Creating the Next Wave of Family Therapy

This article is an exploration of family therapy in Australia based on interviews with seven leading Australian family therapists: Max Cornwell, Carolyn Quadrio, Ron Perry, Laurie MacKinnon, Brian Stagoll, Banu Moloney and Jim Crawley. It explores the attributes and qualities of what makes a good family therapist and seeks to understand how the next generation of therapists can generate a new enthusiasm for family therapy.     

A Journal of Family Social Work conversation with Monica McGoldrick,LCSW

Monica McGoldrick and Judith Siegel converse about Monica’s decision to become a social worker, her interest in families, key people who influenced her along the way, and the inspiration for her work on ethnicity in family therapy.     

‘Drawing the Circle That Takes Them In’: Liz Mackenzie in Conversation

Liz Mackenzie's involvement with family therapy began in 1978 at the Psychiatry Department of the Adelaide Children's Hospital. She contrasts the field then and now, naming some of the dysfunctional facets of family therapy. She became manager of a specialist foster/residential program in the non‐government sector, definitely the most difficult, extending and satisfying period in her working life. In 2007, she is back where it began for her, in the (renamed) Women's and Children's Hospital, working in a Child and Adolescent Community Health team     

Sometimes Words Just Ain't Enough – Enhancing the Contribution of Children in Therapy through Creative Expression

The meaningful inclusion of children in family therapy is an ideal that therapists readily align with and yet struggle to implement effectively. Within a practice that relies heavily on verbal expression, young children provide a unique challenge for therapists, who require developmentally appropriate opportunities for the child to express, document, and share his or her experience in all its richness and colour. In this paper the author utilises art therapy to support greater inclusion of children in family therapy by capitalising on their creative talents and facilitating the child's visual story within the family dialogue. This can assist in the formulation and treatment of systemic issues.     

‘Somebody Else's Roadmap’: Lived Experience of Maudsley and Family‐based Therapy for Adolescent Anorexia Nervosa

The Maudsley and more recent family‐based therapy manualised approaches are positioned by some as the gold standard, evidence‐based therapy for adolescent anorexia nervosa (AN). However, a significant proportion of adolescents and their families either discontinue this therapy and/or find that it simply does not work for them. These adolescents and families are under‐represented in the literature on therapeutic interventions for adolescent AN. This paper begins to address this gap with an in‐depth qualitative case study that explores the lived experience of Maudsley family therapy (MFT)/family‐based therapy (FBT) for one female adolescent (age 14 years) and her family over the period of 3 years (ages 11–14). Although initially handing over the responsibility for her eating was comforting and reinstated a sense of control in the family system, these experiences were not maintained. When she did not progress past the first phase of FBT, she and her family experienced the approach as blaming. She felt silenced and family alliances were weakened. This paper analyses how the family members negotiated and preserved their identities within this disabling context.     

The Neurosequential Model of Therapeutics: An Interview with Bruce Perry

In this interview with Bruce Perry, MD, PhD, Senior Fellow of The Child Trauma Academy, Laurie MacKinnon discusses with Dr Perry developmental trauma and the Neurosequential Model of Therapeutics, an approach to clinical problem solving that utilises a developmental lens and incorporates advances in neurobiological development. Dr Perry gives his perspective on the causal connection between childhood abuse and later psychiatric diagnosis, the child's contact with a violent parent post‐separation, the importance of interventions that address the organisation and functioning of lower parts of the brain and his perspective on the use and limitations of psychotropic medications, cognitive behaviour therapy and family therapy.     

An ecological perspective on family policy: A conceptual and philosophical framework

This article develops a conceptual framework that places family policy within an ecological perspective. The ecological perspective is particularly useful in providing a means both to understand why diversity exists among families and to analyze how human-created rules disparately affect the environments faced by families within and across different societies. Examples are provided of how family policy is conceptualized by organizations and groups that are concerned with family issues, and these examples are critiqued from the ecological perspective. Finally, the article suggests that the values on which an ecological perspective of family policy are grounded can serve as a beginning point to develop a philosophical basis for the development of family policy. Her research interests include family policy and research at the national and international levels. She received her Ph.D. in Social Work and Economics from the University of Michigan.     

Frameworks for Practice in the Systemic Field: Part 2 — Contemporary Frameworks in Family Therapy

This is the second of two articles to map the landscape of practice theory in systemic family therapy. The first article gave a particular chronology of the development of family therapy practice theory, beginning with the frameworks that emerged in the 1960s‐1970s and then tracing the transitional decade of the 1980s. The convergences of three sets of influences — ecosystemic epistemology, the feminist challenge and postmodernist ideas — led to the changed landscape of post‐1990 practice theory. This second article picks up at this point, mapping four contemporary influential approaches in Australian family therapy — the Milan‐systemic, narrative and solution‐focused frameworks, and the dialogical perspective. Social constructionist and narrative ideas together constitute the dominant common theory influence in the post‐1990 practice frameworks, although intersected and used in different ways in the different frameworks. Throughout the history of the development of practice theory, context and relationship remain the enduring parameters of the systemic family therapy field.     

Frameworks for Practice in the Systemic Field: Part 1 — Continuities and Transitions in Family Therapy Knowledge

This is the first of two articles to map the landscape of practice theory in systemic family therapy. In this first article, the representation of knowledge for practice is explored, and an argument is made that while frameworks remain important, the relationship to them is now more conditional and pragmatic. A particular chronology is offered of the development of family therapy practice theory frameworks, beginning with the frameworks that emerged in the 1960s to the 1970s. An analysis is given of the important transitions in the 1980s and three sets of influences in this decade — ecosystemic epistemology, the feminist challenge and postmodernism — are identified. This reading emphasises hidden continuities in the transition, despite the seemingly discontinuous shifts in practice theory from the beginning of the 1980s to the beginning of the 1990s. Context and relationship are identified as the enduring parameters of systemic family therapy knowledge, though understandings of context and relationship have been recast in the contemporary (post‐1990s) practice theory. The second article will explore the four contemporary influential approaches in Australian family therapy — the Milan‐systemic, narrative and solution‐focused frameworks, and the dialogical perspective — and point to intersections in practice ideas and integrative movements.     

Preserving Family Therapy's Legacy

Originating as a plenary address, this article reviews the enduring contribution of family therapy, and asks how it might best be preserved into the future, given that family therapy itself is no longer seen as ‘newsworthy’. The author makes three recommendations: that all future social workers be trained to conduct a three‐session structured family assessment; that all future family therapists be required to participate in a Yalom‐type group therapy experience; and that one member of every child mental health and child protection team be trained to convene and chair interagency case conferences capable of building trust and working towards open communication. A rationale for the three recommendations is provided, in terms of key principles common to family and group work.     

Ten Research Questions for Family Therapy

A growing evidence‐base shows that family therapy works, but many gaps in our knowledge remain about the conditions under which family therapy is effective and how it works. In this paper, ten critical research questions about family therapy that need to be addressed are considered. In short these are:

• 1 Is family therapy as effective in community settings as it is in specialist clinics?
• 2 For what problems is family therapy cost‐effective?
• 3 Does family therapy work for under‐researched problems and populations?
• 4 Do social‐constructionist and narrative approaches to family therapy work?
• 5 Can family therapy protocols be enhanced for non‐responders?
• 6 Can family therapy be combined with other psychotherapies to effectively treat specific problems?
• 7 Can family therapy be combined with pharmacotherapy to effectively treat specific problems?
• 8 What specific factors contribute to the effectiveness of family therapy with particular problems?
• 9 What common factors contribute to the effectiveness of family therapy?
• 10 What therapist and client factors contribute to the effectiveness of family therapy?

     

Teaching and Learning Theory For Family Therapy Practice: On The Art and Craft of Balancing

As with all practice knowledges, family therapy theory sits in a complicated relationship to practice. This paper offers a set of reflections exploring challenges of teaching and learning theory for, and about, practice in family therapy. The importance of teaching particular frameworks of practice sits in tension and balance with the importance of the common factors of therapeutic change, and the inseparability of the use of self and the use of particular practice knowledge. Passion and commitment to particular ways of working is held in balance with the need for flexibility and the freedom to think independently. Discipline and focus is balanced with creativity and the room for integration. A number of balancing practices are identified in the art and craft of teaching, and the contextual issue of power and vulnerability in the teaching and learning relationship is acknowledged. Finally, the three ‘Rs’ in teaching and learning family therapy practice theory are drawn out – reflection, the recursiveness of theory and practice, and the reflexivity of self in relation to context and knowledge.     

The influence of the Milan approach: Five decades of intergenerational change. A conversation with Matteo Selvini

The ‘Milan Approach’ made an enormous contribution to psychotherapy and psychiatry and has been viewed as a bedrock in the family therapy field. Mara Selvini-Palazzoli made a revolutionary shift in the early 1970’s to abandon individual therapy and adopt family therapy to treat anorexia in young women. The goal of the three systemic principles; hypothesising, circularity and neutrality, proposed by the Milan Team is to elicit a useful method to interview families which encourages the production of meaningful information. The Milan group took special care of language. Rather than overly focusing on the label and referring to schizophrenia as a diagnosis, for instance, they used the term ‘families in schizophrenic transaction’. This perspective more realistically explored the origin of problems while looking at ways how to effectively generate change. In the early stages of its development, heavily influenced by the work of the MRI, the team adopted a pragmatic and strategic approach, however the focus gradually shifted towards semantics and the story of the system. While the ‘systemic identity’ was the principal guiding principle, the model was also influenced by social constructionism. This paper is a distillation of a conversation held with Matteo Selvini, son of Mara Selvini Palazzoli. We discussed the four key influential figures who developed the ‘Milan approach’, Selvini Palazzoli, Boscolo, Cecchin and Prata. The focus of the conversation is on Mara and on her influence shaping the approach, its evolution through the years leading to the creation of the Scuola di Psicoterapia Mara Selvini Palazzoli. Matteo also shares his own influence in the evolution of the school through the intervening years. He explains the adapted version of the Milan approach and the amalgam of the original and emerging therapeutic concepts. His key messages to therapists are the importance of working in teams and client follow-ups.     

A Mixed Methods Exploration of Single Session Family Therapy in a Child and Adolescent Mental Health Service in Tasmania,Australia

Single session therapy (SST) is grounded in the belief that clients and families can effect change after one therapeutic encounter, using their own resources, with brief support and assistance from therapists. SST has been found to be an effective intervention for children, young people, and their families presenting with a wide range of difficulties. Research in child and adolescent mental health has shown that over 50% of families find one SST encounter is enough with no need for further specialist input. This study aims to explore family member experiences of SST (undertaken as single session family therapy and termed hereafter SSFT) as an initial intervention in a regional child and adolescent mental health service (CAMHS), specifically in terms of worry, confidence, and satisfaction outcomes. An exploratory, mixed methods convergent design was utilised using a combination of open questions and Thurstone scales. All eligible family members were invited to complete questionnaires before and after the SSFT, asking about level of worry, confidence, and overall satisfaction with SSFT. Quantitative and qualitative findings indicated most family members had a positive experience of SSFT, although differences were found between young people, parents, and siblings. Overall, family members’ level of worry decreased, while only parental confidence in managing the presenting issue(s) increased. Over half of the families did not require further contact with CAMHS following the SSFT. Our findings support previous research that SSFT is an effective, family-inclusive, and well received intervention for a variety of mental health issues facing children and young people. SSFT could be considered a beneficial and well received first response for the majority of CAMHS clients, which prioritises a family-inclusive approach. Future research could focus on attaining a more in-depth understanding of individual family member experiences with a view to improving SST delivery.     

Enhancing Family Therapy's Relationships With Research

The contention of this article is that systemic family therapy has much to gain from a realistic appraisal of its research base, which is as positive as possible. And that through such an appraisal we can find ways of developing the scope of family therapy to the benefit of the profession and thereby, of our clients. Family therapy will benefit if practitioners can present an informed view of research. As a preliminary approach to this objective, I review reasons why perceptions of family therapy underestimate its research base, and why therapists might resist involvement with research. The article then explores the reasons for regarding randomised controlled trials as a ‘gold standard’, and why they are not well fitted for the purpose of evaluating or developing a relational therapy. Next is a consideration of alternative approaches to research, including a consideration of what clients actually want from their therapy, then a brief review of the positive findings of outcome research. Greater emphasis on researching processes in therapy is proposed, and consideration of the ‘common factors’ debate is shown to support priorities that are specific to systemic therapies. The article concludes with suggestions for increasing the involvement of family therapists with research, both as consumers and as research practitioners.     

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.     

JOINING FOR CHANGE: AN INTERVENTION OF STATE CHANGE OR AN INTERACTION OF UNFORESEEN CONSEQUENCES?

This article is in response to Laurie Charlés' (this issue) research article on hostage negotiation. It is suggested that her article provides an opportunity for family therapists to reexamine our own taken-for-granted clinical practices, particularly the practice of joining to achieve rapport. Rapport is considered from the two perspectives of either being an experience of the individual (state trait) or as a dynamic process that is relationally accomplished with unpredictable consequences for both participants. Implications for practice and training are presented.     

Being neither Pollyanna nor Henny Penny: Responding to McDonald and Jones

Abstract

This paper provides an account of the earliest contributions to family theory and practice by social workers, beginning in the late nineteenth century. The paper argues that the first widespread practice of ‘family work’ by the helping professions was carried out by social workers, primarily women, despite this being rarely acknowledged in the family therapy literature. An analysis of gender and its place in the development of professional status and the ownership of ideas is provided.

Summary

This paper has traced the place of the family in social work theory and practice since the beginnings of the profession, with a particular focus on theoretical developments in social work in the United States. A number of points have been argued. Firstly, there is significant historical evidence that social workers, most of them women, pioneered family work many decades before the term ‘family therapy’ was invented. This directly challenges the claim made by a number of family therapy historians that work with families was pioneered by psychiatrists in the 1950s and 1960s. It is argued here that this discrepancy is largely a result of differences in professional power and gender status.

Secondly, it is argued that the impact of psychoanalytic theory on social work was profound, not only in terms of how it might have distracted the profession from further developing its early family systems focus, but also in how its multidisciplinary practice tended to place social workers, again mostly women, in somewhat limited and prescribed positions.

In addition, it is argued that social work's emphasis on the family and family intervention has waxed and waned due to these concepts not appearing to fit neatly into divisions between fields of practice, such as casework, group work and Community development. While social work struggled with finding a place for the further development of family social work theory, the rapidly growing domain of family therapy quickly colonised this field of practice, giving little credit to the ground already laid by social workers.     

The Devil is in the Detail: Clinicians,Academics and Researchers Resolving the Problems of Clinical Research

The difficulties associated with conducting valid family therapy research within a clinical practice discourage many potential researchers. This article will describe collaboration between a group of academics, researchers and clinicians who decided to explore the process and efficacy of systemic family therapy conducted within a working private practice. The specific questions we are addressing are, whether the requests clients bring to their first session of therapy can be reliably classified by practitioners, whether these requests change over time, and whether the nature of the request is associated with therapist and client ratings of therapeutic outcome. Additional questions about the form and nature of the therapeutic alliance as experienced by both client and practitioner are also being explored. This paper will map the passage of the work from inception to its current state where over 140 clients are active participants. In doing so attention will be paid to the obstacles encountered: practical, financial and ethical, and the solutions devised to address these.