Family Therapy: Concepts, Process and Practice

650 Pages·2006·6.24 MB·english

by  Alan Carr

FAMILY THERAPY
Wiley Series in
CLINICAL PSYCHOLOGY
Adrian Wells School of Psychological Sciences,
(Series Advisor) University of Manchester, UK
Alan Carr Family Therapy: Concepts, Process and
Practice, Second Edition
Martin Herbert Clinical Child Psychology: From Theory
to Practice, Third Edition
Graham C.L. Davey and Worry And Its Psychological Disorders:
Adrian Wells (Editors) Theory, Assessment And Treatment
Titles published under the series editorship of:
J. Mark G. Williams School of Psychology, University
(Series Editor) of Wales, Bangor, UK
Richard G. Moore and Cognitive Therapy for Chronic and
Anne Garland Persistent Depression
Ross G. Menzies and Obsessive-Compulsive Disorder:
Padmal de Silva (Editors) Theory, Research and Treatment
David Kingdon and The Case Study Guide to Cognitive
Douglas Turkington (Editors) Behaviour Therapy of Psychosis
Hermine L. Graham, Substance Misuse in Psychosis: Approaches
Alex Copello, to Treatment and Service Delivery
Max J. Birchwood and
Kim T. Mueser (Editors)
Jenny A. Petrak and The Trauma of Sexual Assault: Treatment,
Barbara Hedge (Editors) Prevention and Practice
Gordon J.G. Asmundson, Health Anxiety: Clinical and Research
Steven Taylor and Perspectives on Hypochondriasis and
Brian J. Cox (Editors) Related Conditions
Kees van Heeringen (Editor) Understanding Suicidal Behaviour:
The Suicidal Process Approach to Research,
Treatment and Prevention
Craig A. White Cognitive Behaviour Therapy for Chronic
Medical Problems: A Guide to Assessment and
Treatment in Practice
Steven Taylor Understanding and Treating Panic Disorder:
Cognitive-Behavioural Approaches
Alan Carr Family Therapy: Concepts, Process and Practice
A list of earlier titles in the series follows the index.
FAMILY THERAPY
Concepts, Process and Practice
Second Edition
Alan Carr
University College Dublin and Clanwilliam Institute Dublin,
Ireland
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Library of Congress Cataloging-in-Publication Data
Carr, Alan, Dr.
Family therapy: concepts, process and practice / Alan Carr.— 2nd ed.
p. cm. — (The Wiley series in clinical psychology)
Includes bibliographical references and index.
ISBN-13: 978-0-470-01454-7 (cloth : alk. paper)
ISBN-10: 0-470-01454-7 (cloth : alk. paper)
ISBN-13: 978-0-470-01455-4 (pbk. : alk. paper)
ISBN-10: 0-470-01455-5 (pbk. : alk. paper)
1. Family psychotherapy. I. Title. II. Series.
RC488.5.C367 2006
616.89’156—dc22 2005035562
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN-13 978-0-470-01454-7(hbk) 978-0-470-01455-4 (pbk)
ISBN-10 0-470-01454-7 (hbk) 0-470-01455-5 (pbk)
Typeset in 10/12 pt Palatino by Thomson Press (India) Limited, New Delhi
Printed and bound in Great Britain by TJ International, Padstow, Cornwall
This book is printed on acid-free paper responsibly manufactured from sustainable forestry
in which at least two trees are planted for each one used for paper production.
CONTENTS
About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Foreword Alan S. Gurman . . . . . . . . . . . . . . . xiii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi
Endorsements of the fi rst edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
PART I CENTRAL CONCEPTS IN
FAMILY THERAPY
Chapter 1 Goals of Family Therapy
Across the Lifecycle. . . . . . . . . . . . . 3
The family lifecycle . . . . . . . . . . . . . . . 5
Lifecycle stages associated
with separation and divorce . . . . . 29
The individual lifecycle . . . . . . . . . . . 35
Sex-role development . . . . . . . . . . . . . 41
Gay and lesbian lifecycles . . . . . . . . . 43
Class, creed and colour . . . . . . . . . . . . 45
Summary . . . . . . . . . . . . . . . . . . . . . . . 45
Further reading . . . . . . . . . . . . . . . . . . 47
Chapter 2 Origins of Family Therapy . . . . . . . . . 48
Movements: Child guidance, marriage
counselling and sex therapy . . . . . 49
Disciplines: Social work, psychiatry
and clinical psychology . . . . . . . . . 50
Group therapy: Group analysis,
encounter groups, psychodrama
and Gestalt therapy . . . . . . . . . . . . . 52
Research traditions: Work groups,
role theory and schizophrenia . . . . 53
Gregory Bateson . . . . . . . . . . . . . . . . . 56
Three organising themes: Behaviour
patterns, beliefs and contexts . . . . 68
Summary . . . . . . . . . . . . . . . . . . . . . . . 70
Glossary . . . . . . . . . . . . . . . . . . . . . . . . 71
Further reading . . . . . . . . . . . . . . . . . . 73
vi CONTENTS
Chapter 3 Theories that Focus on Behaviour
Patterns . . . . . . . . . . . . . . . . . . . . . . . 76
MRI brief therapy . . . . . . . . . . . . . . . . 76
Strategic family therapy . . . . . . . . . . . 85
Structural family therapy . . . . . . . . . . 90
Cognitive-behavioural marital and
family therapy . . . . . . . . . . . . . . . . . 93
Functional family therapy . . . . . . . . . 96
Closing comments . . . . . . . . . . . . . . . . 99
Glossary . . . . . . . . . . . . . . . . . . . . . . . . 100
Further reading . . . . . . . . . . . . . . . . . . 106
Chapter 4 Theories that Focus on Belief
Systems . . . . . . . . . . . . . . . . . . . . . . . 110
Epistemology: Positivism,
constructivism, social
constructionism, modernism and
postmodernism . . . . . . . . . . . . . . . . 110
A constructivist approach to
family therapy . . . . . . . . . . . . . . . . . 119
Milan systemic family therapy . . . . . 124
Social constructionist
developments . . . . . . . . . . . . . . . . . . 128
Solution-focused therapy . . . . . . . . . . 132
Narrative therapy . . . . . . . . . . . . . . . . 135
Closing comments . . . . . . . . . . . . . . . . 138
Glossary . . . . . . . . . . . . . . . . . . . . . . . . 140
Further reading . . . . . . . . . . . . . . . . . . 148
Chapter 5 Theories that Focus on Contexts . . . . 154
Transgenerational family therapy . . . 154
Psychoanalytic family therapy . . . . . 164
Attachment-based therapies . . . . . . . 167
Experiential family therapy . . . . . . . . 173
Multisystemic family therapy . . . . . . 180
Psychoeducational family therapy . . 182
Closing comments . . . . . . . . . . . . . . . . 183
Glossary . . . . . . . . . . . . . . . . . . . . . . . . 185
Further reading . . . . . . . . . . . . . . . . . . 193
Chapter 6 Integrative Models . . . . . . . . . . . . . . . 199
Metaframeworks . . . . . . . . . . . . . . . . . 199
Integrative problem-centred
therapy . . . . . . . . . . . . . . . . . . . . . . . 202
Brief integrative marital therapy . . . . 205
Pluralistic couples therapy . . . . . . . . . 207
CONTENTS vii
Integrative applications within
specifi c professions . . . . . . . . . . . . . 209
Closing comments . . . . . . . . . . . . . . . . 210
Glossary . . . . . . . . . . . . . . . . . . . . . . . . 211
Further reading . . . . . . . . . . . . . . . . . . 211
PART II PROCESSES IN FAMILY
THERAPY
Chapter 7 The Stages of Family Therapy . . . . . . 215
Stage 1 – Planning . . . . . . . . . . . . . . . . 215
Stage 2 – Assessment . . . . . . . . . . . . . 219
Stage 3 – Treatment . . . . . . . . . . . . . . . 235
Stage 4 – Disengaging or
recontracting . . . . . . . . . . . . . . . . . . 242
Summary . . . . . . . . . . . . . . . . . . . . . . . 247
Further reading . . . . . . . . . . . . . . . . . . 248
Chapter 8 Formulating Problems and
Exceptions . . . . . . . . . . . . . . . . . . . . 249
The three-column problem
formulation model . . . . . . . . . . . . . 253
The three-column exception
formulation model . . . . . . . . . . . . . 260
Questions to ask when constructing
three-column formulations . . . . . . 264
Recursive reformulation . . . . . . . . . . . 270
Summary . . . . . . . . . . . . . . . . . . . . . . . 272
Further reading . . . . . . . . . . . . . . . . . . 272
Chapter 9 Interventions for Behaviour, Beliefs
and Contexts . . . . . . . . . . . . . . . . . . . . 273
Criteria for selecting interventions . . 273
Behaviour-focused interventions . . . 276
Interventions focusing on belief
systems . . . . . . . . . . . . . . . . . . . . . . . 291
Interventions that focus on historical,
contextual and constitutional
factors . . . . . . . . . . . . . . . . . . . . . . . . 299
Summary . . . . . . . . . . . . . . . . . . . . . . . 312
Further reading . . . . . . . . . . . . . . . . . . 313
PART III FAMILY THERAPY PRACTICE WITH
CHILD- AND ADOLESCENT-FOCUSED
PROBLEMS
Chapter 10 Physical Child Abuse . . . . . . . . . . . . . 317
Systemic model of physical child
abuse . . . . . . . . . . . . . . . . . . . . . . . . . 317
viii CONTENTS
Family therapy for physical child
abuse . . . . . . . . . . . . . . . . . . . . . . . . . 326
Summary . . . . . . . . . . . . . . . . . . . . . . . 337
Further reading . . . . . . . . . . . . . . . . . . 338
Chapter 11 Sexual Abuse . . . . . . . . . . . . . . . . . . . . 339
Systemic model of child sexual
abuse . . . . . . . . . . . . . . . . . . . . . . . . . 339
Family therapy for child sexual
abuse . . . . . . . . . . . . . . . . . . . . . . . . . 347
Summary . . . . . . . . . . . . . . . . . . . . . . . 360
Further reading . . . . . . . . . . . . . . . . . . 360
Chapter 12 Conduct Problems . . . . . . . . . . . . . . . . 361
Systemic model of conduct problems 363
Family therapy for conduct
problems . . . . . . . . . . . . . . . . . . . . . . 371
Summary . . . . . . . . . . . . . . . . . . . . . . . 383
Further reading . . . . . . . . . . . . . . . . . . 384
Further reading for parents . . . . . . . . 384
Chapter 13 Drug Abuse in Adolescence . . . . . . . . 386
Systemic model of drug abuse in
adolescence . . . . . . . . . . . . . . . . . . . . 386
Family therapy for drug abuse in
adolescence . . . . . . . . . . . . . . . . . . . . 394
Summary . . . . . . . . . . . . . . . . . . . . . . . 401
Further reading . . . . . . . . . . . . . . . . . . 402
PART IV FAMILY THERAPY PRACTICE WITH
ADULT-FOCUSED PROBLEMS
Chapter 14 Distressed Couples . . . . . . . . . . . . . . . 405
Systemic model of distressing intimate
relationships . . . . . . . . . . . . . . . . . . . 409
Couples therapy . . . . . . . . . . . . . . . . . 413
Summary . . . . . . . . . . . . . . . . . . . . . . . 429
Further reading . . . . . . . . . . . . . . . . . . 429
Further reading for clients . . . . . . . . . 430
Chapter 15 Depression and Anxiety . . . . . . . . . . . 431
Depression . . . . . . . . . . . . . . . . . . . . . . 431
Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . 432
Systemic model of anxiety and
depression . . . . . . . . . . . . . . . . . . . . 435
Couples therapy for anxiety and
depression . . . . . . . . . . . . . . . . . . . . 440
Summary . . . . . . . . . . . . . . . . . . . . . . . 454
Further reading . . . . . . . . . . . . . . . . . . 455
CONTENTS ix
Chapter 16 Alcohol Problems in Adulthood . . . . 456
Systemic model of alcohol problems
in adulthood . . . . . . . . . . . . . . . . . . . 456
Couples therapy for alcohol problems
in adulthood . . . . . . . . . . . . . . . . . . . 465
Summary . . . . . . . . . . . . . . . . . . . . . . . 475
Further reading . . . . . . . . . . . . . . . . . . 476
Chapter 17 Schizophrenia. . . . . . . . . . . . . . . . . . . . 478
Systemic model of schizophrenia . . . 479
Couples and family therapy for
schizophrenia . . . . . . . . . . . . . . . . . . 484
Summary . . . . . . . . . . . . . . . . . . . . . . . 495
Further reading . . . . . . . . . . . . . . . . . . 496
PART V RESEARCH AND RESOURCES
Chapter 18 Evidence-based Practice in Marital
and Family Therapy . . . . . . . . . . . . 499
Child-focused problems . . . . . . . . . . . 500
Adult-focused problems . . . . . . . . . . . 518
Common factors . . . . . . . . . . . . . . . . . 532
Closing comments . . . . . . . . . . . . . . . . 533
Glossary . . . . . . . . . . . . . . . . . . . . . . . . 535
Further reading . . . . . . . . . . . . . . . . . . 536
Chapter 19 Professional Resources . . . . . . . . . . . . 537
Family therapy associations . . . . . . . 537
Training and supervision . . . . . . . . . . 538
Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . 538
Assessment instruments . . . . . . . . . . . 539
Training videotapes . . . . . . . . . . . . . . . 543
Web resources . . . . . . . . . . . . . . . . . . . 544
Journals . . . . . . . . . . . . . . . . . . . . . . . . . 545
Institutes, associations and websites
for specifi c types of family therapy
and systemic interventions . . . . . . 546
Written communication in
therapy . . . . . . . . . . . . . . . . . . . . . . . 549
Training exercises . . . . . . . . . . . . . . . . 555
Conclusion . . . . . . . . . . . . . . . . . . . . . . 580
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617