لایب سان

Author(s): Ascher, Michael S.; Glick, Ira D.; Heru, Alison M.; Rait, Douglas Samuel

Publisher: John Wiley & Sons, Year: 2015

ISBN: 9781118897218,1118897218,9781118897232,1118897234,9781118897249,1118897242,978-1-118-89725-6,1118897250

Contents Forewords, xix Ellen M. Berman, MD Lloyd I. Sederer, MD Preface, xxvii Acknowledgments, xxxi A Guide for Using the Text, xxxiii List of Tables, xxxvii List of Figures, xxxix Section I Family Therapy in Context 1 The Field of Couples and Family Therapy: Development and Definition, 5 Objectives for the Reader, 5 Introduction, 5 Development of the Family Therapy Field, 6 Definition of Couples and Family Therapy, 9 Core Concepts, 10 General Systems Theory, 10 Family Systems Theory and Homeostasis Over Time, 14 An Integrative Interpersonal Model, 16 Differentiation of Family Therapy From Other Psychotherapies, 16 Clinical Practice Implications, 19 Suggested Reading, 19 References, 19 2 Family Life in Historical and Sociological Perspective, 23 Objectives for the Reader, 23 Introduction, 23 Structure and Function of the American Family, 23 Immigration, 24 Ethnicity, 24 Secular View of Marriage, 25 Structures of Marriage, 26 Divorce, 26 The Functional Single-Parent Family, 27 Stepfamilies, 27 LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer) Couples, 28 Parenting in Post-modern Relationships, 29 Family Types, 30 Multiracial Families, 30 African-American Families, 31 Latino Families, 31 Asian Families, 31 Social Class, 32 Aging of the Population, 33 The Changing Family Life Cycle, 33 Clinical Practice Implications, 34 Suggested Reading, 34 References, 34 Section II Functional and Dysfunctional Families 3 Understanding the Functional Family, 41 Objectives for the Reader, 41 Introduction, 41 The Family as a System, 42 The Couples/Marital and Family Life Cycle, 44 The Individual Life Cycle, 44 The Couples/Marital Life Cycle, 46 Phase of Relationship and Tasks, 46 Marital Coalition, 47 Sex, Intimacy, and Companionship, 49 The Family Life Cycle, 49 Family Tasks, 52 Provision of Basic Needs, 52 Rearing and Socialization of Children, 53 Family Belief Systems, 55 Family Resilience, 55 ix x Contents Clinical Practice Implications, 55 Suggested Readings, 56 References, 56 4 Understanding the Functional Family in a Variety of Family Forms, 59 Objectives for the Reader, 59 Introduction, 59 Impact of an Extended Individual Life Cycle, 59 Marriage, 60 Divorce, 60 Marital Separation, 61 Divorce, 61 Children and Divorce, 62 Binuclear Families, 62 The Functional Single-Parent Family, 63 Mother-Headed Single-Parent Families, 64 Father-Headed Single-Parent Families, 65 Remarriage and Blended Families, 65 Remarried Couple, 66 Stepfamilies (Blended Families), 66 Grandparent-Headed Families, 67 Lesbian, Gay, or Transgendered Families, 67 Parents with a Gender Non-conforming Child, 68 Multiple-Partner Fertility Families, 69 Adoption and Families, 69 Interracial Families, 69 Trends in Parenting, 70 Clinical Practice Implications, 70 Suggested Reading, 70 References, 71 5 Problems and Dysfunction from an Integrated Family Systems Perspective, 75 Objectives for the Reader, 75 Introduction: The Dysfunctional Family System, 75 A Systems Approach to Problems and Dysfunction, 76 Historical Perspectives, 76 Current Perspectives, 77 Structural Problems, 78 The Solution as the Problem, 79 Family Beliefs and Myths, 80 The Larger Social System and Dysfunction, 84 Implications for Treatment—The Development of Symptoms in a Particular Person, 85 Life Cycle Problems and Dysfunction, 86 Unresolved Grief, 87 Toxic Secrets, 87 Task Performance in the Dysfunctional Family, 87 Providing for the Family’s Basic Needs, 88 Maintaining a Functional Marriage: Issues of Sex, Intimacy, and Commitment, 88 Rearing and Socializing of Children, 88 Clinical Practice Implications, 89 Suggested Reading, 89 References, 89 Section III Family Evaluation 6 The Process of Evaluation, 95 Objectives for the Reader, 95 Introduction, 95 Who to Include in the Family Evaluation, 95 Progression of the Family Evaluation Interview, 96 Dimensions of Couple and Family Assessment, 97 Joining with the Couple or Family, 97 Seeing Systemic Patterns, 98 Recognizing Family Developmental Stage, History, and Culture, 98 Identifying Family Structure, 99 Working with a Systemic Model of Change, 100 Role of Historical Material, 101 Role of Individual and Family Diagnoses, 102 Clinical Practice Implications, 102 References, 103 7 The Content of Evaluation, 107 Objectives for the Reader, 107 Introduction, 107 Dimensions of Family Function, 107 Family Evaluation Outline, 107 Gathering Identifying Data and Establishing Current Phase of Family Life Cycle, 108 Gathering Explicit Interview Data, 109 Contents xi What is the Background of the Family Problem?, 110 What is the History of Past Treatment Attempts?, 111 What are the Families Goals and Expectations of the Treatment?, 112 The Family Genogram, 114 Clinical Practice Implications, 114 References, 114 8 Formulating an Understanding of the Family Problem Areas, 117 Objectives for the Reader, 117 Introduction, 117 Rating Important Dimensions of Family Functioning, 117 Communication, 117 Problem Solving, 118 Roles and Coalitions, 118 Affective Responsiveness and Involvement, 118 Operative Family Beliefs and Stories, 119 Recent Family Events and Stresses, 119 Family Classification and Diagnosis, 119 Planning the Therapeutic Approach and Establishing the Treatment Contract, 124 Case Example Illustrating Evaluation and Case Formulation, 126 Suggested Reading, 132 References, 132 Section IV Family Treatment 9 Major Family Therapy Schools and Their Treatment Strategies, 137 Objectives for the Reader, 137 Introduction, 137 Insight-Awareness Model, 137 Family of Origin Model, 140 Systemic-Strategic Model, 141 Structural Model, 141 Cognitive–Behavioral Model, 142 Experiential Model, 143 Narrative Model, 143 Psychoeducational Model, 143 Clinical Practice Implications, 144 Recommended Readings, 144 References, 144 10 Goals, 147 Objectives for the Reader, 147 Introduction, 147 Mediating and Final Goals as They Relate to Schools, 147 The Most Common Mediating Goals, 147 The Most Common Final Goals, 148 Individualizing Goals With the Family, 149 Goals and Their Relation to Process and Content Issues, 151 Mediating Goals and Their Related Strategies, 151 Goals and Related Strategies Common to All Family Therapy Schools, 152 Clinical Practice Implications, 153 Reference, 153 11 Family Treatment: Integrated Strategies and Techniques, 157 Objectives for the Reader, 157 Introduction, 157 General Elements of Psychotherapy and Their Relationship to Family Therapy, 157 Basic Strategies of Family Intervention, 158 Techniques for Supporting Adaptive Mechanisms and Strengths: The Psychoeducational Approach, 158 Techniques for Expanding Emotional Experience, 160 Techniques for Developing Interpersonal Skills, 161 Techniques for Reorganizing the Family Structure, 163 Techniques for Increasing Insight and Conflict Resolution, 167 Techniques for a More Effective Construction of Family Reality, 169 Treatment Packages, 170 Indications for Differential Use of the Basic Strategies, 170 Clinical Practice Implications, 171 References, 171 12 The Course of Family Treatment, 175 Objectives for the Reader, 175 Introduction, 175 Early Phase, 175 Identifying Objectives of the Early Phase, 175 xii Contents Choosing Strategies to Get Started, 175 Distributing the Available Time, 176 Gathering History and Simultaneously Building a Treatment Alliance with the Family, 176 Distinguishing Evaluation from Treatment, 178 Middle Phase, 178 Termination Phase, 179 Conducting Brief Family Therapy: Treatment as It Is Influenced by Time Constraints, 180 Indications for Brief Family or Couples Intervention, 181 Course of Brief Therapy, 181 Techniques, 182 Setting Limited Goals and a Definite End Point, 182 Active Focus: Reinforcement of Family Strengths, Reconceptualization, 183 Active Exploration of Alternatives: Behavioral and Emotional Rehearsal, 183 Homework and Family Tasks, 184 The Problem-Oriented School of Brief Therapy, 184 Crisis Intervention, 185 Clinical Practice Implications, 185 Suggested Reading, 185 References, 185 13 Promoting Change in Family Treatment: Issues of Alliance and Resistance, 189 Objectives for the Reader, 189 Introduction, 189 The Therapeutic Alliance, 189 Models for Dealing with Families That Have Trouble Forming an Alliance, 191 Medical Model, 191 Coaching Model, 191 Conflict Model, 191 Strategic Systems Model, 192 Problems in Creating Change: Resistance and Disconnection, 192 Problems in Creating Change: Emanating from the Family, 193 Problems in Creating Change: Emanating from the Therapist, 193 Problems in Creating Change: From the Therapist–Family System, 194 Problems in Creating Change: Stages of Treatment: At Evaluation and Early in Treatment, 194 Problems in Creating Change: In Ongoing Treatment, 196 Problems in Creating Change: At the Termination Phase of Therapy, 197 Problems in Creating Change: Family Secrets, 197 Techniques to Deal with Resistances or Stalled Therapy, 198 Assume Nothing, 199 Collaboration, 199 Emphasizing family responsibility, 199 Focus on the present, 199 Clinical Practice Implications, 199 Suggested Reading, 200 References, 200 14 Family Therapy: General Considerations, 203 Objectives for the Reader, 203 Introduction, 203 Family Participants, 203 Extended Family and Significant Others, 205 Caregivers, 205 Including Children and Adolescents in Family Therapy, 206 Diagnostic Family Evaluation, 206 Treatment, 207 Therapist Combinations, 208 Co-Therapy, 208 Working as a Team, 209 Setting, 210 Time, Scheduling, and Fees, 210 Keeping a Record of Treatment, 211 Family Therapy in Combination with Other Psychosocial Therapies, 211 Practical Guidelines, 213 Effective Family Intervention, 214 Comparison of Therapy Formats and Strategies, 214 Clinical Practice Implications, 215 References, 215 Contents xiii Section V Couples Therapy 15 Dysfunctional Couples and Couples Therapy, 221 Objectives for the Reader, 221 Introduction, 221 Marriage in Its Historical Context, 221 Couples Difficulties, Problems, and Dysfunction, 222 From a Dynamic Point of View, 223 From a Behavioral Point of View, 223 From a Systems Point of View, 224 From a Psychiatric Illness Point of View, 224 Couples’ Development Dysfunction, 224 Couples Therapy, 225 The Issue of Commitment—The Problem of Affairs, 225 Evaluation of Partners, 226 Goals, 227 Strategies and Techniques of Intervention, 227 A Model for Intervention Based on Patterns of Interaction, 227 Individual Models, 228 Strategies and Techniques, 229 Clinical Practice Implications, 231 References, 231 16 Sex, Couples, and Sex Therapy, 235 Objectives for the Reader, 235 Introduction, 235 Diagnosis—Systems Issues, 236 Some Parameters of Sexual Function, 236 Assessment of Sexual Disorder, 237 Treatment, 240 Lack of Desire, 240 Erectile Disorder, 240 Premature (Early) Ejaculation, 240 Painful Intercourse/Female Orgasmic Disorder, 240 Other Issues Related to Sexuality and Couples, 242 The Spectrum of Sexuality, 242 Sexual Functioning After Rape or Sexual Abuse, 243 Sexual Problems After Medical Illness, 243 Sexual Problems in the Elderly, 244 Clinical Practice Implications, 244 Suggested Reading, 244 References, 244 17 Couples and Families Breaking Apart: Separation and Divorce, 249 Objectives for the Reader, 249 Introduction, 249 Separation, 249 Separation Leading to Divorce, 250 Communicating the Issue of Divorce to Children, 251 Immediate Issues, 252 Therapy for Families Facing Divorce, 253 Divorce and Post-divorce Treatment, 254 Single-Parent and Binuclear Families, 255 Blended Families (Stepfamilies), 255 Goals, 256 Evaluation and Treatment, 256 Cohabiting Couples, 259 Serial Relationships, 260 Clinical Practice Implications, 260 Suggested Reading, 261 References, 261 Section VI Family Treatment When One Member Has a Psychiatric Disorder or Other Special Problem 18 Family Treatment in the Context of Individual Psychiatric Disorders, 267 Objectives for the Reader, 267 Introduction, 267 The Family Model and Individual Diagnosis, 267 Schizophrenia, 268 Rationale, 268 Treatment Considerations, 269 Patients with Schizophrenia Living with or Supported by Families of Origin, 272 Mood Disorders: Bipolar Disorder, 274 Rationale, 274 Treatment Considerations, 276 Mood Disorders: Persistent Depressive Disorder and Major Depressive Disorder, 277 Rationale, 277 Treatment Considerations, 279 xiv Contents Borderline Personality Disorder (BPD), 281 Rationale, 281 Treatment Considerations, 282 Anxiety Disorders, 283 Rationale, 283 Panic Disorder and Agoraphobia, 284 Treatment, 284 Obsessive-Compulsive Disorder, 285 Rationale, 285 Treatment, 285 Post-traumatic Stress Disorder, 285 Rationale, 285 Treatment, 286 Dementia, Amnesia, and Other Cognitive Disorders, 286 Rationale, 286 Treatment Considerations, 287 Eating Disorders, 288 Rationale, 288 Treatment Considerations, 288 Substance-Related Disorders, 289 Rationale, 289 Assessment and Treatment Guidelines, 290 Children of Alcoholic Parents, 291 Psychiatric Disorders of Childhood, 291 Intellectual Disability, 291 Treatment, 291 Autism Spectrum Disorder, 292 Attention-Deficit/Hyperactivity Disorder, 292 Oppositional Defiant Disorder and Conduct Disorder, 294 Anxiety Disorders, 294 Mood Disorders, 294 Childhood Obesity, 295 Clinical Practice Implications, 295 Suggested Reading, 295 References, 295 19 Family Treatment in the Context of Other Special Problems—Violence to Self and Others, 301 Objectives for the Reader, 301 Introduction, 301 The Family Model and Violence, 302 Description of the Problem, 302 How Violent Acts Occur: The Cycle of Violence, 303 Assessment of Individual and Family Systems Issues, 304 Physical and Psychological Consequences of Violence, 305 Treatment, 306 Clinical Issues for Therapists, 309 Intrafamilial Child Sexual Abuse, 310 Individual Issues, 310 Family Issues, 310 Larger System Issues, 311 Assessment, 311 Treatment, 312 Outcomes, 312 The Family Model and Child Abuse, 312 The Suicidal Patient and the Family, 314 Acute Management, 314 Evaluating the Family, 315 Involving the Family, 315 Treating the Family, 316 Discharging the Hospitalized Patient, 316 Clinical Practice Implications, 316 Suggested Reading, 316 References, 317 20 The Family and Treatment of Acute and Chronic Psychiatric Illness, 321 Objectives for the Reader, 321 Introduction, 321 Background, 322 Acute Treatment, 322 The Function of the Acute Team for the Family, 322 Family Responses to Mental Illness of a Family Member, 323 The Family Burden in Psychotic Illness, 323 Rationale for Acute Treatment of Families, 324 Process of Family Treatment in Acute Care, 325 Common Goals of Acute Family Intervention, 326 Particular Decisions in Acute Care and Family Intervention, 328 Family Techniques, 329 A Working Model of Acute Family Intervention, 330 Guidelines for Recommending Family Intervention in an Acute Care Setting, 331 Empirical Studies, 332 Contents xv Families of the Chronically Ill, 333 Community-Based Support Groups, 335 Controversies in the Treatment of Acute and Chronic Psychiatric Illness, 336 Clinical Practice Implications, 337 References, 337 21 Working with Families in the Medical Setting, 343 Objectives for the Reader, 343 Introduction, 343 How Family Functioning Impacts Illness, 343 Gender Matters, 344 Family Health Beliefs, 344 Family Adherence, 344 How Illness Impacts Family Functioning, 345 Family Coping and Adaptation to Illness, 345 Learning to Cope and Adapt, 346 Providing a Therapeutic Space, 347 Caregiving, 347 A Family Systems Interview for Families with Medical Illness, 347 1. Problem Solving, 348 2. Communication, 348 3. Roles, 348 4. Affective responsiveness, 349 5. Affective involvement, 349 6. Behavior control, 350 Family Interventions, 350 Family Support, 350 Family Psychoeducation, 350 Family Systemic Interventions, 351 Multifamily Groups, 352 Clinical Practice Implications, 352 Suggested Reading, 352 References, 352 Section VII Results of and Guidelines for Recommending Family Therapy 22 Indications for and the Sequence of Family Therapy Evaluation and Treatment, 359 Objectives for the Reader, 359 Introduction, 359 Sequence of Evaluation and Treatment Planning, 359 Step 1: Is Family Evaluation Indicated?, 360 Step 2: Is Family Treatment Indicated?, 361 Family Therapy Versus Individual Therapy, 361 Managed Care, 364 Individual, Couples, or Sex Therapy for Sexual Problems, 364 Family Crisis Therapy Versus Hospitalization, 365 Step 3: What Shall Be the Duration and Intensity of Family Therapy?, 365 Family Crisis Therapy, 366 Brief Family Therapy, 366 Long-Term Family Therapy, 366 Step 4: What Model of Family Intervention Is Indicated?, 367 Clinical Practice Implications, 367 References, 367 23 Controversies, Relative Contraindications, and the Use and Misuse of Couples and Family Therapy, 371 Objectives for the Reader, 371 Introduction, 371 Couples Therapy, 371 Couples Conflict and Dissatisfaction, 371 Sexual Issues, 373 Families in the Process of Divorce, 373 Unmarried Couples, 373 The Child as the Identified Patient, 373 The Adolescent as the Identified Patient, 374 Family of Origin Issues, 375 Situations in Which Family Therapy Is Difficult and Perhaps Contraindicated, 375 When Psychopathology in One Family Member Makes Family Therapy Ineffective, 375 When the Family or Therapist Thinks the Risks of Therapy Outweigh the Advantages, 376 When the Family as a Whole Denies Having Family Problems, 377 When Cultural or Religious Prejudices Are Present, 377 Skills and Attributes of the Therapist as They Affect Family Work, 377 Clinical Practice Implications, 377 References, 378 xvi Contents 24 Results: The Outcomes of Couples and Family Therapy, 381 Objectives for the Reader, 381 Introduction, 381 Overview of Psychotherapy Outcome Research, 381 1. Specificity, 381 2. The Difference Between Efficacy and Effectiveness, 382 3. The Difference Between Qualitative and Quantitative, or Exploratory and Confirmatory, Research, 382 4. The Difference Between Process and Outcome Research, 383 What the Studies Show?, 383 Couples Treatments for Adult Disorders, 384 Insight-Oriented Marital Therapy for Marital Distress, 384 Integrative Behavioral Couple Therapy for Marital Distress, 384 Emotionally Focused Couples Therapy for Marital Distress, 385 Behavioral Marital Therapy for Depression, 385 Behavioral Couples Therapy for Alcoholism, 385 Couples Therapy for Posttraumatic Stress Disorder, 386 Family Treatments for Adult Disorders, 386 Schizophrenia and Major Mental Illness, 386 Focused Family Therapy for Bipolar Disorder, 386 Family Treatments for Child and Adolescent Disorders, 387 Brief Strategic Family Therapy for Children and Adolescents with Externalizing Disorders, 387 Functional Family Therapy for Delinquent Adolescents, 388 Multidimensional Family Therapy for Adolescent Substance Abuse, 388 Multisystemic Therapy for Youth at Risk, 388 Functional Family Therapy for Adolescents with Bipolar Disorder, 388 Family-Based Treatment for Anorexia Nervosa, 389 Family Interventions for Medical Illnesses, 389 The Effectiveness of Combining Medication and Family Therapy, 389 Limitations of Family Therapy, 390 Negative Effects of Family Therapy, 391 Inability to Engage and Premature Termination of Family Therapy, 394 Clinical Implications of Data from Couples and Family Therapy Outcome Studies, 395 Clinical Practice Implications, 396 References, 396 Section VIII Ethical, Professional, and Training Issues 25 Ethical and Professional Issues in Couples and Family Therapy, 405 Objectives for the Reader, 405 Introduction, 405 Ethical Issues Inherent in Family Therapy, 405 Conflicting Interests of Family Members, 406 Understanding HIPPA, 406 Secrets and Confidentiality, 407 Issues Involving Gender, Gender Roles, and Sexuality, 409 Ethics in a Managed Care World, 409 Informed Consent, 410 Financial Issues, 410 Professional Issues, 411 The Problem of Boundaries and Dual Relationships, 411 Competencies, 411 Training Issues, 414 Clinical Experiences, 416 Training Programs in Family Psychiatry, 417 A Multidisciplinary Field, 417 Family Therapy Fellowships, 418 Training and Licensure, 418 Clinical Practice Implications, 418 Suggested Reading, 419 References, 419 Index, 421

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