Context Of Family Therapy Research Articles

Couples therapy and the challenges of building trust, fairness, and justice.

The cornerstone of the contextual family therapy model is predicated on the belief that all family members benefit from trustworthy relationships, which result from (a) acknowledging the contributions of deserving family members, (b) engaging in responsible interactions, and (c) ensuring a fair distribution of relational burdens and benefits. Nonetheless, conflicts may arise when one partner asserts a claim to relational resources based on need, while the other believes they are entitled to such resources based on merit. Based on relational ethics and the development of trust, this paper focuses on the therapist's role in facilitating the conflict-resolution process to assist couples in reestablishing individual responsibility and accountability within the systemic framework of couple therapy. It elucidates several clinical strategies, including (a) cultivating trust through fairness and focusing on the importance of reciprocity and equitable give-and-take, (b) detecting destructive entitlement, and (c) marital relationships and ethics of care. Several clinical examples are discussed, as well as common couple relational issues associated with horizontal and vertical relationships, partnership, and fusion, and the impact of gender and power dynamics and trustworthiness based on the feminist lens.

Relational ethics in immigrant families: The contextual therapy five-dimensional framework.

Contextual family therapy offers a unique explanatory and clinically valuable framework to address complex multigenerational processes in families of immigrants who experience cumulative migration-related traumas. In this paper, we offer a new extended, specific conceptualization of immigrant families' generational dynamics using existing literature within the five-dimensional contextual therapy framework illustrated with a clinical example. We highlight the importance of social and relational justice, loyalty, entitlement, and parentification in transgenerational processes in addressing manifestations of these traumas that are frequently overlooked in clinical practice with different generations of immigrant families. Clinical guiding principles include acknowledgment of the social nature of situational injustices and their consequences for relational justices, exploration of loyalty conflicts (familial, cultural, and national), active dialogue of mutual care, exoneration, and stimulating constructive entitlement through active giving. This paper contributes to further development of contextual therapy theory and provides practical guidance for clinicians working with international migrants including second and third generations.

Emotional arousal and reflective functioning among parents participating in attachment-based family therapy for LGBTQ+ young adults and their nonaccepting parents

Objective Parents’ rejection of their LGBTQ + young adults can have a negative impact on their young adult’s psychological welfare, and on the young adult-parent relationship. Parents’ ability to reflect on their child’s pain and unmet needs is thought to evoke empathy and compassion, and reduce rejection. Empirical and clinical evidence suggest that parents’ level of reflective functioning (RF) is impacted by their level of emotional arousal (EA). This study examined the association between parents’ EA and RF within the context of attachment-based family therapy for nonaccepting parents and their LGBTQ+ young adults. Methods 43 therapy sessions drawn from six different cases were coded for parental RF and EA, based on 30-second segments. This generated a total of 343 observations for analyses. Results Hierarchal linear modeling revealed that parents’ level of RF was a function of their concomitant EA, with moderate levels of arousal predicting the highest RF levels. Conclusion Moderate EA may facilitate optimal parental reflective functioning. With nonaccepting parents, who typically present for treatment with high levels of maladaptive fear and shame, therapists would do well to assess their level of arousal and, when indicated, employ downregulating interventions before inviting them to reflect on their young adult’s experience and needs.

In conversation: transgenerational attachment trauma, the infant, and the family therapist

AbstractThis paper shares a far‐ranging set of conversations between professors Jennifer McIntosh, Louise Newman, and Carol George, all child and family practitioners, and infant mental health (IMH) and attachment specialists. They explore the domain of infant–family work with high‐risk populations experiencing complex relational and intergenerational trauma. George and McIntosh discuss the intersection between family therapy and IMH from an attachment perspective. They explore what family therapy can offer to supporting coherence in caregiving states of mind, beyond the offerings of traditional dyadic mother–baby models of intervention. They highlight the infant's contribution to family work, and the application of attachment theory in a family therapy context. Newman and McIntosh discuss a sensitive and graded approach to high‐risk family work with an infant. Newman reflects on when and whom to invite to a family session and the power of enabling the family to speak the unspeakable in the presence of the baby, supporting a future focused path for trauma integration and recovery. For family therapists who may be new to IMH work, there are some important offerings about integrating these fields, bringing into play the family therapist's deep grasp of curiosity, circularity, and capacity to reconceptualise with an IMH perspective on early relational trauma.

Keeping the Ledger Balanced during Pregnancy

ABSTRACT Couples experiencing pregnancy and the transition to parenthood face many challenges. One of the most difficult challenges is attempting to remain balanced in their relationship. In order to discover how couples maintain balance, researchers conducted a secondary analysis of qualitative data using a contextual family therapy lens to investigate how couples keep their relationship ledger balanced during pregnancy. Results indicate that four key components help couples maintain balance in the relationship, namely: 1) Give and take, 2) Relational ethics, 3) Destructive and Constructive Entitlement, and 4) Exoneration. Couples who give attention to these four aspects were more balanced in their relationship and reported navigating the transition to parenthood and pregnancy more effectively. Results from this study provide a framework for therapists to guide couples in discussing important topics that should be discussed throughout the transition to parenthood.

Narrative therapy and the autism spectrum: A model for clinicians

Narrative therapy practices have a long history of application to a wide range of mental health conditions. This paper discusses a novel narrative approach specific to autism and the application of narrative therapy constructs for clinicians working with families who have a member with a diagnosis of autism spectrum brain style differences. The author introduces a visual framework and descriptive language as a reference point to think and talk about autism within the context of narrative family therapy. This framework guides clinicians toward supporting an individualized narrative of the pattern of strengths and differences that are part of the autism spectrum brain style. The narrative approach outlined in this paper provides the entry point for clinicians to guide families toward the development of strength-based narratives that foster connections and resiliency within the family. A narrative therapy model is introduced with three key features highlighted: structuring the session to accommodate for autism spectrum brain style differences, using descriptive language to support the development of alternative narratives, and highlighting key narrative shifts taken from family therapy sessions. Readers are provided with a case study that illustrates the use of narrative therapy structures when working with this unique population of families.

School Absenteeism - Requirements for a Successful Therapeutic Approach

School absenteeism constitutes a severe and increasingly evident problem, which progressively concerns pediatrics as the first point of contact. It affects 2-5% of all children and adolescents who are subject to compulsory education [3]. School absenteeism is associated with an elevated risk of school dropout, drug abuse, unemployment, chronic psychiatric disease and delinquency [2, 3, 10]. To date, there is a lack of effective treatment options for chronic school absenteeism. 67 psychiatric patients (aged 7-17 years) with chronic school absenteeism between 3 months and 2 years (median: 8 months) were treated in a multi-modal therapy setting in a psychiatric day-unit specialized in school absenteeism. 93% of the patients had a history of unsuccessful attempts at therapeutic treatment. 55 out of 67 patients (82%) reported continued school attendance to a regular school 6 months after discharge from the day-unit. An integrated therapy concept is essential for successful treatment of school absenteeism. This incorporates (1) intensive and interconnected psychiatric treatment of patients and - if necessary - their parents within and outside of the schooling context with long-term interdisciplinary support and continuity of therapists, (2) efficient observational learning in small groups with similarly affected patients embedded in a (multi-)family therapy context, (3) an affiliated reliable and psychologically trained "pickup and return service", which, if need be, "hauls patients out of bed" in the morning, and (4) close cooperation with the patients' original schooling institutions.

Teoria do posicionamento e terapia familiar: criando novas posições discursivas na relação entre mãe e filho

Seguindo a premissa Construcionista Social de que o indivíduo se constitui nas relações através da linguagem e partindo de um contexto prático do atendimento com uma família, o objetivo deste artigo é dar visibilidade ao processo de construção de novas posições discursivas para a relação de uma mãe e um filho, a partir do foco no processo de comunicação e do uso de uma metáfora. Teoricamente, nos apoiamos na compreensão do self em sua dimensão relacional. Metodologicamente, utilizamos a teoria do posicionamento como um recurso para dar visibilidade para o processo discursivo em terapia familiar, no qual uma mãe e um filho negociam posições alternativas para seu relacionamento. Concluímos, pela utilidade da teoria do posicionamento na experiência clínica, por permitir colocar em ação a ampliação da noção de identidade, substituindo o enfoque na unicidade pela possibilidade de múltiplas descrições de self.

Relational processes in family entrepreneurial culture and resilience across generations

The study purpose is to empirically demonstrate a theoretically grounded method for elucidating the underlying family relational processes that lead to resiliency that sustains an entrepreneurial culture across generations. The study is grounded in Sustainable Family Business and Contextual Family Therapy theories. Data were multi-informant (parents, adult child) and multi-method (videotaped business decision team interviews with verifying individual member interviews) allowing for coding of both verbal content and affect within interactions. Relational ethics, fairness, and justice in family relationships were used to interpret observable family behaviors indicative of underlying family resilience processes. The state of the family ledger, an overall accounting of the balance of give and take in family relationships over time, was assessed to better understand family resiliency (a capacity from which to draw to facilitate adaptation to change or adversity) and ultimately transgenerational transfer of entrepreneurial culture. Results indicate that entrepreneurial culture is influenced by relational ethics and the family ledger and may be altered across generations. Specifically, a more balanced ledger representing a higher degree of resiliency (a protective factor) opens the door to access and use of other family capital (financial, human, other social capital) that feeds and sustains an entrepreneurial culture across generations.

Family Therapy focusing on Filial Piety among Korean Husbands in Light of Family Systems Theories

My principal concern in this study necessitates a critical review of the practice of filial piety of Korean adult children, especially in the case of the eldest son, in the light of family systems theories such as those of Ivan Boszormenyi-Nagy’s contextual family therapy, Murray Bowen’s intergenerational family systems theory, and the MRI group’s communication/interaction approach. Bowen's perspective of family assessment relates to the degree of differentiation of self and detriangulation from the intergenerational approach. From similar perspective to that of Bowen, Boszormenyi-Nagy's contextual approach emphasizes trustworthiness among family members. From the communication approach of the MRI group, the basic value is that the family should function through clear and direct communication. The issue of Korean filial piety is closely connected to the intergenerational approaches. Especially, practicing filial piety of the eldest son can be appropriately explained, in terms of the concept of the nuclear family emotional system, triangulation, family projection process, and sibling position in Bowen's theory. Boszormenyi-Nagy's concept of invisible loyalty can also be useful to explain the notion of the Korean filial piety of the eldest son. However, even if those theories and therapeutic models, despite their contributions and limitations, can be applied to the issue of Korean filial piety in the couple in question, the cultural sensitivity should be still heeded, particularly for non-Korean, or non-Asian therapists. Therefore, a careful consideration of the models or theories used in the application of family problems is important for family therapists, psychologists and even pastoral counselors.

Implementing Family-Based Musical Interventions in Family Therapy: A Mixed-Methods Research

Although rarely used by family therapists, musical interventions have the potential to become a more common technique in family therapy. Music’s unique therapeutic properties engage families, including young children and adolescents, in a meaningful, therapeutic, “here-and-now” creative process. Musical interventions act as catalysts, enable direct communication, and augment authentic communication patterns in a playful atmosphere. The purpose of this explanatory mixed-methods research was to obtain a greater understanding of the clinical applicability, therapeutic value and future implementation of a musical intervention carried out by family therapists in a family therapy context. The study explored the outcomes of 35 participating family therapists who attended a designated workshop on a structured family-based musical intervention, 18 of whom then applied 38 family-based musical sessions focused on family roles in their clinical work. The results illustrate the family-based musical intervention is a noteworthy tool for family clinical assessment and treatment, easily applicable in a variety of private and public settings with diverse populations. Musical instruments used as intermediary objects are potent vehicles for growing family awareness, functioning, and congruence, as well as inducing opportunities for change. The family-based musical intervention manifests the potential of an interdisciplinary, holistic, biopsychosocial approach to promoting individual and family wellbeing. The article also addresses ethical considerations and implications for family therapy training and education programs.

A Contextual Therapy Framework for MFT Educators: Facilitating Trustworthy Asymmetrical Training Relationships.

This article provides a conceptual framework for asymmetrical relationships between family therapy educators and trainees. Our framework is based on contextual family therapy, and we apply the concepts of trust, entitlement, self-validation, and loyalty to training relationships. We highlight the value of educators modeling responsible uses of power in addition to teaching trainees clinical concepts and skills. We propose that training can be a process where trainers earn constructive entitlement through their interactions with trainees, who then give to future clients, supervisees, and trainees to continue the cycle of intergenerational trustworthiness. We also provide examples that illustrate the application of contextual therapy skills such as multidirected partiality, I-Thou relating, acknowledgment, validation, and accountability to family therapy training.

The Relational Ethics Genogram: An Integration of Genogram and Relational Ethics

ABSTRACTRelational ethics highlighting the role of ethics, justice, trust, and loyalty in close relationships (Boszormenyi-Nagy & Krasner, 1986) is considered as one of the most bountiful yet obscure aspects of contextual family therapy. In this article, a visual diagramming activity integrating relational ethics and genogram work is presented as an assessment and intervention.

Reflections on Relational Ethics: Toward an Ethic of Prevention

Reflections on Relational Ethics:Toward an Ethic of Prevention Margaret Cotroneo (bio) Keywords ethics, interreligious dialogue, family therapy, prevention, relationships, motivation, social justice, social responsibility, theology, public health We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. Martin Luther King, Jr.1 This brief contribution is offered with a deep sense of appreciation for the enduring colleagueship of Professor Leonard Swidler and profound gratitude for his guidance during my doctoral program as I chose a path that navigated the worlds of health care, theology, ethics, and interreligious dialogue. Over the years, this complex interweaving of relationships has served as my living laboratory for ethical reflection. It remains my conviction that the central task of ethics is to strengthen and preserve the human claim on relationship through the continual creation of trust options for the future. In a recent conversation with a good friend of the Jewish faith, I expressed my deep concern about events in Palestine. He responded, “They need to talk to each other.” Well, I thought, that is obvious and perhaps a little dismissive. However, upon reflection, it is not so obvious. “Talking to each other” is exactly the point. Without the initiating approach to another, there can be no possibility of a response, and without the possibility of a response there is no possibility of a trustworthy relationship. “Talking to each other” is essentially a human claim on relationship. However, building upon that claim requires the corresponding obligation to consider the needs, interests, and experiences of relating partners. The term “relational” is subject to many interpretations among ethicists who use it. My own use of the term is grounded in the understanding that all relationships are composed of two or more contraposed sides and that no one side can ever be the measure of the whole of any relationship. Trustworthy relating, then, requires the integration of personal freedom and due consideration for others in our relational world.2 This understanding of a relational ethic derives from my study of families and other close relationships and, in particular, from my study and work with Ivan Boszormenyi-Nagy in the development and applications of Contextual Family Theory and Therapy.3 In this approach, the family is a living laboratory for working out basic trust issues over time. The ethical significance of the family is that it is a system of relationships that bind people to each other over time through the processes of reciprocal care and due consideration—or the converse, binding people through injury and injustice. Because families are dynamic configurations, [End Page 123] the process of relating is dialectical and can only be understood as many-sided and over time. Relationships merit our attention because the nature, kind, quality, and consequences of our relationships have a life beyond any individual consideration; they unite us to the world and live on in their consequences for the future. They are, in effect, working capital for the future. Economist Robert Reich has described relational capital as the “cumulative trust, experience and knowledge” that form the core of any relationship.4 We have ample evidence that the loss of functional trust in critical relationships on which we all depend threatens the welfare of all of us. The recent response to the Ebola epidemic is a case in point. The initial response was marked by confusion at all levels of intervention, irrational fear that ignored science-based knowledge, and a lack of preparedness for a major health threat that quickly crossed borders. Only when the affected parties began to see this in global terms (more relational terms), did they simultaneously begin to identify and address the social, cultural, economic, biological, and environmental determinants. It was necessary to build sufficient “functional trust” and political will to sustain needed relationships while investigating causes and associations, mobilize a cadre of health workers, engage local communities, communicate information truthfully and transparently, invest in finding a “vaccine,” and, eventually, prevent new incidents.5 The resulting interventions have been effective enough to contain the epidemic but not to eradicate it. The question, then, remains: Will there be sufficient “relational capital” to sustain the effort...

The Acknowledgment, Naming, and Giving (ANG) Activity: A Systemic Self of the Therapist Training Exercise

The Acknowledgment, Naming, and Giving (ANG) activity is a systemic self of the therapist training exercise based on several concepts and techniques in Contextual Family Therapy (CFT). It is designed to help family therapy trainees acknowledge (A) acts of destructive entitlement, name (N) the relationships directly affected by destructive behavior, and give (G) to those relationships in trustworthy ways. The activity requests that family therapy trainees consider both their own relational pain and the ways that they have been relationally harmful. In addition, the activity provides options for repairing damage and rebuilding trust in personal relationships that have been harmed. Systemic exercises like the ANG activity are essential components of self of the therapist training, and this article describes the activity in detail, provides guidelines for its use in training, and includes a case example of one trainee's journey through the process.

Deactivating the Buttons: Integrating Radical Exposure Tapping with a Family Therapy Framework

The purpose of this paper is to describe and illustrate with case examples a brief intervention termed Radical Exposure Tapping (RET). RET can be integrated with family therapy to address stuck points where the therapy is hindered by a family member's affective block, an intense and unchangeable emotional reactivity to a specific trigger. RET draws from the methodology of Eye Movement Desensitization and Reprocessing (EMDR) and combines it with the tapping sequence of the Emotional Freedom Technique (EFT) to produce an intervention that is more flexible than EMDR, provides greater rigor than using the EFT technique alone and can be effective in a single session within the context of family therapy. The paper puts this work into context by first over viewing definitions of trauma and Post-Traumatic Stress Disorder, arguing that family members' emotional reactivity may be a symptom of PTSD even when they would not qualify for the diagnosis because they had not experienced a life threatening event.

Relational Dimensions of Environmental Crisis: Insights From Boszormenyi-Nagy's Contextual Therapy

The role of systems-oriented therapists in addressing personal and interpersonal correlates of global climate change and environmental degradation has yet to be elucidated. As an initial offering in this area, this article explores the relational and psychological significance of safeguarding the environment for future generations, or failing to do so, in light of family systems and existential theory. Drawing primarily on key points from Boszormenyi-Nagy’s contextual family therapy, I demonstrate that denying accountability to future generations contributes to existential guilt, self-alienation, and relational stagnation. Therapeutic conversations that illuminate personal responsibility and foster dialogue about interpersonal justice are proposed as a step toward diminishing environment-related suffering and promoting well-being.

Blame and accountability in family therapy: Making sense of therapeutic spaces discursively.

Within the context of family therapy a discursive social constructionist approach was utilized. This illustrated how parents drew upon culturally understood notions of mental health in order to situate the family’s issues within the identified child. Three core analytic issues were identified. First, it was found that parents attributed blame with the identified child. Second, they made direct appeals to the truthfulness of their accounts. Third, the therapist worked to reframe the difficulties as family problems. Thus, through an application of the discursive action model of Edwards and Potter (1992) the social actions and performative nature of family interactions were bound up with parental accountability and therapists moved to refocus the family in a way that maintained therapeutic alliances by offering praise, empathizing, and talking about “feelings.” In this way, a social constructionist, discursive account provided a mechanism for exploring how families interact within the therapeutic space and how child mental health is better understood as a negotiated, rather than fixed concept.

Family mode deactivation therapy (FMDT) as a contextual treatment.

Mode Deactivation Therapy (MDT) was developed as a third wave therapy approach to cater for the challenging population of adolescents with conduct and oppositional behavior problems, emotion dysregulation, physical and sexual aggression, and other complex comorbid psychopathologies. The theoretical construct of MDT is based on the Beck's Mode Model and the principles of Cognitive Behavioral Therapy with elements of Functional Ana- lytic Psychotherapy (FAP), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and mindfulness. The methodology is based on the fundamental proposition that core beliefs based on an individual interpretation of past experiences regulate thoughts, emotions, and feelings when activated by a trigger event. This may lead to aberrant behaviors when cognitive processes are distorted. MDT has proven very successful in practice to balance the dichotomous thinking of the client by exploring positive alternatives on a continuum and realigning perceptions. Family MDT (FMDT) is especially valuable in a family therapy context as the family unit's experiences and interactions inarguably have an integral influence on the youth's beliefs and behavior. MDT is a structured and sequential process, although sufficiently flexibility to utilize continuous feedback loops to optimize the case conceptualization and treatment plan. Evidence is provided to support the claim that MDT is superior to Treatment as Usual (TAU) in treating the target population in an outpatient and residential setting with their families.

The Balance of Fairness in Family Relations: A Contextual Family Therapy Case Study

The Balance of Fairness in Family Relations: A Contextual Family Therapy Case Study