The loyalty bind and sacrifice of the self: Family treatment of adolescent schizophrenia and schizophreniform disorder from a psychodynamic-systemic perspective

This article reviews treatment of families with a schizophrenically functioning adolescent from a psychodynamic systemic perspective. Systemic and psychoanalytic conceptions of family binding and the sacrificial nature of schizophrenic dysfunction, both on an intrapsychic and interpersonal level, provide the theoretical foundation for a multi-dimensional approach to treatment. This treatment approach is predicated on reframing of the adolescent's behavior, a co-therapy model of reparenting and multi-family group therapy to resolve the separation-individuation impasse characteristic of such families. The case of a 16 year old boy and his family is used to illustrate the concepts discussed.At the time this was written the author was a family therapist with Child and Adolescent Services, Coliseum Psychiatric Hospital, Macon, Georgia. He wishes to express appreciation to Dennis Jones, Ph.D., Program Director: A. Allison Grant, M.D., Clinical Director, and the staff of the adolescent unit.     

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.     

Psychodynamic therapy for SUD: Counselor's view

First of all, psychodynamic psychotherapy as treatment for substance use disorder (SUD) works. Ian McLoone, lead therapist with the Alltyr Clinic in Minneapolis, knows that firsthand — he's in recovery from heroin addiction and is in it himself. And despite the fact that addiction therapists aren't taught psychodynamic theory or psychoanalytic psychotherapy in graduate school, where cognitive behavioral therapy (CBT), motivational interviewing (MI) and, to a lesser degree, 12‐Step facilitation are stressed, he became interested in it mainly because of his employer, Mark Willenbring, M.D., a psychiatrist and former medical director of the National Institute on Alcohol Abuse and Alcoholism. We talked to McLoone for this story as a follow‐up to our article on the self‐medication hypothesis of addiction, for which we interviewed its developer, Ed Khantzian, M.D. (see “Psychodynamic psychotherapy: When it helps people in recovery,” ADAW, June 22, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32756 ).     

Becoming the Family Archivist

The author describes some of the ways in which conventional amateur family histories fail to portray the emotional realities of family life. Recent trends in biography and autobiography are explored briefly, and the possibility of a family history informed by systemic as well as psychoanalytic insights is considered. The author's own work, A Family in Time, attempts such a history. The author outlines his sources of information, both documentary and oral, and the special challenges posed by their interpretation. The decisions governing the ordering and selection of data for publication are explored, the author's aim being to present the facts in such a way that a systemic conception of family process over time will be implicit in the material. Implications for the author, for the family itself, and for therapists working with intergenerational process are briefly considered.     

The Use of E‐mail in the Therapy Process

The therapeutic letter has a long history, with roots in psychoanalytic work and continuing application in family therapy. The advent of e‐mail has allowed another form for therapeutic written communication which, while incorporating the benefits of therapeutic letters, adds to these. It has also opened up some potential risks. This article incorporates a brief review of the literature covering therapeutic written communication and offers a case example where e‐mail was used as an adjunct in face‐to‐face therapy with a client who experienced attachment difficulties. This therapy was informed by systemic and psychoanalytic traditions. The authors explore a variety of technical matters including the timing and crafting of e‐mail responses, the integration of written communication with face‐to‐face therapy, impact on the therapeutic relationship and management of crisis. Ethical issues such as confidentiality and duty of care are also considered.     

Exploring the Therapeutic Relationship A Case Study

This paper is focused on the topic of the therapeutic relationship in systemic therapy. It is structured around the discussion of my experience of work with a particular family where the engagement issues were complex, and where there was the potential for a negative therapy sequence. The psychoanalytic concepts of transference, countertransference and projective identification are chosen to discuss my dilemmas — however, the differences between the analytic and systemic contexts of work are noted. Through the discussion of this case study, the potential benefits of using these analytic ideas to understand the therapeutic relationship in specific situations in systemic therapy are identified.     

Interpretation and the Therapeutic Relationship: An Attempt at Integration

The term integrative psychotherapy can have a range of meanings. It can refer to integration between therapeutic approaches grounded in different theoretical frameworks as exemplified in Wachtel’s (Psychoanalysis and behavior therapy: toward an integration. Basic Books, New York, 1977) Psychoanalysis and Behavior Therapy. Many therapists informally practice this sort of integration when, in response to problems and issues presented by the patient, they intuitively borrow from a variety of approaches in their clinical work. Therapeutic integration can also refer to attempts at integration within a single broad therapeutic approach such as psychoanalytic or psychodynamic. This is the direction I will take in this article. My goal in this paper is to contribute to the possibility of integration among different theoretical approaches within psychoanalysis in a delimited area. The delimited area that I will focus on is the tension between an emphasis on interpretation and insight versus an emphasis on the therapeutic relationship as the primary agent of therapeutic change. Rather than an “either-or” position, I will show that integrating theories about both aspects of this process leads to a richer, more complex picture of what happens in psychodynamically-informed therapy.     

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.     

Psychodynamic psychotherapy: When it helps people in recovery

You have almost never read about psychoanalysis or its less intense relative, psychodynamic psychotherapy, in these pages. It's because it doesn't work to treat active substance use disorders (SUDs). But psychodynamic psychotherapy, with all of the psychoanalytic underpinnings, can be very helpful to patients in recovery, because in fact many of these patients are self‐medicating a past trauma.     

Psychological treatment of adolescent substance abusers:: A review

Alcohol and drug abuse among youth has become a major national concern. Psychological treatment strategies reported in the literature that have been used with adolescent substance abusers include five approaches: (a) behavior therapy, (b) skills training, (c) reality therapy, (d) psychodynamic therapy, and (e) family therapy. A limited number of studies have evaluated these treatments. Behavior therapy, skills training, and family therapy approaches show some evidence of effectiveness. However, most studies had methodological flaws.     

On the Project of Using Psychoanalytic Ideas in Systemic Therapy: A Discussion Paper*

Recently in Australian and New Zealand systemic therapy forums, there has been a tentative renewal of interest in psychoanalytic thinking. These local discussions have tended to reference psychoanalytic ideas as part of the struggle to understand emotional experience, and the therapy relationship. This paper reviews the patterns in these discussions, and then considers the wider context of the appearance of this interest in terms of the history and development of systemic theory. Some tentative comments are made about the project of using psychoanalytic ideas in systemic theory and practice.     

Reclaiming the Emotional Aspects of the Therapist-Family System

The shift from first to second order cybernetics has made the concept of the therapist-family system part of the everyday discourse of family therapy. In spite of this shift, there is little focus in family therapy literature on the emotional aspects of the therapist-family system. Relevant process concepts available to us at present, such as induction or accommodation, are poorly defined and inadequate. Three reasons for the neglect of the emotional aspects of family therapy are explored. They are, firstly, more recent theoretical and technical directions, secondly, the politics of gender and thirdly, the enduring difficulty of working with and writing about our own and families' powerful emotions. Finally, following a case example, some psychoanalytic concepts are described and discussed. It is possible that concepts such as counter-transference and projective identification may enrich family therapists' understanding of what is happening within the therapist-family system.     

Fundamentals of Theory and Practice Revisited: Sex Therapy: Historical Evolution,Current Practice. Part I

This is the first of a two‐part series, and provides a contextual history of major trends in sex therapy, notably the psychoanalytic, behavioural and medical models, as well as detailing the family therapy contribution to the field. Part 2 will present the outline of a first interview, and use it to demonstrate a systemic model which explores the interrelationship between the symptom, the presenting person(s), the ‘sexual’ as part of the relationship, the biological, the broader cultural view of sexuality — and the therapist's framework and thinking. Case studies are used as illustration.     

Australian Family Therapy: Have We Lived Up To Our Mission Statement?

In 1983 the Fourth Australian Family Therapy Conference had the theme ‘Merging the Streams — Integrating Trends in Family Therapy’. In his keynote address Brian Stagoll outlined concerns regarding the nature of family therapy as it was then developing in Australia. This article revisits some of these themes to see where we have come from, where we are heading and which topics continue to be ignored. Evidence is drawn from articles that stood out for me in the Australian Journal of Family Therapy (later the Australian and New Zealand Journal of Family Therapy) and selected relevant papers from the 1983 conference itself. Finally, I speculate upon possible reasons for the absence of discussion on certain issues, most strikingly: systemic influences upon indigenous Australians, farm families, working with children in families, certain aspects of gender, the systemic implications of addiction; and environmental impacts on families now and for the future. The danger for family therapy is becoming stuck in a closed system that ignores the wider system.     

Mary Poppins as Family Therapist

This article takes a light-hearted look at popular culture focusing on the 1964 film Mary Poppins. Some aspects drawn from theory underpinning family therapy and from the psychoanalytic ideas of Winnicott and Klein are applied, tongue firmly in cheek. Serious points made include the ubiquitous presence of popular culture in our lives, and the idea that Art/Popular culture may anticipate (or at least accompany) explicit formulation of scientific ideas.     

BOOK REVIEWS

Book reviewed in this article:
Boszormenyi-Nagy, I. and Krasner, B. R. Between give and take: A clinical guide to contextual therapy.
Bepko, Claudia with Krestan, JoAnn. The responsibility trap: A blueprint for treating the alcoholic family.
Jacobson, Neil S. and Gurman, Alan S. Clinical handbook of marital therapy.
Wilkins, Robert and Loudon, Penny. (1987). The therapist's thesaurus: A cartoon guide.
Campbell, David and Draper, Rosalind (Eds.). Applications of systemic family therapy: The Milan approach.
Strean, Herbert S. Resolving marital conflicts: A psychodynamic perspective.     

BOOK REVIEWS

Book reviewed in this article:
Kirschner, Diana A. and Kirschner, Sam. Comprehensive family therapy: An integration of systemic and psychodynamic treatment models .
Anderson, C. M., Reiss, D. J. & Hogarty, G. E. Schizophrenia and the family .
Efron, Donald E. Journeys: Expansion of the strategic-systemic therapies .
Wynne, Lyman C., McDaniel, Susan H., Weber, Timothy T. Systems consultation: A new perspective for family therapy .
Ulrich, David N. & Dunne, Harry P., Jr. To love and work: A systemic interlocking of family, workplace, and career .
Root, Maria P. P., Fallon, Patricia, and Friedrich, William N. Bulimia: A systems approach to treatment .
Fossum, Merle and Mason, Marilyn. Facing shame: Families in recovery .
Ackerman, Norman J. A theory of family systems .     

There are Some Things I Don’t Want to Know: Leichsenring and Rabung’s Long Road to the 2008 JAMA Report

Psychodynamic practitioners have been slow to evaluate their outcomes empirically and to disseminate these findings publicly. This historic stance is changing, with psychoanalytic leaders now calling for more empirical research and with important, recent contributions. This response lauds the JAMA paper as a developmental achievement among dynamic theorists, and as an example of the kind of interdisciplinary scholarship which is needed. The author offers a critique and raises questions about what constitutes the treatment in these quite disparate treatments, spanning 25 years. It compares their findings to those of a current, clinic-based longitudinal study (N = 1,050), and asks if this latter study’s findings might challenge or at least complicate some of the strong assertions Leichsenring and Rabung make.