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.     

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     

Therapeutic Process as a Means to Navigate Impasse? Reflections on a Complex Case of Crosscultural Adolescent Family Therapy

This article explores the process of family therapy with a Turkish‐speaking single‐parent family with four children in which suicidal behaviour and family violence have become the norm. The following example describes a pivotal experience early within my career as a family therapist. The universality of first, being a beginner family therapist, and second, receiving a referral of a daunting, difficult case has led me to share my experience here. Central to this article is the focus on therapeutic process as a means to navigate beyond impasse. It is my hope that those who read this article will consider taking the risk to prioritise the therapeutic relationship, even when anxiety about ‘doing something’ to fix the problems is high.     

Commentary on Studying Circular Questioning “In Situ”

In their discursive study of circular questioning in a systemic family therapy session, the authors raise some interesting perspectives on the original Milan therapy team's guidelines for the therapist as the conductor of therapy. By emphasizing circularity from a discourse point of view, they suggest these guidelines can be used to help family members hypothesize about their own perspectives on themselves and the other family members in circular terms, and, drawing upon Cecchin's notion of neutrality, by creating a state of curiosity in their talk and maybe in their minds. Their emphasis on circularity also helps us to become more sensitive to ways in which the natural recursion in language can help us to appreciate the new guiding lines circular questions can suggest with previously spoken elements. If we follow this line of argument, then circular questions can be seen as a critical part of a therapy we can call recursive family therapy in which we use the recursive element of all natural living languages to help our clients to recursively change their language and lives naturally.     

A Philosophic Stance,Ethics and Therapy An Interview with Harlene Anderson

Harlene Anderson is director of the Houston Galveston Institute. With her late colleague Harry Goolishian she challenged family therapy theory, proposing that as therapists we consider theoretical metaphors based on language and social constructionism, and in effect has moved family therapy in a new direction. The physical and conversational context of interview was the Lofoten Islands, 300 km inside the Arctic circle, Far Northern Norway on the night after Mid Summer's Night, 24th June 1993. Tom Andersen was the host for several days to a gathering called Constructed Realities; Therapy Theory and Research. The aim of the gathering was to explore the concept of Knowledge in the fields of psychiatry, psychology, teaching and social work. The focus was to provide a bridge between the ‘practical’ and the ‘theoretical’ discourses around knowledge and the creation of the knowledge. There were eight main issues around which the conversations revolved — 1) Knowledge: One or Many? 2) Multiple Realities and the Therapeutic Process 3) Human Understanding 4) Language and the Construction of Self 5) Research Alternatives 6) Qualitative Research in Clinical Work 7) Feminist Issues in Theory and Research 8) Power, Ethics and Practice. Harlene Andersen has written extensively on many of these subjects taking a constructivist position and was central to the numerous conversations. She was also one of the prime movers in putting together such a challenging and multi-disciplinary conversation. In conjunction with Harry Goolishian, Harlene Andersen has proposed that what we call ‘problems' are created in language and are dissolved in language. Her interests are in the multiple realities that come to an intersection in a therapeutic conversation and how a therapist can engage with a client to open the possibility for the client to create and find some changes in his/her life. She takes the position that in order for a therapist to be helpful to his/her client, conversational space needs to be created that makes room for the exploration of the client's beliefs and realities. An essential element in this process of creating conversational space is the therapist taking a position of not knowing, of uncertainty, of exploring and making room for the client to talk about what is important for him/her to talk about and not for the therapist to lead from a position of knowing what is best for the client. Harlene Andersen is regarded as a leading theorist and clinician in the therapeutic community who is exploring the broad concept of therapy as a collaborative process at many levels. She is one of the major presenters at the forthcoming New Voices in Human Systems conference hosted by Lynn Hoffman in Northampton, Massachusetts in October 1994.     

Studying Circular Questioning “In Situ”: Discourse Analysis of A First Systemic Family Therapy Session

The present article focuses on the study of circular questioning “in situ,” that is, in the context of the discursive arena of an actual first systemic family therapy session. Two typical circular questions are selected, and discourse analysis heavily drawing from the discursive action model is deployed with the aim to highlight their function in the context of therapist and family members' problem talk. The analysis demonstrates the gradual building of two respective patterns, which both exhibit signs of shifts toward the instillment of a systemic epistemology in relation to problem talk: a shift from homogeneity to heterogeneity in family members' voices, which legitimizes the existence of different viewpoints within a system, and a shift from the construction of an accusation toward its deconstruction, which challenges the linear perception of causality underlying the accusation, thus introducing a more circular perspective. Implications are discussed in relation to contemporary, constructionist systemic family therapy practice, and reference is made to the methodological “promises” and challenges of the deployment of discourse analysis for the scrutiny of systemic family therapy therapeutic techniques and tools under a discursively informed light.     

Thinking About the Emotional Interaction of Therapist and Family

The emotional interaction of therapist and family has been difficult to explore within the field of systemic family therapy. This paper looks at ways of thinking about this process. As a starting point, I take some feelings I had with three families in the course of therapy. These are used to illustrate some concepts from analytic therapy which address the emotional interaction of therapist and family. The kind of theoretical space and guidance offered within systemic family therapy is then explored, and it seems that the Milan frame gives some space for thinking about the process but offers little guidance as to exactly how this might be done. This is a paper about practice, though it's primarily a theoretical discussion. There is no aim of establishing a ‘correct’ way of understanding the emotional interaction of therapist and family.     

Stages of Change Theory in Family Therapy for Sibling Sexual Assault

Family therapy understands the benefits of therapeutically supported dialogue amongst family members when there are challenging themes and topics that need to be discussed. This paper is an attempt to explore ways that family therapists can work with family members who are thrust into therapy rather than ‘voluntarily’ signing up for it. It applies ideas from the drug and alcohol field such as Stages of Change theory and Motivational Interviewing. The paper explores how these ideas and approaches might help family therapists to formulate a concept of resistance and to make helpful dialogue more likely. They are applied to families experiencing sibling sexual assault, where they become involved with a legal response that necessitates a therapeutic intervention.     

Prescribing the Families Own Dysfunctional Rules as a Therapeutic Strategy*

The use of paradox-strategy in therapy is motivated by the fact that many families request help but at the same time seem to reject all offers of help. The therapist may be drawn into a game in which every effort on his part to act as an agent of change is nullified by the family group. In systemic terms these contradictory attitudes derive from the dynamic equilibrium existing between the tendency toward change, which is implicit in the request for help at one level, and the tendency toward homeostasis which at another level imposes the repetition of the family's habitual rules of interaction. The coexistence of these forces can entangle the therapist in the family's paradoxical logic of “help me to change, but without changing anything.” By accepting the contradiction facing him and by “uniting” himself with this within the family, the therapist puts himself into a position opposite to that which the family expects. His response to the family's paradoxical request is a paradox, or counterparadox, because it creates the contradictory communication typical of rigid family systems. By prescribing its own dysfunctional rules to the family, the therapist can stimulate the tendencies toward change present in the family system.     

Therapeutic control in family therapy

This article emphasizes the importance of establishing therapeutic control in family therapy. Therapeutic control is viewed as similar to conducting an orchestra or directing traffic. Problems that interfere with its implementation are related to the limited appreciation by the therapist of understanding the requirements and responsibilities of a leadership role, the lack of knowledge and experience of the therapist, the difficulty in establishing the relationship between presenting problems and family conflicts, being overwhelmed by the perception or expression of strong feelings, discomfort in presenting options. A therapist who is in control of the therapeutic process is able, comfortably and gently, to lead family members, who initially are often in chaos or resistive, to discuss hidden feelings and conflicts. Often, through the therapist's initiative and articulation of understanding of the problems, the family, more relieved than threatemed, is able to focus on major issues.     

The Family Picture

In the family picture the camera records during the first and last session how each family member arranges other members in a tableau or family sculpture. The picture offers the therapist and family a quick opportunity to learn about each other. It visually depicts the coalitions, the separation or togetherness of family members, which help the therapist formulate therapeutic goals. When the pictures taken during the first session are compared with those taken during the last session, they can be a validation of the positive family changes .     

Family Therapy with Adolescents: Giving Up The Struggle

This paper examines problems in adolescence from the perspective of a power struggle between parent(s) and teenager. The structural approach of Minuchin and the strategic approaches of Haley, Madanes, and the Mental Research Institute (M.R.I.) are considered in relation to the significance they attribute to power and power struggles in families with adolescents. It is argued that the M.R.I. approach has certain therapeutic advantages for working with problematic adolescents, primarily because of its focus on understanding and intervening in the power struggle itself. A focus on the power struggle as the ‘problem’ reminds the therapist of the circular nature of parent-adolescent interactions. This awareness assists the therapist to design indirect interventions that are less likely to become absorbed into this vicious cycle. It also encourages a therapeutic stance that prevents the therapist from becoming involved in a power struggle with family members.     

Spiritual issues in family therapy: a graduate-level course

With the advent of the biopsychosocial approach in family therapy, the domain of spiritual issues is increasingly being recognized as important to families. This article will describe a graduate-level seminar on Spiritual Issues in Family Therapy at the University of San Diego that offers family therapy students the opportunity to examine issues of spirituality, religion, and meaning and their place in therapy. One premise of the course is that research has demonstrated that most clients consider their spiritual life to be relevant to personal problems and would prefer a therapist who is comfortable with such topics. The goals of the course include (1) training in opening a dialogue with individuals and families about spiritual issues and discerning when referral may be appropriate; (2) expanding an awareness of wisdom traditions through use of comparative religions material; and (3) identifying from current practice many of the spiritual issues that may arise in the clinical setting.     

Forgiveness and therapy: a critical review of conceptualizations, practices, and values found in the literature

This article is a critical review of how forgiveness is conceptualized in the family therapy, counseling, and clinical psychology literature. A systematic analysis of themes in a fairly comprehensive set of texts was carried out. Three main dimensions emerged along which therapist authors' viewpoints can be located: essentiality, intentionality, and benevolence. Therapy practices and values that correspond with positions along these dimensions are presented. The analysis reveals that greater exploration is needed regarding how forgiveness is related to diversity (e.g., gender, culture, religion, etc.), marginalization, and relations of power. Our objective is to provide a conceptual map for clinicians so that they might locate their own thinking about forgiveness and be better equipped to work sensitively with the forgiveness views and values of their clients.     

Individual Therapy for Couple Problems: Perspectives and Pitfalls

Despite the demonstrated efficacy of conjoint couple therapy, many clients seeking help for couple problems ultimately find themselves in individual therapy for these concerns. Individual therapy for couple problems (ITCP) may evolve from a partner's refusal of conjoint therapy or from the treatment format preferences of either the client or therapist. Having acknowledged the role of partner refusals, we offer some perspectives about the idiosyncratic personal factors and professional background factors that may lead therapists to provide ITCP and discuss the significant pitfalls in its practice. We emphasize five central areas of concern in the ongoing practice of ITCP: structural constraints on change; therapist side‐taking and the therapeutic alliance; inaccurate assessments based on individual client reports; therapeutic focus; and ethical issues relevant to both attending and nonattending partners. We conclude by urging that this very important but largely neglected topic be paid greater attention in psychotherapy research, training and continuing education.