The Association for Family Therapy 2002.

Published by Blackwell Publishers, 108 Cowley

Road, Oxford, OX4 1JF, UK and 350 Main Street, Malden, MA 02148, USA.
Journal of Family Therapy (2002) 24: 423435
01634445

The family therapy journals in 2001:

a thematic review
Mark Rivetta
This article reviews the principal English-language (including British)
family therapy journals for the year 2001. Articles are clustered around
various common themes which include marital therapy and cultural
competency. There is also a discernible interest in working with populations that have received less attention from family therapists such as
substance misusers. Within this literature there is also a trend to import
ideas and methods from other therapeutic traditions. Important research
papers are noted from within these categories, rather than having a separate section. As this is the fifth in a series of reviews, a look back at trends
within the family therapy literature concludes the paper.

It is probable that in years to come the year 2001 will be judged as

the year that was nestled between the millennium and the cataclysm
of 11 September. This means that while 2002 will stand out as a year
when trauma and community tragedy dominates therapy literature,
2001 will slip from memory. This would be a shame because in many
ways 2001 seems to have embodied the continual expansion of
family therapy theory and practice. On the one hand, there was a
consolidation of crucial issues such as marital therapy and cultural
competency. On the other hand, in sometimes quite understated
ways, family therapists described using their therapy with groups of
clients that have rarely been discussed. Within this there was
another trend: to import (or reinstate) ideas from other therapies
such as person-centred therapy or motivational interviewing into
family therapy practice. The literature therefore presents a picture
of family therapists consolidating practice while engaging in subtle
experimentation.

a Family Therapist, Harvey Jones Adolescent Unit, Cardiff; Lecturer in Family

Therapy and Systemic Practice, Bristol University; Childrens Services Manager,
NSPCC Domestic Violence Prevention Service, 44 The Parade, Roath, Cardiff,
Wales, CF24 3AB. E-mail: markrivett@beeb.net

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Mark Rivett

Couples therapy
The year 2001 saw a substantial expansion in articles that sought to
increase family therapists knowledge of couples therapy. For the
purposes of this review I will categorize these articles into two types:
ones which provided a feminist perspective on couples work and
those which sought to integrate other theoretical ideas into this
work.
Vatcher and Bogo (2001) provide a thoughtful practice model
for couples therapy which fuses feminist and emotion focused therapy. They argue that their method recognizes that both men and
women possess a strong, inherent drive to be connected and experience interdependence with intimate others (2001: 70). More
specifically they argue that many young couples presenting for
therapy today are struggling precisely with issues of shifting, contradictory gender roles. The presenting problem is gender (2001: 72).
Later they assert that heterosexual couplehood today is a mess of
contradictions (2001: 75) which is why they have constructed a
therapy that integrates the advantages of emotion focused therapy
with feminist insights. The therapy they outline moves through various stages, including delineating couple conflict (which revolves
around gender roles), noting negative interactional cycles, discovering unacknowledged emotions, and reframing conflict in terms
of attachment needs. The outcome is to move into a stage in which
each partner accepts the other partners needs and new interactional patterns are created.
Other articles address issues of couples facing challenges such
as gay relationships in which one partner is HIV positive (Palmer
and Bor, 2001), interracial couple relationships (Killian, 2001), and
divorced fathers alienation from their children (Vassiliou and
Cartwright, 2001). However, as in other years, domestic violence is
where the challenge of and the feminist perspective on couples
therapy came together most keenly. On this issue 2001 saw some
repetition of previous skilful couples therapy where domestic
violence has occurred, but also a return to an earlier controversy.
Vetere and Cooper (2001) described a unique project that works
with couples where the man has previously assaulted the woman.
This project is contracted to undertake the therapy either by the
courts or childcare agencies. In this regard the service adds a fuller
systemic approach to the work with family violence from the
Ackerman Institute (Goldner et al., 1990), an approach commented
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on by Rivett (2001). However, Hunter (2001) highlighted the

controversies surrounding this issue more fully in a special section
in the Australian and New Zealand Journal of Family Therapy by describing the ethical dilemmas family therapists face in dealing with
domestic violence. She challenges person-centred, feminist, Milan,
post-Milan and narrative therapists alike to acknowledge the ethical
consequences of their form of therapy. For example, she comments
that the main ethical dilemma for the narrative therapist. . . would
be how to work within the legal limitations on confidentiality. . .and
maintain engagement with the clients (2001: 85).
In some senses, Hunters article prepares the ground for the
more radical article by Watson (2001). Watson provides a thoroughgoing critique of the notion that patriarchy is the fundamental cause of domestic violence and that only one form of practice
flows from this analysis. He argues that the perspective that patriarchy causes domestic violence means that: poverty, substance
abuse and compound disadvantage are dismissed (2001: 92).
Moreover, Watson suggests that this one-dimensional understanding of domestic violence (which he regards as feminist inspired) has
silenced other approaches. As a result he calls for diversity in the
field: adequate research into the many forms of intervention.
Goldner (2001) herself provides a commentary upon Watsons
article. In this (true to her own axiom of both/and) she both
agrees with his call for diversity and also reasserts the value of the
feminist perspective. The latter is the fundamental ethical and
political framework, but once this is established there should be
room for many voices and approaches to this grave and complex
problem. Innovation should not be treason (2001: 96). Within this
measured approach to understanding domestic violence, S.
Anderson (2001) contributes a paper that explores the use of assessment measures with couples in which violence has occurred.
The second theme which suffused the couples therapy literature
in 2001 was that of integrating therapeutic methods from other
traditions. The predominant addition was the importing of motivational interviewing (Miller and Rollnick, 1991) although
Middelberg (2001) also provided an excellent description of the
value of projective identification in couples therapy. Rohrbaugh et
al. (2001) adapted motivation interviewing for work with changeresistant smoking. The thesis of their work was that individuals who
fail to alter smoking habits even when their health is at risk are
often caught up in interactional cycles that perpetuate the smoking.
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Mark Rivett

The authors argue that these cycles may be categorized into ironic
processes in which a partners attempts to stop the smoking merely
encourage it. Family therapists would describe this pattern as more
of the same ( la Palo Alto). The other pattern is one where the
symptom fits the system. Rohrbaugh et al. state: smoking can serve
relational functions such as regulating emotional expression and
interpersonal closeness (2001: 21). The authors then apply this
understanding of smoking to a couples intervention model in
which they combine family therapy methods, motivational interviewing (to raise investment in change) and solution-focused questions.
Cordova et al. (2001) also describe adapting motivational interviewing in couples work, but they are interested to see if this
method can be applied as a form of distress prevention strategy.
They argue that only couples who have reached a major crisis will
attend for marital therapy, and thus apart from marital enrichment
programmes, therapists are unable to intervene at the most appropriate moment. Accordingly, they have constructed a Marriage
Checkup intervention. This provides free expert information
about the state of a couples relationship and is based upon the
principles of motivational interviewing (Miller and Rollnick, 1991).
Cordova and his colleagues aim to provide information in a way that
increases motivation for change and carefully nudges couples into
recognizing that they are having difficulties. Their paper reports
that their approach does indeed attract pre-crisis couples who
then appear to have improved relationships even after such a
limited intervention.
Cultural competency
As in other years, articles about cultural competency may be divided
into those that seek to increase knowledge about diverse groups, and
those that stimulate self-reflexivity about diversity. Foremost among
those articles that increased knowledge were a number which highlighted the role of therapy with refugee families. Within the latter
section, 2001 saw a number which researched family therapists attitudes and experiences of cultural competency.
In the first of two papers published in 2001, Sveaass and Reichelt
(2001a) discussed the difficulties encountered when refugee families are referred for therapy. Essentially the authors argue that the
culturally competent therapist must attend to the referral context
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(e.g. how the thinking of the referrer relates to the thinking of the
family) before embarking upon therapy. In this way therapy can be
both respectful and coherent with the families own perceptions of
their needs. In the second paper the same authors (Sveaass and
Reichelt, 2001b) describe involving the referrer in the first family
consultation in order to clarify the views of both family and referrer.
Woodcock (2001: 138) also provided a thoughtful description of the
therapeutic work at the Medical Foundation for the Care of Victims
of Torture. He stated that:
the pre-eminent need of survivors who seek therapeutic help is for a
psychotherapeutic framework that is broadly based and as inclusive as
possible. This will facilitate the emergence of multiple stories that will
enable the reconstruction of their worlds.

The approach that Woodcock therefore outlines is one in which

narrative, psychoanalytical and systemic perspectives are melded into
a whole that also retains a sociopolitical stance. One of the most interesting aspects of Woodcocks paper is that he attends to the therapists experience of listening daily to stories of torture, violence and
sexual abuse. Again he suggests that psychoanalytical approaches may
be helpful in enabling therapists to manage these stories.
Among other articles which considered cultural competency with
specific cultural groups were a number that addressed the needs of
Indian families (Dugsin, 2001; Wali, 2001). However, Khisty (2001)
used her experience as an Indian woman in Australia to reflect
upon how members from one culture connect to a host culture.
Khisty talks about the subtle personal changes that she underwent
when she moved to Australia: Social dilemmas centred on whether
one ought to relate with the Australian politeness or continue
behaving in a way consistent with the typically Indian practice.
Indians stopped behaving like Indians (2001: 19). She gives an
example of being invited out for a meal to another Indians house:
Should one take a bottle of wine along? (as in Australian culture)
or not (as fits the relationship between host and guest within Indian
culture)? Out of the discussions about how therapists can acknowledge and work with these differences, Khisty recommends a transcultural approach because trans implies being beyond both (or
indeed all) cultures. Her premise is that when individuals migrate,
the process of change can be variable but inevitable: in cultural
transition. . .all individuals are continually being transformed
(2001: 23). Moreover, these families are themselves new and cannot
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Mark Rivett

be explained by any cultural stereotype. Nor do the terms assimilation or integration match their experiences.
The second theme within the cultural competency literature in
2001 was one of reflection and research about how competent
family therapists really are. Constantine et al. (2001) surveyed 200
American marital and family therapists in order to assess the interconnection between therapists white racial identity and their views
of their competence in working multiculturally. Interestingly, they
found that therapists reported more confidence in working in a
multicultural society if they had attended relevant courses. Yet a
higher number of courses did not create more confidence! The
authors speculate that this is because such courses emphasize
knowledge, not self-awareness. This would complement the other
finding that a strong white racial identity translated into feeling
incompetent in multicultural work.
Nelson et al. (2001) conducted a different study that relied upon
a qualitative methodology to explore views about ethnicity in family
therapy. They interviewed twenty-nine leading family therapists
and asked them questions ranging from the importance of ethnicity to the process of therapy to what do training programmes need
to do in order to train culturally competent therapists. Their findings were that there are diverse and often contradictory perspectives in the field on this issue. Indeed, they subdivide the sample
into those who responded mostly about the effect of ethnicity upon
therapists, and those who responded about ethnicity affecting the
clients. They also noted that one group of therapists believed in
focusing on ethnicity during therapy, while another group
preferred a global view about diversity practice. These papers
constitute the start of empirical studies that will surely provide more
knowledge about cultural competency in the years to come.
Working with neglected client groups
As noted earlier, in 2001, family therapists addressed working with
a number of client groups that have not been well represented in
previous years. There were, for instance, some articles that
described a solution-focused approach to childhood disability
(Coles, 2001) and a multi-systemic approach to families where one
member has a learning disability (Trimble, 2001). It was however in
the literature related to substance misuse that the family therapy
journals really blossomed.
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In this area, the full creativity and diversity of systemic practice

was truly shown in the way that our tradition does so well. In this
case the diversity was founded upon a solid review of the field by
Rotunda and Doman (2001). They discussed the evidence for the
terms enabling and co-dependency when applied to relationships
between substance misusing individuals and their families. Overall,
they reject the term co-dependency, since it replicates traditional
pathological attitudes to women, extends the disease model to the
whole family and confuses causes with consequences (of substance
misuse). The authors comment that:
The popular notion that spouses of alcoholics possess personality traits
that cause them to exhibit irrational enabling behaviours has been abandoned. . .and replaced with the view that enabling behaviours are normal
reactions to the stress that is present in the alcoholic family.
(Rotunda and Doman, 2001: 260)

The most interesting outcome of this review of research was that it

suggests that even working alone with the partner of a substance
misusing individual can make a difference to the level of misuse
engaged in by that individual. Ultimately, the review provides
further evidence that there are interactional sequences that can be
changed by systemic therapy but that further study is needed to
understand partner responses to addiction (2001: 267).
From this foundation, practitioners explored a number of methods of working and a number of groups to work with. Trute et al.
(2001) researched couples therapy for women who were in addictions recovery and who were also survivors of childhood sexual
abuse. They found that the men and women had different needs
from treatment at this point. The men needed to learn how to deal
with their partners anger and address their view that their partner
was a wounded person, while the women needed to find ways of
containing and dissipating their anger and to translate the gains
they had made individually into relationship gains with their male
partners. Nevertheless, their trial suggested that quite brief conjoint
therapy during an addictions recovery programme significantly
improved the relationship context for the woman.
Other authors also provided extensive descriptions of services
they offered families in which a member misused substances.
Bamberg et al. (2001) concentrated upon group therapy with
parents of substance misusing adolescents. This team offer a structured programme of nine meetings in which a combination of
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Mark Rivett

education and therapy occurs. The topics of the meetings ranged

from encouraging self-management and responsibility to individualised family strategies. They comment that in this work there are
three main steps which are:
[to] ensure appropriate care for the parent. . .[to] ensure working parental
relationships. . .[and] young people must be challenged and encouraged
to establish responsible and reciprocal adultadult relationships.
(Bamberg et al., 2001: 197)

Pichot (2001) on the other hand gave a thorough clinical and

research analysis of a solution-focused approach. This, like other
approaches mentioned above, borrowed methods such as motivational interviewing and intergrated them into a solution-focused
group work programme. Pichot (2001) provides a wealth of audit
evidence to show that this method is effective with a range of
substance misusers and particular emphasis is given to the effectiveness with child protection referrals. One clinical exercise he
described might have general usefulness. This is the idea of an
Emergency Roadside Repair Kit (2001: 13). This technique is
designed to help clients prepare for relapses and consists of, first,
describing the repair kit needed for a car. Second, using that
metaphor, clients are encouraged to describe a repair/relapse kit
that they can carry in their heads in the eventuality of difficulties
recurring.
From Britain, Vetere and Henley (2001) also gave a valuable
description of their own systemic work within a community alcohol
service. This displayed the skill that some systemic therapists have in
working alongside other interventions and indeed in integrating
the systemic model with treatment regimens based on other
perspectives. Working within a stages of change model (which
itself is becoming more widely debated within family therapy circles
see Prochaska, 1999), the authors describe how family therapy can
contribute
to the management of relapse. . .by offering support and helping to think
through and problem-solve around the effects of relapse on relationships,
communication and functioning throughout the family.
(Vetere and Henley, 2001: 89)

They note how complex motivation might be for both the drinker
and their family and they chart the various forms of systemic work
they might do at different stages of the change process. Thus in
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initial stages the authors offer a form of consultation and would

only embark upon couple therapy when the clients think it is right
for them.
Importing from other schools
If traditions of psychotherapy can be compared to religions, they
may also be divided into those which adapt to the culture in which
they find themselves, and those which retain their purity. It has
always seemed to me that family therapy and systemic practice are
therefore more like Hinduism than Christianity: they evolve during
conversations with the outside world rather than during conversations with themselves. In previous sections I have highlighted some
of the imports from other traditions (e.g. motivational interviewing). But 2001 was also the year when these conversations included
the work of Carl Rogers. In these conversations, Rogers was seen as
a precursor to postmodern therapies. Harlene Anderson (2001),
herself an eminent exponent of collaborative approaches, led this
discussion. She described the humanistic and existential roots of
Rogers therapy and made connections between these and her own
postmodern collaborative practice. In particular Anderson noted
Rogers scepticism about there being one kind of reality (2001:
346) and his preference for a therapy that respected a pace,
purpose and outcome determined by the client. She also equated
her thoughts about the therapist not knowing with Rogers dislike
of advice-giving in therapy. In fact this paper by Anderson is possibly the most eloquent definition of what she means by not knowing. Having described the similarities between her practice and
that of person-centred practice, Anderson accepts that there are
differences. These may be summed up, she says, by concentrating
on the therapist intention, goal of therapy and the process of therapy (2001: 356).
Bott (2001), on the other hand, examines the difficulties in
applying Rogers approach to family therapy. He comments that the
postmodern turn in family therapy has been an attempt to humanize the field but a return to Rogers could also do this. However, the
stumbling-block has always been how to apply person-centred ideas
to conjoint work. Botts paper is a valuable theoretical review that
attempts to address this stumbling-block. His conclusion is that
actually many of the person-centred concepts are taken for granted
within family therapy:
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Mark Rivett

these [Rogers humanistic principles] are embedded within the practice of

family therapy, they remain largely unacknowledged, and are thus underdeveloped within a systemic framework.
(Bott, 2001: 375)

Walkers article however sets out to provide a practical application

of the Rogerian perspective in postmodern psychotherapy (2001:
41). He thus delineates Rogers methods of reflection, empathy,
using silences, accepting negative experiences and agreeing to various interpretations. He then describes these as equally postmodern
methods. Walker gives examples from transcripts from Rogers
work and, although seeking to collaborate with the Rogerian
tradition, at times he almost claims that postmodern approaches
are better. For instance, he says that: modernist empathy is a
technical means to some ends. Postmodern empathy is an end in
itself (2001: 44).
McGoldrick and Carter (2001) also contributed a paper in 2001
which sought to outline a systemic approach with single individuals.
Here they drew more upon Bowens ideas than Rogers, but equally
seemed to be pulling in ideas from outside the family therapy field
to describe their kind of coaching with an individual. They define
this form of individual work as aiming to: help the client define his
or her own beliefs and life goals, rather than just accepting the
family or the cultures values unthinkingly or reacting against them
(2001: 282). They note that: coaching is usually done with the most
motivated and functional family member, rather than the most
symptomatic, because this is the person most able to take action to
change his or her part in the family process (2001: 282).
McGoldrick and Carter then provide the stages they undertake
when coaching an individual. They help the person understand the
family system in which they are located, and the system in which
they grew up. They then help the person establish his or her goals
in terms of these systems, and they construct interventions to help
the person achieve these goals. All in all their paper reads like a
return to some older ideas: ones that are often suppressed within
family therapy literature currently.
A summing up: the past five years
This thematic review is the fifth of its kind, and the final one undertaken under the current editor. In this final section, I therefore
want to reflect upon the trends in the journals that I have noticed
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over the past five years. What has continued is that each journal has
its own niche, and it is also noticeable that there is a clear split
between the research-orientated papers and practice papers.
Indeed, over the past five years the output of research appears to be
growing in all the journals. Within the practice papers some abiding themes predominate: cultural competency, domestic violence
and gender. Overall, it would seem that there has been a decline in
articles that are inspired by postmodernism, and with that decline
there has been a rise in papers that try to integrate the lessons from
postmodernism. This year, for instance, Linares (2001) argued for
an ultramodern family therapy. The division between research and
clinical knowledge in particular brings the need for this integration
more into focus. What continues to be outstanding is the breadth
and creativity of practice that resides in the systemic therapy field.
Each of these reviews of the literature stands as testament to this
breadth and creativity. Out of this diversity, sometimes controversy
erupts: for example, Minuchins (1998) disagreements with the
postmodern therapies and Johnsons (2001) strong criticisms of the
Messianic tendencies in family therapy. Over the next five years,
we may expect this diversity to continue. We may also expect the
empirical aspects of our field to become more significant as
evidenced-based practice becomes more accepted. Where the
controversies will come from we will have to wait and see.
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2002 The Association for Family Therapy and Systemic Practice