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.     

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.     

The Go-Between — Strategic Therapy with Teenagers in Separated Families*

The adolescent's experience of divorce needs to be understood within a developmental and systemic framework. Problematic or symptomatic behaviour in teenagers from separated families often reflects on the family's difficulty in managing the transition to a new and different family organisation. The type of problem or symptom presented is shaped partly by the developmental characteristics of the adolescent period, as well as being indicative of unresolved problems within the broader family system. Problem resolution can often require the involvement of both separated parents and their children in a conjoint interview, in which case a strategic family therapy approach can be particularly useful. A strategic approach offers the therapist clear guidelines regarding the focus and process of the interview, and assists the therapist to be in charge whilst remaining neutral in the sense of not allying more with one side or another. Case illustrations are included of a strategic approach with teenagers and their separated families.     

Applied Restorative Justice as a Complement to Systemic Family Therapy: Theory and Practice Implications for Families Experiencing Intra‐Familial Adolescent Sibling Incest

This article considers the impact on and therapeutic responses to families where there has been intra‐familial sexual assault (IFSA) by an adolescent member of the family against another younger member of the family. In doing so, the article will specifically highlight the nexus between systemic family therapy ideas and an applied restorative justice response in the form of Youth Justice Conferencing (YJC), as experienced through working as a family therapist in the area of adolescent sexual offending.     

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.     

Intergenerational solidarity between parents and adult children: a qualitative research among cohabiting and married children in Italy

The objective of this article is to compare the patterns of intergenerational solidarity between adult children who cohabit or are married and their own parents or their partner's parents through the analysis of 50 in-depth interviews. The research did not reveal any different behavioural patterns between cohabiting and married couples. Financial support provided by own parents or partner's parents and the presence of small children constituted positive factors which intensified the frequency of contacts and improved the quality of the relationship. In the event of illness of a parent, both the married and cohabiting couples provided assistance, especially when the illness was not disabling and there were no other kin relatives. When this was not possible, a private caregiver was hired or close family members provided assistance. Only those respondents who cohabited with a partner awaiting divorce were less willing to maintain contacts with their partner's parents. The presence of a family formed by previously married partners and the old age of the parents of the latter compromised the quality of the relationship and the willingness to provide assistance.     

Family Therapy is Just One Option

I trace my development as a family therapist from being a single model worker in systemic family therapy to a more eclectic approach. The context of my work is children's services and private practice. Failure to appreciate when one method of therapy is more suitable than another can lead to family therapy being applied when it is not indicated. The dangers in such mistakes and a lack of careful assessment that includes the ‘feeling state’ of the therapist are illustrated by case vignettes. A possible effect of some therapy techniques is to create a ‘distance’ from clients and to shield the therapist from their emotional distress. I outline situations where I would not use family therapy.     

Family‐of‐Origin Experiences and Adjustment in Married Couples

Within this article a model is tested that examines the relationship between married individuals' experiences in their family of origin and patterns of marital adjustment. Data were analyzed using structural equation modeling procedures, making the couple the unit of analysis. This allowed for an exploration of how one partner's family‐of‐origin experience and the other partner's family‐of‐origin experience uniquely influence each of the partner's experiences of the marriage. Two aspects of the results stand out. First, both husbands' and wives' family‐of‐origin experiences emerged as significant influences on marital adjustment. Second, the data suggest that wives' experiences within their family of origin are more strongly related to both their own accounts of their marriages and their husbands' accounts of their marriages than are husbands' family‐of‐origin experiences.     

‘I Just Don't Agree’: A Voice-Oriented Analysis of An IFPS Case of Alleged Child Maltreatment

In contrast to the many outcome studies of Intensive Family Preservation Services (IFPS), little is known about the underlying personal and relational dynamics of family crisis interventions. This article focuses on the core evolving dynamics of the changing self-presentations of a parent involved in an intensive home-based family preservation case of alleged child maltreatment. Three key family intervention sessions were videotaped and transcribed including both verbal and nonverbal behavior. The Listening Guide Method – a theoretically flexible, qualitative, relationally oriented method of in-depth interpretative analysis – served as our guide for this case analysis. In the processes of change toward a jointly constructed meaningful narrative on responsibility and self-care, two key elements emerged as playing a pivotal role: (1) the momentum of a potential referral of children to out-of-home care that precedes the start of an IFPS intervention and (2) the rhizomatic or root-like intertwinement of the voices of both parent and therapist with respect to the rationale for any involvement of society in the family. We argue that discourses on imminent placement in the context of family preservation deserve a genuine and valuable position in the initial discourse of a family therapist when entering a family in the context of crisis intervention. Both in understanding and driving any processes of change, we may need to reconsider our own willingness to step into the blending interplay of discourse and counter-discourse with our clients on the subject of our often drastic intervention. Consequently, we may read this narrative analysis as an invitation to reflect on the conceptualization of ‘client readiness’ in psychotherapy and to shift our thinking on preconditions for therapy from a client's readiness toward a therapist's attentiveness to listen.     

Personal Reflections of A Family Therapist*

In this informal paper I discuss my personal evolution as a family therapist, developments in the field, the politics of a systems approach in conventional settings, resistances to family and marital therapy by other professionals, some still puzzling aspects of family therapy, whether family or marital therapy works and what do we mean by working, directions my own work has taken, some comments about the nature of family life, the satisfactions and frustrations and stresses of being a family therapist, some hidden agendas of family therapy practices, how one's own personal family relationships affect and are affected by this kind of work, the casualties among family and marital therapists, and, finally, whether family therapists should have family therapy for themselves and their own families.     

Lessons From ‘The Hitting Place’: Reflections of a Family Therapy Novice

This case study is an account of a post‐traumatic family attempting to come to terms with life after violence, and the effectiveness of family therapy in supporting this transition. The fighting between two young girls had maintained the violence in the family dynamic and their highly anxious adolescent brother remained unable to let go of his protective position and move forward with his own life. The backdrop of the case was a novice family therapist and a mother with borderline traits who found it difficult to keep the therapeutic work within the bounds of the therapy sessions. Despite these difficulties meaningful change could be seen after only seven sessions of family therapy.     

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.     

A Passion for Prevention: An Interview with Anne Sved‐Williams

Anne Sved Williams is a perinatal and infant psychiatrist, who was trained in family therapy at the Ackerman Family Institute in New York, in 1976–77. In 1979, she was one of two women (the late Eleanor Wertheim being the other) invited to join the original Editorial Board of this journal. She is Director of Helen Mayo House and Psychiatric Services to the Women's and Babies Division, Women's and Children's Hospital Adelaide. She is a Clinical Senior Lecturer, University of Adelaide. In speaking with Colin MacKenzie, she recalls her introduction to family therapy, her training, her decision to move away from repair work with parents needing help in parenting adolescent children, in order to start ‘at the beginning’ with the parents of infants. She speaks of her pride in the ANZJFT's continuing tradition of Education Update, originally Anne's own initiative.     

Depression movement in family therapy with depressed adolescents

Family therapists presume, observe, and predict that depression can move from member to member in the family system depending upon the dynamics of the system as a whole. When an adolescent who is depressed begins to improve in family treatment, many family therapists have reported that the parents will often begin to experience an increase in their level of depression. This observation has been reported but has not been objectively measured. In this clinical study of four families, adolescent and parental depression during family therapy is measured to determine if depression movement does occur during family treatment. Results indicate that in three of the four families the parents did initially show depression level increases reactive to improvement in the adolescent. Such findings are supportive to the idea that some forms of adolescent depression often do serve a family system function.     

Nothing is as Practical as a Good Theory: Bowen Theory and the Workplace — a Personal Application

Bowen Family Systems Theory is most commonly used to understand and predict family process. It is also applied to other potentially intense relationship systems, especially the workplace. It has been used by workplace consultants and by individuals to understand, and to manage, their own workplace functioning. This paper will draw from several key Bowen concepts to analyse common workplace dilemmas and to suggest responses that may assist the functioning of the individual and the system. The author's own experience as a manager in a child and adolescent mental health programme will be used as the case study to illustrate the theory's application.     

Coming to Terms With Parental Divorce: Associations With Marital Outcomes and the Role of Gender and Religiosity

In this article we examine the current marriage relationship outcomes for children of divorce compared to children from intact families. The sample is 997 matched married couples. Those from families with married parents were more likely to come to terms with issues in their family of origin, and had higher religiosity, less negative communication, and more positive relationship satisfaction than those with divorced parents. Religiosity was effective in helping those with married parents come to terms with family of origin. The variable coming to terms with family of origin predicted positive marital outcomes to some extent for all couples, although for couples where both partners' parents had divorced coming to terms predicted fewer positive outcomes. Coming to terms for females was associated more profoundly with decreases in negative communication for both males and the females, and also predicted satisfaction and stability in more cases than did coming to terms for males.     

Engaging with Parents in Child and Adolescent Mental Health Services

This paper asks the question: How can child and adolescent mental health clinicians constructively engage parents as a resource in the young person's treatment? It draws from qualitative research data that explore parents' experience of their involvement in their adolescent's mental health treatment program. The paper especially focuses on challenges for clinicians in engaging with parents as part of the treatment program for young people. Clinicians' input about their perceptions of interacting with parents is utilised alongside parents' experiences of their involvement in clinical processes. The clinician data revealed key challenges were managing their reactions to parent defensiveness; broadening the focus from just alleviating symptoms in the young person; not taking sides with the young person; and resisting becoming an expert instructor. The paper discusses Murray Bowen's original family research about engaging parents in treatment with the symptom bearer and addresses how clinicians can build a positive alliance with parents that avoids blame while constructively opening exploration of the family relationship process as part of a collaborative approach.     

Beginning Struggles with Families*

Beginning treatment with families is marked by a sense of struggle between the family and the therapist. The family is seen as testing the therapist and as asking through their behavior questions about the therapeutic process. The therapist is advised to focus intently on the beginning interviews, working toward the point where the family relaxes and decides on an intuitive level to enter therapy. The major hurdle is in dealing with the family's anxiety as the therapist attempts to shift the focus from the individual patient to the family as a whole. Strategy in establishing this shift is outlined     

Adolescent Violence—Strategies,Outcomes and Dilemmas in Working with Young People and their Families

MATTERS is a program of Berry Street, and has been in existence since 1990. The service is funded to address parent/adolescent conflict and the service delivery model has developed over time in a direction which incorporates family therapy and conflict resolution techniques. Many families come to the service seeking assistance for problems regarding violence, and increasingly around a young person's violence to parents and other family members. In some instances, violence has been present over a long period and has become normalised within the family's experience. When working with families who present with problems of adolescent violence, the service aims to find a pathway for the young person/family to confront violent behaviour and move to a different position about the meaning of violence in their lives. This paper describes the team's approach to working with adolescent violence, utilising ideas from narrative family therapy and psychodynamic theory, and incorporating issues of power in society, culture and gender. Outcomes, dilemmas and future directions are also discussed.