THE MARGINALIZATION OF FAMILY THERAPY: A HISTORICAL AND CONTINUING PROBLEM

Family therapy, and marital and family problems, are mariginalized in the larger fields of mental and physical health care, which is a misfortune both for family therapy and for other mental health professions. The early family therapists, who had multidisciplinary backgrounds, attempted toestablish a new, nondisciplinary paradigm and also tried to expand the perspectives of the more traditional mental health disciplines. More recently, family therapists have exerted greater effortsto establish marriage and family therapy as a differentiated, autonomous profession. These alternatives each involve dilemmas for the family therapy field. The positive side of becoming a distinctive profession is greater internal strength and clear professional identy; the downside is the threat of increased marginalization in rlation to the other professions, a tendency toward intellectual isolation, and hence restricted opportunities for invigorating new challenges. Family therapy now needs to develop new modes of interchange, collaboration, and selective integration with otherhealth care professions. Such interchange will be beneficial both to family therapy and to other professions.     

The effectiveness of family interventions for physical disorders

This article reviews the evidence for the effectiveness of family interventions in the prevention and treatment of physical disorders. Pathways by which families influence physical health and a typology of family interventions are described. Family intervention studies, particularly randomized clinical trials, are reviewed in four clinical areas: family caregiving of elders, childhood chronic illness, spouse involvement in chronic adult illnesses, and health promotion/disease prevention. Implications for family clinicians and recommendations for future research are presented.     

A BLUEPRINT FOR INCREASING THE RELEVANCE OF FAMILY THERAPY RESEARCH

Family therapy research and psychotherapy research in general have been criticized for their lack of relevance to clinical practice. This paper presents a fivestage model that family therapy researchers can follow to increase the relevance of their work for clinicians and other consumers of family therapy research. Using lessons derived from private industry, the research model is based on a marketing and developmental perspective.     

EFFICACY OF FAMILY THERAPY FOR DRUG ABUSE: PROMISING BUT NOT DEFINITIVE

Drug abuse is an enormous public health problem with consequences not only for individuals using drugs but also for families, communities, and society. Moreover, research evidence and clinical experience agree that drug abuse is one of the more difficult problems to treat. Despite considerable research on the connection between family factors and drug use, and the existence of family therapy models for drug abuse, comparatively few controlled efficacy studies have been conducted. This article presents a critical review of controlled treatment outcome research in the area of family therapy for drug abuse in both adults and adolescents. A number of studies from different clinical research groups demonstrate that different versions of family intevention can engage and retain drug users and their families in treatment, significantly reduce drug use and other related problem behaviors, and enhace particular domains of prosocial functioning. Moreover, a smaller number of comparative efficacy studies have shown family therapy to be more effective than nonfamily therapies. Family therapy of adolescent drug abuse is more developed at present than family therapy of adult drug abuse. Although the results of the reviewed studies are promising, a blanket confirmation of family therapy's efficacy for drug abuse cannot be made at this time because of the relatively small number of studies and the noted methodological limitations of the studies published to date. Nonetheless, substantial progress in this clinical research area has occurred, and if research and funding support continue or can expand, significant breakthroughs in the treamtment of drug abuse with family-based treatments are possible.     

Towards a Multicultural Society: Family Therapy with Greek Families†

Language and cultural differences can pose barriers to effective intervention in migrant families in conflict. Family therapy approaches can provide some useful strategies for overcoming these obstacles. A family therapy approach can (1) emphasise the value of utilizing natural network support systems; (2) provide a model which helps clarify communication problems arising in the relay of information through a third person acting as an interpreter; (3) underline the importance of non-verbal and process aspects of family communication; (4) suggest techniques for negotiating, joining, and finding commonalities of family experience between a therapist and family of different ethnic background. The therapist needs to develop sensitivity to both the universal and specific ethno-cultural structures, norms and problems of families; when this sensitivity is achieved powerful and culturally syntonic healing forces can be released. Examples of successful family therapy interventions in some Greek families in conflict are given.     

THE CLINICAL AND THEORETICAL IMPACT OF A CONTROLLED TRIAL OF FAMILY THERAPY IN ANOREXIA NERVOSA

The paper discusses the practical and theoretical implications of the results of a controlled treatment trial. Family therapy was compared with individual, supportive psychotherapy for the management of severe eating disorder. Family therapy was markedly more effective in achieving improvement in one of four subgroups of patients: (a): those with early onset, short duration; (b) early onset, duration more than 3 years; (c) late onset, after the age of 18 years; (d) those with bulimia nervosa. The therapies used are described, as are the changes in clinical practice arising from the study. Theoretical considerations concerning notions of family structure, the family life-cycle and symptomatic and family change are also discussed.     

How and Why Do Family and Systemic Therapies Work?

My reviews of the evidence base for family therapy conducted over the past 15 years have been guided by four key questions. Does systemic therapy work? What sorts of systemic therapy work for specific problems? What processes occur in effective systemic therapy? Is systemic therapy cost‐effective? In this paper answers to these questions are given. Systemic interventions are effective for about two out of three cases. Specific models of effective systemic therapy have been developed for most common mental health problems. There are many processes shared by evidence‐based models of practice that can be incorporated into the routine practice of research‐informed family therapy. Systemic therapy is cost‐effective and in many cases leads to medical cost‐offsets. Available evidence indicates that family therapy can make a very significant contribution to alleviating suffering and making the world a better place to be.     

THE REPRODUCTION OF FAMILIES: THE SOCIAL ROLE OF FAMILY THERAPY?

Family therapy, while highlighting the significance of family functioning for individual experience and behavior, has in general failed to respond to the critical analyses of the family that have recently been developed, and particularly that offered by the women's movement. Consequently, it cannot investigate the possibility that "dysfunction" in families is actually socially created and maintained. Family therapy's failure to consider the broader contexts of family functioning, a failure that is facilitated by the use of systems theory as its major theoretical underpinning, results in an uncritical acceptance of the contemporary family form.     

What about the family in family therapy research?*

Family therapists are frequently criticised for not publishing any substantiation of the effectiveness of their therapeutic interventions. This paper discusses why clinicians do not evaluate their work through examining current recommendations for family therapy evaluation, and the effects of these recommendations on the family under study. We provide some criteria specific to the family which will assist clinicians in selecting measurement instruments to evaluate family therapy. These relate to ethics, parsimony and design features of the study. The complexity of family therapy evaluation must be addressed if more clinicians are to do evaluation.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

EMPHASES OF THE MAJOR FAMILY THERAPY MODELS: A FAMILY FIRO ANALYSIS

This paper analyzes 13 models of family therapy according to their special emphases on the Family FIRO model's dimensions of inclusion, control and intimacy. We first examined chapters on each model in Gurman and Kniskern's Handbook of Family Therapy; we then sent our preliminary ratings to the authors of the chapters for comment. The final conceptual analysis of the models indicated that 4 family therapy models emphasize inclusion as a primary focus, 4 emphasize control, and 5 emphasize intimacy. We also rated the secondary and tertiary emphases of the models. This analysis provides a possible guide for therapists who wish to be eclectic or integrative in their work, specifically, by suggesting a way to match therapy techniques from different family therapy models to the presenting family issues that each model emphasizes most strongly.     

THE EFFECTIVENESS OF FAMILY THERAPY IN THE TREATMENT OF ADOLESCENTS WITH CONDUCT DISORDERS AND DELINQUENCY

A literature review was conducted on recent studies using family therapy approaches to the treatment of conduct disorders in adolescents. Results from studies conducted since the Shadish et al. (1993) meta-analysis on the effects of family and marital therapies are included. Barriers to effective treatment are identified, costs of care are discussed, and a variety of systems of care in which family interventions are embedded are reviewed.     

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.     

Family Social Work Practice: Onward to Therapy and Policy

ABSTRACT

In a recent article published in the Journal of Family Social Work McNeece (1995) argued that family therapy has no interest in or relevance for social policy interventions. Through the presentation of several arguments he constructs an irreconcilable dichotomy between policy and practice, suggesting that therapeutic interventions are responsible for pulling resources away from the development of effective social policy interventions. This paper challenges the dichotomy between policy and practice and presents an alternative view concerning the relationship between social policy and family therapy. The increasing importance of family policy in family therapy is summarized and a new trend within marriage and family practice, policy as practice, is discussed. Current family practice literature and personal case examples are used to provide alternative viewpoints to three main points that were presented by McNeece concerning family therapy practice, and the therapy/policy interface. Finally, the current practice context of managed care is used to illustrate the interdependence of practice and policy, and the need for a new understanding concerning family practice.     

Family systems functioning,family health roles,and utilization of physical health services

The purpose of the study reported here is to determine the relationship between family systems functioning, family health role, and family utilization of health services. The research is based in the Circumplex Model of Marital and Family Systems (Olson, Sprenkle, & Russel, 1979). Family functioning variables include family level of cohesion, family adaptability, and family type, as measured by FACES II. Family health role (i.e., leadership role and acceptance of sick role) and utilization of health services are measured by scales of the investigator-developed Family Health Questionnaire. The sample consists of 140 parents of 70 families, composed of two parents with children under 25 years of age living at home. Analysis reveals significant relationships between the family level of adaptability and acceptance of the sick role, in conjunction with significant gender and gender interaction effects. There are no significant differences between family cohesion levels or family typologies with the health variables.Su An Arnn Phipps is an Assistant Professor at the University of Oklahoma College of Nursing Graduate Program, Tulsa, 700 N. Greenwood, Tulsa, OK 74106. Her research interests include family systems functioning and family physical health, couples' infertility experience, and fathers' role(s) in family health. She received her Ph.D. from Oklahoma State University in Family Relations and Child Development.     

PERSONAL AUTHORITY IN FAMILY EXPERIENCE VIA TERMINATION OF THE INTERGENERATIONAL HIERARCHICAL BOUNDARY: PART III—PERSONAL AUTHORITY DEFINED, AND THE POWER OF PLAY IN THE CHANGE PROCESS

Present transgenerational family therapy theory is analyzed, and it is suggested that individuation is on a continuum with fusion-triangulation (family systems theory), that relational ethics are on a continuum with invisible loyalties (contextual family therapy), and that there is in fact but one continuum, so that these terms are well-nigh interchangeable. Individuation-relational ethics is presented in a (Hegelian) dialectic with intimacy; and personal authority in family experience is offered as the synthesizing construct in this dialectic. The change process in transgenerational family therapy is briefly noted. It is suggested that playfulness, including paradox and absurdity, is an effective intervention into the intense emotionality of inter generational work. A framework for and sequence of playful interventions are described.     

Sirens’ Call: Understanding Poor Financial Decision Making and Credit Card Misuse

Poor financial decision-making paradigms such as misuse of credit cards exist as ruinous forms of personal debt. Psychiatric and physical health problems arise from financial distress. Significant challenges exist for consumers to become financially solvent. Obstacles that exist in overcoming financial stressors can be explained by behavioral economic theories. These theories explain why consumers make unwise financial decisions. Research, practice implications, and a financial therapy model for improving financial decision-making skills are presented. The need for social work to ally with family economic scholars and policymakers around financial literacy and the development of effective financial therapy interventions is discussed.     

CORRESPONDENCE OF FAMILY THERAPISTS' PERCEPTIONS WITH FRCCCS CODING RULES FOR TRIADIC INTERACTIONS

Family therapy theory, practice, and research across many orientations are concerned with multiperson interactional phenomena such as intercepts, disconfirmations, and indirect communications. This study reports a successful criterion validity test of the rules for coding these triadic features in the Family Relational Communication Control Coding System (FRCCCS) (Friedlander & Heatherington, 1989). Thirty-five experienced family therapists observed two videotaped family therapy interactions and reported their perceptions of each of 25 communications. These perceptions-the criterion-significantly corresponded with the FRCCCS coding rules about the relational control aspects of triadic communications. Discussion focuses on the future use of the FRCCCS in research on family therapy.     

EMPIRICAL VALUES AND THE CULTURE OF FAMILY THERAPY*

The research-clinical practice connection is weak in family therapy. Some have argued, in an inordinate ideological and political tone, that traditional research methods are inappropriate for family therapy. This position mischaracterizes modern day clinical researchers and research. In presenting 10 key dimensions of the research-clinical practice issue in family therapy, this paper addresses some of these misrepresentations. If research and practice are to interact more productively, a major commitment, the scope and implications of which have not yet been realized, will need to be made. Actualizing the research-practice link is a training problem and a fundamental professional issue. Progress in this realm would change the particulars of clinical practice as we know it. These processes will involve nothing less than remaking the culture of family therapy.