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Carr, Alan
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Carr, Alan
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Carr, Alan
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- PublicationPhysical child abuse: A comprehensive family based approach to treatmentPhysical abuse within the family may be conceptualized as the outcome of a complex process in which a child with particular characteristics which rendered him or her vulnerable to abuse, is injured by a parent involved in an ongoing problematic behaviour pattern, subserved by particular belief systems and constrained by historical, contextual and constitutional predisposing factors. When families are referred by statutory child protection agencies to therapy services for treatment, initially a contract for comprehensive assessment should be established with the family and referrer. Assessment should involve interviews with all members of the child system and should cover relevant risk and protective factors and a verbal reconstruction of the abusive incident. A contract for treatment may be offered if the assessment shows that the parents accept responsibility for the abuse, are committed to meeting their child's needs, are committed to improving their own psychological wellbeing and where they have the ability to change. Treatment should be based on clear contracts to meet specific targets. Treatment and case management plans involve a central focus on improving parent-child interaction through direct work with parents and children together. This may be supplemented with couples work, interventions in the wider system and individual work for parents focusing on parent-craft and the management of personal difficulties such as mood and anger regulation. Children may also receive input in therapeutic pre-school placements.
117 - PublicationThe development of family therapy in IrelandIn Ireland family therapy is a small profession, with under 200 registered therapists. The Irish family therapy movement began in the mid-1970s. By 1980 the Family Therapy Network of Ireland in the Republic of Ireland and the Northern Ireland Branch of the UK Association Family therapy had been founded. At present there are three main family therapy training centers in Ireland: two in the south (the Mater University Hospital, affiliated to University College Dublin and Clanwilliam Institute) and one in the north (at Queen’s University Belfast). There is no statutory registration and licensing of family therapists in Ireland. Accredited professional family therapy programs in Ireland are 4-year part-time courses culminating in masters level qualifications. A primary degree in medicine, nursing, psychology, social science or education is a prerequisite for entry. Family therapists in Ireland work in both private practice and the public health service. Most family therapists in the public sector are employed as social workers, psychologists, psychiatrists or nurses, and conduct family therapy as part of their broader professional roles. Couple therapy in Ireland is provided by family therapists, and also by voluntary couple counselors based in networks of local centers, some of which were originally religiously affiliated, without a formal connection to national family therapy associations. The three major future challenges for Irish family therapy are creating a research infrastructure, developing a career structure in the public health service, and introducing statutory registration.
1649Scopus© Citations 5 - PublicationResistance, dilemmas and crises in family therapy: a framework for positive practiceWhen clients believe that they have not got the personal resources to cope with the demands of either living with their problems or taking steps towards the resolution of these, stating their therapeutic dilemma may precipitate a therapeutic crisis. A therapeutic dilemma is a concise statement of the disadvantages and difficulties associated with leaving the presenting problem unresolved and the disadvantages and risks entailed by solving the problem. Invariably, therapeutic crises involve some family members doubting an interactional formulation of the family's problems and redefining these as individual difficulties of a specific family member. That is, someone in the family becomes defined as bad, sad, sick or mad. The pressure to collude with the family and other network members in abandoning an interactional construction of the problem and accepting an individual description is usually very intense. When therapists follow this route they become part of the problem maintaining system. In this paper a framework for conceptualizing therapeutic crises and guidelines for their management are described. These guideline allow the therapist to avoid becoming involved in problem maintenance and to retain a position from which to promote problem resolution. The framework and guidelines evolved within the context of a brief integrative approach to consultation with families who require help with child-focused psychosocial difficulties.
322Scopus© Citations 2 - PublicationThematic review of family therapy journals in 2013In this article the contents of the principal English-language family therapy journals and key family therapy articles published in other journals in 2013 are reviewed under these headings: models of family therapy, developments in family therapy practice, couple therapy, training, diversity, international developments, research and DSM-5.
415Scopus© Citations 1 - PublicationThematic review of family therapy journals 2012In this article the contents of the principal English-language family therapy journals, and key family therapy articles published in other journals in 2012 are reviewed under these headings: therapy processes in the treatment of child-focused problems, autism, adolescent substance use, human immunodeficiency virus, depression and grief, fragile families, mental health recovery, medical family therapy, family business and systemic practice, couple therapy, intimate partner violence, key issues in theory and practice, research, diversity, international perspectives, interviews, and deaths.
688Scopus© Citations 3 - PublicationMilan systemic family therapy: a review of 10 empirical investigationsTen empirical investigations of Milan Family Therapy (MFT) are reviewed in this paper. The studies include both single and comparative group outcome trials; investigations of therapeutic process; clinical audit and consumer satisfaction surveys. Substantive findings and methodological issues are discussed in the light of family therapy and individual psychotherapy research generally. Findings indicate that MFT may lead to symptomatic change in two-thirds to three-quarters of cases and to systemic change in half the treated cases. Engagement of fathers may be important for positive outcome. Technical aspects of MFT, such as the use of screens and teams, may lead to client dissatisfaction in some cases. MFT-based consultation may be effective in resolving therapeutic impasses. Coupled with short-term residential placement, MFT may reduce the risk and complexity of cases as rated by referring social workers.
1319Scopus© Citations 15 - PublicationFamily therapy and clinical psychologyThe results of a survey of 111 clinical psychologists in the Republic of Ireland along with some comparable data from US and UK surveys were used to address a series of questions about the link between family therapy and clinical psychology. Family therapy was not a clearly identifiable sub-specialty within clinical psychology in Ireland. Family therapy theoretical models were used by more than a quarter of the Irish sample to conceptualize their work but by less than a tenth of US and UK respondents. In all three countries about a tenth of treatment time was devoted to the practice of family therapy. In Ireland, the use of family systems models, family assessment interviews and family therapy was more common within the child and family specialty than within the mental handicap or adult mental health clinical psychology specialties. The experience of live supervision and participation in family or couples therapy were important formative factors in the development of some clinical psychologists. Further training in systemic consultation, particularly in situations where an abuse of power has occurred, was identified in the survey as a priority area for continuing professional development. The evolving relationship between family therapy and clinical psychology is discussed in the light of these findings.
378 - PublicationDe Milanese systeemgerichte gezinstherapie: een overzicht van tien empirische onderzoekenIn dit artikel wordt een samenvattend overzicht gegeven van tien empirische onderzoeken van de Milananese gezinstherapie (MGT). Deze betreffen effect-onderzoeken met en zonder vergelijkingsgroepen, onderzoeken van het therapeutisch proces, onderzoeken waarin gebruik wordt gemaakt van klinische intercollegiale toetsing van de kwaliteit van het werk en onderzoeken die de tevredenheid van de clienten peilen.
278 - PublicationThe effectiveness of family therapy and systemic interventions for adult-focused problemsThis review updates a similar paper published in JFT in 2000. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of couples and family therapy for adults with various relationship and mental health problems. The evidence supports the effectiveness of systemic interventions, either alone or as part of multimodal programmes, for relationship distress, psychosexual problems, domestic violence, anxiety disorders, mood disorders, alcohol abuse, schizophrenia and adjustment to chronic physical illness.
8033Scopus© Citations 107 - PublicationHistory of family therapy in Ireland. 2. Profiles of key figuresThis paper presents profiles of individuals who have contributed to the development of family therapy in Ireland. An overview of the history of family therapy in Ireland is given in a companion paper. This paper profiles five of the founders of family therapy in the Republic of Ireland (Nollaig Byrne, Imelda McCarthy, Phil Kearney, Ed McHale and Jim Sheehan); two founders of family therapy in Northern Ireland ( Isobel Reilly, Artie O’Neill , and Arlene Healey) and others who have made distinctive contributions to the Irish family therapy movement (Barbara Kohnstamm, Jo Kennedy, Bernadette O’Sullivan and myself).
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