Making sense of the parenting ‘soft/hard split’

This paper explores the common parenting style tension around nurture versus limit-setting often evident when working with families with a symptomatic child. Firstly it will delve into the parenting ‘soft/hard split’ with an overview of the literature on parenting styles. Next, it summarises the appearance of this phenomenon in the family therapy literature during its formative days, noting how Bowen, Minuchin, Haley, MRI (Bateson), and the Milan associates respond to this parent presentation in their approaches. Next, the paper outlines recent iterations of these family therapy interventions. An expanded discussion follows on Bowen theory's understanding of the parenting tension triangle. The article then outlines elements of the author's qualitative research study of parents' experience of adolescents' mental health treatment where the ‘soft/hard split’ emerged as a repeating theme. Finally, a clinical intervention based on Bowen theory, the Parent Hope Project, is outlined for how it addresses the parenting ‘soft/hard split.’ The goal is to contribute to understanding this phenomenon and its implications for clinical practice.     

The elementary-school functioning of children with maltreatment histories and mild cognitive or behavioral disabilities: A mixed methods inquiry

This mixed methods inquiry examined the school functioning of elementary school-aged children with maltreatment histories and mild cognitive or behavioral disabilities. Quantitative analyses of linked social service and education administrative data bases of 10,394 children in Minnesota with maltreatment histories indicated that 32% were eligible for special education services. Of those children with maltreatment histories and identified disabilities, 73% had mild cognitive or behavioral disabilities. The most frequent primary disabilities categories were specific learning disabilities (33%) and emotional/behavioral disabilities (27%). Children with maltreatment histories and mild cognitive or behavioral disabilities scored significantly below children with maltreatment histories and no identified disabilities on standardized assessments of math and reading, and this gap increased with grade level for math. Qualitative interviews with 22 child welfare professionals and 15 educators suggested why some children with maltreatment histories, especially those with mild cognitive or behavioral disabilities, struggle in school. Risks to school functioning included children's and families' multiple unmet basic and mental health needs which can mask or overshadow children's mild disabilities; poor cross systems collaboration between child welfare, education and mental health systems; and inadequate funding, especially for mental health services. Protective factors included child engagement in school, parent engagement with child welfare services and a professional culture of cross-systems collaboration. Implications are discussed for holistic child, family and system-level interventions.     

Nothing is as Practical as a Good Theory: Bowen Theory and the Workplace — a Personal Application

Bowen Family Systems Theory is most commonly used to understand and predict family process. It is also applied to other potentially intense relationship systems, especially the workplace. It has been used by workplace consultants and by individuals to understand, and to manage, their own workplace functioning. This paper will draw from several key Bowen concepts to analyse common workplace dilemmas and to suggest responses that may assist the functioning of the individual and the system. The author's own experience as a manager in a child and adolescent mental health programme will be used as the case study to illustrate the theory's application.     

Within‐ and Between‐Family Associations of Marital Functioning and Child Well‐being

This study clarifies within‐family and between‐family links between marital functioning and child well‐being. Expanding on existing prospective research, this study tests whether changes in parents' marital functioning are associated with corresponding changes in their children's well‐being, independent from associations that exist when comparing different families. Participants (N = 1,033) were members of married, opposite‐sex couples with children who participated in five waves of a larger study of marriage in the U.S. Army. Spouses' constructive communication, verbal conflict, and marital satisfaction each showed between‐family associations with parent‐reported child internalizing and externalizing problems. In contrast, within‐family associations were significant only for parents' communication behaviors. That is, parents who reported lower levels of marital satisfaction also reported lower child well‐being, whereas change in parents' communication was associated with change in child well‐being over time. Isolating within‐family effects is important for understanding marital and child functioning and for identifying potential targets for effective intervention.     

Does Family Intervention for Adolescent Substance Use Impact Parental Wellbeing? A Longitudinal Evaluation

Adolescent substance abuse is a common problem and family interventions are emerging as a strategy to prevent it and assist family coping. The effectiveness of a prevention‐focussed family intervention was evaluated for its secondary impacts on improving parental mental health and family functioning. Twenty‐four secondary schools in Melbourne Victoria were randomly assigned to either a control condition or an intervention titled Resilient Families. The two intervention levels analysed were: (1) a parenting booklet only and; (2) combining the booklet with face‐to‐face parent education sessions. Parent surveys at baseline were followed up one year and four years later. Repeated‐measures analysis (n = 560) found parents attending parent education demonstrated reductions in mental health symptoms, however this had negative effects on family cohesion and no impact on family conflict. These findings were interpreted in terms of parent education assisting parent mental health by promoting assertive parenting styles that may increase adolescent‐parent tension by encouraging firmer parental boundaries and strategies to reduce adolescent substance use.     

‘Putting Humpty Together Again’: Working With Parents to Help Children Who Have Experienced Early Trauma

Early interpersonal trauma can have a profound impact on young children's emotional, cognitive and physical function, and on their ongoing development. This article outlines the diverse effects of trauma and how they might present in school or childcare settings. It considers the role of the family in the development of children's emotion regulation, especially if trauma occurs in the context of the family and how trauma affects family dynamics. A therapeutic approach is then outlined to help address the multiple areas of difficulty. Work with parents and the whole family is aimed at maintaining physical and emotional safety and building trust between parent and child. Work with the parents, teachers and the child individually is directed at helping the child develop emotion regulation and competence physically, cognitively and interpersonally.     

Supporting Vulnerable Families Through School-Based Mental Health Services: Results of Caregiver and Teacher Focus Groups

Family perspectives facilitate participation and positive outcomes in child mental health treatment. In schools, families and teachers must cooperate to best meet children's mental health needs, also making teacher perspectives important. In this study, caregivers and teachers participated in focus groups following the pilot year of a school-based mental health (SBMH) project. Participants noted successes and challenges of the project and suggested improvements. Although this study focuses on the SBMH project, many of the study implications are applicable to other school mental health programs and may be of value to school and community practitioners.     

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     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

When Baby Brings the Blues: Family Therapy and Postnatal Depression

Postnatal depression impacts on a significant number of women and their families. As a topic it is attracting much interest from researchers as we become clearer about its impact on the long‐term mental health of both women and their partners, as well as on the couple's relationship and their children's mental health. This article will provide a brief overview of postnatal depression and the current research associated with it, and consider the usefulness of systemic family therapy interventions. Examples of these are included along with a clinical vignette.     

Family Communication as a Mediator of Child Adjustment to Divorce

Abstract

Reduced family conflict, consistency in roles and parenting, and limited negative life changes seem to be particularly important variables in promoting children's adjustment to divorce.

The impact of family functioning on child adjustment was investigated in a sample of 22 recently separated or divorced families with a total of 32 children. A series of multiple regression analyses using factors on the Family Assessment Device to predict Child Behavior Checklist scores indicated that family functioning is a significant predictor of children's Externalizing behavior problems. The Communication factor accounted for a significant portion of unique variance in the externalizing scores that was unaccounted for by the other factors. When separated parents can communicate with each other to co-parent their children, as well as communicate affective limit-setting messages to their children, the children exhibit less behavioral problems.     

Advances in Families and Health Research in the 21st Century

We review research on families and health published between 2000 and 2009 and highlight key themes and findings from innovative, methodologically rigorous studies. Whereas research in prior decades focused primarily on whether family structure affects child and adult health, contemporary research examines the contextual and processual factors that shape for whom, for which outcomes, and under what conditions families affect mental and physical health. We discuss how family structure, transitions, and processes within families of origin affect children's health over the life course. We then examine the effects of marital status, transitions, and quality for adult health. We point out limitations in current research, discuss implications of recent findings for policy, and highlight theoretical and methodological directions for future research.     

African American caregivers' resources for support: Implications for children's perceived support from their caregiver

School-aged children often turn to their primary caregiver, such as a mother, father, or other close relative, for support in dealing with difficult situations. This cross-sectional, school-based study examined whether urban, lower-income African American caregivers' stressful life events, affective symptoms, and perceived support from their social network were associated with their children's perceptions of support from and conflict with the caregiver. Forty-six African American children aged 8–12 years and a primary caregiver were recruited from a partnering Midwestern United States elementary school and separately interviewed. Results showed that caregivers' report of greater support from their social network across a variety of domains was associated with children's report of greater instrumental support from their caregiver. Caregivers' report of greater attachment to members of their social network was associated with children's report of greater emotional support from their caregiver. Implications of findings for mental health promotion among children and families are discussed.     

‘I Will Not Leave My Baby Behind’: A Cook Island Māori Family's Experience of New Zealand Māori Traditional Healing

Traditional healers in many parts of the world have used family focused understandings and interventions well before the emergence of western family therapy theory and practice. This paper gives a detailed account of New Zealand Māori traditional healing work with a Cook Island Māori family in which the eldest daughter was in considerable distress as were her family, who believed that she had become maki tūpāpaku (possessed). This account is told from the perspectives of the child psychiatrist, the traditional healer and the mother of the family. While the intervention bears a superficial resemblance to western family therapy approaches, the theoretical foundation reflects the traditional healer's New Zealand Māori world views in which spiritual understandings are paramount, and concepts of mana, tapu and mauri ¹ guide him in the family healing process. The single session described here can be viewed as an indigenous family therapy intervention involving six generations of family members, both living and deceased, in the one room. Conclusions: Indigenous communities have called for traditional healers to be employed alongside child mental health workers and family therapists who work with their communities. Close and sincere collaboration between an indigenous traditional healer and a health professional can offer a family in distress healing possibilities that may not be available to them in conventional child mental health or other family therapy settings.     

The Family Movement,Bowen Theory,and Theoretical Medicine: A View from the 21st Century

Important changes have occurred in the family movement in the United States since it emerged in the mid‐1950s. Psychiatry supported the movement in its early years, but that changed as psychiatry abandoned the biopsychosocial model and adopted the biological paradigm through the 1970s. This development pushed family and other therapies to the periphery of the discipline. Medicine is dominated by the biological paradigm and cause‐and‐effect thinking. The roots of the medical model go back to Pasteur. In contrast, psychiatry in the United States had been dominated through the 20^th century by psychoanalytic thinking, which rendered the discipline a step‐child to medicine. This and other factors pushed psychiatry to get biological. The change generated a ‘failure of nerve’ in the family movement, abandoning the role of the family in schizophrenia in the face of psychiatry's assertion that all serious mental illnesses had nothing to do with the family. Other important changes separating the family movement from psychiatry occurred as well. Bowen theory is anchored in biology and evolution, but it is not a biological paradigm. Maintaining solid connections to the scientific disciplines are important for keeping the theory an open system. The recent emergence of systems biology and systems medicine could challenge psychiatry's allegiance to the biological paradigm and bring family systems theory centre stage in the discipline. These new disciplines may also arrive at a systems theory of the individual that can be integrated with family theory, powering a paradigm shift in medicine as a whole.     

Introducing Evidence‐Based Family Assessment and Therapy in Child and Youth Mental Health Services: Applying Systemic Principles to Maintain,Sustain and Build Capacity

The purpose of this article is to overview the context of the mental health service in which we work, and family therapy's status prior to and after the impact of changes wrought by the introduction of the National Mental Health Policy. We then explore some key issues that we think contribute to the persistence of the occlusion of family therapy in child psychiatric services; and the strategies that we developed and are continuing to develop to support change. Finally, we describe the use of a family assessment instrument that we believe is central to our change strategy.     

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.     

Children's Family Environments and Intellectual Outcomes During Maternal Incarceration

Despite the dramatic increase in incarcerated mothers that has occurred in the past decades, there is a paucity of family research focusing on the children affected by maternal imprisonment. The present study investigated family environments and intellectual outcomes in 60 children between the ages of 2 and 7 years during their mothers’ incarceration. Multiple methods were used to collect data from children, mothers, and children's nonmaternal caregivers. Results indicated that most children experienced multiple risks across contextual levels. Cumulative caregiver sociodemographic risks predicted children's cognitive abilities, although quality of the home and family environment mediated this relation. Results underscore the importance of children's family environments and highlight the need for increased monitoring, service delivery, and longitudinal research with children of incarcerated mothers and their families.     

The Safety First Assessment Intervention: A Whole Family Approach for Young People with High Risk Mental Health Presentations

The following article provides a comprehensive guide to the clinical implementation of the Safety First Assessment Intervention (SFAI). The SFAI is a systemised, whole family approach for young people with high‐risk issues presenting in a mental health crisis. It is underpinned by the Safety First Model (Bickerton et al., 2007 ) and promotes community‐based care. The SFAI operationalises the foundation levels of the Safety First Model (SFM) through a highly structured clinical process. It draws on family systems theory, predominantly the work of Bowen ( 1978 ), to conceptualise distress through a multi‐generational systems lens and to prioritise the young person's natural support system (their family, friends, school and community) as their key resource. The SFAI engages this natural support system and facilitates open communication about symptoms, distress, safety and risk. This promotes a shared understanding of the key issues in a relational context and forms the basis of collaborative risk management. Thus, a system of safety emerges prioritising the family's role in optimising the young person's community‐based recovery. The need for pharmacotherapy and hospitalisation is therefore minimised. The article includes background theory, an outline of the structured assessment intervention and clinical techniques, including strategies for complex family situations. Specific strategies are illustrated with fictional vignettes. The work is based on the authors' accumulated experiences of working with young people and their families and carers in an acute Child and Adolescent Mental Health Service (CAMHS) for over a decade.