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Introduction: learning from practice, linking to theory
What helps family members develop shared, supportive and constructive ways of responding to life events, both expected and unexpected? This chapter will explore how their relational and social context supports the development of resilient coping in a family/kin group. Individual definitions of resilience speak of the ability to bounce back in the face of adversity and overcome life challenges (Rutter, 1999). Joseph and Linley (2008) write of the potential we as individuals hold for post-traumatic growth. Resilience is not about invulnerability or untested capacity to cope. Interestingly, much of the research on the development of individual resilience posits the importance of others, as sources of support and esteem, or the importance of other activities and contexts that support competence, again often involving others (Rutter, 1999). In my therapeutic practice, I am keen to identify and strengthen key interactional processes that support resourcefulness in the couple or family group, in the face of trials, tribulations and too much uncertainty (Smith, 1999). Thus, for me, resilience becomes a concept of ‘within and between’ – the formulation of a set of hypotheses both about what supports resilient coping in individuals and what leads to a shared set of beliefs about, and practices of, resilient coping in the family group. Families will be defined here either as the resident household group, which may span a number of generations, with legal, birth and/or psychological ties, and/or as the ‘problem-determined system’, that is, that group of people with intimate emotional connections organised around particular psychological dilemmas and problems in living. This sometimes includes non-resident members, such as life partners and ex-spouses, and the boundaries may change over time.
To put my thinking about family resilience into context, I am a clinical psychologist and a systemic family psychotherapist and for the past 16 years, I have co-directed a domestic violence project where we work therapeutically with both victims and perpetrators of violence, in all its forms, within any family relationship, for example, siblings, parents and children (of any age), couples, older people and their carers, and so on (Cooper and Vetere, 2005).
Systemic psychotherapists work therapeutically with individuals, couples and families, and offer consultation and systemic interventions with teams, agencies and organizations. The overwhelming findings from the research reviews and meta-analytic studies is that family therapy works compared to untreated control groups, with some demonstrated superiority to standard and individual treatments for certain disorders and populations. This chapter provides a list of people and problems who have found to benefit both clinically and significantly from the couples and family systemic psychotherapies compared to no psychotherapy; the list includes marital/couple distress and conflict, and outpatient depressed women in distressed marriages. Family therapy seems to be more cost-effective than standard inpatient/residential treatment for schizophrenia and severe adolescent conduct disorders and delinquency. Visits by family members to primary healthcare practitioners were reduced following family therapy intervention. The chapter ends with a discussion on the methodological problems and innovations which set the challenge for the future.
Structural Family Therapy was developed by Salvador Minuchin and colleagues during the 1960s as part of the growing interest in systemic ways of conceptualising human distress and relationship dilemmas, and in working therapeutically with those natural systems and relationships, thought to give rise to distress. Structural family therapy is underpinned by a clearly articulated model of family functioning, and has been developed and used most consistently in services for children and families. A growing body of empirical evidence attests to the efficacy of structural family therapy. As an approach it was extensively critiqued during the 1980s by feminist writers and during the 1990s by those interested in the implications of a social constructionist position. Structural family therapy continues to evolve in response to challenges mounted from within and outwith the systemic field, and as part of integrative practice and multi-systemic approaches, with practitioners ever mindful of the need for regular feedback from family members themselves.
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