Cancer in the Family: Review of the Psychosocial Perspectives of Patients and Family Members

As advances in cancer care have led to more treatment options and longer survival for cancer patients, a focus on quality of life for patients and their families has gained importance. This review provides a discussion of stress and coping theory, documents the relevance of this topic area for social work practice, and illuminates the results of a literature review by emphasizing the perspective from which research was collected within the family system. Recognizing the impact of cancer on the lives of patients, their partners, children, and the family as a whole is an essential factor in providing appropriate and adequate psychosocial services to families facing cancer.     

Family Discussion Groups for Patients with Chronic Pain: A Pilot Study

This pilot study investigated the benefits of discussion groups for patients with chronic pain and their family members. Nineteen patients with chronic pain and 41 relatives participated in four consecutive groups. Most patients and family members found their participation clearly helpful for themselves and for the family. The group helped them to improve communication, support and mutual relationships, and to better cope with the pain. Reported beneficial factors were experiencing communality, having a place to discuss things with each other, gaining insights, and learning from fellow‐sufferers and their own family. Post treatment, patients also felt less distressed by the pain, less depressed, less insufficient and showed an increase in life‐control and social activities. Moreover, some aspects of the family climate improved, but only in the perception of the family members. The present study points to the value of a multifamily format in chronic pain therapy and suggests the appropriateness of further controlled investigation.     

DYSFUNCTION AND FAILURE IN OPEN FAMILY SYSTEMS: II. CLINICAL ISSUES*

The “open family” model is widely used as a point of reference for healthy family functioning, but potential dysfunctional aspects of open families are not well understood. A unified theory is used to integrate diverse typological models of families to build a composite clinical picture of the disabled open family. The disabled open family is found to be chaotically enmeshed, caught in its commitment to collective problem solving. Its need for closure, tolerance for ambiguity, and expressive communication style can lead to intensely emotional sustained conflicts. Stress-related symptoms and aggressive acting out may be manifest in individuals, especially children. Dispersal of members may ultimately be necessitated by the exhausting process. Family therapy with the open family requires special attention to its style as a family and its characteristic responses to interventions. The unified theory is shown to be useful in planning strategy and choosing techniques for treatment of open families. The treatment issues connected with the pseudo-open family, a family with open values but severely limited resources in actual operation as an open system, are also highlighted.     

Family Ties and the Discontinuity of Divorce in Black and White Newlywed Couples

This paper explores the relationship of family ties to the marital happiness of husbands and wives from intact and disrupted families of origin and to the likelihood that they will divorce by the 4th year of their marriage. Respondents were 199 Black and 173 White couples interviewed as part of the “Early Years of Marriage” study. Analyses showed differences in family connectedness according to whether the family of origin was disrupted, and some variations by race were also evident. Regression analyses revealed that among all spouses, but especially among wives from divorced families, increased closeness to their husbands' families predicted increased happiness in their marriages. Hazard models showed that when husbands' or wives' parents were divorced or separated, couples' closeness to the husbands' family reduced their risk of divorce. Findings are discussed in the context of family systems theory and gender roles related to the forging of links with kin networks.     

Navigating post-trauma realities in family systems: Applying social constructivism and systems theory to youth and family trauma

Trauma affecting youth and families takes a variety of forms, from random one-time events such as accidents and natural disasters to chronic and highly personal trauma from child abuse or intimate partner violence. Though trauma has received increasing attention in theory and intervention research over the last several decades, the prevailing theories and treatments have limitations due to a linear perspective focused on the trauma problems of the individual. This is particularly concerning given the high dropout rates for trauma-focused treatments and the complexities of intergenerational trauma that cannot be adequately conceptualised at the level of the individual. To inform and improve family-based treatment of youth and family trauma, this paper proposes a theoretical framework informed by social constructivism and systems theory. Social constructivism upholds that reality is constructed through communication as an adaptive process for survival, with multiple potential realities possible. Systems theory promotes a non-linear view of causality within a system, such that the structure and properties of a system determine outcomes more than the inputs that go into the system. Together, the principles of these meta-theories contradict the orthodox focus on traumatic events causing trauma symptoms, and instead imply that family-based treatment should focus on helping families shift assumptions and dynamics that sustain the problem in the present. The joint application of a social constructivism–systems theory framework for trauma introduces several new principles to inform family-based treatment: (a) post-trauma realities; (b) mutual survival; (c) power–justice balance; and (d) adaptive reorganisation. The implications of these principles for youth and family trauma treatment will be discussed. Future intervention development and research should consider these principles in the ongoing effort to improve family therapy for youth and family trauma.     

Family Experience of Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) struggle with unbearable emotions that arise out of interpersonal difficulties. Self‐harm and suicidal behaviours serve to regulate these emotions and to gain a sense of well‐being and control in a treatment context where hospital admissions are avoided by mental health services. Clinician engagement with families may be constrained by their knowing the accepted etiology of the disorder, which includes a causal link with the family environment. Other constraining factors include the negativity of those with BPD toward their family, and their clinicians' diagnostic uncertainty or confusion. This qualitative study explored the experience of families whose close relative with BPD has a long history of self‐harm and/or suicide attempts. Family members were found to have chronic and traumatic stress. Family roles and relationships were strained, as were relationships between the family and the mental health system. The findings of this study indicate that treatment for BPD needs to adopt a systemic approach that considers individuals and their significant family relationships, as well as relationships between the family and treatment providers.     

The allocation of money in cross-class families

This paper examines the patterns of income allocation in cross-class families; that is, in families in which the wife is employed in higher level white-collar or professional employment, and the husband in manual work. Following the work of Jan Pahl (1982 and 1983) families are categorised according to their system of money management. The majority of families here employ either a ‘one purse’system based upon joint family funds, or an independent system based upon separate bank accounts. In addition, couples who use an ‘allowance’system, a shared system, or a variant of the independent system with only one-earner are discussed. Whenever possible, qualitative reports from the families interviewed are drawn upon. The paper reveals ways in which gender-specific behaviour may be observed through the study of families’allocative systems. In particular, the wives’propensity to assume responsibility for food shopping, regardless of the couples’sources of income or allocative pattern chosen, is demonstrated. In addition, however, the source of income – specifically cash payments to the husbands – is seen to have an independent effect upon the couples’perceptions of money within the family. The paper concludes with speculation as to why the majority of these affluent families employ a system of joint family funds.     

Couple and family interventions in health problems

Intervention research for couples and families managing chronic health problems is in an early developmental stage. We reviewed randomized clinical trials of family interventions for common neurological diseases, cardiovascular diseases, cancer, and diabetes, which is similar to the content of previous reviews discussed later. One overriding theme of these studies is that patients with chronic illnesses and their families face a variety of challenges to which researchers have responded with an array of treatment modalities. Very few of the interventions reviewed, with the exception of treatment for adolescents with diabetes, tested family psychotherapy models. Most interventions were time-limited therapeutic interventions that trained families to improve their communication and problem-solving skills, individual and family coping skills, and medical management. Researchers more clearly described mechanisms of change in intervention studies with cancer and diabetes than with other diseases, and not surprisingly, they found greater empirical support for their interventions. Family interventions show promise to help patients and family members manage chronic illnesses. To develop an empirical base for family approaches to managing chronic illnesses, interventions must be based on theories that delineate mechanisms of change in family processes and skills in medical management necessary to maintain patients' and family members' health.     

Out of the Darkness: Three Waves of Family Research and the Emergence of Family Therapy for Lesbian and Gay People

Like family relationships themselves, the history and treatment of lesbian and gay people and their families is complicated. For this paper, three waves of research on the families of gay and lesbian individuals are described. During the first wave, gay and lesbian sexual orientation was seen as a disease and family dynamics were blamed for its genesis. Subsequently in the second wave it was believed that, fearing rejection many gay and lesbian people either distanced or were rejected from their own families and established friendship networks that have been described as families of choice. More recently, in the third wave, the family has been identified as a resource for lesbian and gay youth whereby open relationships with parents can help protect them from mental illness, substance abuse, and HIV risk. Furthermore, an increasing number of same-sex couples are choosing to become parents, overcoming biological and social obstacles. In this article these shifting views of the role of family in the lives of lesbian and gay people will be described along with case material that illustrates the historic influences, current developments and future directions of family treatment for this population. To be maximally effective with gay and lesbian people and their families, clinical social workers and other mental health professionals must understand how family therapy has been influenced by a progression of ideas that continue to evolve. In this paper, research examining the role of the family in the lives of lesbian and gay people will be described in three waves; as a source of blame, to an impediment to gay and lesbian happiness and ultimately a resource that can enhance lesbian and gay well-being. The influences of research on family therapy with this population will be described and case examples will demonstrate how to harness the strengths of family relationships identified in the most recent wave.     

Settling into a new home as a teenager: About establishing social bonds in different types of foster families in Sweden

This paper provides a glimpse into young people's experiences and understandings of everyday life during their initial stages of placement in various types of foster families. The way family interactions strengthen or weaken the social bond between foster youth and foster family is focused upon. In this study the young people in kinship foster families reported the strongest social bonds to their foster families and the adolescents in traditional foster families the weakest. This is in line with previous research. However, youth in network foster families with whom they were not so close prior to placement also reported rather strong social bonds to the foster family, which is not well known. Including network foster families in the study sheds light on the importance of adolescents' active involvement and agency in choosing their foster family. Examples of family interactions which seem to be crucial in strengthening social bonds, also in traditional foster families, are e.g. fair treatment by other family members, mutual family activities, negotiating to find solutions, and, which is not so well known, humorous joking and laughing together.     

How are we doing? Results of receiving family-driven feedback on alliances between families and residential treatment staff over time

Developing working alliances and actively engaging families is essential for youth success in residential treatment. Ideally, these alliances can be fostered by sharing feedback with residential staff about their alliances with families over time to encourage more family engagement and better outcomes for families of youth in treatment. This study measured alliances between families and residential treatment family workers and assessed the effectiveness of an unobtrusive method of sharing working alliance feedback with residential treatment staff. Results revealed that family members rated the working alliance higher than family workers, and that these discrepancies in scores converged over time. In addition, higher family member ratings of the alliance predicted higher family functioning, and longer time in treatment resulted in higher family functioning scores. Lastly, receiving feedback about the working alliance resulted in higher family member ratings of the alliance with their family worker.     

Mental Health Practitioners' Views of the Families of Individuals With Schizophrenia and Barriers to Collaboration: A Mixed Methods Study

Family involvement has been identified as a best practice in the treatment of schizophrenia. Yet studies show a small number of families of individuals with schizophrenia are involved in treatment. In this mixed method study, community mental health practitioners from different disciplines responded to a quantitative survey (N = 88), a qualitative structured question guide (N = 8), and open-ended questions (N = 43) that explored their views of families of individuals with schizophrenia and barriers to collaboration with them. Practitioners did not blame the family for causing their family member's schizophrenia. Barriers to collaboration were reported in three main areas: (a) time/workload barriers, (b) agency/system barriers, and (c) family barriers, while at the same time recognizing family collaboration as effective practice and reporting a desire to engage more families in the treatment process. Younger practitioners viewed organizational factors as more significant barriers to collaboration. Substance use factors emerged as a theme as a barrier to collaboration.     

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.     

Feminism and Family Social Work

The intent of this paper is to explore the applicability of a feminist model for clinical social work mactice with couples and families. A brief overview of the literature relating to feminism social work is presented in preparation for the examination of clinical issues. The feminist critique of traditional family systems theory is summarized and other areas of concern in clinical work with couples and families are explored including family theory and healthy family functioning. A brief overview of feminist family therapy practice literature is provided along with a summarization of training recommendations.     

Separation and Post‐Separation Parenting within Lesbian and Gay Co‐parenting (Guild Parented) Families

Gay men and lesbian women have a long history of jointly creating families and co‐parenting their children together. This qualitative study aims to explore the experiences of separation and post‐separation parenting within same‐sex parented families. This involved semi‐structured in‐depth interviews with 22 separated same‐sex parents in Adelaide, Melbourne, Sydney, Brisbane, and regional Victoria. An adaptive theory approach was used for the collection and analysis of the data. The paper explores data from a cohort of six participants who came from three different multi‐parent families who had experienced a separation – either their own, or that of other parents in their parenting group. The term ‘co‐parenting families’ was found to be confusing due to the different connotations within separation/divorce and same‐sex parent literature. Consequently, the term ‘guild parented families’ was created to describe these families. Participants from these multi‐parent families had very different experiences of family formation and separation compared to others within the wider separated same‐sex parent study. Separation of one or more of the parent couples within these families complicated their original plans and kinship ideals. Each of the families resolved this differently in their post‐separation arrangements. After separation, whole family narratives and/or the role of individual parents, were either questioned or revised as a way of resolving the complexity of their new kinship situation. Following separation, parents often relied on Western kinship norms that privilege biological kinship and the dual‐parent family to construct their post‐separation kinship arrangements. More awareness of families that begin with more than two parents is needed within separation research and amongst separation services and service providers.     

Clinical family assessment: applying structured measurement procedures in treatment settings*

This article describes the use of a battery of structured family measurement procedures to conduct systematic, comprehensive assessments of families who enter treatment. The measures are derived from family research and include self-report questionnaires and structured observation of family interactions. The assessment is multimodal, and examines the entire family unit, the marital subsystem, the individual family members, and the larger social context affecting a family. Two case examples are presented which demonstrate how the structured assessment data are combined with clinical theory and other information about a family to generate initial hypotheses about the functioning of the family system and likely avenues for therapeutic intervention.     

Achieving Competent Family Practice with Same-Sex Parents

Abstract

Due to the increasing recognition of same-sex marriage in different jurisdictions and growing numbers of parents raising children in the context of a same-sex relationship, it is becoming ever more important for family therapists to attain clinical competence in working with families headed by same-sex parents. This paper takes as its premise that good intentions and general acceptance of diversity are not sufficient in working with this population of families. Rather, clinical competence rests on experience working with lesbian and gay clients and knowledge of the impact of heterosexism on parenting in the context of same-sex relationships. Equally critical to competent family therapy practice is a theoretical framework that pulls together complementary concepts from different bodies of theory to analyze family structures and functions in the social context of heterosexism. To this end, this paper reviews family systems theory, structural social work, ecological systems theory and queer theory with an eye to culling complementary constructs relevant to working with same-sex parents. Specific aspects of family functioning such as maintenance of boundaries around and within families and role differentiation between parents are then explored using this theoretical framework. Finally, implications for the clinician working with families led by same-sex parents are reviewed.     

Depression movement in family therapy with depressed adolescents

Family therapists presume, observe, and predict that depression can move from member to member in the family system depending upon the dynamics of the system as a whole. When an adolescent who is depressed begins to improve in family treatment, many family therapists have reported that the parents will often begin to experience an increase in their level of depression. This observation has been reported but has not been objectively measured. In this clinical study of four families, adolescent and parental depression during family therapy is measured to determine if depression movement does occur during family treatment. Results indicate that in three of the four families the parents did initially show depression level increases reactive to improvement in the adolescent. Such findings are supportive to the idea that some forms of adolescent depression often do serve a family system function.     

Multi‐Family Therapy with a Reflecting Team: A Preliminary Study on Efficacy among Opiate Addicts in Methadone Maintenance Treatment

In this study, we evaluate the efficacy of multi‐family therapy at reducing the addiction severity and at improving the psychological and family dynamics of opiate addicts receiving methadone treatment at a public treatment center. The study compares multi‐family therapy with a reflecting team (MFT‐RT) and a standard treatment following a methadone maintenance treatment program. The results show that multi‐family therapy with a reflecting team effectively reduces the addiction severity in several of the areas evaluated and noted that this effect is superior to standard treatment. The psychotherapy patients showed improvement in the areas of employment and social support; their drug use diminished and their psychiatric condition improved. At the same time, they needed a lower daily dose of methadone. In addition, the group undergoing standard treatment showed a noteworthy deterioration in their medical condition. Both groups showed a significant increase in their alcohol use. When applied to family treatments, the systemic‐constructivist approach by the reflecting team offers combined techniques that can help improve care for the families of patients with addiction problems.     

Toward a More Optimal Selfobject Milieu: Family Psychotherapy from the Perspective of Self Psychology

This paper applies the theory of self psychology to the understanding and treatment of families. The healthy family is viewed as a reliable source of selfobject experience for its members, while problems in or between family members are seen as due to a lack of adequate selfobject experience for one or more members. Causes of selfobject failures or misattunements in the family are examined, with an emphasis on the influence of previous relational experiences on current needs, capacities, and experiences of others. Curative factors in this form of family therapy are then outlined, and a treatment approach designed to help family members become better able to provide empathically attuned responses to each other is described, with a case example used to illustrate key points.