Putting the "family" back into family therapy

МОДЕЛІ ПСИХОЛОГІЧНОГО КОНСУЛЬТУВАННЯ ТА ПСИХОТЕРАПІЇ СІМ’Ї

Мета статті присвячена питанням розподілу ресурсів психологічного консультування та психотерапії у контексті надання психологічної допомоги в залежності від поширених скарг клієнтів щодо особливостей сімейного функціонування, для яких доступні емпірично підтверджені психоконсультативні та психотерапевтичні напрямки надання допомоги. Методи. Використані теоретичні методи презентують використання різних підходів до проведення психоконсультативного та психотерапевтичного процесів з сім’єю, як системою. Вказано, що практикуючі психологи прагнуть підтримувати збалансований підхід, враховуючи сильні та слабкі сторони інтегративної позиції. Результати. У результаті виділено основні моделі психоконсультативного та психотерапевтичного процесів, де основу склали три моделі психологічної допомоги, а саме діагностична, педагогічна та психологічна. Підкреслено, що об’єкт діагностики – родина, члени ядерної сім’ї. У фокусі уваги діагностичної моделі – актуальний емоційний стан членів сім’ї, їхні особистісні характеристики, організація (структура, патерни взаємодії) сімейної системи, унікальний досвід сім’ї в подоланні стресової ситуації. У педагогічній моделі увага звернута на роботу, спрямовану розширити межі педагогічної компетентності членів сім’ї: знання й уміння, профілактика дефіциту таких знань та умінь щодо взаємодії з партнером і дітьми; підвищення психолого-педагогічної культури; розширення та відновлення виховного потенціалу родини; активне включення в процес соціального виховання дітей. Психологічна (психоконсультативна та психотерапевтична) модель застосовуються тоді, коли причини труднощів – у сфері особистісних особливостей членів родини. Психологічна модель зорієнтована на розвиток психологічної культури, мислення, поведінки в сфері допомоги здоровим людям. Зазначено, що психологічна модель базується на таких домінантних, ефективних у роботі із сім’єю та збалансованих інтегративних психоконсультативних та психотерапевтичних моделях, як системна модель, психоаналітична модель, трансактна модель, феноменологічна ресурсна модель, модель. Висновки. У висновках узагальнено, що структурно-функційна парадигма включає варіативність моделей, підходів відповідно до травматичних чинників та вибудовує систему фокусів для надання практичної допомоги сім’ї на рівні психодіагностики, психоедукації, психологічного консультування та психотерапії. В межах цих підходів робиться спроба сформувати цілісне уявлення про закономірності та суттєві зв’язки у сфері вивчення структури психологічної допомоги сім’ї.

Families post-release: Barriers and pathways to family therapy

Family therapy has helped repair relational ruptures and restore stability within families for decades. However, service can be inaccessible and underutilized among many minoritized and stigmatized groups, including families post-release. Harmful sociocultural and relational experiences pose considerable risks to families before, during, and after incarceration. While not exhaustive, this article highlights potential attitudinal, relational, and logistical obstacles to family therapy engendered by therapists, clients, or both. Feasible and accessible clinically oriented conceptual and practical pathways of support to combat such obstacles are outlined to help therapists attract and retain families post-release.

Understanding why people with OCD do what they do, and why other people get involved: supporting people with OCD and loved ones to move from safety-seeking behaviours to approach-supporting behaviours

The distress inherent in obsessive compulsive disorder (OCD) can often lead to partners, family members and friends becoming entangled with the OCD in terms of being drawn into performing certain behaviours to try and reduce the distress of their loved one. In the past this has often been referred to somewhat pejoratively as collusion, or more neutrally as accommodation. In this paper we emphasise that this is usually a natural human response to seeing a loved one in distress and wanting to help. This paper provides detailed clinical guidance on how to understand this involvement and how to include others in the treatment of OCD along with practical tips and hints around potential blocks that may require troubleshooting. It also details the relatively recently introduced concept of approach-supporting behaviours, and provides guidance on how to distinguish these from safety-seeking behaviours. The ‘special case’ of reassurance seeking is also discussed.

Key learning aims

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Integrative Systemic Supervision: Promoting Supervisees' Theoretical Integration in Systemic Therapy

Integrative systemic therapy (IST) is a meta-theoretical perspective, grounded in systemic theory and integration, that transcends therapy models in individual, couple, and family therapy. To foster supervisees' theoretical integration and systemic thinking, two of IST's primary tools-the essence diagram and blueprint-are described and applied to inform an integrative, systemic meta-perspective for supervision. Recommendations, specific guiding questions, and examples are provided to operationalize these tools in the multi-level supervision system (i.e., supervisor-supervisee-client system). IST supervisors and other supervisors who are interested in integrative, systemic training can use these tools to guide the process of supervision and strengthen supervisees' ability to hypothesize, plan, converse, and read clients' feedback in relation to the various tasks of therapy. The essence diagram and blueprint are applied to facilitate case consultation and cultivate the development of supervisees' clinical competencies. Particularly, the problem-solving focus of IST has been adapted to include a competency-based and professional growth-oriented dimension for supervision to better promote supervisees' development. Lastly, the advantages and challenges of IST-influenced supervision are discussed.

Lessons from the Transition to Relational Teletherapy During COVID-19

When the World Health Organization declared the coronavirus outbreak a pandemic, clinicians were challenged to maintain continuity of care. Teletherapy became the primary means of service delivery for many who had never or only sparingly used it. The Family Institute at Northwestern University, in response to encouraging findings with respect to the effectiveness of teletherapy and recognizing advantages with respect to access to care, launched our teletherapy services in 2018. As a relationship-based organization, we were keen to exploit the opportunity that teletherapy provides to integrate additional members of the client system into the treatment. Over these two plus years, we have learned a great deal. Our learning was greatly accelerated by our transition to a 100% teletherapy practice in the wake of the pandemic. Teletherapy is a different context. Intentionally managing the context's constraints and exploiting its strengths is key to providing high-quality couple and family therapy. This step is often overlooked or resisted when teletherapy is an occasional add-on to a face-to-face practice.

Integrative Systemic Therapy: Lessons on Collaboration and Training for the 21st Century

The field of couple, marital, and family therapy (CMFT) is at an important juncture of identity development and synthesis. Integrative Systemic Therapy (IST) is a problem-centered metaframeworks approach that meets the growing needs of family therapists working with diverse and complex family systems and restores the field to its original focus on collaboration. This paper describes the process by which IST developed featuring anecdotes from live interviews with the founders. We briefly outline IST's theoretical pillars and the essential way IST practitioners deliver treatment including a blueprint for therapy. Finally, we propose that IST is a comprehensive, systemic guide uniquely beneficial to CMFT training and discuss our approach to integrating IST into our training of students in a COAMFTE accredited program.

Who's in the Room? A Parent-Focused Family Therapy for Adolescent Anorexia Nervosa

Family therapy is often assumed to involve the whole family; that is both parents and children attending the therapist's office together. In practice, however, which family members are included in family therapy, how often, and in what ways, is much more variable. In this article we provide an overview of the recent history of family therapy in regard to who is directly involved in therapy, and contrast changing practices in the eating disorders field with those in the family therapy field more widely. This overview leads into a discussion of current practices in family-based treatment for adolescent anorexia nervosa and the development of a new form of family therapy that is parent-focused.

Individual therapy for couple problems: perspectives and pitfalls

Despite the demonstrated efficacy of conjoint couple therapy, many clients seeking help for couple problems ultimately find themselves in individual therapy for these concerns. Individual therapy for couple problems (ITCP) may evolve from a partner's refusal of conjoint therapy or from the treatment format preferences of either the client or therapist. Having acknowledged the role of partner refusals, we offer some perspectives about the idiosyncratic personal factors and professional background factors that may lead therapists to provide ITCP and discuss the significant pitfalls in its practice. We emphasize five central areas of concern in the ongoing practice of ITCP: structural constraints on change; therapist side-taking and the therapeutic alliance; inaccurate assessments based on individual client reports; therapeutic focus; and ethical issues relevant to both attending and nonattending partners. We conclude by urging that this very important but largely neglected topic be paid greater attention in psychotherapy research, training and continuing education.