Basic Family Therapy

320 Pages·2013·3.18 MB·English

by  Philip Barker, Jeff Chang

Basic Family Therapy
Basic Family Therapy
Sixth Edition
Philip Barker
MB, BS, FRCPsych, FRCP(C), DPM, DCH
Professor Emeritus of Psychiatry,
University of Calgary
Jeff Chang
Ph.D., R.Psych.
Associate Professor, Athabasca University
Director, The Family Psychology Centre
A John Wiley & Sons, Ltd., Publication
Thiseditionfirstpublished2013,(cid:2)C 2013byJohnWiley&Sons,Ltd
(cid:2)C 1981,1986,1992,1998,2007PhilipBarker
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Barker,Philip,1929–
Basicfamilytherapy/PhilipBarkerandJeffChang.–6thed.
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Includesbibliographicalreferencesandindex.
ISBN978-1-119-94505-5(pbk.)
I.Chang,Jeff,1958– II.Title.
[DNLM:1.FamilyTherapy.WM430.5.F2]
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2013006030
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Contents
Foreword ix
Introduction xiii
1 TheDevelopmentofFamilyTherapy 1
Familytherapy’searlyyears 1
1990sandthenewmillennium 9
Summary 13
References 14
2 HealthyFamiliesandTheirDevelopment 19
Ethnicvariations 21
Thefunctionsoffamilies 21
Familydevelopment 22
Theclinicalimportanceoffamilydevelopmentalstages 23
Optimalfamilyfunctioning 24
Summary 26
References 26
3 SomeBasicTheoreticalConcepts 27
Theoriesderivedfromindividualandgrouppsychotherapy 27
Othertheoriesthathavebeenusedinfamilytherapy 28
Otherconceptsandterms 41
Summary 46
References 46
4 AdoptingandRefiningaModelofFamilyTherapy 50
Thenatureoftheoriesandmodels 50
Developingyourmodeloffamilytherapy 52
Selectingandadaptingamodeloffamilytherapy 54
Summary 54
References 55
5 ModelsfortheAssessmentofFamilies 57
Criticaldistinctionsinassessment 58
Conceptualapproachestofamilyassessment 59
TheBeaversSystemsModelofFamilyFunctioning 64
TheDarlingtonFamilyAssessmentSystem 66
Respectiveutilityoffamilyassessmentmodels 67
vi Contents
Summary 68
References 68
6 TheFamilyDiagnosticInterview 70
Theinitialcontact 70
Joiningthefamilyandestablishingrapport 71
Definingthedesiredoutcome 75
Reviewingthefamily’shistory,determiningitsdevelopmental
stageandconstructingagenogram 75
Assessingthecurrentfunctioningofthefamily 79
Developingadiagnosticformulation 83
Offeringthefamilyfeedbackandrecommendations 84
Discussingandarrangingthenextstep 85
Feedbacktoreferringprofessionals 86
Summary 86
References 87
7 EstablishingTreatmentGoals 88
Definingthedesiredstate 89
Intermediateandfinalgoals 92
Motivatingfamiliestoconsiderandsetobjectives 92
Summary 93
References 94
8 WhenIsFamilyTherapyIndicated? 95
Basiccriteriaforemployingfamilytherapy 96
Differingviewsontheplaceoffamilytherapy 97
Someviewsonindications 98
The‘decisiontree’ 100
Contraindicationsforfamilytherapy 103
Summary 105
References 106
9 PracticalPointsintheTreatmentofFamilies 108
Involvingreluctantfamilymembers 108
Maintainingatherapeuticalliance 113
Involvingchildreninfamilysessions 115
Thetherapist’suseofself 118
Transferenceissues 118
Contracts 119
Thespacingofsessions 119
Confidentiality 120
Observers 121
Co-therapy 123
Summary 125
References 125
Contents vii
10 CommonFamilyProblemsandTheirTreatment 127
Introduction 127
Taskaccomplishmentproblems 127
Seriousbasictaskaccomplishmentproblems 132
Communicationproblems 134
Poorlydefinedanddysfunctionalrolepatterns 137
Summary 144
References 144
11 ComplexProblemsandSecond-OrderChange 147
Interruptingproblempatterns 147
Techniquesfocusingonchangingmeaning 156
Theuseofhumour 161
Strategicteams 162
Asecond-ordercyberneticapproach:therapyas
conversation 163
Summary 167
References 168
12 OtherTherapeuticApproaches 172
Experientialapproaches 172
Videoplayback 175
Familymusictherapy 175
Familyarttherapy 176
Familyplaytherapy 177
Familyresilienceandecologicalinterventions 178
Familytherapyandseriousmentalillness 182
Mindfulnesspractices 186
Innovativeformatsforservicedelivery 187
Conclusion 190
References 190
13 AMethodofTherapy 199
Treatmentbystages 200
Terminationinfamilytherapy 211
Summary 212
References 213
14 CoupleTherapy 215
Thehistoryofcoupletherapy 215
Generalconsiderationsincoupletherapy 217
Currentapproachestocoupletherapy 220
Divorcetherapyandmediation 227
Sextherapy 228
Summary 230
References 231
viii Contents
15 TerminatingTreatmentandDealingwithTreatment
Interruptions 236
Treatmentcontracts 236
Opencontracts 237
Indicationsforendingtreatment 238
Howtoterminatetreatment 241
Terminationtasksandritual 243
Emotionalandpsychologicalaspectsoftermination 243
Follow-up 244
Dealingwithtreatmentinterruptions 245
Summary 246
References 247
16 TeachingandLearningFamilyTherapy 248
Wholearnsfamilytherapy? 250
Thedifferentpossiblelearningexperiences 251
Methodsoflearningfamilytherapy 251
Audiovisualaids 253
Objectives 254
Learningfamilytherapyskills 255
Thecontentoftraining 256
Supervision 257
Learningtosupervise 258
Consultation 260
Summary 263
References 263
17 ResearchinFamilyTherapy 265
Whyisfamilytherapyresearchimportant? 266
Isfamilytherapyeffective? 266
Whatmakesfamilytherapyeffective? 267
Isfamilytherapycost-effective? 270
Howcanpractitionersbemoreinvolvedinresearch? 270
Summary 271
References 272
18 EthicsandFamilyTherapy 275
Informedconsent 277
Therapists’values 278
Confidentiality 279
Ethicaldecisionmaking 281
Keepinginformedanduptodate 283
Ethicalissuesinfamilytherapyresearch 283
Summary 284
References 284
Appendix 286
Index 291
Foreword
It was a pleasure and a privilege to read the sixth edition of this book. It
is more difficult, however, to write an adequate introduction, as there are
few enthusiastic phrases that have not already been invoked to describe
the various editions of Philip Barker’s book that have appeared since
the first in 1981. The previous editions have been described as ‘A Classic
Book for Clinicians’ (British Journal of Psychiatry) and as ‘Comprehen-
sive and Stimulating’ (Journal of Clinical Psychiatry). In Contemporary
Psychiatry, an enthusiastic reader gushed, ‘There is an exhilaration at
being exposed to a thorough and articulate scholar,’ while suggesting
the book ‘should be required reading for all students in mental health
disciplines’.
Iwouldliketobeclearthatthisisaneminentlyreadablebookforthose
whoarenewtothediscipline.Anyonewhoisnotnewtothediscipline,how-
ever,andhasseenapreviousversionwillknowthis;readersandreviewers
before me have commented on the skill of the author, who could write a
book on the complex and theoretically diverse domain of family therapy
thatisatoncescholarlyyetthoroughlyaccessible.
Readersofpreviouseditionswillfindtheupdateworthwhileandmaybe
reassuredtonoteafamiliarorderingtomanyofthechapters.Fornewread-
ers,aquicktourofthebookiswarrantedtoprovidearoadmap.Chapter1
reviewstheevolutionoffamilytherapybeginninginthe1950sand,consis-
tentwithpreviouseditions,usesadecade-by-decadeapproachtochronicle
theoretical advances in the field. The chapter succinctly summarizes the
influenceofthepostmodernapproachonfamilytherapy.Chapter2moves
to a discussion of healthy families and their development, including a dis-
tinctionbetween‘normal’and‘healthy’families.Theauthorsusetheframe-
workprovidedbyBarnhillandLongotodiscussthedevelopmentalstages
of families. Chapter 3 reviews important theoretical concepts underlying
family therapy, such as theoretical influences derived from individual and
group therapy. The authors reflect on the importance of systems thinking
andsystemtheory,controltheory,cybernetics,learningtheoryandcommu-
nication theory, returning to the influence of postmodern approaches and
thecollaborativemodel.
Chapter4beginsthetransitiontotheclinicalenvironmentwithacogently
articulatedargumentforwhyitisimportantthatthetherapistshaveawell-
developedmodeltoguidetherapeuticencounters.BothPhilipBarkerand
JeffChangprovidetheirownperspectivesonhowtheyacquiredcoherent
modelsoftherapy,finishingthechapterwithsomesuggestionsonselecting
andadaptingamodeloftherapy.
x Foreword
Thebookthentransitionsintothemostclinicallyorientedsections,begin-
ningwithareviewofvariousmethodsforassessingfamilies(Chapter5)and
progressingthroughsettingoftreatmentgoals(Chapter7),indicationsand
contraindicationsforfamilytherapy(Chapter8)andpracticaltipsfordeal-
ing with issues such as reluctant or missing family members (Chapter 9).
Chapter11outlinesapproachesforcomplexproblems,includingproviding
adetailedapproachto,andaclinicalvignetteof,aparadoxicalintervention.
Chapter13returnsustoamoretheoreticallyorienteddiscussionthatknits
thevariousclinicalchaptersintoacoherentmethodofconductingtherapy.
Throughoutthechaptersthereareconciseandeffectiveclinicalvignettes
thathighlightimportantconceptsandkeepthereaderfocusedonthereal
world.Morerecenteditionsofthisbookhadincorporatedthe(then)emerg-
ingperspectiveoffamilytherapyasacollaborativeprocessinwhichthefam-
ilymembersandthetherapistarepartners.Thisperspectiveiswoveninto
thefabricofthistextand,Ibelieve,contributestothewarmththatemanates
from the pages. It seems clear that these are therapists who are fully and
respectfully engaged with the families they encounter, not only treating
them,butlearningfromthem,alwaysunderstandingsomethingnew.Ifitis
possibleforabooktonotonlyeducatebuttomodelanapproachtotherapy,
thisonedoesso.
Theremainingchaptersdealwith‘specialtyissues’.Chapter14isdevoted
specificallytocouplestherapy,whileChapter15dealswithterminationof
treatment and interruptions. As in earlier editions, the book includes not
onlyanoutlineofhowtoapproachfamilytherapyfromaclinicalperspective,
butalsofromtheeducationalandresearchdomains.Chapter16providesan
overview of teaching family therapy, including objectives, approaches and
learning to supervise. Rounding out the tour, Chapter 17 reviews topical
issuesinresearch,includingasectiononhowfamilytherapistsmaybemore
involvedinresearch.
PhilipandJeffnoteintheirintroductionthatthefieldoffamilyfunctioning
isbecomingmorecomplex,whichincreasesthechallengeofproducingatrue
beginner’s textbook. They have risen fully to the challenge and the result
isasuperblyenjoyableandinformativediscussionofpracticalapproaches
tofamilytherapy.Thishasbeentheauthors’firstexperienceofturningthe
extremelysuccessfulsingle-authorededition(PhilipBarkerwrotethefirst
fiveeditionsasasoleauthor)intoajointeffortandthattooappearstohave
beenaccomplishedwithnoappreciabledifficulty.Howmanydraftspassed
betweenthem,Idonotknow,butthisversionisseamlessinvoice,levelof
detailandfocusontheclinicalsetting.
I would challenge any reader to identify the sections written by one or
the other with any reliability. The authors also write of their fascination
withfamilytherapyand,assuggestedabove,thisshinesthrougheachsec-
tion. Their obvious pleasure and enthusiasm for helping families, and the
creative, flexible but theoretically grounded approaches they describe for
approachingfamiliescanonlycomefromtherapistswhohavebecomehighly
fluentintheirtherapeuticlanguages.
Foreword xi
The only thing disappointing about this book is that it left me wanting
something that I am doubtful I will receive—Beyond the Basics of Family
Therapywrittenwiththesamerelaxed,engagingandclinicallyrelevantstyle.
GlendaM.MacQueen,MD,FRCPC,PhD.
ViceDean,FacultyofMedicine
UniversityofCalgary
Canada