Integrating a Trauma Lens into a Family Therapy Framework: Ten Principles for Family Therapists

This paper aims to show how a trauma lens can be incorporated into existing family therapy practices, changing how therapists perceive presenting problems and therefore the issues and sites of intervention. After reviewing the family therapy literature concerning trauma and defining different types of trauma, the paper discusses how traumatic memories differ from ordinary memories. Ten principles for practice are described to guide therapists in integrating the trauma lens into their family therapy practice. Three case studies are used to illustrate these principles.     

Stemming the Tide of Trauma Systemically: The Role of Family Therapy

The initial section of this article describes the frequency with which people are exposed to various forms of traumatic stressors and the limitations of linear thinking in both assessing and treating the consequences of traumatic exposure as reported by the Institute of Medicine. The middle section of the article identifies the research and theory that supports the utility of systemic thinking and action in working with traumatised systems, especially families. The final section includes an outline of a protocol for family therapists and other systems‐informed practices to help traumatised families and other systems. A critical part of the protocol is that it meets the standards of trauma‐informed practice reflected by the Green Cross Academy of Traumatology and the International Society of Traumatic Stress Studies (ISTSS) guidelines, and the six criteria for evaluating treatment approaches. These criteria include do no harm, exposure titration control, reciprocal inhibition tuning, quantity and quantity of training, fit and fidelity and evidence of effectiveness.     

Child-Focused Family Therapy: Behavioural Family Therapy Versus Brief Family Therapy

We examined the effectiveness of behavioural family therapy (following the treatment agenda outlined in Fleischman, Horne and Arthur, 1983) and brief family therapy (following the procedures outlined in Fisch, Weakland and Segal, 1985), in the treatment of child psychological disorders. The parents of the 49 children referred to the outpatient unit of a children's hospital completed the Child Behavior Checklist (CBCL) (Achenbach and Edelbrock, 1983). Three scales of the CBCL were examined to assess the effectiveness of the two therapeutic approaches pre- to post-treatment. Significant pre- and post-treatment differences were found for behavioural family therapy on the Internalizing, Externalizing, and Sum T scales and for brief family therapy on the Internalizing and Sum T scales. Sum T scales represent the sum of scores across all sub-scales of the CBCL. Neither treatment was found to be more effective than the other.     

Family Therapy Process in a Family Therapy Seminar

The interaction between leaders and members in a year-long family therapy seminar is systematically compared to the process that unfolds between therapist and family during the course of family therapy. A five stage developmental process common to both is postulated and described: (1) Battle for Structure, (2) Naive Enthusiasm, (3) Conflictual Frustration, (4) Task Orientation, and (5) Mutuality. The dynamic elements of each stage are analyzed and factors affecting their development are identified. It is concluded that this five stage process occurs in all similar groups, but that the content of each stage may vary widely from group to group.     

Family Therapy for the Trainee in Family Therapy*

The growth and self understanding of the therapist as a person are considered by most training centres to be a significant part of the training process. This article reports on a pilot project which provided marital and family therapy for trainees in a two-year program. Therapy was established on a contract basis and included individual, conjoint, family intergenerational and small group. Interns and family members responded favorably to the program. Supervisors found the experience enabled trainees to maintain an experiential consistency with a general systems model utilized as the core theory of the training program.     

Adoption and Family Therapy

The aim of this article is to sensitise family therapists to adoption. A major assertion of the paper is that adoptive families are different from biological families. The family therapy context is a natural framework for examining these issues, as adoption affects and alters both birth and adoptive families, and adoption‐related problems occur within the context of the extended family system. The differences between intra‐racial (socially‐motivated) and inter‐racial adoptions are discussed, as well as the differences between closed and open adoptions. The study of families affected by adoption provides a model for other family forms, such as stepfamilies, foster families and families who form through new birth technologies.     

Schizophrenia and Family Therapy

The case presented is of a young man hospitalized twice for schizophrenic disorder before the commencement of family therapy. The therapy which dealt with the family system, specific pathological communication patterns and intra-psychic conflicts, is discussed. As the parents of the young man confronted their inter- and intra-personal problems, the function of his illness disappeared, along with his psychotic symptoms. While demonstrating the process of psychotherapy, the thesis that psychotic decompensation in young people often signifies severe family dysfunction is also presented. Accepting the ‘identified’ patient as such and ignoring the family dynamics may serve to create a chronic schizophrenic illness.     

Teaching Family Therapy

Family therapy is a distinctive treatment modality, differing in techniques, objectives, and problem definitions from other modalities. Integrating it into a social work curriculum poses several difficulties because of this fact. In this paper several themes in the training literature are isolated and problems associated with assisting learners to shift their practice orientation from individuals to families are discussed     

Depression,the Family,and Family Therapy

The potential contribution of family therapists to the treatment of depression remains underdeveloped. Family therapists need to articulate how changes in family functioning might benefit depressed persons, as well as how other problems in the families of depressed persons tend to go unrecognised. Furthermore, family therapists need to be alert to how undetected depression in adults and children may interfere with their ability to meet their goals with families who seek therapy for other persons. This article provides family therapists with (1) an overview of the nature and experience of depression; (2) an introduction to antidepressant medication; (3) a summary of research findings relating depression to its family context and (4) a brief overview of developments in the marital and family treatment of depression.     

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.     

Family Therapy and Substance Abuse

The approaches of family therapies to substance abuse are reviewed and evaluated. Questions from a systemic perspective are raised about the therapeutic efficacy of the structural/strategic family therapies which predominate in the literature. Consideration is given to certain clinical issues and to the place of a systemic perspective in a drug and alcohol service.     

Anxiety Disorders and Family Therapy

The role of family therapy in anxiety disorders is controversial. Empirical data exist only in relation to agoraphobia and obsessive compulsive disorders. Experienced clinicians, generally working with complex cases, regard marital and family conflict as central to many cases, which require a family approach for optimal therapy. In contrast, research workers generally regard marital and family factors as irrelevant to treatment. This is because complex cases are usually excluded from empirical research. This leaves mainly uncomplicated cases without significant family conflicts, for which a family approach is rarely necessary. Techniques for treating anxiety disorders in a marital/family setting are outlined.     

Marital Therapy,EMDR, Herman's Model of Recovery from Trauma The Journey of One Woman and Her Family

Judith Herman (1992, page 183) delineates a three stage model of recovery from trauma: 1) Safety, 2) Remembrance and Mourning, 3) Reconnection. She criticises current treatment methods for their failure to make a difference in the “constrictive symptoms of numbing and social withdrawal … and marital, social and work problems do not necessarily improve”. Family therapy has been criticised often for insufficient focus on emotion and general sensations. This case analysis will illustrate how these shortcomings can be successfully addressed with the use of marital counselling and EMDR. The use of multiple treatment approaches contributed to one client's resolution of recent trauma due to a car accident, of past crises due to marital infidelity and early childhood abuse, with significant changes for her in her current family as well as in her family of origin. Theoretical implications for “family therapy” are raised.     

Utilization of Family Photos and Movies in Family Therapy

This article discusses a technique the authors have designated Family Photo Reconnaisance. They describe the rationale for and process of utilizatizing family photographs and movies in family therapy sessions to evoke past events and memories and to uncover feelings about these occurrences and the people involved in them. Through their utilization, how one has changed over time is vividly seen. Who is missing from the constellation and when they "dropped out of the family orbit becomes obvious as do distorted memories. Family members reexperiencing the past together around their photographs come to better appreciate one another's current feelings and behavior and often are enabled to gain mastery over unresolved conflicts.     

Statutory Family Therapy A Family Therapy Team Approach in Child Protection Practice

This article outlines a team approach that has been created by the author to work therapeutically with families under statutory investigation for intrafamilial child abuse. It was devised for use by protective workers responsible for intervention with adolescents at risk and their families. This approach has been used successfully to combine the dual roles of child protection and family support in the context of statutory intervention.