Therapeutic Assessment with Children in Family Therapy

Therapeutic Assessment with Children (TA‐C) is a brief semi‐structured intervention in which psychological assessment is used to help families with children and adolescents to change. In this paper we introduce the TA‐C model, describe its semi‐structured format and exemplify how it can be applied by family therapists.     

Case‐Based Research in Family Therapy

Traditionally, case‐based research has not been considered as scientific by many in the field due to the lack of controlled conditions and objectivity. However, case‐study material may be more effective than once believed in educating family therapists. Future implications of the role of case studies in family therapy research are considered, including the manner in which case studies might be designed to be more rigorous so that they can serve as the basis for drawing causal inferences in clinical cases, and at the same time, provide family therapists with useful information to improve their skills. A discussion section highlights the future direction of case‐based research in the family therapy literature and how it may be used as an effective learning tool.     

The Body Comes to Family Therapy: Utilising Research to Formulate Treatment Interventions with Somatising Children and their Families

Children and adolescents with functional somatic symptoms are challenging to understand and to treat. The challenges begin at the very outset of the intervention – with the neurological and psychiatric assessments. Patients presenting with functional somatic symptoms, as well as their families, frequently deny any emotional or family problem, and parents are often genuinely baffled as to why a child has suddenly become so ill and why no medical explanation is forthcoming. Families can be unwilling to engage in family assessment and therapy, and therapists may find that standard approaches to family therapy simply can end up alienating these families – the door to therapy is slammed shut. This article is the story of my struggle to understand somatising children and their families and to find a common language to enable us to co‐construct formulations, to agree to a treatment plan, and to work together towards a pathway to health. It is also about the role of research and how knowledge from different system levels – and most specifically about the body – may need to be integrated into the therapy to help bring about change.     

Short Term Family Therapy with Emotionally Disturbed Children*

This study found that short term family therapy using Zuk's “go between process” effected significant improvement in the interpersonal functioning of the family, as perceived by the identified client. The subjects were white, middle-class, intact families who have sons attending classes for emotionally disturbed children at the Centennial School of Lehigh University.     

Using Social Construction Therapy with the REM Family

It is estimated that currently one child in five under the age of eighteen is a stepchild and that by h e year 2000, the remarried (REM) family will outnumber all other family forms. Historically, American society defines any form of family fife that does not conform to the traditional nuclear family as problematic. Family researchers have generally been consistent with society's negative views, using a problem-oriented approach to studying the REM family (Hoffman, 1991; Duncan and Brown, 1992; Coleman, Ganong, and Gingich, 1985). In so doing they have focused on documenting the difficulties of he REM family. This paper attempts to rectify these issues by first exploring the typical problems associated with the REM family focusing on social constructionist themes and therapy which serve to shift the focus of a problem-oriented approach toward a search for the strengths and positive characteristics of the family. Social construction focuses on the sociocultural and the individual relationship influences of language, family and culture. In addition, h e paper proposes a six-stage therapeutic model based on Social Constructionist Theory (Gergen and Gergen, 1983). The six stages of therapy with a remarried family are: ( I ) Joining the Family Meaning System, (2) Proposing the Notion of a Socially Constructed Family Meaning System, (3) Learning the Family's Meaning System,(4) Challenging the Family's Meaning System, (5) Amplifying the New Meaning System, and (6) Stabilizing the New Meaning System. It allows the REM family the ability to construct new meanings around their problems in living in order that they might find workable family solutions.     

Amplifying Deviations in Family Interactions: Guidelines For Trainees in Post‐Milan Family Therapy

Amplifying deviations in family interactions is a critical skill in family therapy, and one that can be implemented following the first reflecting team intervention. This paper will provide trainees with a series of practical guidelines for amplifying deviations, derived from an integration of several models of family therapy. Solution‐focused and narrative questions are employed systemically, with the aim of magnifying virtuous, rather than vicious cycles of interaction. A theoretical rationale for deviation amplifying and a brief case vignette will also be presented.     

The Functional Approach to Using Dreams in Marital and Family Therapy*

This paper presents a process based method for using dreams as an adjunct to marital and family therapy. Based on the functional orientation in psychology, this approach identifies and emphasizes personality and life area strengths rather than weaknesses. Dreams are viewed as pictures of feelings and as guides to the emotional dynamics operating for each individual in a family system. The process variables of expression, feeling, clarity, activity, and contact levels are emphasized. A case study illustrates the application of this approach in the treatment of a disturbed family system.     

Practice‐based Research Networks: Opportunities in Family Therapy?

I would like to continue the discussion of practice‐based research networks (PBRNs). I will provide more detail on what I mean by PBRNs and describe some of the features of existing networks. I will argue that research networks could be a valuable tool for family therapists. But, I also point out that the establishment of the mechanisms and culture necessary for PBRNs to function effectively takes considerable commitment from clinicians and their professional organisations. I will also remount my hobbyhorse and give a more specific account of my thoughts about the use of the internet to provide the necessary infrastructure for these networks.     

Multidimensional Family Therapy: A Science‐Based Treatment System

MDFT is a family‐based intervention for adolescent substance abuse and associated mental health and behavioural problems (Liddle, 2010). Integrative in several ways, MDFT uses an ecological or contextual conceptual framework to understand the developmental tasks of teens and their families. Research‐derived knowledge about risk and protective factors, and proximal causes, correlates and contributors to adolescent drug and related problems inform clinical thinking and interventions with every case. A multisystems approach, MDFT assesses and intervenes in four areas: (1) the adolescent as an individual and a member of a family and peer network; (2) the parent(s), both as individual adults and in his or her role as mother; father or caregiver; (3) the family environment and family relationships, as manifested in day‐to‐day family transactional patterns; and (4) extrafamilial sources of influence such as peers, school and juvenile justice. Interventions are made within and coordinated across domains. Progress in one area or with one person has implications for and use in others. Individual meetings with parent(s) and teen set the stage for family sessions, and family meetings may offer content and new outcomes that need to be brought to extrafamily meetings with juvenile justice or school personnel. MDFT was developed and tested as a treatment system rather than a one‐size‐fits‐all approach. A treatment system offers different versions of a clinical model that vary according to factors such as clinical sample characteristics (older versus younger adolescents, juvenile justice involved versus no involvement in juvenile justice systems), and treatment parameters (type of clinical setting and treatment dose).     

How Routine Patient‐Centered Monitoring Relates to Therapeutic Gains in Family Therapy: A Single‐Case Study

As routine outcome monitoring systems develop, questions emerge about how therapists incorporate feedback into their practice, and how this relates to therapeutic gains. A case of covert grief was monitored in each session with the Personal Questionnaire and the Helpful Aspects of Therapy instruments. At 4 months follow‐up, the Change Interview was administered. Individualized items facilitated access to the private views and needs of each member, which was useful for case formulation and ongoing personalization of the intervention. Qualitative feedback of treatment experiences helped therapists confirm the impacts of interventions, monitor therapeutic alliance, reformulate clinical hypothesis, and plan sessions. Therapists followed a critical triangulation process to decide the clinical meaning of feedback, according to his/her intervention model, expertise, and case‐specific context.     

Trauma and Bowen Family Systems Theory: Working with Adults Who were Abused as Children

Working with survivors of trauma is mostly challenging, exhausting, long‐term and often ‘messy’, when interventions that ‘should’ work, don't, or the unexpected arises. Nevertheless, explanations that speak to recovery from trauma more and more rely on neurobiological concepts to account for any positive change. Combining the family systems approach of Murray Bowen and recent research on the brain and trauma, post trauma symptoms are viewed as part of the ‘family emotional process’ even when traumatic events have emanated from outside the family system itself. Variations in responses to trauma, including dissociation and self‐harm are discussed in relation to chronic anxiety and ‘differentiation of self’.     

Working with the One-Parent Family in Family Therapy

This paper describes the particular problems that arise in the treatment of one-parent families. These problems are seen as stemming from the experience of disruption in the life of the family and the resulting special family structure. Techniques of handling the various resistances and issues that surface are presented and discussed. A case report illustrating many of the points made in the body of the paper is included.     

Educational Achievement of Children From Single‐Mother and Single‐Father Families: The Case of Japan

This article examines the relationships between single parenthood and student achievement in Japan. The study uses sixth‐grade data from the 2013 National Assessment of Academic Ability and the Detailed Survey, which was the first nationally representative parental survey collected through schools in Japan. The results indicate that children of single‐mother and single‐father families perform academically lower than children of two‐parent families. For children living in single‐mother families, more than 50% of the educational disadvantage was explained by a lack of economic resources. For children living in single‐father families, the educational disadvantage was explained more by a lack of parenting resources, measured by discussions at home, supervision at home, and involvement in school, than economic resources. These findings suggest that the gendered labor force and division of labor among spouses in Japanese society may deprive parents of the ability to buffer the negative relationship between single parenthood and children's educational achievement.     

Family Therapy Retention: An Observation of First‐Session Communication

This study examined the relationship between communication patterns and retention among families (n = 18) receiving family therapy. Those that attended 12 sessions were labeled completers (n = 6), 4–8 sessions were middle dropouts (n = 6), and 1–3 sessions were early dropouts (n = 6). Audiotape recordings of the first therapy session were transcribed. The content (positive or negative) and total percentage of communications by the parent, adolescent, and therapist were coded. Completer and middle dropout parents (but not adolescents) showed higher talk time proportions than parents in the early dropout group. Completer families had higher percentages of therapist‐to‐parent communications, while early dropout families had higher percentages of therapist‐to‐adolescent communications. There were no significant differences between middle dropouts and completers in either content or total communications. These findings demonstrate the potential utility of examining within‐session communication patterns and suggest that within‐session processes may determine therapy retention.     

Group Cohesion and Homework Adherence in Multi‐Family Group Therapy for Schizophrenia

This study examined the relationship between levels of group cohesion, defined as whole group relationships, and between‐session therapeutic homework adherence in a multi‐family group therapy (MFGT) for people with schizophrenia. Participants from 18 consenting families attending MFGT groups completed weekly homework adherence ratings, group cohesion and spontaneous between‐session activity measures. Levels of group cohesion at each session were compared with measures of scheduled and spontaneous homework adherence reported at the next session. It was hypothesised that higher levels of group cohesion would be related to homework adherence and other spontaneous between‐session therapeutic activity completed by group members. Results show higher levels of group cohesion were associated with higher rates of spontaneous between‐session therapeutic activity. However, contrary to expectations no significant relationship between cohesion and scheduled homework completion was found. The implications of the findings for group processes and homework adherence are discussed.