Integrating Family Therapy Training in a Clinical Psychology Course

Teaching family therapy to clinical psychology trainees is not common practice in Australian clinical psychology training programs. There is sparse discussion in the literature. Family therapy is an evidence based intervention that complements a diversity of established theories and psychotherapies and would complement the intervention skills of trainee clinical psychologists. The aim of this paper is to illustrate how family therapy training may be integrated into a postgraduate clinical psychology course. The literature on core family therapy knowledge, skills and training methods will form the backdrop to a review of specific family therapy training courses for clinical psychology trainees. This will then be mapped against a consideration of accreditation requirements of clinical psychology courses in Australia and suggestions made for integrating family therapy into their training curriculum. Anecdotal feedback from students provides an initial step toward evaluation.     

Out of the Darkness: Three Waves of Family Research and the Emergence of Family Therapy for Lesbian and Gay People

Like family relationships themselves, the history and treatment of lesbian and gay people and their families is complicated. For this paper, three waves of research on the families of gay and lesbian individuals are described. During the first wave, gay and lesbian sexual orientation was seen as a disease and family dynamics were blamed for its genesis. Subsequently in the second wave it was believed that, fearing rejection many gay and lesbian people either distanced or were rejected from their own families and established friendship networks that have been described as families of choice. More recently, in the third wave, the family has been identified as a resource for lesbian and gay youth whereby open relationships with parents can help protect them from mental illness, substance abuse, and HIV risk. Furthermore, an increasing number of same-sex couples are choosing to become parents, overcoming biological and social obstacles. In this article these shifting views of the role of family in the lives of lesbian and gay people will be described along with case material that illustrates the historic influences, current developments and future directions of family treatment for this population. To be maximally effective with gay and lesbian people and their families, clinical social workers and other mental health professionals must understand how family therapy has been influenced by a progression of ideas that continue to evolve. In this paper, research examining the role of the family in the lives of lesbian and gay people will be described in three waves; as a source of blame, to an impediment to gay and lesbian happiness and ultimately a resource that can enhance lesbian and gay well-being. The influences of research on family therapy with this population will be described and case examples will demonstrate how to harness the strengths of family relationships identified in the most recent wave.     

Family Therapy by a Husband-Wife Team*

Marital and family therapy has traditionally been carried out by a solo therapist or colleaguel co-therapists. Theoretical and clinical advantages and potential difficulties of a husband-wife team will be discussed and comparisons made to the colleaguel co-therapy model. Phases in the development of a husband-wife therapy team and illustrative clinical vignettes will be presented.     

Family Therapy in a Biomedical Context

The role of family therapy has to be redefined in the wake of the reemergence of the medical model in psychiatry, which now encompasses biological, psychological, and social parameters. In this biopsychosocial model, the goal of biological therapy is to promote cognitive and affective regulation through the prescribing of neuroleptic and mood-stabilizing chemicals. The goal of individual psychological therapy is to teach individuals how to achieve intimate relationships and creative work productivity. The goal of social therapy, typified by family therapy, is to promote socialization, involving social belonging and obligation in terms of individual autonomy and freedom. One of the implications of allocating circumscribed objectives to the various therapies is that mental health professionals, even more in the future than in the past, will have to work together as collaborative team members.     

The McMaster Model of Family Functioning

The model of family functioning being presented is the product of over twenty years of research in clinical work with family units. A method of family therapy has been developed based upon this model and will be described in a future issue. The model utilizes a general systems theory approach in an attempt to describe the structure, organization, and transactional patterns of the family unit. It allows examination of families along the total spectrum ranging from healthy to severely pathological in their functioning. It is based upon a Judaeo-Christian value set, and allows attention to be paid to cultural differences and other issues of cultural relativity .     

Enhancing Family Therapy's Relationships With Research

The contention of this article is that systemic family therapy has much to gain from a realistic appraisal of its research base, which is as positive as possible. And that through such an appraisal we can find ways of developing the scope of family therapy to the benefit of the profession and thereby, of our clients. Family therapy will benefit if practitioners can present an informed view of research. As a preliminary approach to this objective, I review reasons why perceptions of family therapy underestimate its research base, and why therapists might resist involvement with research. The article then explores the reasons for regarding randomised controlled trials as a ‘gold standard’, and why they are not well fitted for the purpose of evaluating or developing a relational therapy. Next is a consideration of alternative approaches to research, including a consideration of what clients actually want from their therapy, then a brief review of the positive findings of outcome research. Greater emphasis on researching processes in therapy is proposed, and consideration of the ‘common factors’ debate is shown to support priorities that are specific to systemic therapies. The article concludes with suggestions for increasing the involvement of family therapists with research, both as consumers and as research practitioners.     

Maintaining the Gains: What Worked in the Year after Brief Family Therapy

Brief family therapy, including single session therapy, is widely used to provide a timely and responsive service for children with emotional and behavioural problems. However, there is surprisingly little information about how these children and families fare in the longer term. The brief family therapy program described here was directed toward children with problems of moderate severity. Child Behaviour Checklists (CBCL) were completed by parents before, three months after, and twelve months after therapy; 110 parents also participated in semi‐structured telephone interviews twelve months after therapy. Parents' CBCL ratings showed a significant decrease in children's problems after therapy, which were maintained over the subsequent year, although some children continued to experience difficulties. Parents generally found brief therapy a helpful experience. Ways to strengthen the preventive possibilities of brief therapy work will be identified at both a practical and conceptual level.     

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 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.     

Ten Research Questions for Family Therapy

A growing evidence‐base shows that family therapy works, but many gaps in our knowledge remain about the conditions under which family therapy is effective and how it works. In this paper, ten critical research questions about family therapy that need to be addressed are considered. In short these are:

• 1 Is family therapy as effective in community settings as it is in specialist clinics?
• 2 For what problems is family therapy cost‐effective?
• 3 Does family therapy work for under‐researched problems and populations?
• 4 Do social‐constructionist and narrative approaches to family therapy work?
• 5 Can family therapy protocols be enhanced for non‐responders?
• 6 Can family therapy be combined with other psychotherapies to effectively treat specific problems?
• 7 Can family therapy be combined with pharmacotherapy to effectively treat specific problems?
• 8 What specific factors contribute to the effectiveness of family therapy with particular problems?
• 9 What common factors contribute to the effectiveness of family therapy?
• 10 What therapist and client factors contribute to the effectiveness of family therapy?

     

The Family Floor Plan: A Tool for Training,Assessment and Intervention in Family Therapy*

The family therapy field has produced a number of expressive modalities for use in training and therapy. The family floor plan, as a tool for training, teaches systems concepts while involving trainees in an examination of their family-of-origin. In family therapy, the floor plan can be used to assess family interaction patterns and to intervene. The floor plan tool and its applications are described, including short case vignettes.     

Family Therapy with the Elderly

This article outlines health and lifestyle challenges to elderly persons and associated changes in their family systems. Flexibility, related to attachment patterns, is considered central to healthy adaptation. Family therapy approaches and relevant systemic and cultural factors influencing psychotherapy with the elderly are discussed. Key family therapy concepts and strategies (genograms, transmission of family histories and circular patterns of interaction), are reviewed and exemplified. Four types of family therapy presentations are elucidated by composite case examples. Firstly, the elderly person can be the identified patient. Secondly, another family member can seek help for him/herself in relation to the elderly person. Thirdly, another family member can be the identified patient without direct reference to the elderly person. Finally, the wider health care system involved with the elderly person and family can be the focus of therapy. Family therapy offers important conceptual and strategic advantages in working with the elderly and their systems.     

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.     

Implementing Single Session Family Consultation: A Reflective Team Approach

Setting up and implementing a single session family consultation in a specialist child and adolescent mental health setting, which for a long time has been an organisation and culture that has undertaken a traditional detailed child and family assessment and treatment, brings with it challenges. This paper will look at the history of single session consultation within the field of child and family services and, in particular, child and family services in mental health. It will also look at the development and implementation of a single session therapy program, and associated research on the effectiveness of the program, at the Alfred Child and Youth Mental Health Service. Clinical examples will assist in illustrating the program and its model and structures. Lastly, it will review the research data and compare this with other research data in the field.     

Preserving Family Therapy's Legacy

Originating as a plenary address, this article reviews the enduring contribution of family therapy, and asks how it might best be preserved into the future, given that family therapy itself is no longer seen as ‘newsworthy’. The author makes three recommendations: that all future social workers be trained to conduct a three‐session structured family assessment; that all future family therapists be required to participate in a Yalom‐type group therapy experience; and that one member of every child mental health and child protection team be trained to convene and chair interagency case conferences capable of building trust and working towards open communication. A rationale for the three recommendations is provided, in terms of key principles common to family and group work.     

Correlates of Engagement in Family Therapy

Sixty-five families who continued in conjoint family therapy were compared on a variety of antecedent variables to 65 families who dropped out. The following factors were found to be associated with engagement in therapy: (a) age of the identified patient; (b) number of children in the family; (c) the family's prior involvement with community agencies; (d) the presence or absence of antisocial acting-out; and (e) attendance of father at both the initial intake interview and early treatment sessions. Maximal discrimination between continuing and dropout families was demonstrated by simultaneous consideration of several significant variables. The implication of these results for family therapy selection criteria are discussed.     

Fathers in Family Therapy: A Survey of Family Therapists

Sixty family therapists were surveyed in an investigation of resistance by family members to family therapy. Consistent with other investigations, the father was viewed as the most resistant along a number of dimensions. Therapist behaviors that related to difficulties with the father, specifically, and to family therapy generally, were identified. The implication of these results and possible strategies to reduce the resistance of the father are discussed.     

The Post-Hospital Mental Patient and Family Therapy: Prospects and Populations*

Changes in the pattern of delivery of mental health services have led to dramatic increases in the number of patients discharged from mental hospitals. These post-hospital mental patients represent a new challenge to the field of family therapy. Of the approximately 1 million patient admissions to state and county mental hospitals, general hospitals, and private psychiatric hospitals, over 380,000 are married, and more than half of the remaining patients are estimated to be living with family. Almost 135,000 admissions receive family therapy during their hospitalization, and an estimated 650,000 mental patients will return to their families upon discharge.     

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.     

Family Relocation:

Family domestic relocations for the purpose of employment have increased and indications are that this will continue. Although there are various reasons for relocation which affect its influence, recent research on corporate moves suggests that there are unexplored discrepancies in the findings on how the two genders respond to the relocation. This paper will discuss these differences and will describe how professions unwittingly can contribute to mother and/or wife blaming within the context of family relocation. The results are evident in the literature which produces: (1) a focus on women's responsibility and accountability for the family, to the exclusion of men, and (2) a lack of awareness of the societally prescribed contexts of work and family life that can be oppressive to both women and men. This paper also suggests practice principles that will guide work with family member's adjustment to relocation and that will direct future research.