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.     

Attachment and Divorce

In this paper, recent efforts to integrate attachment theory and family systems theory are reviewed and extended to the context of therapy with families coping with the divorce process. Family members' global working models of attachment, rather than the spousal attachment alone, are proposed as the point of intervention, with the goal of helping families reestablish an "attachment equilibrium" during and after divorce, thus addressing potentially problematic expressions of attachment behavior that could interfere with resolution of the divorce, causing difficulties in future co-parenting and other family functioning.     

Is Family Therapy Including Children?

This paper presents a review of recent child therapy and family therapy texts and training courses in Australia. The aim was to determine the extent to which knowledge and information about child development and emotional and psychological problems in children and adolescents is included in the education and training of family therapists. The paper argues this is crucial to prevent the difficulties of young person's being ignored or exacerbated and discusses relevant ethical issues.     

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.     

Short-term Residential Therapy for the Family: The Eastling Parentcraft Centre Project

This paper describes a short-term residential family therapy project which has been developed at the Eastling Parentcraft Centre, Christchurch, New Zealand. The Eastling Parentcraft Centre provides a community based residential programme for families who have difficulties in family relationships and child management, and with parental self-esteem. The problems may concern bonding, separation, neglect and risk of abuse, lack of social support, and feelings of isolation. The Centre's project is described together with an evaluation of the work with families during the second year of the project's operation. Some aspects of this type of residential work with families are also discussed.     

Using Social Construction Therapy with the REM Family

It is estimated that currently one child in five under the age of eighteen is a stepchild and that by h e year 2000, the remarried (REM) family will outnumber all other family forms. Historically, American society defines any form of family fife that does not conform to the traditional nuclear family as problematic. Family researchers have generally been consistent with society's negative views, using a problem-oriented approach to studying the REM family (Hoffman, 1991; Duncan and Brown, 1992; Coleman, Ganong, and Gingich, 1985). In so doing they have focused on documenting the difficulties of he REM family. This paper attempts to rectify these issues by first exploring the typical problems associated with the REM family focusing on social constructionist themes and therapy which serve to shift the focus of a problem-oriented approach toward a search for the strengths and positive characteristics of the family. Social construction focuses on the sociocultural and the individual relationship influences of language, family and culture. In addition, h e paper proposes a six-stage therapeutic model based on Social Constructionist Theory (Gergen and Gergen, 1983). The six stages of therapy with a remarried family are: ( I ) Joining the Family Meaning System, (2) Proposing the Notion of a Socially Constructed Family Meaning System, (3) Learning the Family's Meaning System,(4) Challenging the Family's Meaning System, (5) Amplifying the New Meaning System, and (6) Stabilizing the New Meaning System. It allows the REM family the ability to construct new meanings around their problems in living in order that they might find workable family solutions.     

Addressing Emotional Communication in Family Relationships in the Treatment of Young People with Anorexia: A Case Study

Family‐based treatment (FBT) is an evidence‐based approach to anorexia nervosa in young people. Because it is not always successful, attention has been given to how families experience the treatment. A number of therapists have proposed possible additions to, or improvements in, the model. In successful cases relational containment may be achieved in the first phase of treatment. The treatment is often successful, but when initial goals, such as weight recovery, are not achieved, continuing to use the techniques described in the manual may become unhelpful. Sometimes therapists may need to address issues such as emotion coaching that are not specifically addressed in the FBT model. We describe a case in which the therapist addressed the family's emotional style in the first stage of treatment. This focus enabled progress to be achieved despite the adolescent's continuing difficulty in eating without parental support, and her escalating symptoms of anxiety and obsessional compulsive disorder (OCD). Therapy helped the adolescent and family understand that anorexic and OCD symptoms can be understood as a way of distracting from and managing distress. When this connection was made in therapy, the parents could help their daughter to manage distress in more adaptive ways. Parents may need help with their own difficulties in processing distress. In this case the parents needed the opportunity to resolve feelings of grief about a miscarriage in order to do so. We propose that therapy should address family difficulties with managing distress from an early stage.     

The AIAC,A Design for Systematically Analyzing Marriage and Family Counseling: A Progress Report*

The Allred Interaction Analysis for Counselors is an instrument for systematically analyzing counselors' and clients' verbal behaviors. It was constructed to provide marriage and family counselors-in-training a method for acquiring meaningful, objective feedback on their counseling behaviors. The interrater reliability coefficients have been high. Results of validity studies have been encouraging. Though the instrument was initially designed from analysis of structured family counseling, research indicates it may have rather wide application for many different counseling approaches and settings.     

Introducing Evidence‐Based Family Assessment and Therapy in Child and Youth Mental Health Services: Applying Systemic Principles to Maintain,Sustain and Build Capacity

The purpose of this article is to overview the context of the mental health service in which we work, and family therapy's status prior to and after the impact of changes wrought by the introduction of the National Mental Health Policy. We then explore some key issues that we think contribute to the persistence of the occlusion of family therapy in child psychiatric services; and the strategies that we developed and are continuing to develop to support change. Finally, we describe the use of a family assessment instrument that we believe is central to our change strategy.     

Working with ‘The Welfare’ in Child-at-Risk Cases

This paper, the second in a series concerned with family therapy in cases involving children at risk of abuse, focuses on how to establish a workable relationship between therapists and child protection professionals and child protection professionals and parents. After overviewing the difficulties faced by therapists in working with ‘the Welfare', we propose guidelines to overcoming common obstacles to successful case management, concluding that therapy often fails when therapists attempt to deal with intrafamilial issues long before external relationships are resolved.     

The Single‐Parent Family and the Family Therapist: About Invitations and Positioning

Single parent families sometimes represent specific challenges to family therapists. In this article a dialogical frame with important concepts such as voice and positioning is proposed to reflect on family therapy practice. This frame is used to reflect on a common invitation in family therapy with single‐parent families: the invitation to take the place of the absent parent. A case of family therapy with a single‐parent family is presented in order to illustrate the importance of flexibility in the therapist's positioning and the way the therapist's experiencing can be used as an empathic bridge to create a dialogical space in which the important issues at stake can be addressed.     

Fathers in Family Therapy: A Survey of Family Therapists

Sixty family therapists were surveyed in an investigation of resistance by family members to family therapy. Consistent with other investigations, the father was viewed as the most resistant along a number of dimensions. Therapist behaviors that related to difficulties with the father, specifically, and to family therapy generally, were identified. The implication of these results and possible strategies to reduce the resistance of the father are discussed.     

Effectiveness of the Coral Tree Family Service family inpatient unit: a longitudinal study exploring change in family functioning

Child mental health disorders represent a major burden to public health in Australia due to high prevalence rates, the widespread impact across domains, and the potential for difficulties to persist into adolescence and adulthood. Extensive evidence exists for the use of parent management training and cognitive behavioural therapy to treat difficulties experienced by children; however, a proportion of children do not benefit as expected from these treatments. The use of complementary therapeutic approaches and variations to the mode and intensity of existing intervention is warranted; family inpatient units represent a unique example of this. The aim of this study is to evaluate the effectiveness of a well-established Australian inpatient unit that admits the whole family, for children aged 12 years and younger referred with mental health, behavioural, or emotional difficulties. This study's longitudinal within-subject study design utilised routinely collected outcome data from the systemic clinical outcome and routine evaluation, 15 item (SCORE-15)—a valid and reliable measure of family functioning—from a sample of 980 participants attending the Family Residential Program. This study reported significant improvement in family functioning across all outcome variables between baseline and post-intervention, with no variables returning to pre-intervention levels at follow-up. Clinically significant changes in overall family functioning showed that 37% of participant scores moved from the clinical range at baseline to the nonclinical range post-intervention. This study represents the first empirical evaluation of the Family Residential Program, and the reported results provide compelling evidence for the program to effect improvement in family functioning for families with long-standing and severe difficulties. Poor rates of questionnaire completion following intervention frequent the literature base of family inpatient units, with low post-intervention (56%) and follow-up (12%) rates evident in this study. This study uniquely contributes to the growing evidence base of family inpatient units using rigorous evaluation methods.     

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.     

An Open-Systems Approach to Teaching Family Therapy*

Through systems concepts are increasingly employed in family and marital therapy, they are usually employed in a limited way, excluding some aspects of the total system. Systems ideas are applied most fully to the nuclear and extended family of the referred patient, and increasingly to the therapist's family of origin. The interface between the influence of the family of origin of the professional and difficulties in his practice is also scrutinized, though more often in a teaching and supervisory context than during therapy. The relationships among the therapist's family of origin, his marriage and family of procreation, and his professional work are more often neglected, and the influence of all three on the dynamics of institutions, training programs and staff groups is least often explored. The authors, a married couple who work together professionally, occupied fin-several years a crucial leadership role in developing the first multi-disciplinary teaching programs in the London area, bringing together key teachers from all the main institutions, with widely differing theoretical orientations, in a group which now forms the Institute of Family Therapy (London). This paper describes their attempt to facilitate a more consistently open-systems approach which appeared to stimulate unusually rapid growth, learning, and group cohe-siveness.     

Monitoring Family Therapy in Clinical Practice A Note on the Use of the Beavers-Timberlawn Family Evaluation Scale

This paper is based on a thesis completed for the degree of Master of Psychological Medicine at Monash University, Melbourne. The aim was to determine if an instrument could be used to determine changes in family dynamics quantitatively and objectively during the course of family therapy. A sample of six families was evaluated on several occasions during therapy using the Beavers-Timberlawn Family Evaluation Scale. The results are discussed in the light of the literature as it relates to outcome studies of family therapy. Certain conclusions are made regarding the process of therapy.     

Language as an Exclusive or Inclusive Concept: Reaching beyond the verbal

Language is a primary means by which practices of inclusion and exclusion are determined in our society. As language is also the primary medium of most narrative family therapies, the politics of our practices with regard to inclusion and exclusion require examination, particularly when working with children for whom language is neither a strength nor a preferred processing mode. In this paper, some young people showing language-based learning difficulties will be introduced. Children's experiences with oppression and colonization will then be briefly considered, followed by the particular experiences of children showing language-based learning difficulties. The interrelationship between language, social-emotional development and social competence will be considered and ways to ‘scaffold’ these children during the therapy process to facilitate their inclusion will be addressed. Throughout the discussion, the implications for narrative family therapists will be explored as we consider whether our fascination with language is wielded in inclusive or exclusive ways and whether we can competently reach beyond the verbal in our practice.     

Family Social Work/Family Therapy

The author responds to Witkin's (1993) comparison of family social work and family therapy. The author argues that family social work and family therapy share important commonalities. He challenges Witkin's characterization of family therapy as outdated. Instead, family therapy is characterized as having contributed important writings about gender and culture to its practitioners. The paper ends with reflections on the implications of social justice for clinicians.     

The Structure of the Families of Schizophrenics

In the families of schizophrenic patients everything is subordinated to the neurotic or psychotic needs of one of the parents, and the whole family then works together to stop that parent from becoming psychotic. The other parent must become completely subjugated or withdrawn and leave the family under the domination of his spouse. This becomes a rigid system in which the patient's role is to “feel nothing, do nothing, and be nothing”, and any minor change in him becomes a major threat to the integrity of the whole family. It is when he can no longer maintain this role that the person becomes clinically schizophrenic. Some of the difficulties in treating schizophrenic patients in individual or family therapy are discussed.