Breaking the race barrier

Through the reflective process of analyzing one's own feelings and reactions to the ethnic minority patient, the white therapist develops an inner clarity that serves as a resource to cope with the unique conflicts one must confront in interracial practice. Only when the therapist has come to some resolution of his or her own feelings about the plight of ethnic minorities in this country can this acumen develop. Although the therapeutic skills applied in psychotherapy with ethnic minorities are in no way different from overall therapeutic skills, certain techniques may be especially useful in interracial practice. For instance, a discussion of the meaning of race and ethnicity in the relationship may curtail racial distortion, prevent stereotyping, and lead to the creation of a therapeutic alliance. When dealing with transference and countertransference issues, the therapist must be particularly attentive to the representation of these same distortions and stereotypes. Formulating clinical problems from dual perspectives, theoretical and sociocultural, is an arduous, but necessary task. Finally, the white therapist must be able to view ethnic minority patients as individuals. Although these patients cope with special problems which must be acknowledged and dealt with in therapy, the therapist must realize there is a common ground on which to communicate. On this common ground, therapists discover the foundation of interracial clinical practice is the ability to accept and respect their patients and themselves as individuals who may have similar anxieties, problems, experiences, and goals. It is through the recognition and sharing of the fundamental human bond that ethnic and racial differences, which may have detrimental effects on interpersonal relationships, are transcended.     

Psychiatric crises: making the most of an emergency room visit

A hospital-based or comprehensive mental health system may attract many patients for a variety of reasons. Labeling a patient's difficulties as "true crises" or "non-crises" detracts from providing growth-producing insights for the patient and identifying useful management strategies for the therapist. The challenge is to foster the patient's emotional development and to facilitate his entry into treatment or strengthen his established treatment. Making the most out of the emergency room visit means exploring appropriate issues with the patient and discussing the content with any therapist who is involved with the patient.     

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.     

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.     

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.     

The therapist who is perceived as "spiritually correct": strategies for avoiding collusion with the "spiritually one-up" spouse

Marital and family therapists who are perceived by the community as having a strong spiritual orientation face unique and difficult challenges. Clients who seek their help often bring a mix of expectations that can create a situation in which the therapist may struggle with multiple roles, some not of his or her choosing. These expectations are especially challenging when one spouse views him-or herself as "spiritually one-up" and wants the therapist to form a spiritually based coalition against the other partner. This paper describes the various dilemmas that therapists may face when clients perceive them as having spiritual expertise and presents strategies that can be used for avoiding these dilemmas. A case study illustrates the use of these approaches.     

Self‐Soothing — A Recursive Intrapsychic and Relational Process: The Contribution of the Bowen Theory to the Process of Self‐Soothing

The concept of self‐soothing originating in the psychodynamic tradition has attracted interest from therapists as a key skill in the managing and regulating of strong affect and emotional discomfort. While a capacity for self‐soothing is implicit in, and a vital prerequisite to, the process of differentiation, Murray Bowen also predicted that the outcome of increased differentiation is improved emotional equilibrium and a capacity for self‐soothing, clearly a recursive process. The attention of Bowen family systems theory to both the relational and intrapsychic aspects of human functioning provides a useful framework through which to explore these aspects of the dynamics of self‐soothing. This article describes some of the key processes involved in developing a self‐soothing capacity within an effort to define a more autonomous self in significant relationships. The author contrasts Family Systems thinking with other theoretical perspectives that speak to the importance of self‐soothing. Finally, the role of the therapist as a facilitator of an environment in which the self‐soothing resources of clients can emerge is considered alongside suggestions and strategies for how a therapist may contribute to a client's own efforts.     

Structuring Home-Based Therapy: Four Phases to Effective Treatment

ABSTRACT

Home-based services are gaining more popularity than in years past. Therapists going into the home are exposed to various treatment issues that differ from those in a clinic or office setting. One of these issues is that of structuring the therapeutic process. Much has been written about the structure and stages of clinic-based therapy; however, little is known about the process of home-based therapy. This paper will delineate four phases of home-based therapy which the in-home therapist can use as a guide to provide faster and more effective services.     

Treatment of Sexually Abused Children: Interview Technique,Disclosure, and Progress in Therapy

ABSTRACT

The closed records of 50 children referred for treatment following sexual abuse were analyzed to determine the relationships between therapist structure for disclosure of the abuse, whether the child disclosed, clinical improvement, and several other variables. Ten children revealed details of their abuse in response to introductory structure by the therapist, while 19 children required ongoing structure to disclose such details. Five children did not respond to therapist structure with a disclosure. In contrast, only 1 out of 11 cases disclosed when the therapist did not structure for disclosure. Six of the children who disclosed took five or more treatment sessions to do so. Those who disclosed showed rates of clinical improvement similar to those who did not disclose. Neither maternal support nor foster home placement was related to disclosure or to clinical improvement.     

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.     

Towards a Multicultural Society: Family Therapy with Greek Families†

Language and cultural differences can pose barriers to effective intervention in migrant families in conflict. Family therapy approaches can provide some useful strategies for overcoming these obstacles. A family therapy approach can (1) emphasise the value of utilizing natural network support systems; (2) provide a model which helps clarify communication problems arising in the relay of information through a third person acting as an interpreter; (3) underline the importance of non-verbal and process aspects of family communication; (4) suggest techniques for negotiating, joining, and finding commonalities of family experience between a therapist and family of different ethnic background. The therapist needs to develop sensitivity to both the universal and specific ethno-cultural structures, norms and problems of families; when this sensitivity is achieved powerful and culturally syntonic healing forces can be released. Examples of successful family therapy interventions in some Greek families in conflict are given.     

Gay Affirmative Psychotherapy: A Phenomenological Study

There is a need for gay and lesbian affirmative psychotherapy in a society in which gay men and lesbians endure prejudice and discrimination. Using a phenomenological model informed by feminist methodology, this study investigated the gay male client's experience of gay affirmative therapy. The participants shared their experiences in in-depth interviews. Phenomenological analysis revealed certain therapist qualities which were experienced as affirmative. Findings showed that with sensitivity, imagination, and experience, the heterosexual therapist can be gay affirmative; the gay therapist may more readily serve as a role model. Results are compared with other research, and recommendations are offered for future inquiry.     

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.     

Mumbling. A defense mechanism in therapy resistance

Mumbling is a defense mechanism that is evidenced in therapy as resistance. Although mumbling is frustrating and annoying at times, it may be a helpful clue to some of the client's most anxiety-provoking thoughts or feelings. If the therapist can note the timing of the mumbling or the tone that accompanies it, these may be the first steps in focusing on the client's most resisted areas in therapy.     

Returning to psychotherapy with the same therapist: A self psychological perspective

Terminations or interruptions of psychotherapy which have been followed by a patient's resuming therapy with the same therapist at a later time have often been viewed as premature with the implication that the initial therapy has been inadequate or deficient. This paper suggests, however, that a patient returns to the same therapist because the selfobject bond established in the initial treatment is still intact, and that the hiatus between treatments can be a time of further development and strengthening of self structure. Two clinical cases are described which illustrate these ideas.     

Dual-Career Marriages: Implications for the Clinician*

This paper discusses the unique characteristics of dual-career marriages/families. These familial units are identified as a high stress group presenting unusual challenges to the clinician. Specific implications for the clinician include (1) values of therapist and clients; (2) critical issues; and (3) assets and liabilities. It is concluded that while dual-career couples may be demanding clients, the therapist can be sure he/she will have an intriguing, eventful, and meaningful experience along the way.