Search

The training of family therapists requires that learning objectives and expectations be specified in empirical terms so that the trainer and trainee can achieve clear goals, identify areas of progress, and meet the special needs of the trainee. This paper articulates the competencies, objectives, and criteria for evaluation used during a time-limited training program for therapists involved in family therapy research conducted at Centennial School of Lehigh University.

The paradigm for inpatient family therapy presented here is intended both as a description of, and a means of thinking about, family therapy in a long-term inpatient setting. It is meant to contribute to a delineation of treatment goals and strategies within a conceptual framework that is rooted in and expresses the complex clinical realities of inpatient treatment, where the locus of family therapy is the family-hospital boundary. The four functions described here are hierarchical in their relationships to each other, each function emerging only in the context of the logically prior function. Although, clearly, inpatient family therapy moves through stages parallel to those of other treatment modalities (14), the purpose of this paper is to explore therapeutic functions rather than present a prescriptive, linear description of successive phases of treatment. Joining, once achieved, cannot be left behind: it needs constant attending to, though more so at some times than others. Similarly with the other functions. It is helpful when pausing to examine one's work to note those functions that, at any given time, seem to be most at issue. For instance, the family of a patient well along the road toward discharge may promote a crisis (e.g., another family member may become symptomatic, the parents' marriage might suddenly seem in danger of falling apart, or the whole thrust of the treatment may be rejected peremptorily). On such occasions the inpatient family therapist must look for precipitating factors, not just in the domain of the family and its functioning and not just in his or her relationship with the family, but also in the context of the family's relationship to the hospital. Is the hospital riding roughshod over the family's feelings? Has important information from the family been ignored? Or, has important information been neglectfully withheld from the family? Is the treatment team moving too quickly toward discharge? Are staff, then, subtly pulling back from the patient or other family members as a way of coping with their feelings of loss? Have staff somehow communicated disappointment or pessimism or despair to the family? Has the family therapist somehow inadequately represented the family's needs to the treatment team or floor staff? Do treatment decisions therefore strike the family as insensitive or thoughtless? Has the family therapist been unable to frame treatment decisions in a way the family can accept and use constructively?

This work is the result of research into chronicity factors in infantile asthma. The research had two main goals. The first, using a sample of 100 asthmatic children, was to reconstruct the therapeutic history of the individual patients on the hypothesis that the therapeutic intervention they had undergone in fact conditioned the quality of the cure demand. The second was to evaluate the influence of family dynamics on the chronic development of infantile asthma. A comparison was made between two interactive models using a sample of 10 families with asthmatic children with chronic tendencies and a sample of 10 normal families. The results show that typical dysfunctional interactive patterns exist in the experimental sample and that they are correlated with the perpetuation of the asthmatic symptom. The paper concludes that every therapeutic intervention that is limited to dealing with the biological component of the asthmatic symptom and ignores the influence of family dynamics becomes itself a major chronicity factor. Thus a "systemic" intervention is considered necessary to prevent chronicity.

In spite of the obvious fact that families differ significantly depending upon their current stage of the life cycle, most of the family therapy literature focuses on intervening in ongoing family interaction without specific attention to the dimension of family development. Family sociologists, on the other hand, while not dealing with modifying family functioning, have provided more detailed tools with which to understand variations in family functioning based on stages of family development. Our work with families in acute distress suggests the need to increase the specificity with which our assessments and interventions are tailored, by incorporating the family developmental view. This paper explores the utility of the family developmental view using the concepts of fixation and regression in the family life cycle. These concepts were found to be relatively refined and quite pragmatic assessment devices that assist therapists in specifying developmental issues of the family. Case examples of actual families in crisis are presented in order to demonstrate the utility of these conceptual tools.

This paper describes the work of a strategic team that came out from behind the one-way mirror. A debate among the team is enacted before the family as a strategy for change. The case of a family that refused to provide information illustrates an application of this method. The debate among the therapists represents a dilemma that is a strategically constructed isomorph of the family situation. From this position, therapists have the option of changing levels between themselves and the family, asking the family to help solve the therapists' dilemma so that they in turn can be free to help the family. The combination of the debate and the change of levels between the therapists and the family creates a therapeutic neutrality for the family. From their meta position, they observe the therapists' struggle to solve the family's problem, which is re-presented as a problem among the therapists. This perspective offers the family the choice of more adaptive solutions to their own dilemma.

The large volume and diversity of family therapy resources can often confuse trainees who are in need of more abbreviated guidelines for managing their clinical responsibilities. This paper presents a structured outline of a problem-oriented first family interview for the family therapy supervisor and the beginning family therapist. We view the first interview as an integrated process including the important tasks preceding and following the initial family meeting. After the goals that shape the work of the first interview are described, a step-by-step guide to the twelve phases of the interview is presented: telephoning; forming hypotheses; the greeting; the social phase; identifying the problem; observing family patterns; defining goals; contracting; checklist; revising hypotheses; contacting the referral person; and gathering records. This approach to the first interview integrates a variety of structural and strategic procedures. The guide, intended for use in conjunction with close supervision, may serve as a foundation on which beginning therapists can build their unique styles.

In this paper it is suggested that there is a link between the condition of anorexia nervosa and certain rigid and implicit family beliefs. These rigid and implicit beliefs are transmitted from one generation to the next and have a highly constraining effect on all family members. More specifically, these beliefs include role prescriptions that are applied to certain daughters. These daughters are vulnerable to the symptoms of anorexia nervosa. The goal of treatment is to challenge successfully the constraining influence of these beliefs. As such beliefs appear extraordinarily resistant to direct challenge, this is best achieved by rendering the beliefs and their specific consequences explicit to family members. An intervention procedure based on this approach is described and its application to "anorectic families" is demonstrated. The description is supported by transcripts of a family in treatment.

Growing interest in concepts of fusion and individuation within a number of different theoretical systems of psychotherapy suggests an emerging shift in perspective in the conceptualization of psychopathology and psychotherapy. This shift may represent a first step in the integration of individual and relational dynamic theories. A theoretical framework for the exploration of processes of fusion and individuation is presented, with suggested applications for the study of problems experienced by adult couples. The process of individuation from fusion to dialogue is outlined in the description of four modes of relationship. In this context, the paper suggests ways in which a variety of problematic relational patterns seen in couples may be viewed as reflecting the partners' struggles to move from fusion to dialogue.

The universal appeal of nostalgia and reminiscence makes photographs a natural instrument for studying the impact of the past upon the present. This paper explores photography as a medium for facilitating reminiscence to discover individual roles, interpersonal relationships, and family dynamics. A method is described for using family photographs in treatment and training of clinicians at a Family Therapy Clinic.

This paper presents a small group design, part of a two-year training program in family therapy, using video playback to enhance self-awareness. Congruence among multiple channels of communication enhances therapist effectiveness; the visual mode has unique advantages in identifying incongruence. Details of the design are described, emphasizing the staging of gradually increased risks from general exercises to more specifically personal foci. The concurrent building of an atmosphere of safety is essential for risk-taking.

A clinical interview affords far more opportunities to act therapeutically than most therapists realize. Because so many of these opportunities remain outside the therapist's conscious awareness, it is useful to elaborate guidelines that orient his or her general activity in directions that are liable to be therapeutic. The Milan associates defined three such basic guidelines: hypothesizing, circularity, and neutrality. Hypothesizing is clear and easy to accept. The notions of circularity and neutrality have aroused considerable interest but are not as readily understood. These guidelines may be clarified and operationalized when reformulated as conceptual postures. This process is enhanced by differentiating a fourth guideline, strategizing, which entails the therapist's decision making, including decisions about how to employ these postures. This paper, the first in a series of three, explores these four interviewing guidelines. The other papers will appear in a subsequent issue. Part II will focus on reflexive questioning, a mode of inquiry oriented toward mobilizing the family's own healing capacity. Part III will provide a scheme for analyzing and choosing among four major types of questions: linear questions, circular questions, reflexive questions, and strategic questions.

This paper reviews some of the recent empirical studies validating the Circumplex Model and describes the newly developed self-report measure, FACES III. Studies testing hypotheses derived from the Circumplex Model regarding the three dimensions of cohesion, change, and communication are reviewed. Case illustrations using FACES III and the Clinical Rating Scale are presented. These two assessment tools can be used for making a diagnosis of family functioning and for assessing changes over the course of treatment. This paper reflects the continuing attempt to develop further the Circumplex Model and to bridge more adequately research, theory, and practice.

Family therapy can be viewed as science and as art. Following leads provided by Gregory Bateson, this paper reflects on problems and promises inherent in both views.

This paper offers recommendations for family research in light of the scientific paradigm ushered in by quantum physics in the early twentieth century. After summarizing the basic discoveries of quantum physics, the author discusses philosophical implications of these discoveries, and then presents implications for conducting scientific research about families within a post-Newtonian paradigm that emphasizes relations, process, and dynamic causation. The author argues for using complementary research models, including linear and systemic, because no one theory or methodology can illuminate fully the inscrutable nature of family processes.

The belief that individual marital therapy (IMT) is an ineffective form of treatment for marriage problems and markedly inferior to the conjoint approaches has become almost an article of faith in family therapy circles. This position was originally advanced in the influential reviews of the research literature conducted by Gurman and Kniskern, and their conclusions have been cited in numerous other articles. This paper re-reviews the research studies purportedly supporting this conclusion and finds almost all of them to be invalidated by gross flaws in design and implementation. It is argued that from the highly inadequate evidence available, no conclusions can be reached concerning either the absolute or relative effectiveness of IMT.

Although the single-parent family is becoming a predominant family structure, there is a surprising scarcity of articles discussing its typical problems or detailing specific therapeutic approaches. This paper attempts, first, to list some core problems encountered by all single parents and, second, to present a sequence of therapeutic approaches geared toward dealing with these problems. Structural theory, with its emphasis on subsystems, generational boundaries, and organizational patterns, provides a framework for viewing the built-in vulnerabilities of the single-parent family unit. Minuchin's (3) emphasis on generational boundaries and the problem of enmeshment underlies the theoretical and therapeutic approach presented here. I have drawn heavily on Haley's (2) idea that the therapist must be an authority, a problem-solver, and a teacher. Finally, the emphasis on creating new organizational patterns is most thoroughly explored in Aponte's (1) discussions of "underorganized families" (many of whom are single-parent families).

Over the last century there have been reports in the psychiatric journals of an unusual disorder, folie à famille, yet the syndrome has been neglected by family theorists. In this paper the literature on delusions shared by families is examined from the perspective of a family therapist. The role the disorder plays in defining the continuum of functional/dysfunctional shared familial beliefs is described, and a case example demonstrating that folie à famille may be underreported is presented.

The severely dysfunctional family is a clinical phenomenon that includes families with a wide range of serious symptoms. These families have been characteristically difficult to engage in treatment, and many do not respond well to traditional family therapy techniques. Some of these families do respond to innovative approaches such as paradox. However, many agencies do not have the capability to implement such highly specialized procedures, nor do all severely dysfunctional families respond well to these techniques. Thus, this paper presents a generic approach to the severely dysfunctional family; the emphasis is on facilitating engagement and maintaining sensitivity to the family's need for stability.

Family therapists disagree over the utility of historical reconstruction for treatment. Following either a behavioral or a psychoanalytic paradigm, theorists insist that history is irrelevant or essential to the treatment process. This paper demonstrates how a variety of family therapy concepts were used in his historical research into the life of the family of William James, the American psychologist and philosopher (1842-1910). This is offered as evidence both that family theory has a contribution to make to the writing of history and that the historical process is important to family therapy. It is suggested that clinical actuality calls forth interventions within both paradigms, often by the same therapist with the same family. The alternatives need not be mutually exclusive, though theory-building is clarified by talking as if the therapist were confronted by an either/or choice.

In certain Ibsen plays a character (would-be family therapist) enters during a crisis revolving around family secrets. Taking two such plays as models, this paper examines family processes and clinical issues surrounding secrets and myths. In Ghosts, Ibsen demonstrates the tragic foreclosure visited upon the Alvings' lives by a generation of secrecy. For contrast, in The Wild Duck the would-be reformer Gregers brings out the truth, to expose and correct consequences of his father's past machinations. The biographical roots of Ibsen's obsession with truth and illusion are explored. Lastly, the notion that Ibsen and early family therapist were reformers is viewed in historical perspective.

In view of the dramatic rise in the divorce rate, this paper proposes that separation and divorce be viewed as normal phases of the family life cycle and be reframed in positive terms, such as a couple "being ready for a new relationship" or children "being the lucky possessors of two families instead of one." It further makes a plea for more extensive family support services, with the goal of prevention and education rather than just amelioration of problems after they have become evident.

A thorough investigation of the literature pertaining to therapy supervision reveals that supervision has never been examined from the viewpoint of the trainee. This paper examines live supervision of family therapy from that viewpoint. It suggests that live supervision is a powerful and effective tool--a tool that engenders strong emotional responses.

A consensus Rorschach was given to the families of 36 male schizophrenics, 13 psychiatrically hospitalized nonschizophrenic controls, and 38 normal controls with the goal of discriminating the families of schizophrenics from the other two groups of families. After the family agreed on a response, each member was asked to write the response on a separate sheet of paper. This study focused on these written responses, the product of the interaction, rather than on the process of reaching agreement. A system was developed to score the responses based on the degree of shared meaning achieved by the family. Adequate interscorer reliability was obtained. The scores significantly differentiated the three groups. More families of schizophrenics had low scores indicating lack of shared meaning than families of hospitalized and normal controls. In the normal control group, more upper-class families had high scores than lower-class families, wheras in the schizophrenic group there was a trend in the opposite direction.

The contemporary psychotherapist is exposed to a variety of conceptual models and paradigms. These are usually presented as opposing truths in different doctrinal schools, but actually they are all valid from one point of view or another. And accordingly, they are all tactically useful at some point or another. I thought it was important to say this, but I did not want to write a dry, academic paper on the subject. So I will tell a clinical story that weaves the threads into a fabric.

This article describes the form of brief therapy developed at the Brief Family Therapy Center. We have chosen a title similar to Weakland, Fisch, Watzlawick, and Bodin's classic paper, "Brief Therapy: Focused Problem Resolution" (20) to emphasize our view that there is a conceptual relationship and a developmental connection between the points of view expressed in the two papers.

This paper discusses the necessity of using both behavioral and family approaches in combination, while working with electively mute children. The symptom and its significance within the family system is presented along with a rationale for avoiding the pitfalls of individual approaches with such children. A case history outlining specific behavioral techniques is described in detail with an exploration of the use of reinforcement theory, counter-conditioning, and successive approximations in bringing about change in electively mute children. The need for bringing about changes within the family system so as to maintain the changes that have occurred through use of the behavior techniques is discussed and presented as crucial to the treatment process. The paper takes the position that either approach, by itself, will not be effective in helping electively mute children but that the treatment of choice is a combination of therapeutic techniques.

Although the family interaction viewpoint has been more widely adopted since it was first introduced and family therapy more widely practiced, there has not been a parallel growth in the practical or theoretical application of the interactional viewpoint. This paper makes a plea for the relevance of this orientation to illness and disease. This area has received some consideration but deserves a much more extensive examination and research effort.

The concept of "sincerity" is often dismissed as being irrelevant to the understanding of families as systems, since sincerity is seen as a linear, intrapsychic construct. This paper makes the opposite argument. Much family communication involves a particular kind of "soft" meanings. Such meanings are flexible and open to varied interpretation, but their use is nevertheless framed by social rules. Sincerity rules function as social agreements to refrain from manipulating "soft" meaning in particular ways. The expectation that family members are (or are not) likely to communicate sincerely is a crucial systems property, altering both the interpersonal strategies and relationship structures that are likely to emerge within families. The analysis of soft meaning developed in this paper suggests new ways of understanding the rich, tangled, sometimes paradoxical communication typical of families. However, a number of premises frequently associated with family systems theory must be abandoned before a clear analysis of family communication can proceed.

An alternative paradigm for diagnosis based on cybernetics, ecology, and systems theory is proposed. This paradigm, termed "ecosystemic epistemology," suggests that diagnosis focus on knowing problematic situations in an ecological and systemic way. Theoretical statements concerning this approach are delineated with specific references to major family therapists. This discussion provides a foundation for an ecosystemic epistemology for diagnosis that addresses the following issues: (a) the meaning of system; (b) the symptom's presence in the system; (c) the therapist's presence in the system; (d) the ecological relationship system that emerges in diagnosis; and (e) the relation between ecosystemic epistemology and the process of diagnosis. In effect, this paper attempts to formally describe the underlying epistemology inherent in the work of therapists who approach diagnosis in an ecological and systemic way.

The plan of this paper is to explore the question: Does a model that includes the principles of double description, circularity, and coevolutionary change, all accounting for shifts in family coalitions over time and the emergence of problems in connection with these shifts, allow the family therapist to design better methods for the understanding and practice of family therapy? Concepts of double description, coevolution, and circularity from Gregory Bateson's writing and the research of other scientists describe the translation of these ideas from pure epistemology to the pragmatics of family therapy. Circular questioning developed by the Milan Associates is presented as a practice method exemplifying how these notions of circularity and coevolutionary change--especially changes in family patterns--are used during actual family sessions.

Three related models of therapy are often grouped together as the strategic therapies. These are brief therapy model associated with the Mental Research Institute, approaches developed by Jay Haley and Cloë Madanes, and the model developed by the Milan associates. Controversy exists, however, as to whether the Milan model should be included as a strategic therapy. It appears that the similarities among the three models can mask deeper differences, thus confounding the confusion. This paper contrast the models in their development, theory, and practice.

This paper reports an evaluation of an intergenerational consultation process designed to help people change significant relationships in the three-generational family system. The paper first describes the theory behind the consultation process that focuses on increasing personal authority in the family system; this is followed by a description of the consultation process. Clients who participated in the consultation process were compared to clients who participated in systems-oriented psychotherapy. The results indicate that clients who participated in the intergenerational consultation reported significantly more change in intergenerational triangulation and personal authority than did the control group. There were no differences between the groups in reported change in presenting problems, satisfaction with therapy, or helpfulness of therapy. Persons who had their parents in the office for a consultation also reported significantly more change in personal authority and less intergenerational intimidation than did clients who did not have their parents in the office for consultation. Implications of these findings for intergenerational theory and therapy as well as future research are discussed.

This paper describes the use of short-term family therapy as a new modality for resolution of pathological grief with young children and adolescents. These families' experience with other modalities of therapy had been disappointing. The unusual cohesiveness of the family was evidenced by resistance to actual or threatened separation. Such activities as entering individual therapy or going to school, camp, boarding school, or residential treatment wer hard to accomplish because of the difficulty with earlier grieving processes and the associated failure of decathexis of the lost person.

This paper discusses the behavior modification technique of charting as a double-bind communication. Though the procedure was initially employed as a step in demonstrating operant conditioning (7) and later in diagnosis of the antecedents and consequences maintaining undesired behavior (8), it also proved one of the more powerful therapeutic interventions. Literature reviews on treatment programs for obesity (6) and behavioral approaches to marital therapy (2) support this contention. Its efficacy can be explained by integrating the viewpoints of behaviorist and family therapy approaches espoused by Haley (4) and Weakland et al. (9). Following are brief case reports in which charting resulted in quick and sometimes dramatic change.

This paper delineates a rarely studied but important family process: how a family perceives and understands the relationships in other families it knows. We hypothesize that these perceptions of other families are fundamental components of a family's shared construing of its social world. Families differ in how they perceive other families, specifically, and in their approach to construing or apprehending their social world, generally. We have hypothesized that these general differences also play a crucial role in shaping the style and competence of family problem-solving. A family's approach to any problem depends upon how it construes or interprets the social context of that problem. Using these general concepts of family life, we construct specific hypotheses linking family problem-solving and interfamily perception. We describe methods for measuring both family problem-solving and how a family perceives other families. Findings confirm our major hypothesis: A family that searches for underlying and subtle patterns in a problem-solving situation will develop a more differentiated and organized conception of other families.

Although researchers have investigated power relationships in families for twenty-five years, conclusions about normative family power patterns have been inconsistent and contradictory. Comparisons across studies have been difficult owing to different definitions of the construct, multiple methodologies, and inconsistent goals. With such confusion, a new, more integrated theoretical approach to the power issue seems warranted, as is suggested by the present paper. The current individual focus on power as a personal attribute can be replaced by a more dynamic, reciprocal, interactive process. Instead of specific or stable power patterns, power interactions should be fluid and time- or situation- specific. No one member would dominate, since power involves a mutual relationship system that changes its content, though not its rules of operation, across decision-making areas. Furthermore, family adjustment would relate to those rules and the family members' reactions to their particular exchange system but not to specific types of power structures. With these considerations, future research should analyze the process, not the content, of power operations in order to maximize the clinical and theoretical utility of its construct.

This paper reports a study that investigated the areas of stress, support, and coping, using the structural model of the social network. The social network model is borrowed from sociology and anthropology and is used to describe and quantify not only an individual's immediate family but also all of those with whom the individual has regular contact. By comparing the networks of a sample of "normal" and schizophrenic males, it was possible to identify differences in their relationships to their social networks, in the make-up of the networks themselves, and in the coping styles and recent histories of the subjects. The results suggest, first, that the network model can be used to investigate the larger social system with which individuals interact and, second, that it may be a valuable approach to the expansion of family research.

This paper describes the development and application of a procedure (The Relationship World Index) to measure the development of intimate relationships. Grounded in symbolic interaction theory, the Relationship World Index is a measure of agreement on important aspects of relationships between members of intimate dyads. The development of the measure was guided by assumptions inherent in symbolic interactionism that predict the emergence of a shared construction of reality that bonds relationship members. Research results are presented providing evidence for the reliability and validity of the measure.

This paper describes the use of paradoxical interventions to change the resistant behaviors of community home residents who were formerly institutionalized in state hospitals and in state schools for the retarded for an average of 27 years. The paradoxical interventions were used following prior therapeutic failures using more traditional behavioral approaches. Seven brief case studies are presented describing the problem, the paradoxical intervention used, reactions to the intervention, follow-up information, and an explanation of the intervention. Some of the paradoxical interventions used include: prescribing the resistance, symptom, or system; reframing; restraining change; reversals; and rituals. Explanations of these interventions are given based upon general systems theory.

This paper uses family systems concepts and the Family FIRO model to show how cigarette smoking occurs in the context of the important relationships in a smoker's life. Specifically, smoking is viewed as a way a person is included in relationships, is in control in relationships, and perhaps is intimate in relationships. When smoking is well-established in the relationship, predictable interaction patterns surround it. When a person tries to quit or succeeds in quitting, these patterns change and may need to be replaced by nonsmoking alternatives. Partners may respond with support and willingness to create alternative patterns, or with undermining behavior stemming from a perceived threat to the established patterns. The model is offered for its heuristic value in guiding research and clinical experimentation. The paper also describes implications for family therapists as consultants to smoking-cessation programs.

The argument of this paper is that current structuralist and quasi-organismic models of family organization are descriptions masquerading as explanations. They correctly assert, but do not account for, the fact that the behavior of each member of a family is related to that of every other member. An adequate account must begin by assuming that people behave according to how they define the situations in which they are actors, and that such definitions of the situation are generalizations learned through repeated interaction with others. Family organization is regarded within this framework as the outcome of an evolutionary process by which some ideas are encouraged or confirmed and others suffer a kind of death or extinction, so that the ideas of each family member lead him or her to behave in ways that confirm or support the ideas of every other family member. That is what is meant by the slogan "family organization as an ecology of ideas." This view of family organization requires a demystified account of resistance in psychotherapy, a bare outline of which is provided in the previous section. The overall conception of the psychotherapeutic process presented here is closest to that of the Palo Alto Brief Therapy Project, though I offer as a conjecture that the effective operations of all the psychotherapies can be explained within this framework.