The Association for Family Therapy 2000.

Published by Blackwell Publishers, 108 Cowley

Road, Oxford, OX4 1JF, UK and 350 Main Street, Malden, MA 02148, USA.
Journal of Family Therapy (2000) 22: 428440
01634445

The family therapy journals in 1999: a thematic

review
Mark Rivetta
This paper reviews the principal family therapy journals for the year 1999.
Of the themes that emerged, reaching out with systemic practice, developing a political edge, gender issues and developments in theory will be
discussed. The paper concludes with a resum of the research reported in
these journals for the review period.

Introduction
As can be expected there are a number of abiding themes that
concern family therapists that recur in the journals from year to
year. However, there has been a marked difference in 1999. In the
previous year one of the predominant themes in the journals was a
review of the value of postmodern theory and practice; in contrast
this year a number of authors have written about making systemic
practice relevant to work in a number of settings. This is not to say
that the previous years debate did not continue to rumble on in the
journals (see Anderson, 1999; Minuchin, 1999; Schwartz, 1999).
However, 1999 gave many examples of therapists using systemic
methods within a large range of settings, and it is this theme which
will begin this review.
Reaching out: applying systemic practice to diverse settings
Applying systemic practice to diverse settings is particularly important in the area of community child development schemes for
British practitioners, as central government funding has created
programmes such as Sure Start, which meet the needs of young
aFamily

Therapist, Harvey Jones Unit, Whitchurch, Cardiff; Lecturer in Family

Therapy and Systemic Practice, University of Bristol; Practice Manager, Domestic
Abuse Service, NSPCC, 44 The Parade, Roath, Cardiff CF24 3AB, UK (address for
correspondence).
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Journals 1999 review

429

children and their families in areas of greatest need (Home Office,

1998: 14). These programmes have a great deal in common with the
American government-funded programmes under the Head Start
initiative. In a series of articles about the value of integrating
systemic theory and practice into the delivery of Head Start
programmes some authors described how family therapy trainees
were attached to programmes as part of their training. This innovative element to training clearly ensured that trainees received a
systemic and not the narrower family therapy training.
Leitch and Thomas (1999) describe both how this unique partnership between twelve training programmes and twelve Head Start
programmes developed, and how the complex issues of trust,
confidentiality and compatibility were negotiated. McDowell, on
the other hand, provided a valuable analysis of the role of the
systemic consultant to these programmes. She noted that the partnership enabled the widening of the definition of family therapy by
incorporating systems consultation into MFT programs (1999:
155). McDowell outlined a four-part consultation model that
includes organizational consultation, staff support and training,
direct work with families and classroom involvement (Head Start is
more closely linked to educational services than Sure Start). She
argued that the consultant needed to develop a third roving eye
from which perspective the organizational culture could be
critiqued. Such a process enabled the Head Start staff to engage
with families who had previously been hard to reach.
Thomas et al., in an excellently articulated analysis of family therapy within client families homes, focus on how involvement in
Head Start changed trainees practice. It includes both the advantages and disadvantages of doing this sort of work. Interestingly,
Thomas and his colleagues comment that working in the homes of
their clients confronted trainees with feelings of incompetence
because their clients had extremely few resources and little selfconfidence (1999: 183). Not only did the reality of these deprived
families lives shock the trainees, but they were also challenged by
the distractions that occurred during sessions, the lack of privacy
(including confidentiality), and finally the blurring of the professional role that occurred. These challenges led the trainees to redefine what they meant by the therapeutic relationship. Indeed, the
concept of being a professional friend began to make sense with
many. The paper continues to itemize the value that working with
such deprived families can bring to clinic-based services. Not least
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Mark Rivett

of these is the belief that therapists should reach out to clients

instead of waiting for them to come into the clinic (Thomas et al.,
1999: 188).
The theme of home-based work continues in other papers.
Snyder and McCollum (1999) provide a model for transferring
clinic-based therapy to home-based therapy; Huston and Armstrong
(1999) discussed home-based therapy for children at risk; and
Madsen (1999) applied narrative ideas to such work. This latter
piece noted that home visiting could ensure that the therapist
retained a cultural curiosity about a family and indeed he argued
that the clinic-based service itself encouraged a pathological
approach to family difficulties. He described using a narrative
framework to help families understand how they fitted with the
helping system as well as the larger cultural narratives that affected
their lives. He concludes by applying these same techniques to the
larger system of the helping agencies themselves.
The process of reaching out has also encompassed the use of
systemic ideas with less typical client groups. Thus Essex and
Gumbleton (1999) provided a thorough description of their
approach with families in which there is denial of severe child
abuse, while Waldman (1999) and Abu Baker (1999) both
discussed the complexities of working with mandated clients.
Moreover, in an article that spans both this category and the next,
Havas and Bonnar (1999) review the limits of parenting in
contemporary society. The paper discusses the challenges to
contemporary families: drug misuse, sexual freedom, urban stress,
family fragmentation, work demands and social violence, to name
but a few. In the face of these challenges, the authors believe that
family therapy which is built upon the concept of the privatized
family merely compounds the blame that society wishes to apportion to families themselves. They argue that traditional family
therapy alone cannot adequately address the risks faced by
adolescents and their families. In particular these authors castigate the strategy of encouraging parents to let go of their adolescents.
Rather, they encourage therapists to borrow from other models
including those from feminism, psychoeducational and public
health approaches in order to construct a therapy that helps families collaborate in changing the whole system in which children
grow up. In a foretaste of the next theme of the year Havas and
Bonnar reiterate that all practice is political (1999: 131).
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Developing a political edge within systemic practice

The reaching out process of family therapy would appear to
denote the emergence of a political sensibility within systemic practice. Pakman, whose work has always challenged the status quo both
politically and culturally, discussed the need for systemic practitioners in crisis mental health services. He described these services as
typically asystemic, disembodied and nonreflective (1999: 84).
Indeed, as such they require a practice of critical social action
(1999: 88) to make available to the service users alternative definitions of their situation. However, Pakman does not want to advocate
a systemic practice that presented idealized practices which would
further marginalize the workers that provided these services to the
marginalized groups of the poor . . . and minorities. Rather it is
the everyday case in the battlefront that we have to deal with in a
creative way, the questionably successful, exhausting case that
makes the bread and butter of therapy in the social service domain
(1999: 89). His innovative article provides some excellent examples
of constructive therapy with mental health service users.
Samuels addressed matters of politics in his Conference speech
to the Australian Family Therapy Association. He argued for therapists to become involved in politics because, first, he believed that
politics was changing to become a transformative phenomenon in
the West. He supported this view by suggesting that technology,
consumerist and ecological politics were all contributing to the
growth of a political energy that could influence the old structures
of political power (1999: 123). Second, he believed that therapists
were at last taking politics seriously and seeking to influence the
political process themselves. Moreover, they were adopting the
methods of social deconstruction within their day-to-day work with
clients (as do narrative therapists). He introduces some interesting
ideas within the conference. He invites the reader to delineate politics in his or her family of origin and to consider world events that
formed their politics. Finally, he interrogates us to describe our own
inner politician (1999: 125). Is this, he asks, a warrior . . . a terrorist, a martyr, a mystic, a philosopher, a diplomat, a bridge-builder, a
negotiator or an ostrich? (1999: 126).
Couples therapy and domestic violence
Since the rise of feminist family therapy, gender politics and the
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Mark Rivett

therapeutic practices associated with it has been the most obvious

arena in which a socially engaged therapy is identifiable. When it
comes to domestic violence there clearly has been an increase in
the pragmatic quality of papers. Bograd and Mederos (1999)
describe a universal screening process for couples where the man
is violent to the woman, and also provide a model for determining
treatment modality. The authors note that assessment for couples
work should always include individual meetings as well as an initial
conjoint session. This assessment involves an in-depth discussion of
the level of lethality and violence as well as factors that would
contra-indicate couples therapy. A series of alternative scenarios
were then discussed including the disclosure of violence in meetings or conflicting reports of violence between the couple. The
article ends with some very practical advice: many battered women
are helped less by therapy than by participation in profeminist
support groups . . . many batterers would benefit more directly
from specialized mens groups for offenders (Bograd and
Mederos, 1999: 308).
On this theme issues of diversity practice in domestic violence
work are becoming central. Thus Bograd noted the glaring omissions in the domestic violence literature of the intersections of
race, class, sexual orientation and gendered asymmetry (1999:
275). Almeida and Durkin take this a stage further by describing
their cultural context model, which makes explicit the way these
intersections shape the experience and response to domestic
violence. Their treatment model includes extensive use of single
gendered groups. Indeed, conjoint therapy only begins for batterers after they have successfully completed the 9-month program
and have shown the necessary changes in behaviour and attitude
(1999: 320).
Goldner (1999) states that she believes there is a growing
rapprochement in domestic violence work. She argues that multiple
perspectives are now being acknowledged, but that outcome
research remains very poor and that legislative changes may
continue to polarize the field. She is of course referring to the
outlawing of couples work where abuse has occurred in some of the
American states. This is significant for British therapists when
central government is seeking to co-ordinate multi-agency action in
domestic violence (Home Office, 1999, 2000). Goldner however
reiterates both her political stance and her commitment to couples
work with these words: working at the moral edge with clients
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seems to inspire them to go beyond the notion of change as a way

to feel better, to change as a way to be better (1999: 334).
In a useful review of helping children who have witnessed domestic violence, Anderson and Cramer-Benjamin noted, family therapists have been slow to address the clinical needs of children
exposed to couple violence (1999: 13). However, they do not
outline a comprehensive approach to help these children and fail
to note practice from other sources (Peled and Davies, 1995), which
may be an example of the isolationism that Goldner (1999) castigates. On the other hand, Van Meyel (1999), a Canadian therapist,
described how she used a play-based family therapy to help very
young children who have witnessed female abuse. This method
progresses from unstructured play with the mother observing, to
structured play in which activities revolve around safety, feelings
and secrets. The final stage of the therapy includes the construction
of a ritual in which mother and child are able to nurture each other,
which may include story-telling, singing or even sharing a special
snack.
Gender: in therapy and relationships
While family therapists commonly address gender dynamics, unlike
psychodynamic therapists they rarely address sexuality explicitly in
their literature. This year this trend began to be reversed. Butler
noted that when we lie down in bed with each other we sleep with
the war between men and women fuelled by patriarchy and differences in physiology, and with the uneasy cease-fire in the erogenous
zone that followed the feminist and sexual revolutions (1999: 24).
Yet she comments that most of us have experienced rare moments
when lovemaking is sensed as healing, wholesome and holy (1999:
25). Her article describes various ways to unlock this aspect of a
couples relationship so that their lives together can become more
coherent. The suitably named Pat Love (1999) on the other hand
provides a biochemical analysis of love and desire. Love argues that
infatuation (or falling in love) appears to be the result of an
increase in a particular chemical in the brain (phenyl ethylamine).
Moreover, she argues that each individual has a biological predisposition to desire a certain amount of sex. A mismatch between a
couple in their predisposition, she asserts, is often the cause of
marital conflict. Her solution is to educate her clients about the
biology of passion. Her article certainly reminds therapists that
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there are physical aspects to the problems of their clients and starkly
poses the dilemmas that a biological perspective causes therapists.
In a similar vein Parker introduces a biological basis to the analysis of gender and debates how to address male/female differences
in therapy. She outlines a psychoeducational method to teach
couples how men and women approach emotional and relationship
problems differently. She then works with couples to ensure a more
egalitarian intimacy (1999:1), which allows relationships to be
more just.
McCarthy (1999) argues that in different types of marital relationship, sexuality means something different. Thus he described
four kinds of marriage: those characterized by complementary
couples, by conflict minimizing couples, by best friend couples or by
emotionally expressive couples. He maintained that sexuality has a
different function in each of these couples and thus sexual problems mean different things in each type of couple. McCarthy
believes that difficulties in sexual intimacy contribute far more to
troubled relationships than good sex improves happy relationships.
He therefore advises therapists to ascertain the role of sexual intimacy within the troubled relationship before discussing how to
improve it. His paper suggests ways that clinicians can address
sexual problems within these couples.
Knudson-Martin and Mahoney (1999) on the other hand present
a thorough description of what a postgender therapy looks like.
This article will deservedly become essential reading for practitioners and trainees alike. It seeks to navigate the rocks between an
essentialist notion of gender and a socially constructed one while at
the same time addressing the very real complexities of negotiating
gender in therapy. The traps of gender work are explored. These
are that: there are natural, unchangeable differences between
men and women; that we unconsciously act out gender scripts; that
we ignore power differences; and that we assume gender equality
has been achieved. To each trap, the authors provide practical
responses and give case examples of their work, which they call
postgender because it seeks to transcend essentialist notions of
gender. In a link to previous parts of this review, Knutson-Martin
and Mahoney comment, the postgender approach requires that
therapists take an active role in the process of social change (1999:
337).
Another gender-centred theme that emerged in family therapy
publications in 1999 is that of divorce. Gorell-Barnes (1999)
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provides a very thoughtful and clinically useful paper which summarized her work with separating and reforming families. Her descriptions focus on men, women and childrens stories about divorce
with a particular slant on factors of resilience that help the family
members rebuild their lives. She notes that the presence of violence
in the couple relationship and intense acrimony following divorce
makes it especially difficult for boys to adjust to the breakdown of
the parental relationship.
Cohen et al. (1999) provide a typology of separating couples
which then points to the kind of mediation that may be successful,
these types being: semi-separated; emotionally withdrawn; couples
in a power struggle; leaver-left couples; battling couples;
enmeshed couples and violent couples. The authors delineate what
therapeutic stance is most likely to be of value; thus with battling
couples assertive guidance is necessary, while with emotionally
withdrawn couples the therapist must clear the emotional field by
clarifying and encouraging communication. This typology relates to
an Israeli legal setting and may need adjusting to other cultures.
Developments in theory
This year also saw some excellent papers that will contribute to the
theory which drives the field. Beyebach and Morejon (1999) in a
well-argued piece described the aspects of other family therapies
that they integrate into solution-focused therapy. These include
technical integration (e.g. techniques that are imported) as well as
theoretical integration (e.g. theories that contribute). However,
they also debate the challenges of integration and acknowledge that
foremost of these is that the solution-focused imperative to stay
simple might be compromised. In an article that reported the
results of a Delphi study, Levine and Fish also investigated the growing integration of different theories in the practice of family therapy. Their results provided ample evidence that first order
practitioners had integrated second order concepts into their
practice although they retained an allegiance to general systems
theory. The results also showed that practitioners suspended their
integration when issues of physical safety arise (1999: 81).
Rober provided a fresh perspective on theories about the self of
the therapist by describing the difference between the role of the therapist and the self of the therapist. He does this within the current vogue
for not-knowing by suggesting that the therapist has a continual
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inner conversation that is a conversation between the self of the

therapist and the role of the therapist (1999: 213). Out of this
conversation emerges recognition of the intuitions, inspirations
and courage to intervene that make up successful therapy. Rober
applies this concept to impasses in therapy. He maintains that
impasses are the result of lacks in inspiration, or of courage. If the
therapist can categorize which is the cause of an impasse and can
reflect on these, then the impasse can be overcome. Robers paper
is one of those rare contributions that provide wisdom and selfawareness at the same time.
Research
In many ways the research that was published in 1999 reflected the
themes already evident in the journals. Thus multi-systemic therapy,
which is clearly a form of systemic therapy that reaches out beyond
the family, was reviewed (Cunningham and Henggeler, 1999) and
methods of engaging multi-problem families were analysed. But it
was research around gender, couples relationships and divorce that
particularly dominated.
Gottman contributed yet more research from his studies of
factors that seem to predict divorce in couples. Carrere and
Gottman (1999) observed marital conflict in 124 newly married
couples. Following a coding of this interaction, the researchers
provided longitudinal data, which confirmed that they could
predict who would divorce by analysing the first three minutes of
this interaction. In a further study Gottman and Levenson explored
the concept that divorce was predictable not only from the way
couples dealt with conflict but from how well they recovered from
that conflict. Once more they argue that there is evidence that the
ability to rebound from the negativity of marital conflict (1999:
291) is a protective factor in a marriage.
Arditti and Prouty examined the relationship dynamics between
divorced fathers and their children in a qualitative study. The
authors draw out useful advice for therapists. They believe that
efforts should be made to minimize the triangulation of children
between divorcing parents and to name the paradox that although
anger following marital break-ups may be healthy for the former
partners . . . the same anger is maladaptive for children (1999: 78).
A rare piece of process research by Butler and Wampler in 1999
investigated couple therapy and considered the issue of
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therapistcouple struggle as a factor in therapy outcome. The

researchers again minutely studied the activities of twenty therapists
with twenty-five couples and rated behaviours in the sessions that
could be classified as either couple responsible (e.g. the couple
were responsible for involvement) or therapist responsible
(e.g. the therapist was responsible for action). Essentially, these
behaviours were then analysed according to how they elicited
co-operation between therapist and couple or struggle between
them. As with previous work, it confirmed that therapist offered
couple-responsible process (1999: 51) produced better outcomes.
Although there was less process research published in 1999, there
was a body of research that demonstrated the growing reflexivity of
family therapists. Thus Diamond and Liddle examined the behaviour of family therapists when a family session became conflictual
between adolescents and their parents. They then compared behaviour that enabled the family to reach a resolution and that which
didnt. Out of this they constructed the concept of a shift event
which relies on the therapists ability to evoke softer, more vulnerable or empathic feeling states (1999: 8) in the clients. Behaviours
that achieved this were shifting the discussion from behaviour to
emotion; naming emotions underlying the conversation; repairing
the therapeutic alliance, and using the self. All of these also
depended on the therapists attention to pacing if he or she was
too fast, too slow or too interventive, then the moment for the shift
would be lost.
Deacon et al. (1999) reported the results of a survey of 175 American marriage and family therapists to discover their attitudes to
therapy for their own problems. The vast majority of respondees
had been to therapy themselves at some point in their lives. Curiously the theoretical orientation of their therapists was mostly
psychodynamic (45.5%) or emotion-focused (21.7%). Moreover,
the number of sessions attended had a median of 18.57 but in one
case reached 3,000. This article provides a rare chance to consider
the mental health status of family therapists themselves. According
to this research, we are not afraid to ask for help when we need it,
but we rarely involve all our families in this help, and we are likely
to choose therapists from a different tradition for our help. Perhaps
there are complex reasons for this: do we choose family therapy as
a profession because of our relationships with our own families?
One curious finding was that those therapists who described themselves as solution-focused were the least likely category to seek
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Mark Rivett

therapy for themselves. Like the best of research this poses more
questions than it answers!
But does research itself make a difference to the family therapist
practitioner? Johnson et al. (1999) sampled a hundred family therapists to ascertain their research activities. The results suggested that
family therapists had a moderate degree of involvement in
research with only two-fifths having ever evaluated the effectiveness
of their work. Most reported reading only the clinical sections of the
professional publications they received. The authors thus wondered
about how current research findings could be communicated to
practitioners!
Final words
Before I end this review, it seems appropriate to comment that
many journals featured obituaries of two contributors to the family
therapy world. One, Mara Selvini-Palazzoli (19161999) has
contributed so much to the clinical practice of so many. The other,
Neil Jacobson (19491999) in his indefatigable study of domestic
violence challenged practitioners and researchers alike. It is sad
evidence that systemic therapy has come of age, that its grandchildren are gradually losing its grandparents.
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2000 The Association for Family Therapy and Systemic Practice