The dream-like, open-endedprocess ofplay therapy has much in common with the family therapy style of the authors. This paper provides a partial list of similarities between play therapy and family therapy. It reviews methods for using play with families and considers the question of indications and contraindications for play therapy with families. Clinical examples are utilized to illustrate throughout the paper.A large blended family was negotiating a second stage identity crisis. They were wrestling with the complex problem of becoming a new family while simultaneously retaining their two-family identification. The two parents were widowed in the past three years. Mother had five children, ages three to 16, and father's sons were 10 and 13. Both families were still grieving the unexpected, shocking deaths of the two lost spouses and parents. In the first interview with the family, there was considerable awkwardness about their presenting complaint: petty stealing by mother's 15-year-old son. It was not long before the three-and five-year-old children began to act out the group's restlessness. One of the co-therapists left the conference room and returned with a large box of toys, magic markers, a large drawing pad and some clay. The interview came alive instantaneously. The younger children immersed themselves in play. A free flowing give-and-take developed in the interview. One of the therapists helped the three year old with a drawing. Father kneaded a fistful of clay. The mother, a 15-year-old sister and the five-year-old son worked together on a tower of blocks. The three year old's drawing was of a rocketship which reminded the 15 year old of how he was feeling.The opportunity to play had diffused the family's focused concern. The toys catalyzed the interview process, changing it from a cautious, conscientious experience into one that was gratifying for all members of the family. At the end of the session, when everyone was filing out, mother and father came last. The mother shook the therapist's hand and said simply, "Thanks for the toys."We had been doing play therapy with the whole family. The open ended, nonrational quality of this interview is the quality of psychotherapy that interests us most. While we steer away from abstract, theoretical descriptions of psychotherapy theory and technique, there are patterns which emerge in our work which we try to conceptualize.

Psychotherapists are forced to face the troubling fact of their ineffectiveness. Part of the sense of uselessness arises out of going face‐to‐ face with family systems. Another part is based in the therapist's theoretical orientation. Two methods for breaking out of this double paralysis are described. Both methods are illustrated with clinical examples.

This paper describes a pattern of group supervision for family therapists based on the spirit of mutual collaboration between Ihe supervisor and group members. Through discussion of clinical work, merging supervision with consullat~on, the supcrvision group supports the dcvelopmen~ of a professional identity, acts as a family therapy laboratory and provides a consciousness-raising . environment for the group members.Supervision, as a process, is different from teaching, which adds information, and different from therapy, which augments the growth of a whole person. Supervision, as we conceive of it, is a process which provides support for, and augments the maturity of a professional role structurc; family psychotherapist.Supervision is a complex process which attends to five interacting regions: (1) the personal dynamics of the psychotherapist, (2) the professional role functioning of the psychotherapist, (3) the process of psychotherapy which has two major components: (a) the interview process (what happens during the interview session) (b) the adminis-\ David V. Keith, MD. is Associate Professor of Psvchiatw. Family Medicine and Pediatrics, ~epartment

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Unexplained menorrhagia and hematuria occurred in a 13-year-old female with a mild inherited platelet disorder who had never experienced prior bleeding as a result of this disorder. An intensive search revealed that this patient was receiving coumadin that was given by the mother. In addition, the mother drew large volumes of blood from the patient under the pretense of following a physician's orders. The mother also falsified the laboratory data to erase from her daughter's file a laboratory result documenting warfarin in the blood.