"Just therapy" with families on low incomes

This article addresses the inadequacies of counseling, therapy, and social work that occurs with low-income families. The author argues that many families who seek help arrive with problems that are usually assessed separately from their socioeconomic and cultural contexts. Careful questioning will often lead to the discovery that the onset of many family problems are located in events external to the family, such as unemployment, bad housing, and racist, sexist, or heterosexist experiences. They can be extremely depressing ongoing experiences that eventually lead parents and children into a state of stress that opens them up to physical and mental illnesses. This article argues that a wide body of research supports such a view and that counseling, therapeutic, and social work practices should address these issues much more directly. It also argues that practitioners have an important role to play in social and economic policy development out of respect for their clients' struggles.     

‘What Was I Thinking?!’ Rhetorical Questions as a Technique to Identify and Explore Impasses in Therapy

Rhetorical questions emerging spontaneously in consultations can be used as a tool for developing self‐reflexivity and exploring the therapeutic alliance in the process of therapy with couples and families. This paper presents a technique based on the enunciation of rhetorical questions, which can point to an impasse in the process of therapy and contain a key to its resolution. The technique focuses on the distinctive feature of rhetorical questions as convening a paradoxical injunction: a question not intended as a question, while uttered as such. The technique in four steps is illustrated by examples from therapy, supervision, consultation, and self‐supervision. Its focus is the interlink between the therapeutic relationship and the process of therapy and it is informed by a second‐order cybernetics approach, dialogical practice, and the systemic literature on emotion. The technique can help develop curiosity in working with families, lead to unforeseen developments, and touch on prejudices not made explicit in previous therapeutic encounters. Whether we are acting as supervisors, therapists, or clients, the creation of a ‘secure enough’ context for rhetorical questions becomes critical to allow freeform exploration.     

UTILIZATION AND INDIRECT SUGGESTION IN MULTIPLE-FAMILY GROUP THERAPY WITH ALCOHOLICS

The great versatility and utility of Ericksonian approaches to psychotherapy are demonstrated by the application of these techniques to large, multiple-family group therapy of alcoholic families. Using such techniques as unconscious conditioning, therapeutic binds, indirect suggestion, and the utilization approach, a therapist can manage an unwieldy group of 70 or 80 resistant patients and lead them in a positive, therapeutic direction. This paper describes how a set of specific goals are achieved using these techniques.     

Working Therapeutically with Indian Families within a New Zealand Context

This article aims to raise awareness amongst non‐Indian therapists working with Indian people by highlighting some of the important aspects of Indian culture within the New Zealand context. Although there is a great deal of diversity amongst Indians, there are some fundamental issues that would have relevance for most Indians. Specific issues relating to immigrant families are discussed, such as the sacrifices made by families in the hope of providing a better future for their children and the difficulties encountered by new migrants. The cultural clash for young people caught between parental expectations and peer pressure can often lead to significant family conflict. Some of the common pitfalls for non‐Indian therapists working with Indian people are outlined and suggestions made in relation to the process of therapy.     

ADAPTING THE MODEL: THERAPEUTIC WORK WITH CHILDREN FROM ARMY FAMILIES

This paper describes the development of a specialised therapeutic service for parents and their young children in an inner city social services family centre. The Under five's counselling service, based on the Tavistock Model, offers brief psychoanalytic interventions to parents who are worried about their young child's development e.g. crying, eating, persistent crying etc. The premise behind setting up such a service was to provide therapeutic intervention to the parent-child relationship at the earliest possible stage, preventing further ongoing difficulties. The paper draws upon observations and interventions with families I have seen in the first year the service was opened. Particular themes which emerged in the work with these families will be highlighted. In particular a link is made between early childhood difficulties and unresolved loss in the mother's lives. Furthermore, the impact of the service upon the rest of the social services family support services is commented upon.     

Structural Problems in the Formation and Function of Blended Families

This paper outlines a structural family therapy analysis of the problems that occur in the formation and functioning of blended families. The difference between blended families and other types of family is discussed and an attempt is made to differentiate blended families from each other. Common structural problems in blended families are described with case study examples. Reference is made to the part that access and custody disputes play in the problems of the blended family and some suggestions are made regarding therapy with these families.     

"I Feel Happy that I Can be Useful to Others": Preliminary Study of East African Women and Their Remittance Behavior

Individuals and their families often migrate for various reasons (e.g., economic wellbeing, civic unrest, medical reasons). Yet often times economic strain can cause families to migrate at different times. This separation within the family units has created the development of transnational family interactions where immigrant families remain emotionally and financially connected across international borders. Remittances, the back and forth exchange of goods and resources between people in the host nation and their counterparts in the country of origin, can often play a vital role in these interactions. Black African immigrants, Black people from the continent of Africa, are one of the fastest-growing immigrant groups in the US and also one of the highest financial remitters. Women are consistent remitters, yet little is known about the financial contributions of women from this continent to their families in their countries of origin. The current study looked at a segment of this population by exploring the remittance experiences of seven immigrant women from the East African countries of Rwanda and Kenya. In-depth, semi-structured interviews were conducted and our thematic analysis revealed five themes: (1) Women felt their families made financial sacrifices for them, (2) Women took on family financial responsibilities, (3) Women felt their families in the country of origin had skewed financial expectations of them, (4) Women felt guilty about their limited finances and inability to send more to their families, and lastly (5) Women invested or had plans to invest in their country of origin.     

Lost in Translation? Embracing the Challenges of Working With Families From a Refugee Background

This article describes the difficulties a mainstream family therapy service experienced in working with families from a refugee background. The experience of six therapists and five bicultural workers, who are also the referring agents, was captured in focus groups, and the reflections that emerged shaped a four‐part approach for working with families from a refugee background. Live consultation, either by the family therapist or bicultural worker, is suggested as a way to marry the expertise of family therapists who are not cultural ‘insiders’ with the ‘lived experience’ and cultural expertise of bicultural support workers. The process of reflecting on therapeutic failure resulted in several principles for working therapeu‐tically with families with a history of refugee trauma, unmet resettlement needs and family relationship challenges. These include maintaining a flexible approach to therapy, ascertaining a clear understanding of the referral context, defining an explicit therapeutic contract from the first session, being mindful of the important role that language plays and terminating therapy if it is contra‐indicated.     

Supervision in Family Therapy: A Developmental Perspective

A group model of supervision of family therapy was implemented by a team of three supervisors with doctoral students in counseling psychology. It was believed that such an approach would provide students with more opportunity to work as therapists with families and to observe a greater variety of families, therapists, and therapeutic styles than in other models. Interchange in supervisory sessions focused on co-therapy issues, observation skills, family dynamics, differing therapeutic techniques and approaches, and planning and goal setting in therapy. This experience contributed to the professional and personal growth and development of students.     

‘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.     

Deception in Family Therapy: Recognition,Implications, and Intervention

Deception, in its many forms, is present in families and relationships across the globe. The impact of the presence and discovery of family secrets or deceptive acts on the individual, the family unit, and the therapeutic process, particularly in the field of marriage and family therapy, has not been thoroughly studied or discussed. Further, deceptive acts during the therapeutic process may have implications for effective treatment planning. This article defines the various forms of deception and its systemic effects on relationships and on the therapeutic process. Possible interventions to address deception in a family therapeutic setting are proposed.     

The COVID‐19 Pandemic and Families in Japan

This paper, which is authored by members of the Japanese Association of Family Therapy (JAFT), describes the COVID‐19 pandemic in Japan from a family systems perspective. The authors are active members of JAFT and include current and past presidents and officers. We describe the course of the pandemic and the ways in which government policies to mitigate the pandemic have affected Japanese families. Challenges that affect Japanese families include the inability to participate in family and social rituals, prescribed gender roles that specifically affect women, high suicide rates, and prejudice against those who are at risk of spreading the infection. The need to shelter in place has also forced family homes to function as a workplace for parents, classrooms for children, and day care services for frail elders, which has resulted in psychological distress among individuals and conflicts among families. We discuss ways that therapists have worked with Japanese families using online therapy.     

Intervention with Families in Extreme Distress (FED)

The FED (Families in Extreme Distress) Project described in this article was developed as an intervention model for families in extreme distress. The concept of families in extreme distress includes not only those families which have been widely regarded as multi-problem families for decades, but also those which may appear to be like any other middle class family. The dis- organization in family functioning that is created by an interaction of many problems results in a durable distress which is repeated throughout successive generations. The intervention design of this project was structured and short- term, and each family in the group met once a week in their own home for ten sessions with a therapeutic team composed of three workers. The target of the intervention was the functioning of the entire family as a unit; and goals included clarifying boundaries, strengthening roles, and developing a communication system. Analysis of the therapeutic sessions revealed several techniques which are useful for intervention with the FED population. The intervention process with these families should be multilevel and case management should not only include providing family therapy, but also advocating and mediating with various institutions in the community, as well as making connections for financial assistance.While some major policy changes may be required to meet the finan- cial and manpower needs involved in such a model, this demonstra- tion project indicates that investing the right resources is worthwhile for effecting change within the FED population.     

The neglected elder: a family systems approach.

Abuse and neglect of older adults is largely an invisible problem. Those who are vulnerable are often hidden from the public eye. Troubled families characteristically maintain an isolated existence and, therefore, the mistreatment of elders can occur without the knowledge of neighbors or interested community members. Factors that operate to keep the problem hidden include society's emphasis on family privacy, the victim's unwillingness or inability to report the problem, stereotypes about the aged, and denial (Quinn, 1986). Although the problem of abuse and neglect of elders is not as prevalent as child maltreatment, it is a significant societal problem in need of increased public awareness. This article will focus on the treatment of elder neglect within the context of the family.     

A Note on Mourning an Adoptive Parent in an Orthodox Jewish Family

ABSTRACT

A sensitive and potentially problematic manifestation of family bereavement situations may occur when one of the mourners is an adopted child. Using an ecosystems perspective, this paper examines the nature of mourning in Orthodox Jewish adoptive families and the therapeutic use of religious ritual and dicta to assist with the maintenance of family homeostasis during the potentially destabilizing period following the death of a relative. A case example is presented, illustrating the value of cooperation between therapists and clergy to determine appropriate interventions. Suggestions are made for the use of analogous rituals to assist a broader range of families.     

Stages of Change Theory in Family Therapy for Sibling Sexual Assault

Family therapy understands the benefits of therapeutically supported dialogue amongst family members when there are challenging themes and topics that need to be discussed. This paper is an attempt to explore ways that family therapists can work with family members who are thrust into therapy rather than ‘voluntarily’ signing up for it. It applies ideas from the drug and alcohol field such as Stages of Change theory and Motivational Interviewing. The paper explores how these ideas and approaches might help family therapists to formulate a concept of resistance and to make helpful dialogue more likely. They are applied to families experiencing sibling sexual assault, where they become involved with a legal response that necessitates a therapeutic intervention.     

Routine-Work-Related-Absence:

Work-related-parental-absence is becoming more common in our society, however the literature has not kept pace with this growing trend. The routine exiting and reentry of a spouse or parent creates disruption in the family system which necessitates family coping. This paper explores the effects of work-related-absence on families and the coping mechanism commonly used by these families. A theoretical framework is developed hypothesizing relationships deduced from the literature. The framework also illustrates the importance of therapeutic intervention for families experiencing difficulty coping with routine absence of a spouse or parent.     

Houses are a Necessary Illusion: Uncovering Family Process Through Asking Families to Draw a Plan of their Homes

The way families organise their living space is an indicator of family relationships. The physical shape and organisation of houses, flats and dwellings of all kinds are not ‘unchanging natural phenomena’, they are historical, cultural, economic and family constructions. Therapists, like families, ‘do not see that they do not see’ (von Foerster, 1994). They are partly ‘blind’. This becomes apparent when a therapist asks a family to draw the plan of their house. The therapeutic task illuminates the organisation of family bonds, and provides insight into the causes of family suffering. A clinical example is given.     

Therapeutic control in family therapy

This article emphasizes the importance of establishing therapeutic control in family therapy. Therapeutic control is viewed as similar to conducting an orchestra or directing traffic. Problems that interfere with its implementation are related to the limited appreciation by the therapist of understanding the requirements and responsibilities of a leadership role, the lack of knowledge and experience of the therapist, the difficulty in establishing the relationship between presenting problems and family conflicts, being overwhelmed by the perception or expression of strong feelings, discomfort in presenting options. A therapist who is in control of the therapeutic process is able, comfortably and gently, to lead family members, who initially are often in chaos or resistive, to discuss hidden feelings and conflicts. Often, through the therapist's initiative and articulation of understanding of the problems, the family, more relieved than threatemed, is able to focus on major issues.     

The Logical Difference Between Prevention and Treatment

The authors have spent 2 1/2 years investigating the process of change in family systems presenting with addictive symptoms in one or more of their members. The context of this research has been the systemic family therapy of more than 36 families in a hospital based drug and alcohol service. Emergent from this research is evidence of potentially destructive effects upon families and addicts who present requesting help, by referring them to programmes which are educative or preventative in nature. The case will be put for a clear distinction to be made between the functions of ‘prevention’ and ‘treatment’ in multi-disciplinary teams in addiction services (and by implication other community health services); and for establishing a more rigorous intake system based upon such a distinction and designed to respond more appropriately to presenting requests by potential users of such a service.