Anxiety Disorders and Family Therapy

The role of family therapy in anxiety disorders is controversial. Empirical data exist only in relation to agoraphobia and obsessive compulsive disorders. Experienced clinicians, generally working with complex cases, regard marital and family conflict as central to many cases, which require a family approach for optimal therapy. In contrast, research workers generally regard marital and family factors as irrelevant to treatment. This is because complex cases are usually excluded from empirical research. This leaves mainly uncomplicated cases without significant family conflicts, for which a family approach is rarely necessary. Techniques for treating anxiety disorders in a marital/family setting are outlined.     

Adolescent and parent alliances with therapists in Brief Strategic Family Therapy with drug-using Hispanic adolescents

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent, adolescent) and family level (within-family differences) for families that either dropped out or completed family therapy. Participants were 31 Hispanic adolescents and their family members who received brief strategic family therapy for the treatment of adolescent drug use. Videotapes of first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that Completer cases had significantly higher levels of alliance across all family members than Dropout cases, and Dropout cases had significantly higher unbalanced alliances than Completer cases. Clinical implications are discussed.     

Adolescent and Parent Alliances With Therapists in Brief Strategic Family TherapyTM With Drug-Using Hispanic Adolescents

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent, adolescent) and family level (within-family differences) for families that either dropped out or completed family therapy. Participants were 31 Hispanic adolescents and their family members who received brief strategic family therapy for the treatment of adolescent drug use. Videotapes of first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that Completer cases had significantly higher levels of alliance across all family members than Dropout cases, and Dropout cases had significantly higher unbalanced alliances than Completer cases. Clinical implications are discussed.     

How and Why Do Family and Systemic Therapies Work?

My reviews of the evidence base for family therapy conducted over the past 15 years have been guided by four key questions. Does systemic therapy work? What sorts of systemic therapy work for specific problems? What processes occur in effective systemic therapy? Is systemic therapy cost‐effective? In this paper answers to these questions are given. Systemic interventions are effective for about two out of three cases. Specific models of effective systemic therapy have been developed for most common mental health problems. There are many processes shared by evidence‐based models of practice that can be incorporated into the routine practice of research‐informed family therapy. Systemic therapy is cost‐effective and in many cases leads to medical cost‐offsets. Available evidence indicates that family therapy can make a very significant contribution to alleviating suffering and making the world a better place to be.     

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.     

THE ROLE OF THE MENTAL HEALTH PROFESSIONAL IN CONTESTED CUSTODY:

Two different roles for mental health professionals in contested custody cases are presented. The first, the evaluator of competence model, is the more traditional one; its underpinnings are individually-oriented concepts: the clinician is a diagnostician and evaluator, making a recommendation to the court, and the family's input in the decision-making is minimal. The second role, a facilitator of change, comes out of family therapy theory; its focus is on helping the family to change and resolve their issues so that custody can be decided fairly: it is evaluative only secondarily, that is, if the family is unable to resolve the dilemma themselves. When working with contested custody cases, which are really unresolved family problems, the second approach is more promising.     

Grieving for the loss of the perfect child: Parents of children with handicaps

Family reaction to the diagnosis of a child with a handicap marks the occurrence of a family crisis. The losss experienced by the family at the birth of a handicapped child is explored within a framework for grieving. A wholistic model for the grieving process, which is based on a view that grieving has important biological, intellectual, emotional, behavioral and spiritual aspects is presented. Examples from clinical cases are offered to illustrate this process. Implications are provided for better understanding and facilitating of the grief process for both the family and the helping professional.     

‘Implicit’ remittances in family relationships: The case of Bangladeshis in Italy and beyond

In this article – based on 100 in-depth interviews with divided and reunited Bangladeshi families in Italy, Bangladesh, and London – we discuss how remittances are influenced by gender relations within the family, what social meanings they assume, what family memberships they reinforce, how the intertwining between migration and family cycle affects them. By adopting an intersectional approach, we show how economic transfers are normally sent to the family of the first-migrant man, although they may assist the emigration of the wife's male relatives: a phenomenon that we call ‘implicit remittances’. A second set of results concerns changes over time in remittances and two events of the family cycle are decisive: the family reunification in Italy and the demise of parents in the country of origin. In both cases, remittances are reduced, cease, or are limited to gifts in particular circumstances.     

Family support in practice: voices from the field

This paper revisits core family support messages for social work practice in working with children and families, linking to findings from high-profile child protection cases in the UK and the Republic of Ireland. Drawing on a comparative study where these identified practice messages were explored through the lens of testimony of family support workers in the UK and Ireland, these core messages are examined. Operating with hard-to-engage children and parents, we hear how families and family support worker colleagues now view the core functions of child and family work across both jurisdictions (Ireland and England). The authors argue that by naming a more detailed set of practices that are deemed as most useful by families, based on the benefits and challenges of intensive family support work, key messages arise that have major resonance for social work and multiagency practice into the future. A basic message from this study is that valuable lessons on engagement and intervention with families can be drawn for professionals by examining the practice elements of this group of paraprofessionals in the child and family arena. This paper adds to debates on the role of support and intervention in social work and family support work.     

Capital Usage in Adverse Situations: Applying Bourdieu’s Theory of Capital to Family Farm Businesses

The paper applies Pierre Bourdieu’s theory of capital to explore how farming family businesses respond to critical changes by using different forms of capital. The paper tells the story of three cases from the United Kingdom (UK): case one lost the entire farm business in the 2001 Foot and Mouth Disease (FMD) crisis; case two the family had to overcome the sudden death of the farmer; and in case three the farmer was diagnosed with a terminal illness. The results indicate that levels of economic capital are adversely affected, whilst social and symbolic capitals are important in assisting family members to cope and continue the business operations. The paper raises questions for future research and provides interesting findings for those involved with family business.     

Can child fatalities,end product of child abuse,be prevented?

Study of a sample of child abuse/neglect families where a child fatality has occurred suggests several indicators for identifying potential child fatalities. In contrast to families where child abuse is not followed by a child fatality, child abuse cases where a fatality does occur are characterized by abuse of more than one child in the family, a more chaotic family constellation, the mother as perpetrator of the abuse, and high levels of both human and milieu stress. The study also identifies gaps in services to sample families and suggests changes.     

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.     

Explicit Versus Implicit Family Decision-Making Strategies Among Mexican American Caregiving Adult Children

Changing U.S. demographics make it increasingly vital to investigate experiences of Latinos caring for aging parents, with specific emphasis on how these families, who often value family closeness, make decisions about caregiving. This study investigates relationships among use of implicit versus explicit decision-making strategies, generation since immigration, and orientation toward family. Findings suggest that those with more recent immigration to the United States were more likely than those who immigrated longer ago to describe family decision making about their parents' care as implicit. Those that were classified as using predominately implicit decision making were also found to be not significantly different from those classified as predominantly explicit with regard to their overall support of a collective orientation toward family. There were exceptions to this, however, regarding two specific aspects of orientation toward family: engagement in shared activities with family members and avoiding family conflict by making choices that are consistent with the family values. In both cases those categorized as implicit expressed stronger endorsement of these specific values. These findings suggest that the relationship between family decision-making strategies, generation since immigration, and orientation toward family is more complex than suggested previously in the literature. Implications for future research and practice are offered.     

FAMILY ASSESSMENT IN CHILD CUSTODY DISPUTES*

This paper has operationalized family systems theory to explicate the interfacing dynamics between family dissolution and child custody disputes. The authors suggest that clinical assessment and intervention in these matters which focus solely on individual and marital, or child dimensions, fail to recognize the powerful influences of systemic family process. A family assessment model, evolved from clinical work with over 200 court-referred custody cases, is described. The model involves a cross-sex therapy team with each member responsible for a specific family subsystem. The role of each therapist and the functioning of the team is outlined. Specific criteria for determining custody recommendations are identified based on patterns of family process and dissolution.     

AVOIDING A COMMON PITFALL IN COMPULSORY SCHOOL REFERRALS

When a family is compulsorily referred by the school for therapy, treatment failure often ensues if the family therapist, ignoring the probability of a powerful conflict between family and school, focuses prematurely on family dynamics. An alternative approach to such cases is proposed, based on questioning the "function of the symptom" notion, acknowledging the parents' predicament vis-à-vis the school problem, and conceptualizing therapy as the development of better teamwork.     

Homeless Careers: A Framework for Intervention

Abstract

The present paper identifies three ‘homeless careers’ abstracted from the diversity and complexity of individual cases and pathways. These are the ‘youth career’, the ‘housing crisis career’ and the ‘family breakdown career’. The paper discusses the usefulness of the career typology for framing interventions. A core argument is that early intervention involves different forms of practice in each pathway. For young people, early intervention has to occur when they are at the ‘in-and-out’ stage, before they have made a permanent break from family. For adults experiencing housing crisis, early intervention is about providing assistance to people before they lose their accommodation. The family breakdown career commonly involves domestic violence, so although early intervention may involve family reconciliation, in many cases it involves supporting victims of domestic violence to move to alternative, secure accommodation.     

Case‐Based Research in Family Therapy

Traditionally, case‐based research has not been considered as scientific by many in the field due to the lack of controlled conditions and objectivity. However, case‐study material may be more effective than once believed in educating family therapists. Future implications of the role of case studies in family therapy research are considered, including the manner in which case studies might be designed to be more rigorous so that they can serve as the basis for drawing causal inferences in clinical cases, and at the same time, provide family therapists with useful information to improve their skills. A discussion section highlights the future direction of case‐based research in the family therapy literature and how it may be used as an effective learning tool.     

Capitalism,Protestantism and the Private Family: Comparisons among Early Modern England,France, and the American Colonies*

The study of western family change lies disintegrated, divided into two largely independent intellectual communities–family history and theoretical family sociology. An integration of the two fields is proposed. The results of family historical research from three national cases, England, France, and the North American Colonies, are used to evaluate critically the family theories of Parsons, Seccombe, Zaretsky, and Horkheimer. The pattern of family organization regarded as modern, including the differentiation of the family from other social institutions, the emergence of companionate marriage, and the consolidation of authority over the family in the role of the father, characterize the family systems of England and the Colonies better than that of France. A theory of modern family organization is proposed that identifies the emergence of a culturally dominant middle class and the institutionalization of Protestantism as facilitating conditions for the development of this private family system.     

Limitations of family therapy

Summary This paper concerns inself with therapeutic difficulties in marital and family therapy due to an inability to resolve value discrepancies between the therapist and the family in question. The guarded prognosis due to lack in motivation to change is reinforced by the presence of chronic pathology, cultural differences, and the unwillingness or inability of the family/couple to engage in a valid therapeutic contract. This is especially true when acting-out adolescents are involved. This, and the limitations imposed by an agency and a private practice setting, is exemplified to two case illustrations. Clinical course, details, and psychodynamics are discussed as are the pros and cons of treating such families. Recommendations concerning modifications in techniques of intervention are made. The cases lead to the conclusion that while traditional (or even untraditional) psychotherapeutic procedures are likely to prove ineffective, an analysis of negative outcomes might help to devise strategies to cope with such families and lead to further theory building. References to the pertinent literature are made.