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Journal
of
Family
Therapy
(1979)
1:
253-269
Children
in family therapy
Christopher DareX andCaroline Lindsey-f-
The distinctive skills of child psychotherapy can be utilized in thedevelopment of a form of conjoint family therapy especially applicableto the field
of
child psychiatry. It
is
suggested that the engagementofchildren in the process particularly enhances the specific character-istics and potentialities of this form
of
treatment.
Family therapy as a treatment strategy has now been practised for morethan twenty-five years. During that time, social changes have occurredwhich have made it possible for the family, as a whole, to be seen as ‘thepatient’. Originally, family therapy as a clinical intervention developed inthe context of the ‘new’ family-orientated views of schizophrenia, both inthe U.S.A. and Great Britain.However, family interventionsbecamea logical outcome
of
changes in conceptualization of the origins of psycho-logical problems within the fields of child guidance and child psychiatry.This was particularly true of Great Britain, where the relatively scarceresource
of
individual psychotherapeutic skills outside the major centres,left a therapeutic gap which family therapy now appears to be filling. Inthe United States of America, the more wholeheartedly psychotherapeuticapproach within the mental health professions, resulted in conflict overthe establishment of family therapy,
and
psychoanalytic psychotherapistswhoworkwithchildren, onboth sides of the Atlanticarecommonly apprehensiveabout the pread of family therapy.Concernhasbeen expressed that the family therapy approach has three drawbacks:
1)
Thatthe individual needs of the child in the family will be lost in the welter
of
family events.
(2)
That the skills of making contactwithchildren andproviding them with
a
setting within which they can express their innerworlds, will not be developed (McDermott and Char,
1974).
(3)
That thechanges in personality structure and in the balance of internal conflicts,that are sought in ndividual psychoanalytic psychotherapy, will not occurin family therapy.These three preoccupations are important and valid but family therapy
*
Royal Bethlem and Maudsley Hospital, Denmarkill, London
SE5
8AZ.
-f
The Tavistock Clinic,
120
Belsize Lane, London
NW3
5BA.
253
01634445/79/030253+17 $02.00/0
0
979
The
Association
for
FamilyTherapy
 
254
C.
Dare and
C.
Lindsey
neednotcarry thesedisadvantages, if adequatemeasuresareaken. Within the child mental health professions, constant pressure is necessaryin order o keep the needs of childrenat thecentre
of
interest. Thefundamental skills of makingcontactwithchildren andunderstanding their inner worlds must be acquired.The present authors have drawn specific attention to the links betweencertain features of child psychotherapy and family therapy (Dare, 1975)and are engaged in developing a form of family therapy which is particu-larlyaimed at meeting the needs of families presentingwithyoung children, including pre-school and young latency age groups.We have conducted preliminary research into the outcome of our formof family therapy (Northey, 1974) and reported clinical outcome findings(Dare
et al.,
1976). These results encourage us to believe, firstly, that ourinterventions are symptomatically effective for a wide range of present-ing childproblemsand secondly, that changeoccurs in basic psycho- pathogenic processes in the family.In this paper are described our techniques of initiating children intofamily therapy, which whilst not strikingly different from that reportedby Ackerman (1966,
1970);
Satir 1964); Guttman (1975) and Zilbach
et al.
(1972), aredifferent rom the techniques ommonlyobservedemployed inGreat Britain and he
U.S.A.
The emphasis is upon heretention of amoreonsistenthildrientation throughout whole family reatments. This does notresult n neglect of adultneeds butavoids
a
possible risk of family herapy, namely that of it becomingmarital therapy in the presence of the children.Furthermore, Northey’s study suggested that following treatment thereare improvements in marital harmony (shown by diminution in expressedhostility between parents). We have found, repeatedly, improvement inwhole ystem unctioning, in erms of openness of communication,increased mutual regard of the needs of others, equalization of attentionpaid to
all
the children, with reduction of scapegoating, as well as decreasein individual symptoms
of
anxiety, depression, psychosomatic states andsome disorders of conduct (see Tables
1
and 2).The theoreticalrameworkusedor the understanding of family processes is derived from psychoanalytical conceptualizations of individualpsychological development, and interpersonal relations and from systemstheory. Systems theory and psychoanalytic views of the family are compli-mentary rather than antagonistic.
A
system cannot exist without trans-actional content and intrapsychic content
is
indubitably ordered by thestructured impingement of the external family system. Intergenerationalfactors show the continuous impact of the past on the present, both by
 
Children n family herapy
255
virtue of
the
intrapsychic expectations, beliefs and psychological structureof the individual family members, and
by
tendencies to
the
repetition
of
past sequences and patterns of family interactions
in
the current familylife.
Par excellence,
the oedipal triangle represents an internal conflict, aninterpersonal system and a multi-generational ‘myth’ system.TABLE
1.
Summary of major presenting problems of
50
cases taken on fortreatment
School non-attendancePsychosomaticEnuresisEducationally sub-normalAssessment for special educationDepressed-unhappyReferred as psychoticAntisocial problems at home and outside
13
9
3
2
3
S
2
10
Presented as a singlepatient’
42
Presented as
a
‘family problem’
S
TABLE
2.
Summary of outcome
At closure considered unchanged
6
Serious problems remaining but referredproblem alleviated
9
Re-referred
S
Referred foraritalreatment
4
At closure considered improved orconsiderablymproved
31
of 00

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