4-month period concerning their reactions to and perceptions of reflecting team practice. Six domains concerning reflecting team practice emerged from the analysis: (a)benefits of its use, (b) effects of gender, (c)recommended use, (d) contraindicated use, (e) the importance of creating spatial separateness between couple and team members, and (f) sequences of communication between the couple and team members that elicit change. The latter two domains described the process of reflecting team practice (i.e., steps in how it is used and how it is implemented). The role of ethnog rahy in reflecting team practice and in family therapy research is discussed.     

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.     

Family therapy: An orientation

Conclusion The family therapist is an active, involved therapist. He must be emotionally lithe and resilient, prepared to deal with, or deal out, the unexpected. His challenge is to learn to use his own impulses and reactions in a way that the family can use to understand themselves better. He makes use also of any people and resources in the family's environment which might be of help to them. There are some basic techniques and orienting principles available to the family therapist, and it is these which it has been the task of this paper to set forth. Beyond these, the responsibility rests with each family therapist to comprehend himself and his place in his own family, and then to use his creativity to transform what he knows and what he feels into a form which can be used by the families he treats in their development.     

For the Sake of the Children

Without exception divorce is a significant event in the life of any child. For the child, divorce may represent a sense of loss, a sense of failure in interpersonal relationships, and a prelude to a difficult transition to new life patterns. Unfortunately, in our society today there is a limited support system available to the family through this process of change and emotional stress. Today, regardless of even religious beliefs, it is widely accepted that there are those situations in which it is impossible for all family members to remain together in the traditional pattern of living. The psychological effects of divorce and separation on children cannot be viewed in a unitary way. The circumstances around the divorce and separation must be considered as well as the age, sex, and personality makeup of the child. When we consider the effect of divorce or separation on children, we must equally consider the effects of living in a home where there may be ongoing tension, conflict and stress. "For the sake of the child," regardless of the short and long-term consequences, divorce or separation at times is the most viable solution to optimizing the potential of that child for sound emotional and personal growth.     

‘My Child is Anxious Because We Might Get Deported’: Brief Therapy from MRI with an Immigrant Family in the United States

As we go to press in a COVID-19 world, the topic of anxiety is foremost on our minds. While each situation has to be considered in its own context, how to manage different anxieties has common denominators. There is currently a sharp increase in forced migration around the globe so mental health professionals must develop effective skills, like the ability to adapt services to different contexts and cultures, to manage the needs of immigrant people. Problem-Solving Brief Therapy, as developed at the Mental Research Institute in Palo Alto, is a systemic model of therapy, which aims at promoting change in the complaint the presenting client (the ‘talker’) cares about. The model’s roots in Constructivism foster integrating the clients’ beliefs and values into therapy to allow the therapists to adapt to the clients’ particular needs. This paper is the analysis of a single case where the therapist worked with an immigrant family because their child suffered from severe anxiety related to the parents’ threatened deportation. The paper focuses on premises and strategies that allowed minimising cultural barriers between therapists and family members, thus facilitating a strong therapeutic alliance conducive to improvement.     

An exploratory investigation of family functioning for child inpatients: Implications for practice

This paper presents the results of an empirical investigation of family functioning for a sample of child and adolescent psychiatric inpatients. The McMaster Family Assessment Device, completed by patients and other family members at the time of the child's admission, provides an assessment of family competence in six areas; problem solving, communication, roles, affective communication, affective involvement, and behavior control. Results indicate that families of child and adolescent inpatients experience significant problems across all dimensions of family functioning. Further, patients report that family problems are more severe than do other family members. Implications of the study findings for social work practice are discussed.     

An Educational Model of Family Consultation*

This approach to working with families under stress recognizes the family as a system interacting via communication patterns among its own members and within a larger context of peers, neighbors, school, work, and community agencies. The goal is to help the family become a support system for all its members, more capable of meeting both adult and child needs for ongoing socialization and personal growth. The model is educational in that the focus is on teaching the family to identify strengths as well as dysfunctional behavior, and to acquire some basic communication and problem-solving skills. Methods are both cognitive and experiential. The approach is useful in short-term therapy with single families or groups of families.     

The Family Picture

In the family picture the camera records during the first and last session how each family member arranges other members in a tableau or family sculpture. The picture offers the therapist and family a quick opportunity to learn about each other. It visually depicts the coalitions, the separation or togetherness of family members, which help the therapist formulate therapeutic goals. When the pictures taken during the first session are compared with those taken during the last session, they can be a validation of the positive family changes .     

Engaging Fathers in Family Therapy with Violent Adolescents

Violent behavior in adolescents can often signal profound distress or pain arising from family conflicts, hostile marital separations, sudden losses and other family turmoil. By circumventing blame the therapist engages the family in a constructive process that allows adolescents to change and grow and parents to share pain and sorrow about their own issues and responsibilities for their children. This re‐establishes healthy generational boundaries, produces a clearer co‐parenting alliance (e.g. after divorce) and creates sibling support. This paper describes an experiential approach, for working with violent adolescents in family therapy influenced by the pioneer work of Satir and Whitaker. It integrates systemic and developmental theories linking the presenting problem to relevant family events. The therapist: (1) explores adolescent development in the family and social context; (2) establishes a therapeutic alliance through understanding the interpersonal context for violent behavior, and (3) re‐directs negative actions into positive connections with family members. Segments of family therapy sessions with two adolescent boys and their families from different cultural backgrounds illustrate the impact of paternal absence for adolescent well‐being and the need to actively engage fathers in family therapy. Mario, the father's ‘tumor’, and Juan with his despairing violence are two problematic adolescents brought to therapy because of their aggressive behavior at home and/or in the school. The paper describes how to give them a different voice and build a therapeutic alliance with the family.     

Family Assessment and Intervention Using an Interactive Art Exercise

The authors have developed a family-centered interactive art exercise from a synthesis of clinical tools used by attachment theory and family art therapists. The exercise aims to facilitate assessment and treatment of families with younger children (two to eight years) at a tertiary referral child and family psychiatric facility, by observing how a family collectively as well as individually sets about planning and completing an art task. Art exercises allow for both verbal and non-verbal communication. The exercises are deliberately kept simple in order to span a range of developmental abilities, and allow the therapist/s to observe from behind a one-way screen, so as to be less intrusive in the family dynamics. Although developed for assessment with a specific population, the exercise is likely to be useful in other clinical situations and has been used as a treatment tool by the authors.     

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.     

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.     

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.     

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.     

La metafora: the power of metaphors and creative resources in working systemically with families and children with autism—a conversation with Carmine Saccu

Metaphors are valuable tools of expression, which give meaning to situations and allow the spontaneous processing of feelings and emotions. As therapists, we can support clients to develop and create their individual metaphor to explain their own meaning of experiences or communicate their perception of problems. Creativity provides us with a rich landscape to explore, expand, and enrich ourselves as therapists and consequently our clients. As systemic therapists, we are responsible for the co-creation of a human process, which has at its core safety in allowing expression, connection, and movement. Through a respectful and curious approach, we can develop pathways to tap organically into our ‘creative selves’ while reaching into our clients' creativity and selves as catalysts for connection and positive change. Creative resources and therapies have been successfully used in psychotherapy to enhance the mental and emotional well-being of children, particularly children with autism who have limited verbal capacity or who are non-verbal. These children also wish to be understood in expressing their thoughts and feelings; however, they use other methods of communication – sometimes obvious, sometimes not. Therefore, it is important that a therapist can access diverse ways to support the child through this process. The creative use of animals in therapy neutralises spaces, eliciting calm, safety, and healing. This is particularly the case when working with this group of children. This paper is derived from my conversation with an elder statesman of the family therapy profession, Professor Carmine Saccu. He is a jovial master storyteller who craftfully communicates via metaphors. Through creative means, play, and humour, he has developed a remarkably unique way of working with children, especially non-verbal children with autism. He uses his canine, co-therapist Mafalda, as a powerful resource and intervention strategy to safely elicit engagement and connection in the therapeutic space.     

Does the Therapeutic Relationship Matter? A Follow-up Study of Adherence and Improvement in Family Therapy

A follow-up study of 83 families treated by family therapy at a child guidance clinic was conducted and the relation of client/therapist interaction to (i) drop out from therapy and (ii) improvement was examined. Early terminators were found to differ significantly from continuers as to their ratings of their relationship with the therapist, and trends were found for therapists' feelings to be associated with adherence to therapy. Early terminators were not distinguished by diagnosis, severity of case, or improvement rating. Improvement, on the other hand, was not associated with therapists' or clients' attitudes to each other. It is suggested that these factors are of greater significance in “joining” therapy than in its course.     

Family Work and Acquired Brain Damage

Acquired Brain Damage (ABD) causes immense difficulties for individuals and families and is increasingly recognised as a serious community issue. This paper focuses on the burden placed on family members with a head injured relative. The authors propose that when working with families with a member with a neuropsychological condition, the family therapist may be required to embrace a more flexible role. Depending on the developmental needs of the family, the family therapist may at times: provide educational information about brain damage and its effects arrange family support groups or wider network meetings be the family's advocate in the context of complex legal and financial bureaucracies or undertake marital, sexual or family therapy when required. Whatever the role played, a ‘family sensitive practice’ approach by family therapists is advocated. It is also deemed useful to develop a theoretical assessment model which helps the therapist locate where individual family members are in their negotiation of the tasks of grieving, restructuring, identity reformation and achieving a sense of growth after head injury. Further implications for clinical practice are outlined.