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The renaissance of family therapy?

Published online by Cambridge University Press:  28 January 2013

Extract

A major theme at the recent Australian Association Family Therapy conference in Perth in October 2012 was how to define the discipline of family therapy, what it is and isn't, the limits and boundaries of its practice and profession and the extent to which core systemic thinking and practices have been integrated into other mental health and therapy approaches. One interesting question is how much do we gain, and risk, as family therapy is taken to a wider audience as an evidence-based or family-sensitive practice in mental health, psychology or psychiatry? Perhaps we have adapted so well to changing times and trends that we risk losing our radical voice and identity? Indeed does family therapy have a final chapter in its narrative, and here I am mindful of Cechhin, Ray and Lane's (1994) wonderful story of the ‘the last family therapist’, unable to exit the field and retire gracefully, as meetings, conferences, workshops, writing and the reading of books and articles, go on. Alternatively is family therapy like the proverbial phoenix rising anew from the ashes, regenerating into something new that for now we only see as ‘through a glass darkly’? Are we possibly witnessing a renaissance in the tapestry of family therapy theory and practice as we take its message to a more general audience? Heady questions indeed, and in many ways the articles in this issue all resonate with these themes, as they reflect on the creative effectiveness of the ‘open dialogues’ approach in helping persons with serious mental health issues, examine the contribution of systemic and collaborative approaches in therapeutic assessment and outcome research, illustrate how to engage relational healing in an adult attachment interview, explore the possibilities for family work/therapy in aged psychiatry and dialogue about possible links between systemic and psychoanalysis, therapy and spirituality.

Type
Guest Editorial
Copyright
Copyright © The Authors 2013

A major theme at the recent Australian Association Family Therapy conference in Perth in October 2012 was how to define the discipline of family therapy, what it is and isn't, the limits and boundaries of its practice and profession and the extent to which core systemic thinking and practices have been integrated into other mental health and therapy approaches. One interesting question is how much do we gain, and risk, as family therapy is taken to a wider audience as an evidence-based or family-sensitive practice in mental health, psychology or psychiatry? Perhaps we have adapted so well to changing times and trends that we risk losing our radical voice and identity? Indeed does family therapy have a final chapter in its narrative, and here I am mindful of Cechhin, Ray and Lane's (1994) wonderful story of the ‘the last family therapist’, unable to exit the field and retire gracefully, as meetings, conferences, workshops, writing and the reading of books and articles, go on. Alternatively is family therapy like the proverbial phoenix rising anew from the ashes, regenerating into something new that for now we only see as ‘through a glass darkly’? Are we possibly witnessing a renaissance in the tapestry of family therapy theory and practice as we take its message to a more general audience? Heady questions indeed, and in many ways the articles in this issue all resonate with these themes, as they reflect on the creative effectiveness of the ‘open dialogues’ approach in helping persons with serious mental health issues, examine the contribution of systemic and collaborative approaches in therapeutic assessment and outcome research, illustrate how to engage relational healing in an adult attachment interview, explore the possibilities for family work/therapy in aged psychiatry and dialogue about possible links between systemic and psychoanalysis, therapy and spirituality.

To begin Judith Brown in her article Theory, practice and use of self in the open dialogues approach to family therapy: A simple complexity or a complex simplicity? takes us on an informative, intimate and reflective journey into open dialogues. This is based on her recent study tour to the outpatient adult mental health unit in Keropudas Hospital in Tornio, Western Lapland, Finland, where the approach originated, and the associated child and adolescent polyclinics at Tornio and Kemi, where she had a unique opportunity to observe clinical sessions and participate in dialogue with team members. In a triptych paper that weaves together images and descriptions from her reflective journal with pointed observations about clinical practice and the therapist's use of self, the paper presents three major themes of Joining Together, Drawing Close and Being With. It explores the seven theoretical principles of the open dialogue approach and illustrates its increasing relevance for family therapists, not just for those working with psychosis in acute adult mental health but across a variety of practice settings. Continuing this dialogue there is an affirming reflection on Judith's article, Visiting Open Dialogues, from Markku Sutela who is Chief Psychologist at Keopudas Hospital, on the Senior Faculty at the Institute for Dialogic Practice and co-author with Jaakko Seikkula of several key articles on Open Dialogues.

In Therapeutic Assessment with Children (TA-C), Filippo Aschieri, Francesca Fantini and Paolo Bertrando describe a brief semi-structured family intervention that uses psychological assessment in a collaborative way to help families with children to change. TA-C is part of a developing research literature and the authors describe its various steps in detail. This includes how to construct assessment questions in collaboration with the family, plan and conduct psychological testing with the young person while the parents observe, the family intervention session and separate feedback sessions with both parents and the child, the latter taking the creative form of a fable. A fascinating and detailed practice narrative illustrates how TA-C can be seen as an integral part of a systemic and dialogical approach to family therapy.

Rolf Sundet in Postmodern-oriented practices and client-focused research: possibilities and hazards, brings traditional therapy outcome research and postmodern collaborative practices together in a way that is mindful of therapeutic assessment. The article draws on an on-going patient-focused qualitative research study in a child and adolescent mental health family therapy unit in Norway. It describes the use of standardized outcome measures, such as the Outcome Rating Scale and the Session Rating Scale used by Duncan and Miller (2000), as conversational tools to help monitor and provide feedback on therapeutic practice. This allows therapists to construct an effective, helpful and accountable therapy culture in collaboration with service users and managers. Following Foucault, the author cautions against a potential abuse of outcome measures, particularly where they are used as part of a discourse or technology for monitoring and controlling therapy in a competitive market economy.

Heather Chambers in The Adult Exploration of Attachment Interview in Family Therapy presents a therapeutic interview developed to help individuals, parents and couples explore their close attachment relationships. The AEAI brings out a person's early relational learning, especially their attachment needs and uses externalising language to help tolerate difficult memories, improve emotional regulation, reduce guilt and shame, integrate thoughts and feelings, improve their understanding of self and others, and disrupt the repetition of unhelpful familiar patterns. The author describes in detail the stages of the interview, the role of the therapist and provides examples of attachment-informed questions, which is followed by two practice illustrations showing its application to therapy. This is an interesting contribution to the evolving literature on attachment-based therapies in family therapy.

In ‘I'm not a family therapist. OK?’ Working Constructively with Families in Aged Psychiatry, Catherine Hudgson, Pam Rycroft and Shraeveni Giri present the first phase of a research study into the role of family work/therapy in aged psychiatry. The authors summarise the results of interviews with 28 professionals in a community aged mental health service in Melbourne, which examined their attitudes, beliefs and experiences in relation to working with families and carers. Two main issues emerged, one concerning what ‘family work’ entails and its perception by clinicians, the second, how to involve family members and carers in everyday practice. There was a wide range of views about family work, its value for families and whether or not clinicians felt competent enough or able to engage in it. The paper concludes with a discussion of how to recognise, define and value family work/therapy in this important and growing area of clinical practice and which sustainable interventions to target in the second phase of the study.

In Conversations with Jim Crawley, Steve Lionello interviews Jim Crawley to acknowledge his significant contribution to couple and family therapy over a long and distinguished career. Jim is the author of many books and articles, 11 appearing in this journal between 1980 and 2005, a former Director of the Marriage Guidance Council of WA and a lecturer in the Masters in Social Science (Counselling) degree at Edith Cowan University. He has had a significant impact on numerous students and practitioners in the couple and family therapy field. Steve traces several milestones in Jim's journey, including his synthesis of systemic and psychoanalytic ideas and a more recent exploration between psychotherapy and spirituality. Max Cornwell, a friend and colleague of Jim and a previous editor of the journal, 1985‒96, provides a compelling snapshot and commentary.

All in all a compelling issue as we heartfully thank Cambridge University Press for their fantastic publishing support in 2012 and look forward to engaging with Wiley-Blackwell in 2013. Readers can anticipate another guest issue in June 2013, compiled by Tom Strong (Calgary) and Robbie Busch (Perth) on the timely topic of DSM 5 and Family Therapy, and the focus of a future issue will be Training and Supervision in Family Therapy.

References

Cecchin, G., Lane, G. and Ray, W. A. (1994). The Cybernetics of Prejudices in the Practice of Psychotherapy. Karnac Books, London.Google Scholar
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