In this article we describe the therapeutic practice of creating illustrated storybooks in family therapy with traumatized children. Illustrated stories offer a predictable structure to sessions and facilitate engagement and participation of children in therapy. The therapeutic emphasis of storybooks can be adjusted to take into account a child's life story, verbal capacity, level of anxiety, and traumatic hyperarousal. The creation of storybooks is an active process that embraces important aspects of trauma-specific interventions, including expression of trauma-related feelings; clarification of erroneous beliefs about the self, others, or the traumatic event; and externalization of traumatic stimuli into artwork, allowing for exposure and habituation of the arousal response. A focus on visual images together with narrative takes advantage of children's developmental capacities and spontaneous pleasure in the creation of art, thus minimizing anxiety and enhancing feelings of mastery, competence, and hope. The creation of storybooks is compatible with family interventions that foster a safe family context, strengthen attachment relationships, insure appropriate structure and boundaries, and enhance parenting capacity as well as those interactions that facilitate understanding and dialogue between family members.

In this article we discuss the network paradigm as a useful base from which to integrate attachment and family systems theories. The network perspective refers to the application of general systems theory to living systems, and provides a framework that conceptualizes the dyadic and family systems as simultaneously distinct and interconnected. Network thinking requires that the clinician holds multiple perspectives in mind, considers each system level as both a part and a whole, and shifts the focus of attention between levels as required. Key epistemological issues that have hindered the integration of the theories are discussed. These include inconsistencies within attachment theory itself and confusion surrounding the theoretical conceptualizations of the relationship between attachment and family systems theories. Detailed information about attachment categories is provided using the Dynamic Maturational model. Case vignettes illustrating work with young children and their families explore the clinical implications of integrating attachment data into family therapy practice.

This article describes the treatment of five traumatized children (aged 4-8 years) using adjunctive group art therapy, and reviews the theoretical basis for such a treatment strategy. All the children had been exposed to cumulative traumatic experiences involving threats to caregivers in the context of conflictual, violent and unresolved parental separation. All presented with symptoms of post-traumatic stress, developmental problems related to trauma, had difficulties with any discussion of traumatic events or family concerns, and reacted with hyperarousal and/or an 'emotional shutdown' response. Previous treatments included a combination of social, family, psychological and biological interventions including: outpatient family therapy, medication, admission to a therapeutic day programme, inpatient family work and home visits by nurses, with partial response. The group, a structured, low anxiety, interactive setting, was a therapeutic intervention developed by a child psychiatrist and an art therapist to facilitate further therapeutic change. The therapeutic use of artworks facilitated exposure to traumatic cues in a less direct manner, allowed for desensitization of anxiety and unpleasant body sensations, helped the children recount the story of the parental separation and to label and articulate affective states using art and narrative. Positive family changes and coping skills the children were using to manage ongoing stresses were made overt. Positive expectations of the future were promoted. Key therapeutic and theoretical aspects of the group intervention are described.

The authors have developed a family-centered interactive art exercise from a synthesis of clinical tools used by attachment theory and family art therapists. The exercise aims to facilitate assessment and treatment of families with younger children (two to eight years) at a tertiary referral child and family psychiatric facility, by observing how a family collectively as well as individually sets about planning and completing an art task. Art exercises allow for both verbal and non-verbal communication. The exercises are deliberately kept simple in order to span a range of developmental abilities, and allow the therapist/s to observe from behind a one-way screen, so as to be less intrusive in the family dynamics. Although developed for assessment with a specific population, the exercise is likely to be useful in other clinical situations and has been used as a treatment tool by the authors.

Children exposed to significant abuse, neglect and household dysfunction often present a confusing and difficult‐to‐treat clinical picture. This paper discusses the use of systems theory to develop treatment plans for maltreated children in clinical settings. Although its value is well recognised in the literature, systems thinking is not easy to implement in ordinary clinical settings and the systemic approach is not universally practised. Systems theory is an integrative theory, which helps clinicians identify and prioritise key areas of difficulty, and organise information from multiple system levels into a well‐defined treatment plan. Treatment plans take into account not only patient but also service factors, and to be viable in clinical settings must function within the limits of organisational reality. A case vignette is provided.