Intervention with Families in Extreme Distress (FED)

The FED (Families in Extreme Distress) Project described in this article was developed as an intervention model for families in extreme distress. The concept of families in extreme distress includes not only those families which have been widely regarded as multi-problem families for decades, but also those which may appear to be like any other middle class family. The dis- organization in family functioning that is created by an interaction of many problems results in a durable distress which is repeated throughout successive generations. The intervention design of this project was structured and short- term, and each family in the group met once a week in their own home for ten sessions with a therapeutic team composed of three workers. The target of the intervention was the functioning of the entire family as a unit; and goals included clarifying boundaries, strengthening roles, and developing a communication system. Analysis of the therapeutic sessions revealed several techniques which are useful for intervention with the FED population. The intervention process with these families should be multilevel and case management should not only include providing family therapy, but also advocating and mediating with various institutions in the community, as well as making connections for financial assistance.While some major policy changes may be required to meet the finan- cial and manpower needs involved in such a model, this demonstra- tion project indicates that investing the right resources is worthwhile for effecting change within the FED population.     

Engaging Fathers in Family Therapy with Violent Adolescents

Violent behavior in adolescents can often signal profound distress or pain arising from family conflicts, hostile marital separations, sudden losses and other family turmoil. By circumventing blame the therapist engages the family in a constructive process that allows adolescents to change and grow and parents to share pain and sorrow about their own issues and responsibilities for their children. This re‐establishes healthy generational boundaries, produces a clearer co‐parenting alliance (e.g. after divorce) and creates sibling support. This paper describes an experiential approach, for working with violent adolescents in family therapy influenced by the pioneer work of Satir and Whitaker. It integrates systemic and developmental theories linking the presenting problem to relevant family events. The therapist: (1) explores adolescent development in the family and social context; (2) establishes a therapeutic alliance through understanding the interpersonal context for violent behavior, and (3) re‐directs negative actions into positive connections with family members. Segments of family therapy sessions with two adolescent boys and their families from different cultural backgrounds illustrate the impact of paternal absence for adolescent well‐being and the need to actively engage fathers in family therapy. Mario, the father's ‘tumor’, and Juan with his despairing violence are two problematic adolescents brought to therapy because of their aggressive behavior at home and/or in the school. The paper describes how to give them a different voice and build a therapeutic alliance with the family.     

We Don't Need Your Help,But Will You Please Fix Our Children

A Bowen Family Systems therapist employs concepts of triangles and the family projection process to view a child's symptoms as embedded in the broader family patterns. This article will examine the dynamics of two family therapy cases where parents anxiously asked for their children's symptoms to be fixed. These cases will be used to explore the common presentation in child and adolescent mental health, where the parents are concerned for their children but are also keen not to open their own ‘can of worms’. The presenting problem in the first case was violent hostility between adolescent sisters and in the second case was an adolescent's anorexia. Drawing on client feedback, I reflect on the therapy process behind the divergent outcomes. In case one, the parents were willing to address their own troubled relationship and family of origin, while in case two, the parents discontinued therapy when family of origin dynamics began to be explored. The article suggests how the therapist can evoke parents' curiosity about their role in anxious family patterns, without them feeling blamed.     

Family Therapy: A Client-Centered Perspective

>This article first critiques therapist-directed approaches to family therapy in the light of research findings on therapist variables (empathy, warmth, genuineness) associated with positive outcomes in psychotherapy. Second, two polar opposite positions in family therapy — psychodynamic and family systems — are examined and found to have much in common. The two approaches are based on a pessimistic view of the family, which is seen as an intractable unit, resistant to its own growth. Third, an alternative, phenomenological view of the family is developed, which more optimistically assumes the family to be motivated for enhancement and growth. Finally, a client-centered approach to family therapy is described.     

What Novice Family Therapists Experience During a Session… A Qualitative Study of Novice Therapists' Inner Conversations During the Session

“What do novice family therapists experience during a session with a couple or family?” This is the central question in this article. A videotape‐assisted recall procedure was used to study novice family therapists’ inner conversations. The therapists' reflections were analyzed using thematic analysis. This resulted in a coding system that distinguishes four main domains: (a) reflections concerning the self; (b) reflections about the therapy process; (c) reflections on emotions about the family members; and (d) managing the session as well as own emotions. The study furthermore revealed that during a session, novice family therapists experience strong emotions, such as self‐criticism and irritation. Both emotions may encompass dangers, as well as opportunities for the therapeutic alliance and the process.     

Genograms Redrawn

Abstract

One of the challenges faced by GLBT families is defining and representing family relationships in a way that is not constrained by heterosexist notions of family. This study explores the usefulness of asking lesbian couples to depict family relationships by adapting the genogram (family tree) techniques used in family therapy. Six lesbian couples were asked to construct their own family tree and to comment on the process. Genograms were found to be useful but needed to be redrawn, for example, with tiers and circles rather than traditional symbols. Drawing and redrawing genograms highlighted the importance of acceptance and affirmation versus homophobia and heterosexism in defining family relationships for the lesbian couples interviewed.     

Personal Reflections of A Family Therapist*

In this informal paper I discuss my personal evolution as a family therapist, developments in the field, the politics of a systems approach in conventional settings, resistances to family and marital therapy by other professionals, some still puzzling aspects of family therapy, whether family or marital therapy works and what do we mean by working, directions my own work has taken, some comments about the nature of family life, the satisfactions and frustrations and stresses of being a family therapist, some hidden agendas of family therapy practices, how one's own personal family relationships affect and are affected by this kind of work, the casualties among family and marital therapists, and, finally, whether family therapists should have family therapy for themselves and their own families.     

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.     

Practice Experience and Theory Boundaries: An Argument for Theory Diversity in Family Therapy

This paper addresses the relationship of family therapy to its own knowledge, and the relationship between theory and practice experience. An argument is made that family therapy has related oppositionally not only to outside knowledges, but also to its own knowledge in its successive and frequent knowledge shifts. This oppositionality had led to a dominant story which downplays themes of continuity in our own development of theory. It has also fuelled a momentum toward purity and anti‐eclecticism. Postmodernist thinking within family therapy has both allowed and disallowed the space for theory diversity, and there has been a similar paradox with respect to attention to lived experience. The paper begins and ends with a discussion of three pieces of practice experience and leads to a plea for theory diversity in family therapy in the interests of meeting the complex demands of practice.     

Reclaiming the Emotional Aspects of the Therapist-Family System

The shift from first to second order cybernetics has made the concept of the therapist-family system part of the everyday discourse of family therapy. In spite of this shift, there is little focus in family therapy literature on the emotional aspects of the therapist-family system. Relevant process concepts available to us at present, such as induction or accommodation, are poorly defined and inadequate. Three reasons for the neglect of the emotional aspects of family therapy are explored. They are, firstly, more recent theoretical and technical directions, secondly, the politics of gender and thirdly, the enduring difficulty of working with and writing about our own and families' powerful emotions. Finally, following a case example, some psychoanalytic concepts are described and discussed. It is possible that concepts such as counter-transference and projective identification may enrich family therapists' understanding of what is happening within the therapist-family system.     

FAMILY THERAPY AND IDEOLOGY*

Contemporary family therapy is examined in terms of its ideological content. The adoption of cybernetics and biological systems theory to the family has led to the erroneous belief that familytherapy is exclusively concerned with natural systems, is process oriented, content relative, and above ideology. This article argues that the family and the enterprise of family therapy are social systems and under the influence of the ideology particular to a given society. The strategic family therapy treatment of a family with a drug-addicted member serves as an example to clarify the ideological themes of contemporary family therapy. These themes are: (a) family reductionism and blaming; (b) the relabeling of personal injustice into communicational terminology; (c) the assumption that the nuclear family is optimal; (d) the conceptualization of therapy as a commodity; and (e) the model of human relatedness and intimacy supported by family therapy.     

Interview With Michael Kerr

The following article was written by Dr Michael Kerr in response to questions put to him by Barbara Fraser; Linda Mackay and Lu Pease when he visited Australia two years ago. These three family therapists took it upon themselves to prepare this interview in recognition of Dr Kerr's unique vantage point on Bowen Theory and family therapy. Michael Kerr was trained by Murray Bowen in the 1970s and subsequently went on to work as faculty at the Georgetown Family centre. He succeeded Bowen as director of the centre where he has devoted his professional life to the understanding, application and extension of theory. He is the co‐author with Dr Bowen of Family Evaluation: An Approach Based on Bowen Theory (Kerr & Bowen, 1988), which remains the most esteemed text on this theory. He is also the editor of Family Systems: A Journal of Natural Systems Thinking in Psychiatry and The Sciences. Bowen's Family Systems Theory grew out of years of research from the 1950s‐1970s, which included observations of inpatient families with a schizophrenic member and using data from Bowen's own interactions with his family of origin (Bowen, 1978). The theory continues to be influential in family therapy with its most well‐known contributions being the process of triangling, the intergenerational transmission of family patterns and the concept of differentiation of self. (Brown, 1999). The following discussion from Dr Kerr brings a fresh perspective on the current applications and developments of this systems theory     

Lessons From ‘The Hitting Place’: Reflections of a Family Therapy Novice

This case study is an account of a post‐traumatic family attempting to come to terms with life after violence, and the effectiveness of family therapy in supporting this transition. The fighting between two young girls had maintained the violence in the family dynamic and their highly anxious adolescent brother remained unable to let go of his protective position and move forward with his own life. The backdrop of the case was a novice family therapist and a mother with borderline traits who found it difficult to keep the therapeutic work within the bounds of the therapy sessions. Despite these difficulties meaningful change could be seen after only seven sessions of family therapy.     

Feminist In(ter)ventions in Family Therapy†

Family therapy is often receptive to new ideas but so far it has only engaged with the second wave of feminisms in a restrained and conditional way. In this article we map the influence of feminisms on the life of family therapy and conclude that its dominant conceptual frameworks have so far resisted feminist revision. Ironically, while feminist post-modernist thought has helped to loosen the modernist grip on family therapy, family therapy's embrace of post-modernism synthesizes and displaces rather than centres feminist concerns. Since post-modernism is not post-patriarchal, the result may be exclusion of feminist perspectives that offer a principled and liberating way through current dilemmas in family therapy. Feminist perspectives are not mere voices among others; they hold promise for the development of a more inclusive theory and practice based on a valuing of inter-connectedness and an ethics of care and responsibilty.     

Reliability and Validity of the Global Assessment of Relational Functioning (GARF) in a Psychiatric Family Therapy Clinic

The reliability and validity of the Diagnostic and Statistical Manual of Mental Disorders-IV Global Assessment of Relational Functioning (GARF) was evaluated in consenting participants presenting to a family therapy training clinic. The purpose of this study was to (a) assess whether the GARF could be administered quickly in a marriage and family therapy training clinic, (b) assess the inter-rater and internal reliability of GARF ratings of intake sessions, (c) examine the relationship of GARF ratings to established measures of relationship functioning, and (d) compare GARF ratings to a measure of depressive symptoms. Study participants completed the General Functioning Subscale of the Family Assessment Device (GFS/FAD), the Quality of Marriage Index (QMI), and the Center for Epidemiologic Studies–Depression Scale (CES-D). After intake sessions were conducted with study participants, GARF ratings were made by an American Association for Marriage and Family Therapy Approved Supervisor or Supervisor-in-Training, a therapist trainee, and two observing trainees who had observed the session from behind a one-way mirror. Cronbach’s coefficient alphas and the average intraclass correlation coefficients were both .82 when ratings of the supervisor and two observers were compared and .78 and .79, respectively, when ratings of the supervisor, two observers, and therapist were evaluated. There was significant agreement between GARF ratings made by the supervisor and therapist (but not observers) and scores on the GFS/FAD, QMI, and CES-D. Results suggest that GARF ratings can be made quickly and reliably, especially among raters with greater clinical experience, and are related to measures of relational functioning and depression. Implications for research and marriage and family therapy training are discussed.     

Why Are So Many (If Not Really All) People and Families Disturbed?*

Many personal and family problems grow out of our not knowing how to process an intricate network of dualities, contradictions, dilemmas, paradoxes, and momentums that are intrinsic to the human condition rather than resulting from “disturbance” or pathology. What we have been learning in family therapy is that the processing of both “right” and “wrong” ways, or “good” and “bad” behaviors, is more likely to yield health and growth, whereas failures to process these dualities are far more the culprit of emotional disorders than bad or wrong behaviors as such. What really becomes important in family life is not the ability to stay out of trouble, but to get out of trouble, that is the ability to process conflicts and dilemmas and unfairness constructively. This way of looking at families helps us to account for and integrate many of the hard empirical findings that have been gathering now for twenty years in family therapy.     

Patients' Perspective on Family Therapy for Anorexia Nervosa: A Qualitative Inquiry in a Chinese Context

This article presents a qualitative study of the subjective experiences of 24 Chinese adolescents and young women who have been suffering from anorexia nervosa and who have received family treatment from a university‐based family treatment centre in Hong Kong. In‐depth post‐treatment interviews were conducted and have been transcribed and thematised using content analysis. The narratives that have emerged have facilitated hearing the clients' and their family members' voices, especially in the areas of (a) perceived concepts of family therapy, (b) the perceived therapeutic relationship and its linkage to positive change, (c) perceived intervention strategies as employed in family treatment, and (d) the participants' own role in problem‐solving. The study has enabled the author to refine the family treatment model, which has been adapted from the Micucci's (1998) model, with additional components introduced by the author to enhance family treatment in a Chinese context.     

The prevalence of later life family concerns in the marriage and family therapy journal literature (1976-1985): a content analysis*

This study assessed the frequency with which the marital and family therapy journal literature focused on problems associated with aging in a family context. Content analysis was used to assess the prevalence of later life family concerns in two leading journals, Family Process and the Journal of Marital and Family Therapy, during a 10-year period (1976-1985). Results indicate that neither journal covered later life family issues to any appreciable degree. It is concluded that elders in marital and family relationships constitute a new frontier for the extension and elaboration of family therapy.     

Approaches to the study of gender in marriage and family therapy curricula

This study compares two accredited marriage and family therapy programs: One includes a separate course on gender, and the other integrates gender throughout the curriculum. Students from the two programs rated their own and their peers' experience of how gender education effects therapy, program culture, and personal life. Results indicate that students from the integrated program view their peers as incorporating gender ideas in therapy to a significantly greater extent (t = 2.83, p < .05) than do students in the gender course program. However, students from the program that has a gender course leaned more toward agreement with feminist concepts than did students from the integrated program. Overall, students appear to be learning about gender and integrating these concepts into their work as therapists. Discussion is included on how to choose a gender curriculum.     

Integrative Family Therapy for Child Behavioural Problems in a Parenting Support Agency

This paper describes family therapy for behavioural problems in a parenting support agency. It discusses the literature on the effectiveness of family therapy with child behaviour problems within a community support environment. The paper presents a detailed family case study, which is discussed from an integrative family therapy framework. Narrative therapy is used as an overarching framework for integrating systemic therapy and parenting skills to help a family with a mixed cultural Aboriginal and Australian background. This allows sessions that are meaningful for the family and encourages a connection to their own resources and to their community, besides creating a safe space for a dialogue that hears and values all voices.