Family Therapy Following the Death of a Child*

The reactions of the entire family system to the death of a child are examined. The case illustrates therapeutic interventions dealing with changes in family structure, guilt and mourning processes in parents, anxiety and other reactions of children, and the cognitive confusion of both children and adults. The problems for the therapist in working with a family following the death of a child are discussed.     

Staying with it: A case study

Abstract

This is a case study which illustrates some of the conflicts and dilemmas facing local authority social workers in child protection. The worker had to learn to understand and deal with his feelings about a client, who was at different times unable to communicate verbally, sexually procative and seductive, hostile and aggressive. For the client there was a gradual shift from acting out her fears and fantasies about men, to being able to verbalise and trust the worker.

The worker moves towards an understanding of the client's problems and also of his own difficulties in dealing with the case. He believes that his personal involvement was of value to the client.     

Despite years of failed treatments,patient cuts back on drinking

A social worker, a mother and conference calls all united for what looks at this time like a happy outcome for one young man, despite the failure of multiple treatments. Residential treatment, individual counseling, Vivitrol, AA attendance, an interventionist and a stint at an unlicensed rehabilitation center all may have helped in this case study of a young man — age 36 by the time he started working with Patrick Doyle, a social worker who is a family coach enlisted by the patient's parents. But ultimately, they all failed, and the young man was in risky territory, with binges and blackouts. What saved him was his mother's decision to stand up to the insistence by the “recovery team” on total abstinence. The recovery team included Doyle, who recounted the story to ADAW last week, the parents, the therapist, and the interventionist.     

The celebration of death in group process

This paper discusses the mobilization of group resources in facing death. It delineates the evolvement of group process when patients and therapist learned of the oldest member's terminal illness. It deals with the group's commitment to his request for help in dealing with his last life crisis by being actively with him through his hospitalization and last rites; the commitment to death with dignity; the group's responses to the therapist as role model in dealing with death and seeing a facet of her which had not been evident to them within the confines of the office, the working through of the patients' and therapist's feelings of loss of loved ones particularly the father; and the countertransference resistance which resulted and its effect on group process.     

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.     

Locating an American romanticism: Emerson,Cavell, 'Experience'

Abstract

This article reads Ralph Waldo Emerson's 1844 essay 'Experience' as a work of mourning that gives rise to critical reaction in the romantic tradition to specific philosophical ideas New England had imported from Europe early in the 19th century. The author reads this transatlantic interaction in the wider context of journal entries, arguing that the death of Emerson's son is a test to Emerson's philosophy and his literary form, indeed, the highest challenge, against which the claims of philosophy and literature could only fail. Moreover, it is the failure of his philosophy to contain his son's death, to express it, that makes Emerson's essay romantic. Defining romanticism as incompletion: the impossibility of a total system which would include, for example, the death of the other (Cavell, Lacoue-Labarthe, Nancy, Blanchot). This, the author argues, proposes a 'location' for American romanticism that constitutes an adequate response to Critchley's contention, in his reading of Cavell, that Emerson is not, in fact, romantic.     

Family Therapy in France: An Australian Perspective

This article is an exploration of family therapy in France by an Australian social worker and family therapist. It also reports on the 2010 European Family Therapy Conference and includes an interview with Dr Mony Elkaïm that provides an overview of his work. All this is discussed in terms of its relevance for family therapists in Australia. It is followed by a brief response from Dr Elkaïm.     

Social work intervention with bereaved children

Abstract

Bereavement in childhood can seriously affect a child's development. There is a tendency to diminish the child's experience of loss because bereaved parents are often less sensitive to their children and because children express their grief in a more discreet manner than is typical of adult grief. This tendency leads to the child's needs being underestimated and under-reported. A model of social work intervention which advocates short-term involvement has been shown to have a significant effect upon the well-being of the child and his family. The paper begins with a brief review of the literature on mourning, which highlights various perspectives on the role and nature of the process. A model of mourning which embraces the differences between adult and child mourning will be proposed which is informed by the principles of attachment theory and defined as a continuing process of adjustment rather than a resolvable experience of loss. This model of mourning has implications for social work intervention and is the foundation of the practice model. The practice model involves six bereavement counselling sessions with the parent, six play sessions with the child and formal and informal involvement with the child's teacher. It has four aims: (I) to enhance sensitivity in the parent to the child's experience of loss and mode of mourning, (2) to develop an improved pattern of communication within the child-parent relationship, (3) to develop resources for the child in his personal environment and (4) to enhance the child's resourcefulness within his mourning thus enabling him to feel more competent in the longer term. The model is founded upon an awareness of the need for short-term intervention within the context of a long-term issue and seeks to address both perspectives simultaneously. Some of children's commoner responses to bereavement will be outlined within the context of the play sessions and methods for resolving the problems associated with them will be discussed. Finally the nature of reasonable outcomes for the work will be considered.     

Beginning Struggles with Families*

Beginning treatment with families is marked by a sense of struggle between the family and the therapist. The family is seen as testing the therapist and as asking through their behavior questions about the therapeutic process. The therapist is advised to focus intently on the beginning interviews, working toward the point where the family relaxes and decides on an intuitive level to enter therapy. The major hurdle is in dealing with the family's anxiety as the therapist attempts to shift the focus from the individual patient to the family as a whole. Strategy in establishing this shift is outlined     

Envy and anger in a boarding-school setting

Abstract

This paper looks at social work practice in a boarding-school setting. Individual work with mothers of two of the children is described, and structures which may help the school in dealing directly with parents are examined, focussing particularly on feelings of envy and anger. The counter-transference feelings of the worker in this kind of setting are touched on briefly, and it is concluded that a link with a boarding-school may be a useful tool in establishing support and working with deprived families.     

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.     

Post-Suicide Grief Work In Family Therapy

The following case report describes the treatment of a family following the death by suicide of its principle male figure. It describes the way the various family members were helped to deal with the unresolved grief reaction that had come to play a destructive role in the life of this bereaved family. Working with the family group allowed a direct observation of the mourning processes of the various family members. In particular, we could see the attempt of the identified child patient at keeping the memory of the lost object alive become an obstacle to a natural resolution of her mother's mourning at that same loss.     

EFFECTS OF A FAMILY-ORIENTED TRAINING EXPERIENCE ON THE ROLE OF THE PHYSICAL THERAPIST

This article describes ways in which a family-oriented psychologist contributed to a reconceptualization of the appropriate role for the physical therapist in patient care. The article identifies aspects of the changing role of the physical therapist, specifically its expansion to include skilled psychosocial interaction with patient and family for the purposes of reassurance, support and instruction. A primary shift involved changing from focus on the individual and his or her disability to focus on the patient in the context of his or her family. The article briefly describes elements of appropriate psychological training which can be incorporated successfully in a physical therapy educational experience, and concludes with a case example illustrating the basic points relevant to this type of interdisciplinary collaboration.     

Sadness and Chronic Illness: A Conversation with Bruce Perham

Bruce Perham is a social worker and narrative therapist who works at Alzheimers Australia Vic., the peak body representing the interests of people affected by dementia. He previously worked at an adoption agency, the Spastic Society (now Scope), and the Multiple Sclerosis Society. Bruce trained in family therapy in Melbourne and in narrative therapy with Michael White at the Dulwich Centre. Bruce has created an extensive range of written and video resources for people with dementia and MS and their family members. He describes how his family of origin, his resultant personal struggles as an adult, and narrative therapy, have profoundly influenced his work with people with chronic illness and their families, in particular, his approach to sadness.     

Two accounts of the management of racial different in psychotherapy

Abstract

In this paper, the authors present material from their clinical work, in which racial difference impinges directly on the psychotherapeutic encounter. They examine the primitive origins of racism from a psychoanalytic view point and discuss their management of related issues within the framework of psychoanalytic psychotherapy.

Part of a session from a psychotherapy group is described by Sue Davison, in which one member is excluded as part of a dramatisation entered into by all the group members for defensive purposes. The therapist, by calling attention to the painful reality which was banished from awareness, enabled the group members to recover their capacity to think, rather than re-enact the trauma.

The case study by Fakhry Davids describes work with a woman whose struggle in life is against a racist, intolerant mother. This mother is projected onto her black therapist, and a session is described in which the dynamics of this projection begin to be unravelled. Her therapist is experienced as an intolerant, oppressive mother to whom the patient's own hatred and intolerance has become attached, and the patient is enabled to take back some of these projections. The defences she uses illustrate a common way in which so-called “liberals” disown their hidden racism.     

Family Unity Meetings: Decision Making and Placement Outcomes

ABSTRACT

The sample consisted of all families (747) who were invited to receive a Family Unity Meeting from a Public Child Welfare Agency in a large urban county. Data was derived from the review of agency case files. The design was a retrospective case review with an embedded prospective study. This study describes factors that distinguish between CPS clients who accept an invitation to participate in a Family Unity Meeting (FUM) and those clients who decline to participate. The meeting process is described, and logistic regression is used to identify variables that predicted successful outcomes FUM meetings.

Families with reunification as a goal were the most likely cases to agree to participate followed by Voluntary and Permanency Planning cases. Cases with severe neglect were the least likely group to participate in a meeting process. Approximately nine people attended an average meeting. Maternal relatives were more likely to attend than paternal relatives.

Empirical evidence was found to support the notion that FUM expands the notion of family. Only 38% of children were placed with a parent after a meeting, but 82% of children were placed with a family member. Children were not placed with either the parent or family if the social worker had placement as a goal before the meeting. Cases with permanency plans were also less likely to be placed with the family. Social workers were more likely to agree with a placement with relatives if they had a concern about parental drug abuse. Having a maternal aunt in attendance at the meeting was predictive of having a child placed with the family.

Social workers and families stated concerns prior to the meeting diverged. Families were more concerned with economic and financial issues than were the social workers. Social workers were more concerned with child protective service issues (type of abuse, placement issues, etc.) and the behavior of the parent (substance abuse, mental health, etc.) than was the family. Paying attention to family issues such as finances may be a necessary precursor to families focusing on more complex matters like substance abuse or parenting practices.

Placement outcomes were consistent with worker's goals stated before the meeting. If a social worker said they wanted to place a child with the family before the meeting, that placement was most likely the outcome of the meeting. Social workers may be guiding the decisions of the family. If this interpretation is correct then it raises questions about who makes decisions at the meeting. An alternative conclusion is that the social workers are good diagnosticians who know prior to the meeting if placement is necessary, and know what decisions the family will make.     

Responding to children’s ‘emotion talk’: a conversation analysis of a therapeutic encounter between a social worker and two siblings using child-centred play therapy

ABSTRACT

Reflection of feelings is a hallmark strategy of non-directive child-centred play therapy that enhances children’s emotional awareness and equips them with emotionally expressive words. The case presented here describes the application of child-centred play therapy by a social worker with two young children (aged four and six) with sibling rivalry issues. One of the sessions was videotaped, which enabled the use of conversation analysis to dissect the language patterns used by both the clients and the social worker. This in-depth verbal analysis illuminated subtle nuances in the children’s interactions and behaviour while also providing the social worker with the opportunity to reflect on practice. This case discussion presents a snapshot of that session and allows readers to understand how such therapy occurs.     

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.     

Thinking About the Emotional Interaction of Therapist and Family

The emotional interaction of therapist and family has been difficult to explore within the field of systemic family therapy. This paper looks at ways of thinking about this process. As a starting point, I take some feelings I had with three families in the course of therapy. These are used to illustrate some concepts from analytic therapy which address the emotional interaction of therapist and family. The kind of theoretical space and guidance offered within systemic family therapy is then explored, and it seems that the Milan frame gives some space for thinking about the process but offers little guidance as to exactly how this might be done. This is a paper about practice, though it's primarily a theoretical discussion. There is no aim of establishing a ‘correct’ way of understanding the emotional interaction of therapist and family.