Architecture: A Template For Generating Design And Construction Possibilities For Therapy

The architectural processes of design and construction can be adapted to the design and construct of human solutions. Architecture provides a generative metaphor for therapy as well as a coherent and comprehensive conceptualisation for developing an integrated therapeutic eclecticism. The notion of ‘therapy as architecture’ is general enough to encompass all models of therapy. However, the paper confines its application of the architectural metaphor to the field of family therapy, and in particular to the briefer approaches to family therapy. Also, the paper demonstrates the utility of this architectural template for providing specific guidance on how to design and construct a therapeutic form in keeping with the client's brief and context. A case vignette illustrates how an architectural therapy works.     

Child-Focused Family Therapy: Behavioural Family Therapy Versus Brief Family Therapy

We examined the effectiveness of behavioural family therapy (following the treatment agenda outlined in Fleischman, Horne and Arthur, 1983) and brief family therapy (following the procedures outlined in Fisch, Weakland and Segal, 1985), in the treatment of child psychological disorders. The parents of the 49 children referred to the outpatient unit of a children's hospital completed the Child Behavior Checklist (CBCL) (Achenbach and Edelbrock, 1983). Three scales of the CBCL were examined to assess the effectiveness of the two therapeutic approaches pre- to post-treatment. Significant pre- and post-treatment differences were found for behavioural family therapy on the Internalizing, Externalizing, and Sum T scales and for brief family therapy on the Internalizing and Sum T scales. Sum T scales represent the sum of scores across all sub-scales of the CBCL. Neither treatment was found to be more effective than the other.     

Brief Family Therapy: A Critique of Kinston and Bentovim

There has been a growing interest in the use of brief family therapy with children. Despite this increased interest, research into the effectiveness of this approach appears to have lagged behind clinical practice. The present paper critically reviews a study by Kinston and Bentovim (1978) which could be viewed as typical in the area of brief family therapy. Analysis of Kinston and Bentovim's investigation revealed serious methodological deficiencies and raised some important clinical issues in brief family therapy studies. These include the importance of training in family therapy, the use of a consistent theoretical framework, and flexibility in the application of techniques. On the basis of this review, recommendations are made that future investigations of brief family therapy follow the guidelines necessary for valid psychotherapy research.     

Maintaining the Gains: What Worked in the Year after Brief Family Therapy

Brief family therapy, including single session therapy, is widely used to provide a timely and responsive service for children with emotional and behavioural problems. However, there is surprisingly little information about how these children and families fare in the longer term. The brief family therapy program described here was directed toward children with problems of moderate severity. Child Behaviour Checklists (CBCL) were completed by parents before, three months after, and twelve months after therapy; 110 parents also participated in semi‐structured telephone interviews twelve months after therapy. Parents' CBCL ratings showed a significant decrease in children's problems after therapy, which were maintained over the subsequent year, although some children continued to experience difficulties. Parents generally found brief therapy a helpful experience. Ways to strengthen the preventive possibilities of brief therapy work will be identified at both a practical and conceptual level.     

Satisfaction With Family Life Scale

We wanted to present validity and reliability data for the Satisfaction With Family Life (SWFL) scale. This instrument has been successfully used in a variety of family samples and offers a brief, widely applicable tool to measure satisfaction with family life. The SWFL scale, modeled after the Satisfaction With Life scale, was designed to assess an individual's global judgment of family satisfaction, which is theoretically predicted to depend on a comparison of family life circumstances with one's own standards and expectations. The scale consists of five items on a Likert-type scale. Data were collected from parents and adolescents in 15 different family samples that vary across time, place, and culture. Across all samples a consistent unidimensional factor structure was maintained, with Cronbach's alpha ranging from .94 to .79. Evidence of usability, criterion, and construct validity were also established. The SWFL scale consistently distinguishes differences in family satisfaction among samples that would theoretically be predicted to have different levels of family satisfaction. The SWFL scale provides a brief, psychometrically sound, and widely applicable option for measuring satisfaction with family life.     

Family Therapy and the Family Doctor − 1

The author shows that the family doctor's burden of responsibility in the area of psychological dysfunction in the community is immense. Traditionally he has little training, limited knowledge, and a paucity of skills, in the areas of counselling and psychotherapy. The author argues that structural and strategic family therapy skills may be applicable to family practice and of benefit to the family doctor. A brief introductory course and subsequent feedback are described.     

Evaluation of Family Therapy: A Comparison of Therapists' and Clients' Views**

In this evaluation of therapy experience for 82 families by brief therapy at Bouverie Clinic to 1976–1977, therapists' and clients' rating of outcome were obtained. After termination of therapy both therapists and clients reported high improvement rates in the presenting problem(s) as well as in the quality of family relationships and in the family's ability to deal with further problems. High agreement was found between therapist’ and clients' ratings of outcomes. Therapists were more favorable than clients in their ratings of change in the presenting problem and in their ratings of change in the quality of family relationships, but not in assessing the change in family's further problem solving ability. At follow-up clients were predominantly satisfied with their therapy experience. In addition, therapists' ability to predict outcome accurately, after the second of therapy, was strongly supported by our finding.     

Producing Family Problems: Organization and Uses of the Family Perspective and Rhetoric in Family Therapy

This article applies and extends literature on the micropolitics of trouble and family rhetoric perspectives by analyzing how therapists in a family therapy agency practicing the brief model used family rhetoric in defining and responding to client problems. Family rhetoric is the use of images of family (the family perspective) to (1) persuade others to one's preferred orientation to issues of mutual concern and (2) attribute identities to one's self and others. The article focuses on how the therapists rhetorically enacted and applied the family perspective in interactions with colleagues and clients to define and remedy client troubles. In general, troubles were defined and remedied by treating them as products of clients' family systems, defined as enduring roles, relationships, and perspectives. The therapists sought to remedy client troubles by initiating changes assessed as appropriate for their troubles and family systems. The article concludes by considering some of the implications of the findings and analysis for the sociological study of human service work.     

Time in the Therapeutic Domain

This paper sets out to examine theoretically the role that “time” plays in therapy. It proceeds by investigating the appearance of “time” in the therapeutic literature: specifically, research regarding the efficacy of brief therapy and attendance of clients in therapy, psychoanalytic concepts of “time”, family therapy's recent emphasis on the future and conceptualisations available about “time” and its role in problem formation and resolution. A summary of these findings precedes a discussion emphasising the problems of crisis, irreversibility and chronicity. The conclusion re-emphasises the need for a multi-modal approach to any future theorising on “time” in the therapeutic domain.     

Deactivating the Buttons: Integrating Radical Exposure Tapping with a Family Therapy Framework

The purpose of this paper is to describe and illustrate with case examples a brief intervention termed Radical Exposure Tapping (RET). RET can be integrated with family therapy to address stuck points where the therapy is hindered by a family member's affective block, an intense and unchangeable emotional reactivity to a specific trigger. RET draws from the methodology of Eye Movement Desensitization and Reprocessing (EMDR) and combines it with the tapping sequence of the Emotional Freedom Technique (EFT) to produce an intervention that is more flexible than EMDR, provides greater rigor than using the EFT technique alone and can be effective in a single session within the context of family therapy. The paper puts this work into context by first over viewing definitions of trauma and Post‐Traumatic Stress Disorder, arguing that family members' emotional reactivity may be a symptom of PTSD even when they would not qualify for the diagnosis because they had not experienced a life threatening event.     

Family Therapy … What's in a Name?*

The 2nd Australian and New Zealand Family Therapy Conference, held in Melbourne in July 1992, invited those making presentations to address the Conference theme Family Therapy … what's in a name? In a closing address to a plenary session of the Conference, I used the metaphor of first names (family) and surnames (therapy) to suggest that names are central to issues of identity. Our first name of “family” differentiates us within the larger group who share the surname “therapy”; but what does it mean to belong to the larger group sharing the name “therapy”? Historically, much of family therapy's energy has gone into issues concerned with establishing difference — difference within family therapy in terms of models and approaches, and difference from other approaches to therapy. Yet now perhaps family therapy would benefit from exploring what it shares in common with others who hold the same surname of “therapy”, with the possibility such dialogue could lead to mutual enrichment.     

Integrative Family Therapy With Childhood Chronic Illness: An Ethics of Practice

A challenge for contemporary family therapists is negotiating differences between modern and postmodern frameworks in the practice context. Modernists espouse a systemic metaphor; use evidence‐based and interventive approaches, including strategic, structural‐ or solution‐focused techniques, and believe in the therapist's knowledge, expertise and power to influence individuals or families to change. On the other hand, postmodernists follow a social constructionist, dialogical or narrative paradigm, which identifies the main ingredient of therapy as language, conversation, understanding and the therapist's ‘not knowing’ stance in eliciting a person's expertise and story Yet many practitioners adopt a middle way between these paradigm polarities, one that is less theory‐driven and more pragmatic, flexible, integrative and practice‐based. This is consistent with evidence‐based practice and research demonstrating common factors across all therapies. The value of preserving systemic thinking in family therapy is recognised while reaching forward to a postmodern social constructionist and dialogical approach. The article describes this integrative stance in family therapy as paramodern based on an ethics of practice. This is illustrated by a detailed case study of integrative family therapy, which addresses anxiety, anger and sleeping issues associated with a chronic childhood illness called Perthe's disease.     

When Baby Brings the Blues: Family Therapy and Postnatal Depression

Postnatal depression impacts on a significant number of women and their families. As a topic it is attracting much interest from researchers as we become clearer about its impact on the long‐term mental health of both women and their partners, as well as on the couple's relationship and their children's mental health. This article will provide a brief overview of postnatal depression and the current research associated with it, and consider the usefulness of systemic family therapy interventions. Examples of these are included along with a clinical vignette.     

Amplifying Deviations in Family Interactions: Guidelines For Trainees in Post‐Milan Family Therapy

Amplifying deviations in family interactions is a critical skill in family therapy, and one that can be implemented following the first reflecting team intervention. This paper will provide trainees with a series of practical guidelines for amplifying deviations, derived from an integration of several models of family therapy. Solution‐focused and narrative questions are employed systemically, with the aim of magnifying virtuous, rather than vicious cycles of interaction. A theoretical rationale for deviation amplifying and a brief case vignette will also be presented.     

Therapeutic Alliance; A View Constructed by a Family Therapy Team

Therapeutic Alliance is a construct which may have value for a family therapy team and influence its day to day practice. This paper discusses whether family therapeutic alliance can be observed, described and measured, and gives an account of the development of the Family Therapeutic Alliance Scale (FTAS) by a brief strategic family therapy team. Our focus is on the use of statistical technique as a means of clarifying the team's construct of therapeutic alliance, informing the team process without being the final arbiter in development of the scale. The second stage outlines the investigation of the usefulness of the construct with a wider group of family therapists. In individual psychotherapies measures of therapeutic alliance have been shown to predict outcome. Our early work suggests this is also true for family therapies and the FTAS may be a predictor for outcome in family work.     

THE EVALUATION PHASE OF SYSTEMIC FAMILY THERAPY*

The initial, evaluation phase of family therapy is of decisive importance within the systemic perspective. Contacting a therapist is always a complex action for a family. The therapist's evaluation must include the possibility that continued contact may influence the family negatively and limit their potential for change. If there appears to be a logical context in which continued therapy can be justified, it will be necessary to use the first three or four sessions to collect essential data and to organize them meaningfully. It is essential to clarify the circular interaction that is maintaining the symptom, as well as the presence of specific family structures and traditions, and the kind of relationships the family attempts to establish with the therapist. On the basis of this information, the therapist can build models of the family's functioning. These models, according to general system theory, make possible logical intervention in complicated, living systems, without distorting them by artificially splitting them into their component parts. Two models that are important to our treatment perspective—the phenomenological and the mythical—are presented.