The "Flip"-Sustaining Complexity and Multiplicity Post-Quarantine.

This article describes poststructural ways of responding to the pandemic by looking for openings or gaps within more traditional ways of interacting with dilemmas. The author situates herself within a "positive deviance" epistemology, which looks for what already works rather than getting captured by the current problem. We "flip" what are the usual ways of responding and explore three different programs that illustrate inventive and assets-based approaches. Linking-Lives Storython, created specifically to utilize our COVID shelter-in-place experience; Re-Authoring Teaching: Creating a Collaboratory, begun 12 years ago to meet the needs of a widespread community; and Witness to Witness, a current response to contemporary disastrous situations-all have utilized technology to open possibilities for those who are helped as well as those who are helpers. The article shows how each program has specifically flipped more traditional ways of responding, but also how this "flip" employs a practice of "disciplined improvisation." Each program has a built-in structure that depends on technology to make it work; each has a disciplined approach that allows the helpers to improvise to meet the needs of the receivers. It is this "flip," this way of thinking, that can sustain us and our work in times of great complexity and multiplicity.

En este artículo se describen las formas posestructurales de responder a la pandemia buscando aberturas o grietas en las formas más tradicionales de interactuar con los dilemas. La autora se sitúa dentro de una epistemología de "desviación positiva", que busca lo que ya funciona en lugar de quedar atrapada por el problema actual. Nosotros "damos un giro" a las formas típicas de responder y analizamos tres programas diferentes que ilustran métodos inventivos y basados en ventajas. Linking-Lives Storython, creado específicamente para aprovechar nuestra experiencia de confinamiento por la COVID-19; Re-Authoring Teaching: Creating a Collaboratory, que se inició hace doce años para satisfacer las necesidades de una comunidad amplia; y Witness-to-Witness, una respuesta actual a situaciones contemporáneas de catástrofe, han utilizado la tecnología para abrir posibilidades tanto a quienes reciben ayuda como a aquellos que ayudan. El artículo demuestra cómo cada programa ha dado un giro específicamente a las formas más tradicionales de responder, y también cómo este "giro" emplea una práctica de "improvisación disciplinada". Cada programa tiene una estructura incorporada que depende de la tecnología para que funcione; cada uno tiene un método disciplinado que permite a los ayudantes improvisar para satisfacer las necesidades de los receptores. Es este "giro," esta forma de pensar, que puede apoyarnos y apoyar nuestro trabajo en tiempos de gran complejidad y multiplicidad.

Black Lives Matter: We are in the Same Storm but we are not in the Same Boat.

Black Lives Matter is a clarion call for racial equality and racial justice. With the arrival of Africans as slaves in 1619, a racial hierarchy was formed in the United States. However, slavery is commonly dismissed as that less than noble aspect of the United States' history without really confronting the legacies of racial inequality and racial injustice left in its wake. White supremacy, based on the myths of white superiority and Black inferiority, have obscured racial inequality and racial injustice, resulting in blaming the victims. Using Black Lives Matter as a platform, we focus on some key considerations for theory, research, education, training, and practice in clinical, community, and larger systems contexts. Broadly, we focus on Black Lives Matter, literally; Black dehumanization; historical oppression; healing; and implications for the field of family therapy. More specifically, we draw attention to health disparities, mass incarceration and aggressive policing, intergenerational racial trauma, restorative justice, and antiracist work.

El movimiento Black Lives Matter (Las vidas de los negros son importantes) es un llamamiento a la igualdad y la justicia racial. Con la llegada de los africanos como esclavos en el año 1619, se formó una jerarquía racial en los Estados Unidos. Sin embargo, la esclavitud generalmente se desestima como el aspecto menos noble de la historia de los Estados Unidos sin afrontar realmente los legados de desigualdad e injusticia raciales que dejó. La supremacía blanca, basada en los mitos de la superioridad blanca y la inferioridad negra, han ocultado la desigualdad y la injusticia raciales, lo cual condujo a la culpabilización de las víctimas. Utilizando el movimiento Black Lives Matter como plataforma, nos centramos en algunas consideraciones clave para la teoría, la investigación, la educación, la capacitación y la práctica en contextos clínicos, comunitarios y en sistemas más grandes. En líneas generales, nos centramos en Black Lives Matter, literalmente; en la deshumanización de los negros, la opresión histórica, la recuperación, y las consecuencias para el área de la terapia familiar. Más específicamente, visibilizamos las desigualdades sanitarias, el encarcelamiento masivo y la vigilancia policial agresiva, el trauma racial intergeneracional, la justicia reparadora y la labor antirracista.

The Musings of a Family Therapist in Asia When COVID-19 Struck.

In response to the COVID-19 crisis in Asia, a family therapist in Hong Kong shares her experiences and reflections, both personally and professionally from an Eastern lens. From a state of shock and immobilization to moments of contemplation, she highlights her struggle with being caught between her Eastern roots and Western training, which has become more salient in facing COVID-19. While the latter pulls her toward a more problem resolution stance, the former pulls her toward a more accepting position. As a result, her therapy is shaped in such a way that she tends to raise more questions instead of providing answers.

En respuesta a la crisis de la COVID-19 en Asia, una terapeuta familiar en Hong Kong comparte sus experiencias y reflexiones, tanto a nivel personal como profesional, desde una perspectiva oriental. Desde un estado de conmoción e inmovilización a momentos de contemplación, ella destaca sus dificultades al sentirse atrapada entre sus raíces orientales y su formación occidental, que ha adquirido más importancia a la hora de enfrentar la COVID-19. Si bien la última la lleva hacia una postura más orientada a la resolución de problemas, la primera la inclina hacia una postura más aceptadora. Como resultado, su terapia está moldeada de tal manera que ella tiende a plantear más preguntas que a ofrecer respuestas.

Family Science in the Context of the COVID-19 Pandemic: Solutions and New Directions.

The coronavirus disease 2019 (COVID-19) pandemic has precipitated substantial global disruption and will continue to pose major challenges. In recognition of the challenges currently faced by family scientists, we share our perspectives about conducting family research in the context of the COVID-19 pandemic. There are two primary issues we address in this article. First, we present a range of potential solutions to challenges in research, resulting from the pandemic, and discuss strategies for preserving ongoing research efforts. We discuss approaches to scaling back existing protocols, share ideas for adapting laboratory-based measures for online administration (e.g., using video chat platforms), and suggest strategies for addressing missing data and reduced sample size due to lower participation rates and funding restrictions. We also discuss the importance of measuring COVID-19 relevant factors to use as controls or explore as moderators of primary hypotheses. Second, we discuss how the COVID-19 pandemic represents a scientifically important context for understanding how families adjust and adapt to change and adversity. Increased stress precipitated by the pandemic, varying from acute stress associated with job loss to more chronic and enduring stress, will undoubtedly take a toll. We discuss ways that family scientists can contribute to pandemic-related research to promote optimal family functioning and protect the health of family members.

La pandemia de la enfermedad por coronavirus 2019 (COVID-19) ha precipitado una alteración mundial considerable y continuará planteando grandes dificultades. En reconocimiento de las dificultades que enfrentan actualmente los científicos especializados en familias, compartimos nuestras perspectivas acerca de llevar a cabo investigaciones sobre la familia en el contexto de la pandemia de la COVID-19. Hay dos cuestiones principales que abordamos en este artículo. Primero, presentamos varias posibles soluciones a las dificultades que surgen como consecuencia de la pandemia y explicamos estrategias para mantener los esfuerzos de las investigaciones en curso. Debatimos la necesidad de reducir los protocolos existentes, compartimos ideas para adaptar medidas basadas en laboratorios y administrarlas en línea (p. ej.: el uso de plataformas de videollamadas), y sugerimos estrategias para abordar datos faltantes y un tamaño reducido de las muestras debido a los índices más bajos de participación y a las restricciones de financiación. También debatimos la importancia de medir factores relevantes de la COVID-19 para usar como controles o analizar como moderadores de hipótesis principales. Segundo, explicamos cómo la pandemia de la COVID-19 representa un contexto científicamente importante para comprender cómo las familias se ajustan y adaptan al cambio y a la adversidad. El aumento del estrés precipitado por la pandemia, que varía de un estrés agudo asociado con la pérdida del empleo a un estrés más crónico y duradero, indudablemente causará estragos. Debatimos las maneras en que los científicos de familia pueden contribuir a investigaciones relacionadas con la pandemia a fin de promover un funcionamiento familiar óptimo y proteger la salud de los miembros de la familia.

Enveloping Mothers, Enveloped Sons: Positions in Chinese Family Therapy.

The increasing acceptance and use of psychotherapy in contemporary China powerfully attests to the "psychologization" of Chinese society. Yet attending therapy is only one aspect of psychologization. Analyzing the practice of therapy through case examples illuminates the broader sociocultural context of China's "psycho-boom." This includes insight into what I term an expansive-I notion of personhood. This non-singular notion of personhood is a major challenge for Chinese therapists. Therapists' attempts to resolve clients' problems by reorienting them according to psychological ideals highlight the multiple, at times contradictory relationships between psychotherapy, the state and families.

Global Mental Health: A Call for Increased Awareness and Action for Family Therapists.

Global mental health (GMH) is an emerging field that focuses on the need for culturally sensitive mental health services in low- and middle-income countries (LMICs). While many new initiatives have been established worldwide to understand GMH needs and to provide care in LMICs, family therapists have primarily worked with families in high-income countries. The few existing family-based initiatives in GMH focus on psychoeducation and are typically not based on general systems theory. However, emerging trends in family therapy may enable family therapists to impact mental health issues in LMICs. These trends, which are shared interests of both family therapy and GMH, include collaborative care, a growing emphasis on the importance of culture in understanding and treating mental health issues, recognition of the ability of families to support or impede recovery from mental illness, and the use of strength-based and evidence-based treatments. This paper describes ways for family therapists to become active in the GMH community.

Multidimensional Family Therapy: Evidence Base for Transdiagnostic Treatment Outcomes, Change Mechanisms, and Implementation in Community Settings.

This article summarizes the 30+-year evidence base of Multidimensional Family Therapy (MDFT), a comprehensive treatment for youth substance abuse and antisocial behaviors. Findings from four types of MDFT studies are discussed: hybrid efficacy/effectiveness randomized controlled trials, therapy process studies, cost analyses, and implementation trials. This research has evaluated various versions of MDFT. These studies have systematically tested adaptations of MDFT for diverse treatment settings in different care sectors (mental health, substance abuse, juvenile justice, and child welfare), as well as adaptations according to treatment delivery features and client impairment level, including adolescents presenting with multiple psychiatric diagnoses. Many published scientific reviews, including meta-analyses, national and international government publications, and evidence-based treatment registries, offer consistent conclusions about the clinical effectiveness of MDFT compared with standard services as well as active treatments. The diverse and continuing MDFT research, the favorable, multi-source independent evaluations, combined with the documented receptivity of youth, parents, community-based clinicians and administrators, and national and international MDFT training programs (U.S.-based organization is MDFT International, www.mdft.org; and Europe-based organization is www.mdft.nl) all support the potential for continued transfer of MDFT to real-world clinical settings.

25 years of systemic therapies research: progress and promise.

OBJECTIVE: In this article we describe and assess the state of the science on systemic psychotherapies. In the quarter century since the first issue of Psychotherapy Research was published, considerable progress has been made. There is an increasingly solid evidence base for systemic treatments, which includes a wide range of approaches to working conjointly with couples and families. Moreover, there are exciting new developments that hold promise for explicating the dynamic processes of therapeutic change in couple and family systems. METHOD: We begin by explaining how we view "systemic therapies" as different from individual approaches and then summarize what we have learned in the past 25 years about this set of treatments, how we have learned it, and what we have yet to learn. RESULTS AND CONCLUSIONS: We consider current trends in research on outcomes and change process mechanisms, and end with speculations about what lies ahead in the interrelated domains of systemic research and practice.

Review of family therapy and dementia: twenty-five years on.

BACKGROUND: We reviewed the literature on family therapy and dementia to investigate the following: what is known about the use of family therapy in the context of living with dementia; what are the challenges of working in this context; and what guidelines/models are available to guide family therapists working with families living with dementia. METHODS: We searched English language literature from 1992 onwards, classified the resulting papers into broad categories of theoretical, expository, or research (descriptive, quantitative, or qualitative), and conducted a narrative review to draw learning points from the identified papers. RESULTS: In total 31 papers were identified: five theoretical, 11 expository; and 15 research papers. Several papers described methodologies; psychotherapeutic interventions applied to family members; or complex intervention packages in which the role of family therapy could not be separately identified, rather than family therapy. A range of outcomes were investigated, often involving the caregiver. Several authors suggest areas in dementia care where family therapy is likely to be beneficial. CONCLUSIONS: Although the literature on family therapy and dementia has grown over the past 25 years and suggests potentially useful roles for therapy, a number of challenges exist in terms of context, family, and therapy itself. There is a need for further research, particularly into the following fields: How to evaluate the success of therapy; how to ensure treatment integrity; how to make techniques from family therapy available more widely; and how to train the health and social care workforce in working with families.

Family therapy in Brazil: current status.

In the last three decades there has been a noticeable trend in the redefinition of the nuclear family in Brazil. A recent increase in the rates of divorces and paradoxically also in the rates of marriages, the legalization of same-sex unions and adoption by these couples, and the phenomenon of teenage pregnancy are some of the aspects that reflect on the current Brazilian family. This review highlights these changes and describes how family therapists in Brazil are facing the challenge of assisting these families, in a continental-sized country with uneven distribution of training courses and healthcare assistance.

Predictors of patient and caregiver distress in an adult sample with bipolar disorder seeking family treatment.

Little is known about the potentially unique sources of distress in populations seeking family-oriented treatment for bipolar disorder. The present study aimed to characterize this new treatment population by measuring depression, anxiety, quality of life, knowledge of bipolar disorder, therapeutic alliance, and mental illness stigma in 43 bipolar patients and 41 caregivers at family treatment intake. In all, 50% of patients and 27.6% of caregivers had significant depressive symptoms, whereas 51.2% of patients and 45.5% of caregivers had significant anxiety symptoms. Caregiver anxiety was inversely related to patient anxiety, stigma, and poor alliance. Treatment nonadherence was associated with more anxiety and stigma in patients and less anxiety in caregivers. In summary, family-oriented bipolar treatment seekers are significantly distressed at intake, and may benefit from lowering anxiety and stigma in patients and raising awareness and concern in caregivers. Future research should further clarify the complex relationships between caregiver and patient symptoms and attitudes.

[Dietary interventions and social care for treating obesity in children]. / Therapie der Adipositas aus sozialpädiatrischer, ernährungstherapeutischer und gesundheitswissenschaftlicher Sicht.

The prevalence of obesity and associated comorbidities among children and adolescents has risen worldwide throughout the past 3 decades. To break this trend, population-based activities in health promotion/prevention and health care are necessary. Studies showed that long-term eating behavior improvement with the cooperation of the patient's family together with child-friendly organization support both individual therapeutic improvements as well as a relevant reduction of obesity prevalence. A significant BMI reduction can be achieved with a normal varied diet, whose energetic value is 300-400 kcal/day below the patient's daily energetic needs, due to the lower consumption of fat and sugar. This requires, however, that the entire family be willing to change their unhealthy eating behaviors (e.g., soft drinks and fast food) and to introduce regular meals into their daily routine. Sensibly, most therapies combine diet therapy with increased physical activity and parental training. Controlled media consumption, active leisure-time behavior, and a structured daily routine are further conditions for successful weight reduction. The high-risk groups for pediatric obesity, i.e., families with migration background and/or low socioeconomic status, have been poorly reached by established programs.

Review of family-based psychosocial interventions for childhood cancer.

OBJECTIVE: To report the findings of a systematic review of family-based psychosocial interventions with pediatric oncology populations. METHODS: A number of intervention studies documenting psychosocial interventions for childhood cancer populations, that incorporated multiple family members, were examined. RESULTS: Twenty-one studies were identified that met the criteria for inclusion and provided the data necessary for synthesizing the results. Findings illustrate that multiple family members are integrated into interventions for childhood cancer in a number of ways. Considerable variation was observed regarding the family member combinations targeted and the intervention modalities employed. A minority of interventions met the criteria for empirically validated treatments; however, evidence of beneficial outcomes was observed across the majority of interventions reviewed. CONCLUSIONS: Findings suggest the feasibility, acceptability, and potential effectiveness of family-based psychosocial interventions in pediatric oncology. Recommendations for conducting future intervention studies are provided including the integration of qualitative methods in evaluations of family-based interventions.

Early intervention of eating- and weight-related problems.

Obesity and other eating-related problems are widespread and are associated with harmful physical, psychological, and social problems. The dramatic increases in rates of pediatric obesity has created a mounting need for psychologists and other mental health care providers to play a significant role in the assessment and treatment of youth with eating- and weight-related problems. Therefore, it is imperative for providers to be aware of the causes and consequences of eating- and weight-related problems and to be familiar with evidence-based assessment and intervention approaches. Currently, the most well-established intervention approaches are family-based behavioral treatments, and weight loss maintenance treatments with a socio-ecological focus are promising. This paper provides a comprehensive review of these topics and highlights the important roles that mental health care providers can have. Medical settings are often the patient's first point of contact within the healthcare system, making mental health care providers in such settings uniquely suited to assess for a broad range of eating- and weight-related problems and associated comorbidities, to deliver relevant evidence-based interventions, and to make appropriate referrals. Moving forward, providers and researchers must work together to address key questions related to the nature of eating- and weight-related problems in youth and to achieve breakthroughs in the prevention and treatment of such problems in this vulnerable population.