Family Context Therapy: A Model for Family Change*

Starting where family group therapy fails, this article breaks new territory in family context therapy. Consolidating the past 14 years of his work, Dr. Bell sets forth a conceptual program and methods to meet problems that earlier forms of family therapy could not reach. Here he provides a model drawn from studies, theories, and personal experience of organizational patterns, interrelations, and change among community institutions that provide settings for family functioning. His new methods are designed to modify the family environment so as to solve family problems and promote beneficial family growth—a framework that may bring together a broad variety of existing family development approaches.     

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.     

The Single‐Parent Family and the Family Therapist: About Invitations and Positioning

Single parent families sometimes represent specific challenges to family therapists. In this article a dialogical frame with important concepts such as voice and positioning is proposed to reflect on family therapy practice. This frame is used to reflect on a common invitation in family therapy with single‐parent families: the invitation to take the place of the absent parent. A case of family therapy with a single‐parent family is presented in order to illustrate the importance of flexibility in the therapist's positioning and the way the therapist's experiencing can be used as an empathic bridge to create a dialogical space in which the important issues at stake can be addressed.     

Two Case Studies on Family Work with Eating Disorders and Body Image Issues

This article highlights the need for clinicians who work with eating disorders and body image problems to address the deeper family issues underlying these symptoms. The authors propose an eclectic approach including family systems, structural and experiential family therapy theory as a guide. The paper begins with an overview of family therapy theories currently used in the treatment of eating disorders, and goes into greater detail about the three theories highlighted in the eclectic model proposed. The authors present two cases with actual case dialogue, demonstrating how they used this composite model. This article has both theoretical and practical implications for clinicians working in the field.     

Integrating Family Therapy Training in a Clinical Psychology Course

Teaching family therapy to clinical psychology trainees is not common practice in Australian clinical psychology training programs. There is sparse discussion in the literature. Family therapy is an evidence based intervention that complements a diversity of established theories and psychotherapies and would complement the intervention skills of trainee clinical psychologists. The aim of this paper is to illustrate how family therapy training may be integrated into a postgraduate clinical psychology course. The literature on core family therapy knowledge, skills and training methods will form the backdrop to a review of specific family therapy training courses for clinical psychology trainees. This will then be mapped against a consideration of accreditation requirements of clinical psychology courses in Australia and suggestions made for integrating family therapy into their training curriculum. Anecdotal feedback from students provides an initial step toward evaluation.     

Family Therapy is Just One Option

I trace my development as a family therapist from being a single model worker in systemic family therapy to a more eclectic approach. The context of my work is children's services and private practice. Failure to appreciate when one method of therapy is more suitable than another can lead to family therapy being applied when it is not indicated. The dangers in such mistakes and a lack of careful assessment that includes the ‘feeling state’ of the therapist are illustrated by case vignettes. A possible effect of some therapy techniques is to create a ‘distance’ from clients and to shield the therapist from their emotional distress. I outline situations where I would not use family therapy.     

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.     

Family patterns associated with anorexia nervosa*

A family systems perspective was used to explore familial transactional patterns related to anorexia nervosa. Father, mother and daughter, interpersonal assessments of parental initiative and daughter responsive behaviors as reported on Benjamin's (1974) Structural Analysis of Social Behavior (SASB), were combined to serve as data for a hierarchical cluster analysis. Out of the 22 families with an anorexic child and the 22 matched control families, 7 family groups with unique family dynamics differentiating one from another emerged out of the clustering procedure. Prototypic family profiles were established and examined using Benjamin's (1984) program Figure (FIG) to explicate central features of the family transactional relationships. With no single family pattern characterizing the families of the anorexic daughters, the study challenges earlier family theories that postulated a single anorexogenic family system, and supports a broader, more complex view of anorexics and their families.     

Object Relations Family Therapy: Articulating the Inchoate

In recent years there has been a renewed interest in psychodynamic ideas within the family therapy literature. While some authors have explored the usefulness of psychodynamic concepts in the systemic context (Byng-Hall, 1995; Flaskas, 1993, 1996; Luepnitz, 1988, 1997), others have argued that psychodynamic models of family therapy should be given more credence in systemic work with families (Guttman, 1991). This paper describes Object Relations Family Therapy (ORFT), a psychoanalytic model of family therapy, in plain English in order to minimise the obscurity of some of the existing terminology and to emphasise the utility of more contemporary formulations. ORFT addresses the interface between psychoanalytic and systemic theories. It offers a way of conceptualising complex family dynamics at both the interpersonal and intrapsychic levels. It also integrates an understanding of nonverbal, unstated and often implicit processes in its formulation of problem development. The unique contribution of ORFT is elaborated using a clinical example.     

Family Social Work/Family Therapy

The author responds to Witkin's (1993) comparison of family social work and family therapy. The author argues that family social work and family therapy share important commonalities. He challenges Witkin's characterization of family therapy as outdated. Instead, family therapy is characterized as having contributed important writings about gender and culture to its practitioners. The paper ends with reflections on the implications of social justice for clinicians.     

家庭现代化理论及其发展的回顾与评述

本文主要回顾和介绍了家庭现代化理论在最近50年间被西方学界批评和修正的过程,并对其主要理论观点的发展变化进行了梳理和评论。这些主要理论观点的发展变化包括:对一元化和单线演进的家庭变迁理论进行反思,逐步接受家庭变迁存在多种路径和复杂多样模式的可能性;家庭变迁研究的分析范畴经历了从家庭结构到家庭关系的转变;在方法上,不再执着于对传统和现代家庭及其行为进行简单的分类,等等。     

Family Therapy and Young Children A Case of Potential Child Abuse

Parental distress often places young children in grave danger of physical abuse. In this paper a family therapy approach is used with a single parent family with young children where physical abuse is a distinct possibility. The paper outlines some of the basic concepts used in the therapy and focuses on the effective use of relabelling as a means to diffuse anger and open the way for constructive change within the family system.     

An Educational Model of Family Consultation*

This approach to working with families under stress recognizes the family as a system interacting via communication patterns among its own members and within a larger context of peers, neighbors, school, work, and community agencies. The goal is to help the family become a support system for all its members, more capable of meeting both adult and child needs for ongoing socialization and personal growth. The model is educational in that the focus is on teaching the family to identify strengths as well as dysfunctional behavior, and to acquire some basic communication and problem-solving skills. Methods are both cognitive and experiential. The approach is useful in short-term therapy with single families or groups of families.     

Integrating Attachment Theory into Family Therapy

Solution‐focused therapies have had only short‐term effectiveness for clients with serious problems stemming from abuse who come to our family counselling centre in Auckland, New Zealand. In seeking long‐lasting change, we have begun integrating attachment theory into the family systems therapy we have been practising. The Adult Attachment Interview (George, Kaplan, & Main, 1985) has been incorporated into a case in order to study the effectiveness of integrating attachment and family systems theories. This case illustrates how information gathered about the mother's attachment pattern can help the therapist comprehend the client's response to the present crisis, and clear a path through what can appear to be an overwhelming labyrinth of presenting issues.     

Family Phone Therapy in University Counseling and Psychological Service Centers: A Family Systems Approach

Abstract

This paper offers family phone therapy as a method for student mental health practitioners to overcome the obstacle of geographic distance between students and their families when family therapy is the treatment of choice. The issues of confidentiality, triangulation, diversionary conversation, and mixed communication, which present unique concerns when engaging in family phone therapy, are introduced and strategies to deal with them are discussed. A case example is presented to demonstrate the utility of family phone therapy in dealing with problems that students who use university mental health services can typically experience. Finally, implications of dealing with students' developmental tasks from an individual or family systems perspective are discussed.     

Ten Research Questions for Family Therapy

A growing evidence‐base shows that family therapy works, but many gaps in our knowledge remain about the conditions under which family therapy is effective and how it works. In this paper, ten critical research questions about family therapy that need to be addressed are considered. In short these are:

• 1 Is family therapy as effective in community settings as it is in specialist clinics?
• 2 For what problems is family therapy cost‐effective?
• 3 Does family therapy work for under‐researched problems and populations?
• 4 Do social‐constructionist and narrative approaches to family therapy work?
• 5 Can family therapy protocols be enhanced for non‐responders?
• 6 Can family therapy be combined with other psychotherapies to effectively treat specific problems?
• 7 Can family therapy be combined with pharmacotherapy to effectively treat specific problems?
• 8 What specific factors contribute to the effectiveness of family therapy with particular problems?
• 9 What common factors contribute to the effectiveness of family therapy?
• 10 What therapist and client factors contribute to the effectiveness of family therapy?

     

Family Therapy with the Elderly

This article outlines health and lifestyle challenges to elderly persons and associated changes in their family systems. Flexibility, related to attachment patterns, is considered central to healthy adaptation. Family therapy approaches and relevant systemic and cultural factors influencing psychotherapy with the elderly are discussed. Key family therapy concepts and strategies (genograms, transmission of family histories and circular patterns of interaction), are reviewed and exemplified. Four types of family therapy presentations are elucidated by composite case examples. Firstly, the elderly person can be the identified patient. Secondly, another family member can seek help for him/herself in relation to the elderly person. Thirdly, another family member can be the identified patient without direct reference to the elderly person. Finally, the wider health care system involved with the elderly person and family can be the focus of therapy. Family therapy offers important conceptual and strategic advantages in working with the elderly and their systems.     

Family therapy saves the planet: messianic tendencies in the family systems literature

It is not unusual occasionally to hear individual family therapists describe their work as an effort to "save the world." The messianic notion that family therapy should be the world's salvation is not simply a fancy of individual clinicians, but is deeply imbedded in several of our field's most fundamental theories. This article explores messianic arguments in the work of some of family therapy's most important thinkers, including von Bertalanffy, Bateson, and Keeney, and then discusses the implications that these arguments have for the clinical and theoretical development of our field.     

Fathers in Family Therapy: A Survey of Family Therapists

Sixty family therapists were surveyed in an investigation of resistance by family members to family therapy. Consistent with other investigations, the father was viewed as the most resistant along a number of dimensions. Therapist behaviors that related to difficulties with the father, specifically, and to family therapy generally, were identified. The implication of these results and possible strategies to reduce the resistance of the father are discussed.     

Family Therapy: A Client-Centered Perspective

>This article first critiques therapist-directed approaches to family therapy in the light of research findings on therapist variables (empathy, warmth, genuineness) associated with positive outcomes in psychotherapy. Second, two polar opposite positions in family therapy — psychodynamic and family systems — are examined and found to have much in common. The two approaches are based on a pessimistic view of the family, which is seen as an intractable unit, resistant to its own growth. Third, an alternative, phenomenological view of the family is developed, which more optimistically assumes the family to be motivated for enhancement and growth. Finally, a client-centered approach to family therapy is described.