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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.
108 - PublicationEvaluation of the Genesis Counselling ServiceCorduff Counselling Service was the forerunner of the Genesis Psychotherapy Family Therapy Service (hereafter referred to as Genesis). It was established in 1993 by the Corduff Community Core Group as a community service to provide psychotherapy and counselling to individuals, couples and families in Corduff and the Greater Blanchardstown area. It was initially set up and managed by voluntary staff, who had trained at the Clanwilliam Institute, to provide a systemic family therapy service to clients in the local community. Over an 11 year period the service has developed considerably in size and professionalism and now serves the Dublin 15 area or Community Care Area 6. The aim of this service evaluation and review was to assess the effectiveness of Genesis and identify the optimal path for future development.
528 - PublicationHistory of family therapy in Ireland. 1. A bird's-eye viewThis paper presents an overview of the history of family therapy in Ireland. Profiles of key figures in the development of family therapy in Ireland are contained in a companion paper. In 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 centres in Ireland: two in the south (the Mater Hospital, affiliated to University College Dublin and Clanwilliam Institute) and one in the north (at Queen’s University Belfast). These centres run professional family therapy training programmes accredited by national and European psychotherapy associations, with which family therapists register. Accredited professional family therapy programmes 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. The curriculum includes academic tuition and research, clinical practice, and personal development. 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 counsellors based in networks of local centres, some of which were established by religiously affiliated organizations, 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.
1134 - PublicationResearch on the therapeutic alliance in family therapyThe chapter opens with a brief description of therapeutic alliance assessment scales that may routinely be used in clinical practice and then research which highlights the strong relationship between the therapeutic alliance and outcome in marital and family therapy is discussed. The remainder of the chapter is a selective review of process research which points to specific practices that therapists may incorporate into their own styles to improve the quality of therapeutic relationships.
1526 - PublicationFathers in family therapy: Lessons from researchTreatment outcome research has shown that for 2/3 to 3/4 of cases family therapy is an effective intervention for child focused problems. One factor that has consistently been shown to enhance the effectiveness of family therapy is father involvement. Where fathers do not attend at least some therapy sessions, it is more likely that the family will drop out of treatment or that therapy will not lead to problem resolution. An important question arising from this finding is how best to engage fathers in family therapy and how to create opportunities within therapy for fathers to contribute to resolving presenting problems. In this paper the implications for clinical practice of research on the role of fathers in families and family therapy will be explored.
144 - 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).
716 - PublicationChild sexual abuse: A comprehensive family based approach to treatmentNarrow definitions of CSA which focus on repeated penetrative abuse yield prevalence rates of 2% and 4% for males and females respectively. Most abusers are male. About two thirds of all victims develop psychological symptoms and for a fifth these problems remain into adulthood. Children who have been sexually abused show a range of conduct and emotional problems coupled with oversexualized behaviour. Traumatic sexualization, stigmatization, betrayal and powerlessness are four distinct yet related dynamics that account for the wide variety of symptoms shown by children who have been sexually abused. The degree to which children develop the four traumagenic dynamics and associated behaviour problems following sexual abuse is determined by stresses associated with the abuse itself and the balance of risk and protective factors within the child's family and social network. Case management requires the separation of the child and the abuser to prevent further abuse. A family therapy based multisystemic programme of therapeutic intervention should help the child process the trauma of the abuse and develop protective relationships with non-abusing parents and assertiveness skills to prevent further abuse. For the abuser therapy focuses on letting go of denial and developing and abuse free lifestyle.
224 - PublicationPutting families first: An evaluation of Functional Family Therapy in an Irish contextCurrent evidence suggests that up to 20% of Irish adolescents have significant behavioural problems, a figure consistent with results of epidemiological studies of youth mental health problems in other countries.Functional Family Therapy (FFT) has consistently been identified in authoritative international reviews as a family-therapy programme for treating adolescents at risk for juvenile delinquency with a particularly strong evidence-base including many controlled trials, and a well developed training and monitoring system for implementing FFT in new community-based sites.Between 2010 and 2014, a research programme to evaluate the effectiveness and implementation of FFT at Archways Families First was conducted by a research team at University College Dublin, in collaboration with Indiana University, and the team of FFT therapists at Archways Families First. The results of this programme, described in this summary report, provide strong support for the effectiveness of FFT as practiced at Archways Families First in reducing behaviour problems and the risk of juvenile delinquency.
476 - PublicationDepression and power in marriageTo investigate the association between depression and power within marriage, 14 couples in which the female partner was depressed were compared with 14 non-depressed couples on a range of variables which assessed power bases, processes and outcomes, three domains identified in Cromwell & Olson's (1975) analysis of marital power.
185 - PublicationTherapeutic dilemmas and crisis phonecalls in family therapy: Guidelines 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 their resolution, stating their therapuetic 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. In this paper, a framework for conceptualizing therapeutic crises and guidelines for theri management are described. These guidelines allow the therapist to avoid becoming involved in problem maintenance and to retain a position from whcih 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.
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