DO WE REALLY UNDERSTAND? AN EXPERIENTIAL EXERCISE FOR TRAINING FAMILY THERAPISTS

This paper presents an experiential exercise for training beginning marriage and family therapists, as well as several adaptations of the format. The basic exercise consists of role playing a therapy session in which the people playing the clients speak a language that is not understood by the therapist-in-training. Although the therapist cannot understand the clients, the clients can understand the therapist. This exercise assists students to become more cognizant of the need to be cautious and curious in the cocreation of meaning in therapy. In addition, this exercise builds confidence and clinical skills, such as learning about nonverbal communication while observing process.     

Cognitive-Behavioral Family Therapy with a Family in High-Conflict Divorce: A Case Study

Children who live in families with high-conflict divorce situations are increasingly coming to the attention of clinicians. This paper explains the nature of the impasse of high-conflict divorce. It presents a brief theoretical overview of cognitive-behavioral family therapy as an effective approach to treatment for high-conflict divorce families. A case study that successfully utilized a cognitive-behavioral approach to family therapy is presented. Specific techniques such as parent training, communication and empathy skills, problem-solving skills, assertiveness training, role-modeling on the part of the therapist and application of the concept of reciprocal inhibition were included in the cognitive-behavioral family treatment. An N=1 research design is graphically illustrated for evaluation purposes.     

Family Phone Therapy in University Counseling and Psychological Service Centers: A Family Systems Approach

Abstract

This paper offers family phone therapy as a method for student mental health practitioners to overcome the obstacle of geographic distance between students and their families when family therapy is the treatment of choice. The issues of confidentiality, triangulation, diversionary conversation, and mixed communication, which present unique concerns when engaging in family phone therapy, are introduced and strategies to deal with them are discussed. A case example is presented to demonstrate the utility of family phone therapy in dealing with problems that students who use university mental health services can typically experience. Finally, implications of dealing with students' developmental tasks from an individual or family systems perspective are discussed.     

The Use of E‐mail in the Therapy Process

The therapeutic letter has a long history, with roots in psychoanalytic work and continuing application in family therapy. The advent of e‐mail has allowed another form for therapeutic written communication which, while incorporating the benefits of therapeutic letters, adds to these. It has also opened up some potential risks. This article incorporates a brief review of the literature covering therapeutic written communication and offers a case example where e‐mail was used as an adjunct in face‐to‐face therapy with a client who experienced attachment difficulties. This therapy was informed by systemic and psychoanalytic traditions. The authors explore a variety of technical matters including the timing and crafting of e‐mail responses, the integration of written communication with face‐to‐face therapy, impact on the therapeutic relationship and management of crisis. Ethical issues such as confidentiality and duty of care are also considered.     

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.     

Towards a Multicultural Society: Family Therapy with Greek Families†

Language and cultural differences can pose barriers to effective intervention in migrant families in conflict. Family therapy approaches can provide some useful strategies for overcoming these obstacles. A family therapy approach can (1) emphasise the value of utilizing natural network support systems; (2) provide a model which helps clarify communication problems arising in the relay of information through a third person acting as an interpreter; (3) underline the importance of non-verbal and process aspects of family communication; (4) suggest techniques for negotiating, joining, and finding commonalities of family experience between a therapist and family of different ethnic background. The therapist needs to develop sensitivity to both the universal and specific ethno-cultural structures, norms and problems of families; when this sensitivity is achieved powerful and culturally syntonic healing forces can be released. Examples of successful family therapy interventions in some Greek families in conflict are given.     

Intervening in Family Systems with Observer Messages*

This article presents an approach to family therapy in which a group of observers becomes part of a therapeutic team by introducing strategic messages into the sessions. The observers, who operate from behind a two-way mirror, are thus able to effect change in both the family system and the therapeutic system consisting of family and therapist. Messages are described in terms of five components: function, target, timing, content, and delivery. Some guidelines for effective team functioning are given and three examples illustrate the approach. Finally, implications for training are discussed.     

Narrative Therapy with Pre‐schoolers – Unfolding the Story

This paper describes an application of Narrative Therapy to working with pre‐school aged children in the family setting. Techniques have been specifically tailored and adapted to meet the developmental needs of this age group and assist with therapeutic engagement through all phases of therapy. We focus on three components: theme‐development, externalising the problem or helper, and multi‐sensory communication. Two cases are presented, which illustrate the therapeutic work with 4 year old children.     

Lost in Translation? Embracing the Challenges of Working With Families From a Refugee Background

This article describes the difficulties a mainstream family therapy service experienced in working with families from a refugee background. The experience of six therapists and five bicultural workers, who are also the referring agents, was captured in focus groups, and the reflections that emerged shaped a four‐part approach for working with families from a refugee background. Live consultation, either by the family therapist or bicultural worker, is suggested as a way to marry the expertise of family therapists who are not cultural ‘insiders’ with the ‘lived experience’ and cultural expertise of bicultural support workers. The process of reflecting on therapeutic failure resulted in several principles for working therapeu‐tically with families with a history of refugee trauma, unmet resettlement needs and family relationship challenges. These include maintaining a flexible approach to therapy, ascertaining a clear understanding of the referral context, defining an explicit therapeutic contract from the first session, being mindful of the important role that language plays and terminating therapy if it is contra‐indicated.     

SNARES IN FAMILY THERAPY

Telephone calls after therapy sessions, concurrent individual treatment of family members, the offer of secret revelations, and the use of psychoactive drugs all involve issues and events that can be insidious to effective family therapy. Various tactics are presented which not only succeed in controlling these incidents, but which also use them as important occasions for therapeutic intervention within the model of family therapy developed by Selvini Palazzoli and her colleagues in Milan.     

Expanding the Horizons of Forgiveness Therapy: A Cross-Cultural Application with a Bedouin-Arab Woman

This paper highlights forgiveness therapy, a therapeutic approach that has received limited attention in the social work literature. This study represents a beginning exploration of its cross-cultural application. Theoretical and empirical perspectives on forgiveness and forgiveness promoting psychotherapy are provided, and Enright’s pioneering process model is delineated. A case study of the utilization of forgiveness therapy with an Israeli Bedouin-Arab woman who experienced a traumatic interpersonal injury within the polygamous family is presented. LaRoche and Maxie’s guidelines for conducting cross-cultural psychotherapy are utilized to examine important dynamics that emerge in the case study. These authors’ recommendations, which are consistent with a process-oriented conceptualization of culture, as well as intersectionality, appear potentially useful for informing the transcultural application of forgiveness therapy. Future research questions and directions related to the utilization of forgiveness promoting psychotherapy with diverse populations are considered.     

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.     

Two is Better than One: Use of Behavioral Techniques within a Structural Family Therapy Model

This paper encourages the combination of behavioral and family therapeutic techniques within the family context. The approach discussed is most helpful during the beginning to intermediate stages of family therapy and serves to provide the therapist with the necessary leverage to allow for effective intervention and change. Three case histories are presented to illustrate the techniques discussed     

Resistance in Marital Therapy*

This paper offers a conceptual approach as well as examples of resistance to marital therapy. It is aimed at beginning marital clinicians to provide an understanding of the natural existence of resistance to therapeutic change. A model which conceptualizes resistance based on two divergent emotions is presented. This model can aid the clinician in assessing each individual's willingness to improve throughout the process of therapy. The examples of marital resistance may aid clinicians to be more aware of the forms which resistance can take.     

Discursive psychology as a method of analysis for the study of couple and family therapy

The field of couple and family therapy has benefitted from evidence generated from qualitative approaches. Evidence developed from approaches relying on language and social interaction using naturally occurring recordings of real‐world practice has the benefit of facilitating practice‐based recommendations and informing practice. The aim of this article is to provide an overview of one approach to discourse analysis, Discursive Psychology (DP), demonstrating how a social constructionist framework and focus on discourse can provide an important contribution to the field of therapy. To illustrate the methodological decision‐making process for researchers and/or practitioners who utilize DP, we draw upon a video‐recorded therapeutic session involving Tom Andersen. To conclude, we make recommendations for practitioners using DP to explore and examine therapeutic practice.     

Family Therapy: A Phenomenological and Active Directive Approach

Because the most popular forms of family therapy, psychodynamic and systems-oriented therapy, appreciably fail to consider family members as individuals in their own right, a phenomenological-humanistic view of families who come for therapy would serve to correct this oversight. The particular phenomenological view espoused by those who do client-centered family therapy, however, is too passive and neglects some of the realities of human disturbance. A "third force" in family therapy is therefore outlined in this paper, which combines a phenomenological-humanistic approach with a highly active-directive attempt to help family members surrender their misperceptions of themselves and others and to make profound philosophic changes in their intrapersonal and interpersonal attitudes and behaviors. As an example of this kind of phenomenological and active-directive approach, some of the principles and practices of rational-emotive therapy (RET) are outlined and applied to family counseling.     

Walk-in Together: A pilot study of a walk-in online family therapy intervention

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk-in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof-of-concept study investigating the acceptability and short-term effectiveness of an online walk-in family therapy service, Walk-in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk-in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre-session, post-session, and at 6 weeks follow-up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi-structured interview data. Post-session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post-session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well-received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk-in delivery model. This proof-of-concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk-in, telehealth model to meet the rising demand for therapeutic support for families in distress.     

When Strategic Approaches get Stuck: Maps out of the Mire

Using a biopsychosocial model, a three dimensional map provides guidelines for changing from strategic therapy when progress in this approach falters. The method is pragmatic and atheoretical, and brings together ideas from various schools which empirically have been found useful. Practical and inclusive guidelines are offered for family (and individual) therapy which address two important issues: reinforcement of change when progress is occurring, and a shift from an interactional to another dimension when stuck points are reached. The multi-dimensional approach is clear, can be used by individuals or teams, lends itself to teaching and is of particular value for entrenched and complex problems. Four case histories are presented to highlight the approach.     

Dream analysis in family therapy

Theoretical and practical aspects of dream analysis in family therapy are explored with case examples. The dream is considered tobe a disguised communication and it is used to aid in diagnosis and treatment. The dream is shown to be of special value with families who block communication or only appear to be cooperative. It is used to explore the unconscious elements of family life. Deciphering the dream helps to open new possibilities of communication within the family.     

Raising the Stakes in Child-at-Risk Cases Eliciting and Maintaining Parents' Motivation

This paper, the third in a series concerned with family therapy in cases involving children at risk of abuse, describes an approach to maximising parents' interest and commitment to therapy. After overviewing the difficulties faced by therapists in working with parents who are notorious for their ‘resistance’, we provide guidelines for minimising the negative consequences of notification and for constructing therapeutic leverage in order to elicit and maintain parents' motivation throughout the course of therapy.