FOUR USEFUL INTERVENTIONS IN BRIEF FAMILY THERAPY*

At the Brief Family Therapy Center we have developed some interventions that have repeatedly been found useful. Once a generalizable intervention is designed for a particular case and found effective, the team attempts to replicate by using it in other appropriate situations. When a pattern of usefulness emerges, it is time to think about and study what is going on that makes the intervention useful. The purpose of this paper is to describe four such interventions, the situations in which to use them or not use them, and our thinking about what is going on in each example.     

TOWARD CONSTRUCTING THE THERAPEUTIC SYSTEM*

The authors revise some of the concepts presented in their previous publications (Andolfi & Angelo, 1981; Andolfi, Nicolò-Corigliano & Menghi, 1983) and develop them further in light of their recent clinical experience. They emphasize that the therapist is not an outside neutral observer, but an active participant in the construction of the therapeutic system. The therapist can, at different times, be caring, detached, supportive, or provocative. In the fantasy of his clients he is a person who knows how to enter into a relationship and how to move out. By entering as the third pole in various triangles and activating new dimensions of rapport, he constructs complex relationships within the evolving therapeutic process. The authors also reevaluate the importance of the individual in the family as an agent of change and as a mediator of triangular relational messages.     

SOLUTION-FOCUSED THERAPY: TOWARD THE IDENTIFICATION OF THERAPEUTIC TASKS*

Brief therapy has often been regarded as “problem solving therapy.” This article discusses the development of a solution-focused approach to clinical practice. Solution-focused therapeutic tasks and interventions are described.     

OBLIGATED CLINICAN SELF-DISCLOSURE: JONE THERAPITS'S INTERVENTIONS FOLLOWING A FAMILY MEMBERS'S PUBLICIZED MURDER*

This article describes a family therapist's management of the sudden collision between profesional and personal boundaries following the publicized murder of her spouse. Reasons are offered to explain why it is becoming difficult for all clinicians to control the process of self-disclosure in therapy. Strategies used to meet the demands of affirming professional distance while maintaining therapeutic effectiveness are described. Brief recommendations are proposed for therapists in group, medical, rural, inpatient, and underserved settings. It is hoped that this case study will generate further discussion and assist health care providers who may face this challenge in the future.     

STRATEGIC THERAPY WITH DEPRESSED MARRIED PERSONS: INITIAL AGENDA,THEMES AND INTERVENTIONS*

A strategic approach to depression is outlined. Reasons are given for initially working with each spouse separately. For the purpose of discussion, three interrelated aspects of depressive marital situations are distinguished: the unsatisfying marriage, the distress of the depressed person and the spouse's response. Interventions focus on dampening the marital conflict rather than solving the problems that are presented; reframing depression as an active, dignified practice; and blocking the spouse's tendency to become over-involved in well-meant but unhelpful efforts to assist the depressed person. A case example is provided.     

THE EFFECTIVENESS OF FAMILY INTERVENTIONS IN THE TREATMENT OF PHYSICAL ILLNESS

Although a large body of research demonstrates that the family has a powerful influence on physical health, the evidence for the effectiveness of family interventions in physical illness is less conclusive. Family therapy and other family interventions appear to be most effective in chronic childhood illnesses such as asthma and diabetes. Family interventions have also been shown to be effective in the management of some cardiovascular and neurologic disorders and for the treatment of obesity. Family therapy appears to be more effective than individual therapy for some groups of patients with anorexia nervosa. This research supports the increasingly important role of medical family therapy in the new health care system. Recommendations for future research are discussed.     

PARENTAL REVERSALS: A FRAMEWORK FOR CONCEPTUALIZING AND IMPLEMENTING A CLASS OF PARADOXICAL INTERVENTIONS*

This paper describes a class of paradoxical interventions the author calls parental reversals which involve inducing parents to reverse either their injunctions or their position regarding a problem with a child. A taxonomy, as well as guidelines for the selection and implementation of these paradoxical interventions, is presented.     

IMPASSE AND CHANGE: A SYSTEMIC/STRATEGIC VIEW OF THE THERAPEUTIC SYSTEM*

This paper examines how clients and therapists, together, create impasses or change. First, the general concept of a “therapeutic system” (therapist-plus-client) is briefly reviewed. Second, a model is described that synthesizes systemic and strategic ideas about therapeutic systems. Third, a series of questions based on this model is proposed for analyzing and resolving impasses. Finally, application of this framework is illustrated with a case.     

FACILITATING INTIMACY: INTERVENTIONS AND EFFECTS

The Present study investigated by effects of two sets of marital interventions taken from Emotionally Focused Therapy (EFT) and Cognitive Marital Therapy (CMT) on level of marital intimacy, dyadic trust, and dyadic adjustment. It was hypothesized that both EFT and CMT would have a positive effect on levels of intimacy, trust, and adjustment as compared to a wait-list control group and that there would be a differential effect in favor of EFT as compared to CMT. Thirty-six couples free of marital distress and seeking to enhance theor intimate relationship were randomaly assigned to EFT, CMT, or a wai-list control group. Therapists' interventions were monitored and found to be faithfully implemented. Groups were equivalent on demographic variables and the quality of the therapeutic alliance. Both EFT and CMT group posttest means were found to be significantly higher than controls on the self-report measures of intimacy, Observational measures of intimacy revealed differential effects in favor of EFT as comopared to CMT at posttest. At a 10-week follow-up, EFT group means were significantly higher than CMT on self-reported intimacy and adjustment.     

ONE PERSPECTIVE ON THE MILAN SYSTEMIC APPROACH: PART II. DESCRIPTION OF SESSION FORMAT,INTERVIEWING STYLE AND INTERVENTIONS*

The Milan method of working with families includes a number of unique innovations. Among these are a pattern of creative teamwork that clearly separates the cognitive constructions of the therapist in contrast to the belief systems of the family, a style of interviewing that releases information latent in the family, and some novel interventions that facilitate the family's capacity to discover its own non-symptomatic solutions.     

THE NEUROBIOLOGY OF AFFECTIVE INTERVENTIONS: A CROSS-THEORETICAL MODEL

The integration of information from neuroscience with the practice of psychotherapy presents with numerous challenges. However, neuroscience research can guide practitioners in the purposeful use of the therapeutic relationship to enhance clinical outcomes. This article reviews such research pertinent to mental health and psychotherapy, and presents an a-theoretical model of intervention, guided by this information that can be incorporated into various therapeutic orientations.     

AN EXPLORATION OF THE THERAPEUTIC RELATIONSHIP AND COUNSELLING OUTCOMES IN A PROBLEM GAMBLING COUNSELLING SERVICE

This study examined the relationship between a number of counselling process variables thought to influence counselling outcomes in a sample of 150 clients undertaking short‐term counselling in the state‐wide government funded Gambler's Help problem gambling counselling services in Victoria, Australia. Factors measured included psychosocial well‐being of clients prior to and after counselling, client readiness to change, self‐reported gambling activity levels before and after counselling, self‐assessment of current gambling behaviour, strength of therapeutic alliance, self‐reported counselling outcomes achieved in the area of symptoms, life matters, and related problems and a measure of client satisfaction with the service. The therapeutic alliance was found to have the strongest predictive power with respect to the level of problem resolution achieved by clients across all but one of the problem areas. The implications of these findings for clinical social work practice and education of practitioners are noted.