Summary Structural-Strategic family treatment of the family and child with chronic illness presents a unique challenge to the therapist. This paper reviews the salient issues that influence the conceptualization and treatment of the family with a child with chronic illness. The paper suggests that knowledge of noncompli-ance with medical regimens, medical aspects of chronic illness, normal childhood development, and Structural-Strategic family concepts are necessary for the family therapist treating these families. Examples of treatment techniques are provided and illustrated with case presentations.
Summary Summary It is argued that a focus on the home-school system is critical in working from a Structural/Strategic approach to child school problems. The Structural/ Strategic conception of these types of problems is presented with a focus on three areas of difference between home and school subsystems that are likely generators of problems: beliefs, structure, and developmental adaptation. Techniques for assessment and intervention are presented.
Summary This paper examines a systemic approach to a specific form of child sexual abuse, father-daughter incest. While the father is responsible for the sexual abuse per se, a systems approach to incest believes that there are a variety of family dynamics present in incestuous families. These family dynamics center around structural issues (particularly regarding boundaries), problem-solving deficiencies, and dysfunctional communication patterns. Sample family treatment programs are examined. The goals of these programs center around changing family structure, enhancing conflict resolutions skills, and altering family communication patterns. Preliminary treatment outcome data for these family treatment programs is promising.
Summary The primary purpose of this article is to provide the therapist with general guidelines for conducting treatment with families of adolescent substance abusers from a structural-strategic orientation. After a brief review of the general literature and research on family therapy with adolescent substance abuse, an outline of the structural-strategic model will be presented, followed by specific modifications for treatment of substance abuse with adolescents.
(1990). The Systemic Treatment of Bulimia. Journal of Psychotherapy & The Family: Vol. 6, No. 3-4, pp. 89-105.
Summary This paper presents an approach to working with families of young children with behavior problems that emphasizes accountability as a way of clarifying the roles of therapist, parents, and, most importantly, children. The concept of accountability in relational ethics is presented and examined in clinical situations involving families with young children. Several examples are presented to illustrate how the concept of accountability clarifies the problems to be solved, what steps should be taken, and who should take them.
A total of 84 male and female adolescents were surveyed for SFS, family systemic functioning, and four types of social stress (Induced Transitions, Daily Hassles, Developmental Transitions, and Circumscribed Life Events) in relation to level of antisocial and delinquent behavior to determine the individual and cumulative effect of these psychosocial predictors. Univariate analyses indicated that perceived and Desired Family Cohesion, Daily Hassles, Circumscribed Life Events, and Developmental Transitions correlated significantly with reported antisocial and delinquent behavior, but SES and gender did not. Multivariate analyses affirmed that SES was of little use in understanding such behavior, at least among the general population, and that family functioning and social stress contributed interactively. Desired Cohesion was the most reliable indicator, with other family and stress variables' importance differing for males and females. These findings suggest that a family's ability to support each other and to harness that support to cope with transitions and stress during adolescence relates to a lower level of antisocial behavior.
Therapy with behavior problems focuses on partial shifts in behavioral sequences, and will often result in the experience of solutions as "partial" by the family and/or therapist. Simply applying general concepts of Structural-Strategic therapy, without considering the specific problem or circumstance of the family is conceptually too simple to be effective most of the time. Many families may respond better to less forceful therapeutic approaches, while others may best respond to greater intensity. Failure to consider the importance of family information can lead to unnecessarily conflicted relationships with the family, what has been termed therapeutic bullying by some. Failure to consider the family-extra-familial interface, family subsystems, developmental, social, or other pertinent contextual and circumstance influences can result in muted and unsustained impact. These guidelines and pitfalls are not intended to be all encompassing but merely highlight considerations the conscientious therapist should consider.
Summary This article explores the subject of dying, death and bereavement, their impact on the elderly person, and the potential for psychotherapeutic intervention. The article discusses the perceptions of the therapist on death and bereavement and on dying and old age and examines the therapeutic process in working with the bereaved.
SUMMARY This paper offers a cognitive conceptualization of personal mythology, presents a model for working with individual's personal mythology, and considers the integral relationships among personal myths, family myths and cultural myths.
(1989). Nine Assumptions for Work with Ethnic Minority Families. Journal of Psychotherapy & The Family: Vol. 6, No. 1-2, pp. 35-52.
Summary This article addresses some of the recent information that has been collected on the issues of alcohol misuse in later stages of the life span. It discusses the risks to both long-term alcoholics who have grown old with their drinking problem and the issues facing those persons for whom the risks of alcohol become apparent in later life. Three cases are included to illustrate the different consequences of alcoholism in the family as it impacts on separate members and generations within the family system. Authors discuss some principles of intervention and prevention that can and should be applied by different mental health and health practitioners that work with older persons and their family groups.
SUMMARY Family myths are both homeostatic and morphogenic and they contain within them (as does symptomatic behavior) many of the necessary components for change. In this case report, the therapy process is described as primarily a place to see family mythology in development where plots can shift, endings can be changed and new characters introduced. Four central myths were explored with this family of mother, father and two young children by juxtaposing, rewriting and shifting the meaning of various family rituals, symbols and stories. Techniques that clinicians can use to work with the evolution of family myths are highlighted such as puppet shows, bringing in symbols, gift giving, telling of open ended fables and termination rituals.
(1989). Play with Young Children in Family Therapy. Journal of Psychotherapy & The Family: Vol. 5, No. 3-4, pp. 159-172.
Enhance the intervention strategies you use in therapy with older adults and their families. This significant new book provides practitioners with information, insight, reference sources, and other valuable tools that will contribute to more effective intervention with the elderly and their families. Outstanding scholars have contributed original material that addresses the major issues in treating the elderly from the practitioner's point of view; the biological, psychological, social, and spiritual concerns of the aged are examined in order to formulate a systemic and comprehensive treatment plan. Destined to become a classic in a challenging new area of psychotherapy, the unique Aging and Family Therapy promises to guide and inform practitioners who will be called upon to provide assistance to the increasing number of older adults who will be in need of mental health services.
Summary This paper views cohabitation among the elderly from a legal perspective and presents realities of which many family practitioners may not be aware. Five key areas that the therapist and his or her clients should recognize will provide a foundation for understanding the responsibilities and potential legacy of the cohabitation. By design, this paper should contribute to the avoidance of the costly and unpleasant resort to legal suit. An appended list of 28 legally-oriented items should be considered at the outset of cohabitation.
