Family Therapy: Out from Behind the Hero Narrative

Schools of family therapy have been highly selective in their presentation of the theory/practice nexus. Family therapy's method of teaching (the infamous workshop format) has hampered it's growth as a practice and academic discipline. An inadvertent, unhelpful legacy of Gregory Bateson has been that lesser scholars have aped his capacity to draw on other fields of knowledge without his rigour, or his propriety. Family therapy's cavalier dealings with bodies of knowledge and its reliance on miraculous case studies has resulted in the bypassing of individual suffering. The heroic narrative that has dominated family therapy has precluded other styles of stories for therapists, theorists and clients. Family therapy has been dominated by the myth of the hero, with its accompanying motif of the puer eternus (the eternal youth). Family therapy has been forever reinventing itself, forever the ‘new kid on the block’. This fascination with newness has interfered with family therapy's capacity, at times, to consolidate its genuine value as a therapeutic entity.     

‘Family ideology’: identification and exploration

The issue of ‘family ideology’ has been systematically ignored by a majority of ‘family¹ scholars whilst it has been taken for granted by a minority. The following study arises from the author's attempts to explore the issue of alternative theoretical approaches to the analysis of family life’.² Increasing numbers of contemporary researchers concur in recognising the diversity of ‘family forms’ and the inappropriateness of speaking of ‘The Family’.³ Despite these recognitions many researchers find themselves re-adopting the term ‘The Family’ in their discussions and especially in the titles of their work. For example. Segal clearly recognises that the ‘traditional family model’ no longer reflects the reality of our lives (1983, 11) and yet the title of her book is What is to he done about THE FAMILY? (emphasis added). One reason for the re-importation of the idea of ‘The Family’ may be found in the rather limited nature of previous conceptualisations of ‘family ideology’. With the exception of Barrett (1980), recognitions of ‘family ideology’ tend to be conceptualised in terms of sets of partisan beliefs supporting a particular ‘family form’. Thus the concept of ‘The Family’ is rarely regarded as being problematic in itself, rather attention is paid to the presumed virtues or deficiencies of the particular form of ‘The Family’ which is assumed to be prevalent. Notwithstanding the recognition of ‘family diversity’ or the inappropriateness of the term ‘The Family’, nearly all discussion becomes a straightforward attack upon, or defence of. ‘The Family’.⁴ Only very rarely does analysis avoid this trap and question whether ‘The Family’ really exists to be attacked or defended; thus Collier et al. have asked ‘Is there a Family?’ (1982) and the present author has asked ‘Do we really know what “The Family” is?’(Bernardes, 1948a). The objective here is to identify and explore a specific conceptualisation of ‘family ideology’. The aim is to avoid engaging in attacks upon, or defences of, ‘The Family’ but rather to address the ideological context of such debates themselves, especially in respect of the assumed existence of ‘The Family’. It is hoped that this approach will stimulate a much more critical examination of ‘family ideology’ and the concept of ‘The Family’. More generally, the attempt to conceptualise ‘family ideology’ in this much broader sense is seen as a pre-requisite for the development of an alternative theoretical approach to the analysis of ‘family life’.     

Family Therapy's Coming of Age: Less Haste,More Speed

Responding to the question implicit in the title of the 1985 National Family Therapy Conference ‘Coming of Age’, the author argues that Australian family therapy still has a number of issues to face before it can be said to be a mature and independent adult. The paper focuses on three issues — ideology in family therapy, theory for practice, and practice itself— and raises questions about the adequacy of Australian family therapy's theoretical maturity, suggesting that there is still too much reliance on the ‘new’ and on the ‘guru’ rather than on a solid building on therapeutic experience.     

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.     

Mitigating Intergenerational Trauma Within the Parent‐Child Attachment

Nine‐year‐old Ben was said to hate women. His mother was terrified he'd ‘grow up a woman basher’. This paper describes the work done with Ben and his family at the Hobart Child and Adolescent Mental Health Service. We drew predominantly on three therapeutic modalities: Theraplay, Family Attachment Narrative Therapy and Dyadic Developmental Psychotherapy. Our work enabled Ben's mother to navigate the aftermath of her own trauma history in order to heal Ben's attachment trauma.     

Setting the House on Fire: The Melbourne Interview With Salvador Minuchin

Brian Stagoll interviewed Minuchin via satellite in front of a conference plenary audience at the Inaugural Pan Pacific Family Therapy Congress in Melbourne, 2001. Minuchin looks back over his working life, and weaves the various leaders of the family therapy field in the US into an ‘American Quilt’. He also responds to questions about his own impact on the field, and his prediction that by 2000, family therapy would be triumphant.     

Love is Not All You Need: A Revolutionary Approach to Parental Abuse

This case story is a composite of similar family situations where the parents were at risk of harm from their teenage children and commonly the father/step‐father has moved out of home leaving the mother to parent the children on her own. Several of these cases involved physical threats to the lives of the parents. These referrals occurred in a Child, Adolescent and Family Mental Health Service and a Family Therapy NGO between 1985 and 2005. This approach is offered as a complement to the widely published ‘non‐violent resistance’ approach of Haim Omer and his colleagues. We hope it goes some way to address what Lavi‐Lavavi et al ( 2013 , Journal of Systemic Therapies, 32(4), 79–93). describe as ‘the mother's plight’:

The plight of the mother continues to present a major challenge… We are also seeking ways to allow the mother more breathing space, help her to disengage from abrasive conflicts, acknowledge her contribution and sacrifice, and provide her with vantage points that may help her recognize and enhance small improvements. Hopefully, these measures will enable women to evolve from unacknowledged victims to pillars of the family’ (p. 92).

     

No Small Change: Process‐Oriented Play Therapy For Children of Separating Parents

This article looks at a process‐oriented play therapy for children adversely affected by parental separation. Process‐oriented play therapy is a therapeutic method that involves the therapist directly entering the ‘world of play’ with the child, by amplifying various modes of expression and helping underlying meaning to emerge, in order to help children access aspects of their life they feel they have no say in. One particular case has been used as an example, involving ‘Jim’ (pseudonym) and his mother, who attended the play therapy session.     

At the Heart of Therapy: A Conversation With Ron Perry

Ron Perry has recently retired from his position as Director of the Institute of Counselling in Sydney, a position that he held for 35 years. Over the course of his career, his interest in all aspects of counselling, and his enthusiasm for family therapy, led him to attend numerous training programs and workshops overseas as well as in Australia. Like others at the time, he progressed through the ‘new’ models of therapy as they evolved over the 1960s, 1970s, 1980s and 1990s. He has been a consultant to many individuals and groups across Sydney, and was a trainer and supervisor for 10 years with Margaret Topham's Family Therapy Institute of Australia. In 2005 Ron was awarded an Order of Australia Medal for ‘service to the community as a counsellor, particularly as one of the founders of the Psychotherapy and Counselling Federation of Australia’.     

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.     

The Milan Principles of Hypothesising,Circularity and Neutrality in Dialogical Family Therapy: Extinction,Evolution, Eviction… or Emergence?

The primary aim of the three Milan principles of hypothesising, circularity and neutrality was to proffer an effective methodology for interviewing families, with a secondary aim of casting off the stereotypical personal therapist qualities such as intuition, charisma and concern. The progression of the principles from the original Milan model through to contemporary approaches is intriguing. The following article consists of two sections. First it tracks the progression of the three principles through the Milan, post‐Milan and postmodern approaches to family therapy. Given their recursive nature, they are revealed as responsive to developments in theory and practice, as well as the influence of the wider societal context. The second section of the article explores hypothesising, circularity and neutrality in the contemporary approach of dialogical family therapy. The relevance of the three principles to the therapeutic process, the therapeutic role and the therapeutic relationship is considered. Such an exploration does not seek definitive answers or ‘truths’, but seeks to conceptualise a vague ‘knowing’ that there is continual learning and growth in grappling with the tensions in this field, in remaining ever curious, in asking the questions …     

The Ecological Perspective Revisited*

Family therapy inaugurated a radical change in the way many emotional and psychiatric problems are understood. ‘Systems thinking’ dictated that the individual needed to be seen within a larger systemic context if his/her behaviour was to be understood and effective intervention carried out. The logical extension of this way of thinking is to argue that the family itself must be viewed within a wider context. This perspective has appeared a number of times in the family therapy literature, particularly in the ‘ecological’ tradition. Utilising an ecological perspective can, however, lead to a new and less clearly defined role for the therapist, and there are thus good pragmatic reasons working against its adoption.     

A Pilot Study to Explore the Influence of the ‘Safety First Assessment Intervention’ on the Family Environment

The family environment is considered an important influence on a young person's well‐being. The ‘Safety First Assessment Intervention’ is a model of care that considers and incorporates the importance of family environment when assessing and managing distressed young people. This pilot study explores the influence of the ‘Safety First Assessment Intervention’ on the family environment of young people referred to Child and Adolescent Mental Health Services. A pre‐ and post‐design was used, with families completing the Family Survey before and after their assessment/intervention. The Family Survey was correlated with a validated measure of family function, the APGAR, and pre‐intervention. Significant changes in multiple dimensions of family environment, including reduced level of distress for the adult, increased level of distress for the young person, improved sense of how the family felt the adult was managing currently, and improved confidence in family communication were found. There was no significant change in how the adult understood their role in helping the young person manage their distress. A thematic analysis showed trends in the current concerns for young people and adults as well as the difficulty young people in distress have in identifying their strengths. This pilot study demonstrates that the ‘Safety First Assessment Intervention’ can influence the family environment in a positive way and highlights the importance of using a family‐based approach for distressed young people.     

A Black and White Model for Teaching Family Therapy: Empowerment by Degree

In this article, I describe and reflect on the rationale, development and teaching of the first university‐based post‐graduate course in family therapy delivered to Aboriginal child, family and health workers. Alongside my Cultural Consultant, Shaun Coade, and with support from key staff at the Bouverie Centre in Melbourne, I developed and delivered the first four iterations of the La Trobe University Graduate Certificate in Family Therapy to Aboriginal students and a relatively small number of non‐Aboriginal students. Since 2008, the course has been successfully completed in six Victorian locations and is currently being delivered at Shepparton and in Cooktown, Queensland. The term, ‘Black and White’ was coined by Shaun and by the Aboriginal family therapy students to describe the delivery of a family therapy curriculum that meets mainstream University requirements while being embedded in Aboriginal culture and Aboriginal wisdom. A largely unanticipated bonus was the realisation that the model of teaching also has important implications for the mainstream teaching of family therapy. After providing a brief summary of enrolment and graduation rates, the article picks up on elements of the teaching and learning that proved to be central to the successful delivery of the course.     

The influence of the Milan approach: Five decades of intergenerational change. A conversation with Matteo Selvini

The ‘Milan Approach’ made an enormous contribution to psychotherapy and psychiatry and has been viewed as a bedrock in the family therapy field. Mara Selvini-Palazzoli made a revolutionary shift in the early 1970’s to abandon individual therapy and adopt family therapy to treat anorexia in young women. The goal of the three systemic principles; hypothesising, circularity and neutrality, proposed by the Milan Team is to elicit a useful method to interview families which encourages the production of meaningful information. The Milan group took special care of language. Rather than overly focusing on the label and referring to schizophrenia as a diagnosis, for instance, they used the term ‘families in schizophrenic transaction’. This perspective more realistically explored the origin of problems while looking at ways how to effectively generate change. In the early stages of its development, heavily influenced by the work of the MRI, the team adopted a pragmatic and strategic approach, however the focus gradually shifted towards semantics and the story of the system. While the ‘systemic identity’ was the principal guiding principle, the model was also influenced by social constructionism. This paper is a distillation of a conversation held with Matteo Selvini, son of Mara Selvini Palazzoli. We discussed the four key influential figures who developed the ‘Milan approach’, Selvini Palazzoli, Boscolo, Cecchin and Prata. The focus of the conversation is on Mara and on her influence shaping the approach, its evolution through the years leading to the creation of the Scuola di Psicoterapia Mara Selvini Palazzoli. Matteo also shares his own influence in the evolution of the school through the intervening years. He explains the adapted version of the Milan approach and the amalgam of the original and emerging therapeutic concepts. His key messages to therapists are the importance of working in teams and client follow-ups.     

Family Therapy in Child and Adolescent Mental Health Practice: Integrating Family Therapy in Child and Adolescent Mental Health Practice: An Ethic of Hospitality

This article integrates family therapy in contemporary child and adolescent mental health services as an evidence‐based practice. An integrative practice model is proposed where contextual approaches like systemic and narrative therapy complement and enrich individual problem‐focused models such as biological psychiatry and cognitive therapy. This is based on an ethic of hospitality towards all therapy discourses and the following best practice guideline: ‘To make optimum space for a systemic and narrative understanding contributes to evidence‐based practice in a contemporary mental health service.’ After discussing some dilemmas of integrative practice, I illustrate the therapeutic process by a detailed example of integrative family therapy with a depressed suicidal adolescent.     

The Discursive Performance of the Alliance in Family Therapy: A Conversation Analytic Perspective

Following the ‘discursive’ turn in family therapy, the attention of practitioners shifted towards understanding how culture and language shape meaning‐making in therapy. In this article, we demonstrate how conversation analysis (CA) can be used to examine the processes and outcomes of systemic/constructionist practice. We used CA to study collaborative interactions of a renowned constructionist therapist Karl Tomm and one client‐family. Viewing collaboration as a pivotal aspect of the therapeutic alliance, we demonstrate how the ‘split’ within‐system alliances were developed and sustained in the course of therapy and how they were discursively transformed into ‘intact’ alliances. The therapist's efforts to align with perspectives of family members (and subsystems) seemed pivotal in this process.     

A Comparison of Seven Family Therapy Approaches

Dimensions which should be part of a family theory are developed by drawing from ‘Integrative Family Therapy’, a theory incorporating the concepts, hypotheses, and techniques of American family therapists. The family theories of seven family therapists (Minuchin, Haley, Zuk, Friedman, Speck, Boszormenyi-Nagy, Rubinstein) are described and compared with one another. Their limitations are shown and thereby the characteristics of approaches of family therapy are indicated. Their contribution to a more encompassing ‘Integrative Family Theory’ is shown.