‘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.     

The feminist/emotionally focused therapy practice model: an integrated approach for couple therapy

Emotionally focused therapy (EFT) is a well-developed, empirically tested practice model for couple therapy that integrates systems, experiential, and attachment theories. Feminist family therapy theory has provided a critique of biased assumptions about gender at play in traditional family therapy practice and the historical absence of discussions of power in family therapy theory. This article presents an integrated feminist/EFT practice model for use in couple therapy, using a case from practice to illustrate key concepts. Broadly, the integrated model addresses gender roles and individual emotional experience using a systemic framework for understanding couple interaction. The model provides practitioners with a sophisticated, comprehensive, and relevant practice approach for working with the issues and challenges emerging for contemporary heterosexual couples.     

THE QUESTION CUBE: A MODEL FOR DEVELOPING QUESTION REPERTOIRE IN TRAINING COUPLE AND FAMILY THERAPISTS

This paper presents a three-dimensional model for teaching questioning to those wishing to develop skills in couple and family therapy. The model breaks questions into their component parts of format (the style of the question: open, closed, forced choice, rating, or ranking); orientation (the person who is being inquired about: self or other), and subject (the content of the question: behavior, feelings, beliefs, meaning, or relationship). The model is presented in the context of our post-Milan version of couple and family therapy training. The model is useful in that it allows students gradually to increase their repertoire of questions in a way that offers step-wise learning and integrates with their existing skills.     

NEIGHBORHOOD DISADVANTAGE, SOCIAL CAPITAL, STREET CONTEXT, AND YOUTH VIOLENCE

This article integrates arguments from three perspectives on the relationship between communities and crime—constrained residential choices, social capital, and street context perspectives—to specify a conceptual model of community disadvantage and the violence of individual adolescents. Specifically, we propose that status characteristics (e.g., race, poverty, female headship) restrict the residential choices of families. Residence in extremely disadvantaged communities, in turn, increases the chances of violent behavior by youths by influencing the development and maintenance of community and family social capital, and by influencing the chances that youths are exposed to a criminogenic street context. We assess our conceptual model using community contextual and individual-level data from the National Longitudinal Study of Adolescent Health. Our findings suggest that individual or family status characteristics influence violence largely because of the communities in which disadvantaged persons and families reside. Although we find that community social capital does not predict individual violence, both family social capital and measures of an alternative street milieu are strong predictors of individual violence. Moreover, our street context variables appear to be more important than the social capital variables in explaining how community disadvantage affects violence.     

Family Therapy in Child and Adolescent Mental Health Practice: Integrating Family Therapy in Child and Adolescent Mental Health Practice: An Ethic of Hospitality

This article integrates family therapy in contemporary child and adolescent mental health services as an evidence‐based practice. An integrative practice model is proposed where contextual approaches like systemic and narrative therapy complement and enrich individual problem‐focused models such as biological psychiatry and cognitive therapy. This is based on an ethic of hospitality towards all therapy discourses and the following best practice guideline: ‘To make optimum space for a systemic and narrative understanding contributes to evidence‐based practice in a contemporary mental health service.’ After discussing some dilemmas of integrative practice, I illustrate the therapeutic process by a detailed example of integrative family therapy with a depressed suicidal adolescent.     

Object Relations Family Therapy: Articulating the Inchoate

In recent years there has been a renewed interest in psychodynamic ideas within the family therapy literature. While some authors have explored the usefulness of psychodynamic concepts in the systemic context (Byng-Hall, 1995; Flaskas, 1993, 1996; Luepnitz, 1988, 1997), others have argued that psychodynamic models of family therapy should be given more credence in systemic work with families (Guttman, 1991). This paper describes Object Relations Family Therapy (ORFT), a psychoanalytic model of family therapy, in plain English in order to minimise the obscurity of some of the existing terminology and to emphasise the utility of more contemporary formulations. ORFT addresses the interface between psychoanalytic and systemic theories. It offers a way of conceptualising complex family dynamics at both the interpersonal and intrapsychic levels. It also integrates an understanding of nonverbal, unstated and often implicit processes in its formulation of problem development. The unique contribution of ORFT is elaborated using a clinical example.     

Introduction to the special section: The role of cognitive-behavioral interventions in couple and family therapy

Marriage and family therapists' perspectives on cognitive–behavior family therapy (CBFT) have seen major changes over the years. The focus on cognitions and behaviors in treatment is now widely embraced by marriage and family therapists because of the effectiveness of the approach and its flexibility and integrative potential. This article provides an introduction to the special section and a brief history and overview of the application of CBFT to the field and some of the benefits it can provide to the growing and ever-challenging area of couples and family therapy.     

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 FAMILY CRISIS INTERVENTION LITERATURE: WHAT IS MEANT BY “FAMILY”?*

Family crisis intervention is a rapidly growing area of clinical care in family therapy which lacks clear conceptualization, especially with respect to how “family” fits into crisis intervention theory. This paper integrates recent concepts from the family therapy literature into three views: family as background, family as context, and family as a unit. The family crisis intervention literature (56 publications) is reviewed and categorized according to these three views. Clarity in how “family” is viewed and consistency between theory and practice are examined. Recommendations for improving the conceptualization of “family” in family crisis intervention theory and practice are made.     

Family therapy as a dialogue of living persons: a perspective inspired by Bakhtin, Voloshinov, and Shotter

There are not a lot of conceptual tools that can help a family therapy teacher to talk and teach about the importance of the therapeutic relationship in family therapy practice. The idea that family therapy can be conceived as a dialogue might offer a fresh and promising perspective. Mainly inspired by the work of Bakhtin, Voloshinov, and Shotter, the author considers if the concept of dialogue can help us to talk about something that is there all the time in our family therapeutic practices, although sometimes unnoticed, and that is hard to talk about because we lack the necessary conceptual tools. When we choose to conceptualize family therapy as dialogue, the focus of the therapist is not primarily on data collection, information processing or problem analysis. The therapist is not primarily concerned with knowing, or with not-knowing. Instead, the focus is on the idea that first and foremost therapy is a meeting of living persons, searching to find ways to share life together for a while. Clinical vignettes that feature children's drawings in family therapy are used as illustrations.     

Neurobiology and the Therapeutic Action of Psychoanalytic Play Therapy with Children

This paper presents neurobiological aspects of the therapeutic action of psychoanalytic play therapy. The author contends that play integrates diverse modes of neural processing because of its inherently enactive and verbal nature. Admixtures of new and familiar self/other configurations emerge, simultaneously shaping and fostering integration of procedural and declarative modes of experience. Complex self-other configurations develop in play therapy because of its intrinsic integration of multiple experiential modes. The paper includes an illustration of play treatment with a boy who presented with a disorganized attachment pattern, an attendant deficit in affect regulation, and who manifested frank psychotic symptomatology.     

INTEGRATING INDIVIDUAL AND SYSTEMS APPROACHES: STRATEGIC-BEHAVIORAL THERAPY

The existing literature on the integration of family and individual approaches, largely analytic in orientation, consists of models which, for the most part, are not brief in application. An alternative, brief model is presented which integrates an individual, cognitive-behavioral approach with a strategic approach at both pragmatic and theoretical levels. The Strategic-Behavioral model justifies the selective use of behavioral frames in strategic therapy and offers guidelines for their selective application.     

Family Financial Socialization: Theory and Critical Review

Financial literacy research of the past 40 years (1970–2010) has largely ignored the reasons for sociodemographic differences in financial outcomes. The primary purpose of this paper is to initiate a theoretical discussion regarding family financial socialization—what it is; why it is important; and how its tenets could help advance understanding of individual differences in financial literacy. To this end, we propose a conceptual model that integrates family socialization theory and recent trends in financial literacy research. The study concludes with an interdisciplinary critical review of 100 articles which provide illustrations, highlight gaps, and present opportunities for further research with many practical guidelines for advancing deeper understanding of financial literacy from a socialization perspective.     

Speaking the Unspeakable: Reclaiming Grief and Loss in Family Life

Despite their core place in family life, grief and loss have received only sporadic attention in the family therapy literature. In examining this neglect we briefly revisit earlier family therapy understandings of grief and loss in families, and present a theoretical framework (drawing on Worden, 1982; Walsh & McGoldrick, 1991) that comfortably integrates a wide range of family grief experiences including death and more ambiguous losses.     

Spousal,Family and Gender Effects on Expected Retirement Age for Married Pre-retirees

The overall purpose of this study was to examine the degree to which retirement is a contextually embedded, family decision rather than an individualized, male-centric one. Using data from a 2010 survey of married pre-retirees ages 35–70 in Michigan, US, we created a General Linear Model to predict expected retirement age. The model incorporated the effect of spousal and family variables on expected retirement age, and because the work/family interface is highly gendered, we explored interactions with gender. The study used a life course perspective in its framing and analysis, and found that expected retirement age was related to both personal and family characteristics and that the relationship of spousal and family factors were gendered and complex.     

In Defence of a Modern Medical Model: Purism and Eclecticism in Family Therapy*

Family therapists criticise the ‘medical model’ for relying on linear causality, focusing on pathology rather than health processes and tending to coerce the family into preconceived models. These criticisms might be legitimately levelled at 19th Century models but not at modern medical models which include the circularity of general systems theory, attention to ecological field, and understanding of reciprocal influences of many factors such as emotions, antibodies, genetic endowment, nutrition, interpersonal relations, environmental stress, and symbiotic micro-organisms. This modernised medical model is consistent with modern family therapy theory which integrates general systems theory, ecological theory, communication theory, small group process, role theory and metaphoric communications. Family therapy purists define themselves by contrasting their differences with ‘the medical model’. Eclecticists tend to be practitioners who use broad theoretical frames of reference and commonsense, straight-forward, direct intervention where it is likely to work but will resort to indirect, metaphoric or paradoxical intervention for the more complex and resistant family.     

TRAINING THE PERSON OF THE THERAPIST IN STRUCTURAL FAMILY THERAPY

Structural Family Therapy needs a training model that integrates the existential, human mutuality of the therapeutic relationship with its technical elements. This paper offers a theoretical foundation for training structural family therapists in the use of self, discusses a model for training, and gives a case example illustrating personal training in a clinical context.     

Tolstoy and The Heroes of Family Therapy

This paper presents Tolstoy's view of history in ‘War and Peace’ against the background of recent post-modern developments in philosophy and family therapy. Family therapy, like philosophy, is now caught between a modernist and a post-modernist outlook, between ‘systematising’ or traditional scientific tendencies, and ‘edifying’ or literary practices. The former is represented by the idea of the family as a system and the latter in a metaphor of therapy as conversation. It is proposed that the edifying philosopher is sounding very much like the family therapist of the 1990s. Both share a newer metaphor of keeping the conversation going, and the idea that therapy is philosophy and philosophy a therapy. The discussion is grounded in Tolstoy's understanding of heroes in history and some implications for family therapy.     

Working with Stepfamilies

Stepfamilies are complex family systems that warrant a specific model to guide therapy practice. Once a stepfamily has formed it's easy to overlook the lack of an attachment history that is commonly embedded in a biologically connected nuclear family. This can result in stepparents picking up parental responsibility for their stepchildren, which often may not go well. This paper highlights the need for clarity concerning the different levels of connection within a stepfamily, and the importance of avoiding ‘nuclear family‐style’ solutions and assumed attachments. This is especially important in the early stages of the relationship when everyone is adjusting to changing circumstances, which is often a time when issues of loyalty and betrayal fuel many of the actions taken. A range of family therapy techniques can be helpfully adapted to working with stepfamilies, especially as relationships with children often bring them to therapy. In particular, therapists can utilise ideas from structural family therapy to help guide the stepfamily to navigate the complexities of everyday life.