Family Constellation — A Therapy Beyond Words

Family Constellation, a psychotherapeutic approach associated with the name Bert Hellinger, has become a popular yet also controversial form of systemic therapy in the German‐speaking therapy community. ‘Family Constellation’ (Familienstellen) means the individual client's physical‐emotional positioning and re‐positioning of substitute family members in relation to each other, with help of a therapeutic group. Family Constellation is a one‐session approach that addresses family‐of‐origin issues. The therapeutic process is highly experiential, utilising multiple sensory modalities. Hellinger locates his model within phenomenology, and his practice has roots in several therapy schools. His model offers complementary therapeutic techniques in our ‘languaged’ world of family therapy.     

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.     

Family Therapy for the Trainee in Family Therapy*

The growth and self understanding of the therapist as a person are considered by most training centres to be a significant part of the training process. This article reports on a pilot project which provided marital and family therapy for trainees in a two-year program. Therapy was established on a contract basis and included individual, conjoint, family intergenerational and small group. Interns and family members responded favorably to the program. Supervisors found the experience enabled trainees to maintain an experiential consistency with a general systems model utilized as the core theory of the training program.     

On Learning and Teaching Family Therapy

This paper explores some ideas about the process of learning to be a family therapist. It considers the questions: how does one learn to think like a family therapist? How is family therapy best taught? How is it learned? The author's experiences in learning and teaching are described. It is argued that family therapy differs from other approaches to therapy in some fundamental respects, and that learning to ‘be’ a family therapist is a different kind of task than learning to be a practitioner of other therapeutic approaches. The paper examines some key theoretical constructs, especially the idea of ‘levels’ of thinking, which are seen as central to both the learning and practice of family therapy.     

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.     

Adoption and Family Therapy

The aim of this article is to sensitise family therapists to adoption. A major assertion of the paper is that adoptive families are different from biological families. The family therapy context is a natural framework for examining these issues, as adoption affects and alters both birth and adoptive families, and adoption‐related problems occur within the context of the extended family system. The differences between intra‐racial (socially‐motivated) and inter‐racial adoptions are discussed, as well as the differences between closed and open adoptions. The study of families affected by adoption provides a model for other family forms, such as stepfamilies, foster families and families who form through new birth technologies.     

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.     

The Experiences of Parents of Adolescents in Family Therapy: A Qualitative Investigation

While understanding clients’ experiences in family therapy is becoming increasingly important, we know very little about how the parents of adolescents in family therapy perceive and experience this process. The current study uses a multicase qualitative design and constructivist theoretical framework to describe the experiences of 15 parents of adolescents attending family therapy in private practices. Constant comparative analysis revealed four core categories that described parents’ therapeutic experiences: (a) pretherapy presentation, (b) supportive therapeutic climate, (c) family therapy process, and (d) reflections on the therapy experience. The implications of study findings for clinicians and researchers are presented and discussed.     

Schizophrenia and Family Therapy

The case presented is of a young man hospitalized twice for schizophrenic disorder before the commencement of family therapy. The therapy which dealt with the family system, specific pathological communication patterns and intra-psychic conflicts, is discussed. As the parents of the young man confronted their inter- and intra-personal problems, the function of his illness disappeared, along with his psychotic symptoms. While demonstrating the process of psychotherapy, the thesis that psychotic decompensation in young people often signifies severe family dysfunction is also presented. Accepting the ‘identified’ patient as such and ignoring the family dynamics may serve to create a chronic schizophrenic illness.     

Family Context Therapy: A Model for Family Change*

Starting where family group therapy fails, this article breaks new territory in family context therapy. Consolidating the past 14 years of his work, Dr. Bell sets forth a conceptual program and methods to meet problems that earlier forms of family therapy could not reach. Here he provides a model drawn from studies, theories, and personal experience of organizational patterns, interrelations, and change among community institutions that provide settings for family functioning. His new methods are designed to modify the family environment so as to solve family problems and promote beneficial family growth—a framework that may bring together a broad variety of existing family development approaches.     

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.     

Organizational Consultation and the Teaching of Family Therapy: Contrasting Case Histories*

This paper describes the process of attempting to teach the principles and effective utilization of family therapy to the indigenous staff of two mental health institutions. Both interventions are conceptualized as entrees into entrenched organizational systems requiring shifts in power alignments, clarification of self and group goals, articulation of needs, reallocation of resources, and attention to group process in order to succeed. One case, where such issues were overlooked and neglected, resulted in failure in which apparently little learning of family therapy occurred. The second, where these issues were anticipated, addressed and resolved, resulted in successful learning of family therapy, implementation of therapy programs and lasting change in the organizational climate to support those programs. The teacher of family therapy, by functioning as an organizational consultant, can help create the kind of working conditions which are best suited to effectively treating families.     

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.     

Multiple Family Therapy Systems

This paper investigates multiple family therapy (MFT), a treatment method which includes several families in a series of sessions with the therapist(s). A brief historical development of MFT is included as well as reports of multiple family therapy groups found in the literature. The characteristics of this treatment method are delineated with special attention to the elements of change attributed to MFT and the stages of development in MFT groups. The role of the therapist and special problems in MFT are also explored. Some implications for research are outlined, indicating that MFT is lacking adequate validation as a treatment modality. Possible advantages inherent in multiple family therapy systems, which have been suggested by therapists' clinical findings, are also reported.     

Emotionally Focused Family Therapy and Play Therapy for Young Children Whose Parents Are Divorced

ABSTRACT

Divorce is common and can pose risks to those involved. Although divorce affects all parts of the family system, young children face extraneous challenges due to their unique developmental stage and limited cognitive ability. Emotionally focused family therapy (EFFT) works to enhance attachment bonds by restructuring a family’s negative interaction cycle and can be useful for repairing relationships between parents and their children who are suffering negative effects of parental divorce. Whereas adults have the skills to express themselves verbally, young children often use imaginary play to convey their emotional experiences and unmet attachment needs. By using play therapy techniques within an EFFT framework, adults and children can better communicate their perspectives concerning difficult life events such as parental divorce.     

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.     

Correlates of Engagement in Family Therapy

Sixty-five families who continued in conjoint family therapy were compared on a variety of antecedent variables to 65 families who dropped out. The following factors were found to be associated with engagement in therapy: (a) age of the identified patient; (b) number of children in the family; (c) the family's prior involvement with community agencies; (d) the presence or absence of antisocial acting-out; and (e) attendance of father at both the initial intake interview and early treatment sessions. Maximal discrimination between continuing and dropout families was demonstrated by simultaneous consideration of several significant variables. The implication of these results for family therapy selection criteria are discussed.     

Family Social Work Practice: Onward to Therapy and Policy

ABSTRACT

In a recent article published in the Journal of Family Social Work McNeece (1995) argued that family therapy has no interest in or relevance for social policy interventions. Through the presentation of several arguments he constructs an irreconcilable dichotomy between policy and practice, suggesting that therapeutic interventions are responsible for pulling resources away from the development of effective social policy interventions. This paper challenges the dichotomy between policy and practice and presents an alternative view concerning the relationship between social policy and family therapy. The increasing importance of family policy in family therapy is summarized and a new trend within marriage and family practice, policy as practice, is discussed. Current family practice literature and personal case examples are used to provide alternative viewpoints to three main points that were presented by McNeece concerning family therapy practice, and the therapy/policy interface. Finally, the current practice context of managed care is used to illustrate the interdependence of practice and policy, and the need for a new understanding concerning family practice.