Ethics and family therapy: the case management of family violence*

All family therapists, and especially Milan-style systemic therapists, have been trained to take a neutral stance regarding family issues, based on a circular causality model of family interaction. Therefore, when therapists deal with family violence, their ability to perceive individual responsibility for unethical behavior is weakened or suppressed. In fact, this ability is the primary tool in developing effective treatment planning in cases of family violence: The actively physically abusive man needs to be in individual and/or group therapy, not conjoint or family therapy. The ethical judgment of the therapist is what determines the limits of family therapy.     

Understanding Play in the Treatment of an Encopretic Boy

This paper provides a clinical illustration of the symbolic use of play in the treatment of an encopretic boy of eight. The historical and contemporary literature relating to both play and to encopresis are reviewed. Process material and case formulation are presented to provide examples of the way in which intrapsychic conflict is interpreted.     

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 futility of child therapy

Summary If one takes into consideration modern communication and family systems theory, it is apparent that the therapist's effectiveness may be greatly hampered in situations where she works with the child alone in a play therapy situation. Seeing a child alone in play therapy often tends to play into the already existing double bind situations in a family. The family aims at rejecting new behavior patterns which emerge because it has adapted to the problem behavior. By seeing the child and related family members, an open therapeutic contract can be established aimed at educating and preparing the family to be more receptive to new behaviors via new means of communication. The therapist becomes the active intervening agent in the system, available to all of the members. With the therapist serving as the nurturer which the family lacked, its members learn how to be available to each other in a new way. Once nurturance occurs, the family members feel strengthened to maturate and respond differently to each other.     

Helping Low-Conflict Divorced Parents Establish Appropriate Boundaries Using a Variation of the Miracle Question: An Integration of Solution-Focused Therapy and Structural Family Therapy

The authors discuss the implications of divorce and the effect that divorce has on the relationships between family members. Parents are encouraged to develop appropriate co-parental boundaries that direct and influence subsequent interactions between family members. Using an integration of solution-focused therapy and structural family therapy, a variation of the miracle question is suggested as a means to help parents gain confidence in making changes in behavior. The miracle question also is intended to help parents set new goals for themselves and increase the ability to cooperate and communicate as co-parents. A case study provides an example of this idea.     

Family Therapy for Disturbed Children: Some Experimental Results in Special Education*

The assumption that family attitudes play an important role in motivating children to learn is widely held. It is believed that poor family attitudes can offset the effects of the best educational program. This study employed psychotherapy to influence attitudes of families with a child in a school for the emotionally disturbed. The results indicated that family therapy improved the classroom behavior of the children as well as behavior observed by their parents at home.     

Alcoholics Anonymous and Family Therapy*

Alcoholism affects the family of the alcoholic as well as the individual problem drinker. Change in drinking behavior is often brought about by change in the alcoholic's family members. There has been a natural evolution in the alcoholism field of self-help groups for mates and children of alcoholics. This development has paralleled the recent growth and development of family therapy as a major mode of psychotherapeutic intervention. Yet, crossfertilization of ideas and intervention strategies between the two fields has been slow in occurring. Arguments over whether one uses family therapy or A.A. and Al-Anon persist. This paper focuses on ways in which family therapy and the A.A. self-help groups add to, rather than detract from, one another. A note of caution about the misuse of family therapy when alcoholism is present is also provided.¹     

Unlocking the family secret in family play therapy

Family play therapy combines play therapy with family systems therapy. When family secrets are revealed in a family setting, with play to cushion the family's anxiety, families have the opportunity to resolve long-standing intrapsychic and interpersonal difficulties that impede the psychological well-being of both children and parents. Family play therapy effectively reduces symptomatic behavior in children in an age-appropriate manner—an advantage over family therapy that may be geared to adult cognitive levels. It also gradually shifts the family to a systems perspective of its problems in a non-threatening way, thereby facilitating the child's connection to his or her primary caretakers.Ms. Eaker is a psychotherapist in private practice in Family Systems Theory, and therapist for the United Federation Teachers' Stress Management Program and various Employee Assistance Programs, and a PhD candidate.     

The restructuring of family schemas: a cognitive-behavior perspective

Cognitive-behavior therapists define schemas as cognitive structures that organize thought and perception. Schemas are also viewed as having an integral influence on emotion and behavior In this article, I examine the role of schema in family conflict and the specific interventions used in restructuring them during the course of family therapy. Further discussion highlights the concepts of attributions, assumptions, and family standards, and the role they play in schemas, as well as the overall family dynamics. Finally, a series of steps are suggested for facilitating the process of schema analysis and thought restructuring during the process of family therapy.     

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     

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.     

THE "INCESTUOUS FAMILY" REVISITED: A CRITICAL ANALYSIS OF FAMILY THERAPY MYTHS

From a feminist perspective, the family therapy literature concerning incest fails to perceive the patriarchal context of abusive behavior and consequently blames the victim. This paper critiques the family therapy literature by drawing on the feminist discourse concerning incest. Several pervasive myths are identified: (a) that fathers and mothers are pathologically disturbed or inadequate; (b) incest is caused by separation and loss; (c) family isolation or a rigid external boundary explains incest; and (d) incest serves a function in maintaining family organization. By analyzing the contradictions arising from these polemical positions, we propose criteria for developing an adequate clinical account of incest.     

The Power Equity Guide: attending to gender in family therapy

In the past two decades, feminist scholars have challenged the field of family therapy to incorporate the organizing principle of gender in its theory, practice, and training. In this paper, we introduce a training, research, and therapeutic tool that provides guidance for addressing or observing gender and power differentials in the practice of family therapy. As a training tool, the Power Equity Guide helps trainees to translate their theoretical understanding of feminist principles into specific behaviors in therapy. Researchers and supervisors can use the Power Equity Guide to evaluate the practice of gender-informed family therapy. We also provide specific suggestions for its use by trainers, supervisors, therapists, and researchers.     

Psychological treatment of adolescent substance abusers:: A review

Alcohol and drug abuse among youth has become a major national concern. Psychological treatment strategies reported in the literature that have been used with adolescent substance abusers include five approaches: (a) behavior therapy, (b) skills training, (c) reality therapy, (d) psychodynamic therapy, and (e) family therapy. A limited number of studies have evaluated these treatments. Behavior therapy, skills training, and family therapy approaches show some evidence of effectiveness. However, most studies had methodological flaws.     

HELP AND HINDRANCE: PARENTS OF DIVORCING CHILDREN*

Much research exists on the impact of divorce on the nuclear family. Less is known about the response of the extended family to a divorce. In this study, the authors examined divorcing children's perceptions of their parents' behavior; divorcing children experienced their parents' reactions as supportive, non-supportive, or “mixed.” Types of helpful behaviors were categorized and patterns of unhelpful parental behavior were elaborated. Implications of the study for therapy and for an understanding of parent-adult child relationships are discussed.     

In-home family therapy: indicators of success

In this study, we explore how specific individual, family, and family-within-community characteristics, as well as aspects of in-home family therapy, relate to responses to treatment. The Child and Adolescent Functional Assessment Scale scores and Global Assessment of Functioning scores were used as outcome measures. Results revealed significant differences between pre- and post-scores for clients receiving in-home family therapy services, providing an initial indicator of treatment success. In addition, primary family caregiver social support, role performance in school/work, and self-harmful behavior were indicative of successful outcomes. Clients with higher problem levels had the greatest rates of change, and clients receiving more hours of services fared better in therapy.     

The loyalty bind and sacrifice of the self: Family treatment of adolescent schizophrenia and schizophreniform disorder from a psychodynamic-systemic perspective

This article reviews treatment of families with a schizophrenically functioning adolescent from a psychodynamic systemic perspective. Systemic and psychoanalytic conceptions of family binding and the sacrificial nature of schizophrenic dysfunction, both on an intrapsychic and interpersonal level, provide the theoretical foundation for a multi-dimensional approach to treatment. This treatment approach is predicated on reframing of the adolescent's behavior, a co-therapy model of reparenting and multi-family group therapy to resolve the separation-individuation impasse characteristic of such families. The case of a 16 year old boy and his family is used to illustrate the concepts discussed.At the time this was written the author was a family therapist with Child and Adolescent Services, Coliseum Psychiatric Hospital, Macon, Georgia. He wishes to express appreciation to Dennis Jones, Ph.D., Program Director: A. Allison Grant, M.D., Clinical Director, and the staff of the adolescent unit.     

An Educational Model of Family Consultation*

This approach to working with families under stress recognizes the family as a system interacting via communication patterns among its own members and within a larger context of peers, neighbors, school, work, and community agencies. The goal is to help the family become a support system for all its members, more capable of meeting both adult and child needs for ongoing socialization and personal growth. The model is educational in that the focus is on teaching the family to identify strengths as well as dysfunctional behavior, and to acquire some basic communication and problem-solving skills. Methods are both cognitive and experiential. The approach is useful in short-term therapy with single families or groups of families.     

ADVANCES IN COACHING: FAMILY THERAPY WITH ONE PERSON

This paper describes the process of "coaching" individuals in their efforts to change themselves in the context of their nuclear and parental family systems. Although this approach is regarded as one of the major modes of intervention in family therapy, the actual methods and techniques for intervention are not widely understood. Moreover, we have expanded the Bowen approach to address powerful cultural and family life cycle influences. The goal of coaching is to help clients define themselves proactively in relationship to others in their families without emotionally cutting off or giving in. Coaching begins by training clients to become observers and researchers of their own role in the family and of family patterns of behavior. Coaching then moves to help them bring their behavior more in line with their deepest beliefs, even if this means upsetting family members by disobeying family "rules."     

The prediction of learning in family therapy training programs*

Research on family therapy training has produced very little data regarding the kinds of trainees that do best in family therapy training programs. This study attempts to provide some rough and preliminary data on that issue. One hundred and seventy trainees, drawn from seven different structural!strategic training experiences, were evaluated as to how much they learned by taking the Family Therapy Assessment Exercise pre- and posttraining. Their performance was correlated using a hierarchical regression analysis with a number of trainee variables such as amount of conjugal family experience, amount of experience doing family or individual therapy, or prior knowledge of family therapy. The results indicate that, as predicted, conjugal family experience was positively related, and prior knowledge was negatively related to performance. Prior experience doing individual therapy was also positively related to performance.