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.     

‘Somebody Else's Roadmap’: Lived Experience of Maudsley and Family‐based Therapy for Adolescent Anorexia Nervosa

The Maudsley and more recent family‐based therapy manualised approaches are positioned by some as the gold standard, evidence‐based therapy for adolescent anorexia nervosa (AN). However, a significant proportion of adolescents and their families either discontinue this therapy and/or find that it simply does not work for them. These adolescents and families are under‐represented in the literature on therapeutic interventions for adolescent AN. This paper begins to address this gap with an in‐depth qualitative case study that explores the lived experience of Maudsley family therapy (MFT)/family‐based therapy (FBT) for one female adolescent (age 14 years) and her family over the period of 3 years (ages 11–14). Although initially handing over the responsibility for her eating was comforting and reinstated a sense of control in the family system, these experiences were not maintained. When she did not progress past the first phase of FBT, she and her family experienced the approach as blaming. She felt silenced and family alliances were weakened. This paper analyses how the family members negotiated and preserved their identities within this disabling context.     

Incorporating Internet‐based Interventions into Couple Therapy: Available Resources and Recommended Uses

Although there are a number of highly efficacious in‐person treatments designed to ameliorate relationship distress, only a small proportion of distressed couples seek out in‐person treatment. Recently developed internet‐based interventions based on these in‐person treatments are a promising way to circumvent common barriers to in‐person treatment and give more distressed couples access to these efficacious interventions. The overarching aims of this review are to provide couple and family therapists with a broad overview of the available internet‐based interventions and provide suggestions about how these interventions might be utilized before, during, or after in‐person treatment. The majority of the review centres on internet‐based interventions for distressed couples and covers four distinct types of resources: relationship advice websites; assessment/feedback interventions; enrichment interventions for satisfied couples; and interventions targeting at‐risk or distressed couples. Included is a case study of one couple's journey through a newly developed intervention targeting at‐risk couples, OurRelationship.com . Internet‐based interventions targeting individual psychopathology (e.g. anxiety and depression) are also reviewed. These interventions would be particularly useful as an adjunctive resource for in‐person couple or family therapy when referrals for a concurrent in‐person individual therapist are not feasible (because of time, financial, or geographic constraints). We close with three appendices: two appendices with information on currently available internet‐based interventions; and one appendix with recommendations on how to incorporate these resources into in‐person therapy.     

Treating Serious Emotional and Behavioural Problems Using Multisystemic Therapy

Multisystemic therapy (MST) is a family‐ and community‐based treatment of serious emotional and behavioural problems presented by adolescents. The development of this model began in the late 1970s, and today MST is a leading evidence‐based treatment of serious antisocial behaviour in youths, with programs transported to more than 30 states in the United States and 12 nations, including Australia and New Zealand. This article rerviews the theoretical rationale that underlies MST and presents the central clinical features of the intervention model. In addition, the training and quality assurance protocols used to promote MST program fidelity and treatment adherence are described. Finally, findings from approximately 15 published randomised and two quasi‐experimental clinical trials with youths presenting serious clinical problems (e.g., violence, substance abuse, serious emotional disturbance, sexual offending, and chronic illness) are summarised.     

Family‐Supportive Organizational Culture and Fathers' Experiences of Work–family Conflict in Sweden

This study explores fathers' experiences with work–family conflict and their perceptions of how supportive the organizational culture at work is regarding fathers' work–family needs, and whether a family‐supportive organizational culture is associated with less work–family conflict. A total of 377 fathers working in private Swedish companies were surveyed. While a modest proportion of fathers experienced high levels of work‐to‐family conflict, less family‐to‐work conflict was reported. Further, fathers perceived little work–family support from top managers, supervisors, and co‐workers. Our results indicate that the cultures in the examined companies have norms that separate work and family from each other. Fathers seem likely to experience work–family conflict as long as the family‐supportive organizational culture, especially at the work group level, is not well‐developed. When fathers experience their work organizations as family‐supportive, they are likely to be better able to combine work and family and thus to help Swedes achieve a more gender‐equal society.     

The Well‐Being of Adolescents in Households With No Biological Parents

On the basis of a large, nationally representative sample of 19,071 American middle‐school students, the current study compares adolescents living with neither biological parent with their peers in five other family structures on a wide range of outcome measures. The results reveal some overall disadvantages of living with neither parent, although the disadvantages relative to nontraditional families are limited. Differences in family resources either partially or completely account for outcome differences between non‐biological‐parent and other family structures. Further, boys and girls in non‐biological‐parent families appear to fare similarly. Finally, measurement problems and their implications are discussed.     

Social Relations Model Analyses of Perceived Self‐Control and Trust in Families

How do people know which family member is trustworthy? In this study, the authors tested the hypothesis that people use their perception of a family member's self‐control as an indicator of his or her trustworthiness. Eighty‐four Dutch families consisting of 2 parents and 2 children completed questionnaires assessing each family member's trust in and perceived self‐control of the other 3 family members. This full‐family design enabled the authors to examine their hypothesis in horizontal relationships, between family members of equal status (i.e., parent–parent and sibling–sibling relationships), and vertical relationships, in which partners have unequal status (i.e., parent–child and child–parent relationships). Consistent with the hypothesis, Social Relations Model analyses showed that being perceived as having higher self‐control is related to greater trustworthiness among adults and children in the large majority of horizontal and vertical relationships (10 out of 12). These findings highlight that perceived self‐control is an important factor by which to gauge trustworthiness in families.     

The Family‐Friendly Community and Its Life Course Fit for Dual‐Earner Couples

Much is known about family‐friendly workplaces. This article examines the less understood family‐friendliness of the communities in which dual‐earner couples reside. Using data from a representative sample of dual‐earner couples (N = 727) in upstate New York, we examine how individual, couple, and neighborhood characteristics are associated with perceptions of community family‐friendliness. Using a life course perspective, we find that couples with young children rate their communities more favorably than do other couples. Findings also indicate that for couples with children of their own, living in a neighborhood with many other families with children is associated with higher ratings of family‐friendliness. We term this match, between a couple's life stage and their neighborhood's demographic structure, life stage‐neighborhood fit.     

Gendering the Organization of Home‐based Work in Turkey: Classical versus Familial Patriarchy

This article examines the link between industrial homework and family dynamics in Turkey by asking how and why varied patterns emerge in the organization of industrial homework. I develop a framework for the analysis of gendered organization of industrial homework by comparing labour practices in extended family and nuclear family households. In extended family households, subcontracts are made between industrial enterprises and male family members. Women carry out piece‐rated work at home under the supervision of male family members and have very little contact with people outside their family. In nuclear family households, subcontracts are made between women homeworkers and industrial enterprises or middle persons. Women work at residential streets and neighbourhood homework stores, as well as at home. They have control over their income as well as their working hours. To explain the divergent practices of industrial homework, I show that enterprises incorporate distinct patterns of patriarchy into the subcontracting arrangements through gendered organization of industrial homework.     

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).     

Addressing Emotional Communication in Family Relationships in the Treatment of Young People with Anorexia: A Case Study

Family‐based treatment (FBT) is an evidence‐based approach to anorexia nervosa in young people. Because it is not always successful, attention has been given to how families experience the treatment. A number of therapists have proposed possible additions to, or improvements in, the model. In successful cases relational containment may be achieved in the first phase of treatment. The treatment is often successful, but when initial goals, such as weight recovery, are not achieved, continuing to use the techniques described in the manual may become unhelpful. Sometimes therapists may need to address issues such as emotion coaching that are not specifically addressed in the FBT model. We describe a case in which the therapist addressed the family's emotional style in the first stage of treatment. This focus enabled progress to be achieved despite the adolescent's continuing difficulty in eating without parental support, and her escalating symptoms of anxiety and obsessional compulsive disorder (OCD). Therapy helped the adolescent and family understand that anorexic and OCD symptoms can be understood as a way of distracting from and managing distress. When this connection was made in therapy, the parents could help their daughter to manage distress in more adaptive ways. Parents may need help with their own difficulties in processing distress. In this case the parents needed the opportunity to resolve feelings of grief about a miscarriage in order to do so. We propose that therapy should address family difficulties with managing distress from an early stage.     

‘Let's Talk About Children’: Investigating the Use of a Family‐focused Intervention in the Gambling Support Services Sector

The family‐focused mental health intervention, ‘Let's Talk About Children,’ has positively influenced the lives of families affected by parental mental illness. This paper outlines the use of this brief, strengths‐based intervention for parents with gambling and other co‐occurring issues from the gamblers’ support services sector. Over a six‐month period, a training manual and accompanying resources were adapted for the gamblers’ support services sector and a targeted training session developed. Nine problem gambling counsellors from three Victorian gambling support services trialled the Let's Talk About Children intervention over a four‐month period. Qualitative data were gathered through focus groups, interviews, and practice enquiry groups to determine the impact of the Let's Talk About Children model for gambling support services. The results are presented as ‘practice wisdoms and recommendations’ reporting on the impact of the trial and to provide some guidance to support others in the implementation of a specific family‐focused intervention. This paper reports on the first exploratory trial of Let's Talk About Children for the gambler's support services sector in Australia.     

‘So I Feel Like I'm Getting It and Then Sometimes I Think OK,No I'm Not’: Couple and Family Therapists Learning an Evidence‐Based Practice

This research concerns itself with the experiences of couple and family therapists (CFTs) learning about and using an evidence‐based practice (EBP). The engagement with EBP is growing across many aspects of the mental health and health care systems. The EBP model is now being applied in a broad range of health and human service systems, including mental and behavioural health care, social work, education, and criminal justice (Hunsley, 2007). The dialogue about the role of evidence‐based approaches in the practice of CFT and research literature is also evolving (Sexton et al., 2011; Sprenkle 2012 ). Interestingly, while the research delves into what are the best approaches with different populations and presenting issues, little research has explored the experience of CFTs themselves, particularly while learning an EBP. Using a phenomenological approach called interpretive phenomenological analysis (Smith, Flowers & Larkin, 2009), this research explores the experiences of CFTs learning and using an EBP. The paper reports on key issues, challenges, and areas for CFTs, educators, and supervisors. As researchers, educators, administrators, policy makers, and CFTs struggle with what works best with which populations and how best to allocate resources, this research contributes to dialogues about how best to educate and support CFTs, and the complexity of doing research in real‐life settings.     

Places for Place‐Based Policy

Place‐based policy is both ubiquitous and widely criticised. The conventional economic case against place‐targeted interventions is strong, relegating its application to a narrow range of cases of immobile labour resources, market imperfections and/or other externalities. However, both internationally and domestically, equity considerations lead to policies and programmes for disadvantaged regions and their populations. Budget constraints and accountability suggest a selection or ‘triage’ process targeting places with the highest returns in contributing to social welfare. Furthermore, the challenges facing rural areas may be fundamentally different in developed from developing countries. This article proposes a framework for assessing places appropriate for place‐based policies, using the examples of Canada, Chile and Peru.     

Family Therapy for Kids Without Families: Working Systemically With Children and Young People in Residential Care

A significant proportion (4%, Australian Institute of Health and Welfare, 2008) of children and young people in Australia live in some form of residential care, usually in small group‐homes staffed by residential care workers in shifts. However, as Hawkins‐Rodgers (2007) points out, these placements are often not resourced to heal the effects of trauma and multiple attachment disruptions in their residents. The lack of an archetypal ‘family’ has led in the past to family therapists considering that there is little work to be done with such clients. This leaves such placements to be supported most frequently by clinicians who specialise in behaviour management and other linearly founded models of practice. The Alternate Care Clinic (ACC) is the first mental health service in New South Wales dedicated entirely to children and young people in out of home care with a high level of complex needs. This article examines the systemic therapeutic model the clinic has developed in the last two years. In particular, the article seeks to explore the importance of ‘meaning making’ in a diffuse parental system, particularly with regards to the term ‘family’. The complexities of working in this area and possible ways forward are illustrated with a closely worked case study.     

Action‐Oriented Research: Strategies for Engaged Scholarship

Action‐oriented research is a methodological approach for doing collaborative research with practitioners and community partners that can inform practice, programs, community development, and policy while contributing to the scientific knowledge base. This article discusses how family scholars can use action‐oriented research to work together with community partners to address their need for useful information about their practices and programs. We present some practical strategies that can help guide the action‐oriented research process including how to develop collaborative relationships with community partners; suggestions for determining sound, action‐oriented research questions; guidelines for selecting and implementing appropriate research designs; and considerations regarding data collection and the dissemination of findings.     

The research to teaching initiative: infusing faculty research into the MSW curriculum

Social work educators have a responsibility to facilitate student utilization of research‐based knowledge. Tremendous research based knowledge is generated at many schools, but due to multiple responsibilities, faculty often find it difficult to share their findings with fellow faculty outside of their immediate project team, or to inquire into the research efforts of their colleagues within the school. This paper describes the development, implementation and preliminary evaluation of Research to Teaching, an initiative to infuse the curriculum of a school of social work with current research findings from its faculty. The goal of the Research to Teaching initiative is to take current publications from faculty, and distill them into easy‐to‐use lecture materials including slides summarizing the content, teaching notes, discussion questions, and group activities such as skill practice, simulation, and other integrative activities. These lectures are placed on a site within the school's larger website, and are accessible to all faculty, students, alumni, and other interested individuals.     

Engaging Fathers in Family Therapy with Violent Adolescents

Violent behavior in adolescents can often signal profound distress or pain arising from family conflicts, hostile marital separations, sudden losses and other family turmoil. By circumventing blame the therapist engages the family in a constructive process that allows adolescents to change and grow and parents to share pain and sorrow about their own issues and responsibilities for their children. This re‐establishes healthy generational boundaries, produces a clearer co‐parenting alliance (e.g. after divorce) and creates sibling support. This paper describes an experiential approach, for working with violent adolescents in family therapy influenced by the pioneer work of Satir and Whitaker. It integrates systemic and developmental theories linking the presenting problem to relevant family events. The therapist: (1) explores adolescent development in the family and social context; (2) establishes a therapeutic alliance through understanding the interpersonal context for violent behavior, and (3) re‐directs negative actions into positive connections with family members. Segments of family therapy sessions with two adolescent boys and their families from different cultural backgrounds illustrate the impact of paternal absence for adolescent well‐being and the need to actively engage fathers in family therapy. Mario, the father's ‘tumor’, and Juan with his despairing violence are two problematic adolescents brought to therapy because of their aggressive behavior at home and/or in the school. The paper describes how to give them a different voice and build a therapeutic alliance with the family.