A model for outpatient treatment of young adolescents with anorexia nervosa

The recent literature is reviewed and interpreted as supporting the view that anorexia nervosa is a disorder with discrete subgroups. Two cases are presented which suggest that one particular subgroup of anorexics shares a common dynamic of failure to resolve the issues inherent in the rapprochement crisis of the separation-individuation sequence. The reworking of residuals from the rapprochement crisis, particularly the union of good and bad self, modulation of omnipotence, and integration of hostility, are essential aspects of therapy with these anorexics. The treatment of choice for anorexics in this subgroup is described as an outpatient team approach which separates medical from psychotherapeutic interventions, adolescent therapy from that of parents, and avoids hospitalization if at all possible.Maxine L. Penn is in Private Practice in Potomac, Maryland.     

Juvenile anorexia nervosa: family therapy's natural niche

Juvenile Anorexia Nervosa (AN) is a severe problem both in terms of presenting symptomatology and its tendency toward chronicity. Researchers have consistently shown that family-based approaches are superior to individual approaches for the treatment of juvenile AN. This article addresses the capacity deficit of trained family therapists to treat this disease. The author reviews the effectiveness of Structural Family Therapy as a treatment of juvenile AN and the essential concepts and skills required by the family therapist to treat this disorder. The concepts of therapeutic crisis induction, enactment, and therapeutic intensity are discussed in detail. Recommendations are made for future research.     

Intervening in Family Systems with Observer Messages*

This article presents an approach to family therapy in which a group of observers becomes part of a therapeutic team by introducing strategic messages into the sessions. The observers, who operate from behind a two-way mirror, are thus able to effect change in both the family system and the therapeutic system consisting of family and therapist. Messages are described in terms of five components: function, target, timing, content, and delivery. Some guidelines for effective team functioning are given and three examples illustrate the approach. Finally, implications for training are discussed.     

Short Term Family Therapy with Emotionally Disturbed Children*

This study found that short term family therapy using Zuk's “go between process” effected significant improvement in the interpersonal functioning of the family, as perceived by the identified client. The subjects were white, middle-class, intact families who have sons attending classes for emotionally disturbed children at the Centennial School of Lehigh University.     

Goals of Family Therapy*

A review of family therapy goals is presented and discussed. Therapy goals are divided into two major categories: 1) Specific Goals for Specific Families; and 2) General Goals. The latter category is further divided into goals having to do with family interaction and those related to symptoms and character traits of individual family members. Familial and individual goals are discussed in relation to the concept of interrelated, hierarchically arranged systems.     

The Relationship Of Family Theory To Family Therapy*

This paper deals with the knowledge and thinking of the therapist, who is the link between theory and therapy. Based on the self-analysis of a single family consultation interview, the various theories employed and the decision points are described. It is suggested that therapists can espouse many theories or single ones, but are always confronted with difficult decisions. Some features of the field of family therapy which foster an overevaluation of science and certitude are discussed.     

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.     

A Systems Model of Family for Family Therapists*

A family model that provides a classification system for family therapists is presented, based on an integration of family systems research in healthy and disturbed families and clinical data. The model provides tools for cross-sectional, process-oriented family assessment derived from consideration of family competence in task performance and family operating style. Seven family types result-optimal, adequate, midrange centripetal, midrange centrifugal, midrange mixed, severely dysfunctional centripetal and severely dysfunctional centrifugal. Identifying characteristics of each type are provided, and intervention strategies and approaches are discussed that follow logically from the assessment.     

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.     

Training Issues in Family Therapy*

Group versus individual supervision, the family therapy training model, videotape as a training method, and training paraprofessionals in a traditional academic setting are discussed from the authors' experience in conducting a family therapy training program. Editor.     

Family Therapy and Lithium Deficiency*

Lithium carbonate's usefulness in relieving the more dramatic symptoms of bipolar-affective disorder can obscure the family systems components of this illness. A compromised form of family therapy results which may stabilize the marriage but cause troubles for the larger family system. This paper offers a partial modus operandi for keeping family therapy systems oriented and avoiding the infantilization of the identified patient which occurs when the importance of purely medical treatment is overplayed.     

Family Therapy Training in Israel*

In Israel the difficulties met with in training social workers in family therapy arise from inherent resistance to change in social and other professional agencies and from insufficient experience in the methodology of training. The family in Israel—a developing country—is undergoing wide-reaching social and cultural changes, which make for additional difficulty in using training models developed in other countries. Nevertheless, graduates of the family therapy program of the Institute for Training and Continued Education of Social Workers in Tel-Aviv, Israel, have shown substantial improvement in several areas of working with problem families.     

The Family and Juvenile Delinquency*

This paper examines the effect of various “family variables” on the etiology of juvenile delinquency. These self-report data are unique in that they are from reports by parents of their child's behavior, the nature of the child's life at home, and parental perceptions of their relationship with the child. How the family and delinquency literature fit into control theory's conceptualization of the importance of a child's attachment to the family as a determinant of delinquency is evaluated. Variables measuring (1) family structure, (2) poor parental characteristics, (3) household characteristics, and (4) parent-child relationships are examined. The attachment variable was found to be the strongest predictor of delinquency and helps to “interpret” the effects of other variables that are significantly related to delinquency. The variables that predict male delinquency were found to be different from those that predict female delinquency. Characteristics of the parents' marriage play an important role for boys, while misbehavior of girls is more strongly predicted by variables measuring parent-child interaction and parental control.     

Gender Orientations and Family Strategies*

Des interviews qualitatives de 95 femmes mariées ayant entre 18 et 45 ans ont été menées afin d'étudier les points de vue de ces dernières sur le mariage, les enfants, le travail et les politiques familiales. Nous avons comparé les opinions des femmes plus traditionnelles avec celles des femmes favorisant l'égalité des sexes, et nous avons pu constater que plusieurs idées étaient partagées, notamment sur le mariage et les enfants. Étaient à l'origine de divergences les stratégies familiales régissant l'opportunité du mariage et des naissances ainsi que la priorité accordée aux questions familiales par rapport aux autres aspects de la vie. Ceci nous porte à croire qu'il faut considérer deux éléments lorsqu'il s'agit de mieux comprendre le mariage et la procreation, soit la hiérarchie sexuelle et les points de vue des particuliers sur le roLle des hommes et des femmes dans notre société. Based on open-ended interviews with 95 married women aged 18 to 45, the authors explore basic orientations toward marriage, children, work and family policy. While women with more traditional gender role orientations are contrasted with those who hold more egalitarian views, there are striking similarities among the women in the sample. In particular, marriage and children are clearly preferred. The differences relate to the family strategies associated with the timing of marriage and births and the priority given to family questions in comparison to other aspects of life. This leads the authors to conclude that both gender structures in society and gender role orientations of individuals are important in understanding marriage and childbearing.     

Alcoholics Anonymous and Family Therapy*

Alcoholism affects the family of the alcoholic as well as the individual problem drinker. Change in drinking behavior is often brought about by change in the alcoholic's family members. There has been a natural evolution in the alcoholism field of self-help groups for mates and children of alcoholics. This development has paralleled the recent growth and development of family therapy as a major mode of psychotherapeutic intervention. Yet, crossfertilization of ideas and intervention strategies between the two fields has been slow in occurring. Arguments over whether one uses family therapy or A.A. and Al-Anon persist. This paper focuses on ways in which family therapy and the A.A. self-help groups add to, rather than detract from, one another. A note of caution about the misuse of family therapy when alcoholism is present is also provided.¹     

Contemporary Concerns in Family Therapy*

The literature indicates that recent clinical concerns concentrate on certain problem areas, while neglecting others. Theory building is slow; agreement on definition, indications, selection, evaluation, training programs, and a unifying conceptual schema is still lacking. Intervention and outcome evaluation remain insufficient. A need for broadness, flexibility, and avoidance of dogmatization is underlined. Resistance to a family and community intervention model continues. It is argued that strength rather than pathology needs emphasis. Some strategies to develop family therapy further are suggested and recommendations made to overcome outlined obstacles.     

Family Therapy with Substance Abusers: Legal Considerations Regarding Confidentiality*

This paper explores various problems in the area of confidentiality often confronted by family therapists working with substance abusers. The scope and intent of the Federal Regulations controlling the release of all alcohol and drug abuse patient records and information are examined. Also, the rules regarding the release of confidential information by family therapists to attorneys, other family members and third-party funding sources are explained. Suggestions regarding the release of information in questionable cases are made. Finally, the growing use of family therapy in treating substance abusers, and its impact on confidentiality law and policy, is noted.