Assessment in transitional family therapy: The importance of context.

Abstract

The call was a sobering one. Mrs. Sullivan asked for individual therapy for her daughter, Joanna, age 13. She said Joanna seemed unhappy because of a deteriorating relationship with Joanna's older sister, Margo, age 18. Mrs. Sullivan said she herself had benefited from psychotherapy and wanted the same for Joanna. While scheduling an appointment for Joanna, Mrs. Sullivan said offhandedly that she wondered whether Joanna's unhappiness related in any way to the young girl's diagnosis of muscular dystrophy 3 years earlier. Joanna's older sister, Margo, was wheelchair bound with the same disorder and had recently entered college and acquired a new health aide. The family's perspective was that Joanna's "normal" life was a blessing in comparison. When asked who suggested my name (S.H.M.), Mrs. Sullivan said the therapist she and her husband had seen when they were separated last summer. Without hesitation, I scheduled two assessment sessions: one for the family and another for Joanna and Margo, who wanted to come in together. I asked for permission to talk to the Sullivans' marital therapist and made a note to ask permission from the girls to talk with their physician. It was unclear at the time whether I would need to assess Joanna individually; it was clear that her difficulties were embedded in a complex web of family stress, loss, and physical strain.' A critical component of assessment is the evaluation of both presenting problem and context. The family-systems view of human behavior pays particular attention to context and its reciprocal, often hidden, impact on the presenting complaint. The value of family assessment is not limited to relational disorders. With any patient, regardless of the presenting complaint, family meetings can open up new vistas of understanding that sud-'The cases described i n this chapter are actual cases treated by the authors. The names and details of the cases have been changed to preserve anonymity.

Linking Human Systems: Strengthening Individuals, Families, And Communities in the Wake of Mass Trauma

“…We need to determine the overall level of stress within the system and the balance between stressors and resources (Garmezy & Rutter, 1983; Hobfoll, 1989, 1998; Landau‐Stanton, 1990; Rutter, 1987, 1993). We also need to assess whether connectedness and continuity of the transitional pathway have been disrupted (Landau, 2002, 2005; Landau‐Stanton, 1986, 1990; Watson & McDaniel, 1998). For example, do families and communities know stories about past adversities and how they were overcome?…”

Enhancing Resilience: Families and Communities as Agents for Change

“…The LINC Community Resilience model evolved from transitional family therapy (TFT; Horwitz, 1997; Landau‐Stanton, 1982; Landau & Garrett, 2006; Landau‐Stanton & Clements, 1993; Seaburn, Landau–Stanton, & Horwitz, 1995; Watson & McDaniel, 1998). This approach to therapy, which I began to develop in my research and practice in South Africa in the 1970s, was further honed with colleagues in the early days of the University of Rochester's Division of Family Programs 2…”

“…We also need to determine the balance between stressors and resources (Hobfoll, 1998). In addition, we need to assess whether continuity of the transitional pathway has been disrupted and whether themes of resilience are being mobilized (Landau, 2004; Watson & McDaniel, 1998).…”

“…It depicts, across time and over as many generations as possible, important community themes and scripts, events, relationships, conflicts, and strengths. It also maps the community's belief systems and position within its geographic, social, and cultural context (Landau, 2004; Watson & McDaniel, 1998). This information is used to identify key transitions and highlight times when multiple transitions coincided.…”

Communities that care for families: The LINC Model for enhancing individual, family, and community resilience.

“…This enables people to gain perspective on the complex systems in which they live and to see their family and/or communities in a fresh light. The process diffuses blame and anger and makes room for more constructive interactions that draw upon a full range of resources and strengths (Landau, 2007; Landau-Stanton, 1986; Watson & McDaniel, 1998).…”