Termination in Family Therapy: At Last a Beginning

Termination is a neglected area in family therapy. This paper examines termination from the point of view of non-specific, strategic and psycho-dynamic approaches. Completion of the therapy contract; completion of individual meetings; unsatisfactory progress; and symptom removal are considered under the heading of general approaches, while strategic approaches Includes a discussion of provocative, paradoxical and metaphorical interventions.     

INTEGRATING INDIVIDUAL AND SYSTEMS APPROACHES: STRATEGIC-BEHAVIORAL THERAPY

The existing literature on the integration of family and individual approaches, largely analytic in orientation, consists of models which, for the most part, are not brief in application. An alternative, brief model is presented which integrates an individual, cognitive-behavioral approach with a strategic approach at both pragmatic and theoretical levels. The Strategic-Behavioral model justifies the selective use of behavioral frames in strategic therapy and offers guidelines for their selective application.     

THE THEORY AND PRACTICE OF STRUCTURAL AND STRATEGIC FAMILY THERAPIES: A DELPHI STUDY

The present study employed the Delphi procedure to examine the similarities and differences in the theory and practice of structural and strategic family therapy. A three-phase Delphi questionnaire was sent to a national panel of knowledgeable structural and strategic therapists, who were asked to identify and reach a consensus of opinion about items they thought important to a profile of either structural or strategic family therapy. In addition, questions were devised to examine the Mental Research Institute, MRI, Haley/Madanes, and Milan/Ackerman approaches to strategic family therapy. The final profiles are described and discussed.     

Considering justice: an exploratory study of family therapy with adolescents

Feminist approaches to therapy with adolescents emphasize an empowering focus on the strengths of adolescents while simultaneously insisting that therapists become aware of their own biases toward today's adolescents. However, a review of the family therapy literature finds little mention of feminist approaches for addressing injustices (e.g., family scapegoating, negative societal views of adolescents, and gender oppression) that arise in family therapy with adolescents. Therefore, this study explores clinical approaches and resources suggested by a surveyed group of self-identified feminist family therapists. In addition, we also recommend several approaches and resources that will aid family therapists in creating a more just climate for family therapy with youth.     

Adolescent and parent alliances with therapists in Brief Strategic Family Therapy with drug-using Hispanic adolescents

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent, adolescent) and family level (within-family differences) for families that either dropped out or completed family therapy. Participants were 31 Hispanic adolescents and their family members who received brief strategic family therapy for the treatment of adolescent drug use. Videotapes of first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that Completer cases had significantly higher levels of alliance across all family members than Dropout cases, and Dropout cases had significantly higher unbalanced alliances than Completer cases. Clinical implications are discussed.     

Adolescent and Parent Alliances With Therapists in Brief Strategic Family TherapyTM With Drug-Using Hispanic Adolescents

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent, adolescent) and family level (within-family differences) for families that either dropped out or completed family therapy. Participants were 31 Hispanic adolescents and their family members who received brief strategic family therapy for the treatment of adolescent drug use. Videotapes of first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that Completer cases had significantly higher levels of alliance across all family members than Dropout cases, and Dropout cases had significantly higher unbalanced alliances than Completer cases. Clinical implications are discussed.     

Integrative Family Therapy With Childhood Chronic Illness: An Ethics of Practice

A challenge for contemporary family therapists is negotiating differences between modern and postmodern frameworks in the practice context. Modernists espouse a systemic metaphor; use evidence‐based and interventive approaches, including strategic, structural‐ or solution‐focused techniques, and believe in the therapist's knowledge, expertise and power to influence individuals or families to change. On the other hand, postmodernists follow a social constructionist, dialogical or narrative paradigm, which identifies the main ingredient of therapy as language, conversation, understanding and the therapist's ‘not knowing’ stance in eliciting a person's expertise and story Yet many practitioners adopt a middle way between these paradigm polarities, one that is less theory‐driven and more pragmatic, flexible, integrative and practice‐based. This is consistent with evidence‐based practice and research demonstrating common factors across all therapies. The value of preserving systemic thinking in family therapy is recognised while reaching forward to a postmodern social constructionist and dialogical approach. The article describes this integrative stance in family therapy as paramodern based on an ethics of practice. This is illustrated by a detailed case study of integrative family therapy, which addresses anxiety, anger and sleeping issues associated with a chronic childhood illness called Perthe's disease.     

An Integrated Structural/Strategic Approach To Family Therapy

While the structural and strategic family approaches have many similarities, their espoused differences have sometimes left therapists in a position of having to choose between them. However, they may be more compatible than has commonly been believed. This paper reviews their basic concepts and operations and presents a model for integrating both approaches in a concurrent and contrapuntal fashion, drawing on the best and most appropriate features of each. Case examples are used to clarify points. Special attention is given to the technique of "strategic disengagement." A set of rules is provided for decision-making as to when one approach or the other might be applied.     

The Theory Behind the Traps — Considerations for the Practice of Family Therapy in a Multi-frame Work Team*

Family systems theory as an approach to problem generation and change is practiced in many settings where other theoretical stances are also held. The issue of successful team work within a clinic where other therapists work from psychoanalytic and behavioural models is addressed. Structural, strategic and systemic approaches are compared with the psychoanalytic and behavioural. Particular attention is paid to apparent similarities between psychoanalytic and systemic family therapy theory. It is concluded that basic differences exist which make successful merging of the two views impossible. Practical examples of difficulties and attempted solutions are offered.     

The prediction of learning in family therapy training programs*

Research on family therapy training has produced very little data regarding the kinds of trainees that do best in family therapy training programs. This study attempts to provide some rough and preliminary data on that issue. One hundred and seventy trainees, drawn from seven different structural!strategic training experiences, were evaluated as to how much they learned by taking the Family Therapy Assessment Exercise pre- and posttraining. Their performance was correlated using a hierarchical regression analysis with a number of trainee variables such as amount of conjugal family experience, amount of experience doing family or individual therapy, or prior knowledge of family therapy. The results indicate that, as predicted, conjugal family experience was positively related, and prior knowledge was negatively related to performance. Prior experience doing individual therapy was also positively related to performance.     

In-home family therapy: indicators of success

In this study, we explore how specific individual, family, and family-within-community characteristics, as well as aspects of in-home family therapy, relate to responses to treatment. The Child and Adolescent Functional Assessment Scale scores and Global Assessment of Functioning scores were used as outcome measures. Results revealed significant differences between pre- and post-scores for clients receiving in-home family therapy services, providing an initial indicator of treatment success. In addition, primary family caregiver social support, role performance in school/work, and self-harmful behavior were indicative of successful outcomes. Clients with higher problem levels had the greatest rates of change, and clients receiving more hours of services fared better in therapy.     

Therapeutic Alliance; A View Constructed by a Family Therapy Team

Therapeutic Alliance is a construct which may have value for a family therapy team and influence its day to day practice. This paper discusses whether family therapeutic alliance can be observed, described and measured, and gives an account of the development of the Family Therapeutic Alliance Scale (FTAS) by a brief strategic family therapy team. Our focus is on the use of statistical technique as a means of clarifying the team's construct of therapeutic alliance, informing the team process without being the final arbiter in development of the scale. The second stage outlines the investigation of the usefulness of the construct with a wider group of family therapists. In individual psychotherapies measures of therapeutic alliance have been shown to predict outcome. Our early work suggests this is also true for family therapies and the FTAS may be a predictor for outcome in family work.     

Family Therapy in Child and Adolescent Mental Health Practice: Integrating Family Therapy in Child and Adolescent Mental Health Practice: An Ethic of Hospitality

This article integrates family therapy in contemporary child and adolescent mental health services as an evidence‐based practice. An integrative practice model is proposed where contextual approaches like systemic and narrative therapy complement and enrich individual problem‐focused models such as biological psychiatry and cognitive therapy. This is based on an ethic of hospitality towards all therapy discourses and the following best practice guideline: ‘To make optimum space for a systemic and narrative understanding contributes to evidence‐based practice in a contemporary mental health service.’ After discussing some dilemmas of integrative practice, I illustrate the therapeutic process by a detailed example of integrative family therapy with a depressed suicidal adolescent.     

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.     

Treatment of psychogenic seizures in adolescents

This article will review the problem of psychogenic seizures in adolescents and the impact of family therapy and individual therapy on treatment. Why particular individuals are prone to psychogenic seizures, the relationship between psychogenic seizures and family dynamics, and unresolved individual issues will be covered. The article will address a selected case, with a specific clinical paradigm for treatment.     

Systemic Therapeutic Approaches with Sexual Minorities and Their Families

Abstract

GLBTQ families encompass very diverse forms, all of which are interwoven with other differences such as class, race, ethnicity, religious and spiritual beliefs. This article will familiarize the reader with some challenges faced by families of sexual minorities and how different family therapy approaches might be applied. Training issues for therapists are identified and future areas for development are discussed.     

USING REPEATED MEASURES DESIGNS IN PROGRAM EVALUATION OF FAMILY THERAPY*

Data from 14 simulated families were analyzed with both a repeated measures and an ordinary analysis of variance design in order to illustrate the differences between the two approaches. The advantages of repeated measures designs for the analysis of family data in the program evaluation of family therapy are highlighted.     

Empathy — Still at the Heart of Therapy; The Interplay of Context and Empathy

Developing skilled and delicate approaches and interventions aimed at assisting families (or systems) to solve entrenched problems has been an exciting and stimulating aspect of family therapy over its relatively short existence. Recently, more and more authors have re-emphasised the need for respect and mutuality in dealing with clients, the need for the therapist to be aware of the clients' frames of reference and idiosyncratic solutions, some arguing that it is preferable to take less of the expert, interventionist stance. The necessity for empathy underlined in many earlier approaches to therapy is mentioned, though generally ‘in the small print’, in the reports of the processes being investigated and developed. This article re-considers empathy, always known to be at the heart of the counselling/therapy¹ process, but perhaps too easily assumed at present. It contends that empathy remains essential, that it can be understood more fully, and thereby used more effectively. Some of the traditional understandings of empathy, mostly from writings on individual therapy, are considered. Working with families and systems demands a broader understanding and different applications. The therapist must be capable of empathy with the context and the relationships as well as with individuals. While asserting that human beings are generally capable of empathy, the article examines some particular aspects of its use in therapy, particularly with families; it contends further that a fuller understanding of empathy can enrich the whole process of therapy. The article argues that empathy remains an indispensable guide to intervention with the family, the system or the person, whatever form the intervention (or non-intervention) may take.     

THE NEIGHBORING FIELD OF BRIEF INDIVIDUAL PSYCHOTHERAPY*

The author presents the field of brief individual psychotherapy as a coherent set of conventions, despite its diverse origins in the schools or traditions of dynamic, behavioral, interpersonal or cognitive, and strategic psychotherapy. He proposes the advantages of these shared conventions, but also their drawbacks. He proposes how this neighboring field could help the field of family therapy reduce its errors.