Abstract
Dr. Robert T. Constable and Dr. Daniel B. Lee utilize a family life cycle approach to teach students and clinicians how to intervene with family members who experience instability in their family due to relational issues that undermine their family’s ability to function. This very useful volume that focuses on family interaction, family strengths and resilience, and social work interventions within a transcultural perspective enables the reader to gain new skills in helping these individuals across cultures in completing their tasks, enhancing their relationships, and stabilizing their family. In a synthesis of family therapy interventions to focus on family strengths, Constable and Lee reflect confidence that this text affirms their purposes of introducing students and clinicians to both family therapy and social work with families.
Constable and Lee bring a wealth of academic knowledge, practice skill, and clinical insights and judgments as experienced social work faculty members and clinicians to the knowledge and skills this book presents. The volume includes 12 chapters of between 20 and 25 pages each. Each chapter includes content that fully supports the focus of the chapter and the book’s broader goal of educating the reader in social work practice with families. Each chapter also includes skillfully composed and relevant case examples that illustrate the content, focus, and issues in the chapter, as these cases enable the reader to gain practice skills and insights into the chapter’s topics. Frequent references and content support the use of empirically supported interventions in helping family members achieve their goals and moves beyond “practice wisdom.” A list of between 7 and 18 discussion questions follows each chapter. A very useful reference list is included at the end of each chapter, too.
While neither the author nor the publisher uses the following framework, the book’s chapters and content may be organized in the following framework that offers the reader a structural focus that supports the goal of educating the reader in social work practice with families.
Chapters 1 through 3 introduce the reader to basic information and research on families, social work practice, and the family life cycle. Chapter 1 discusses the strengths perspective as a theoretical foundation in working with families. The chapter presents various ideas that shaped family work over time such as the helping relationship, casework, and the transactions between a family and its wider environment. The chapter closes with content on topics such as the roles families have for meeting their members’ needs, coping styles among families that are resilient, and the transcultural perspective. In discussing the effectiveness of family practice, Constable and Lee cite Gruman’s (2001) research and state, “A number of approaches to couples intervention were validated by random clinical trials (RCT)” (p. 11). Constable and Lee also briefly discuss 3 studies of 38 random clinical trials (RCTs) of family intervention, 47 RCTs of child and adolescent externalizing behavior, and 38 RCTs of child and adolescent internalizing behavior and conclude that systemic therapy is more efficacious than control groups. Constable and Lee state, “In these studies, described in greater detail in chapter 12, for the broad majority of each group (34/38, 42/47, 33/38), systemic therapy was either significantly more efficacious than control groups without a systems-oriented intervention, or systemic therapy was more efficacious than other evidence-based interventions” (p. 12).
Chapter 2 probes the relational issues families face. It explores family membership, the “person-in-relation” within the family as “I” and “me,” attachment theory, and relational change and development. Two case examples are presented and discussed.
Chapter 3 discusses the family life cycle, relational tasks, language, and communication. Some of the content here is foundational, and the authors make excellent use of this section to truly educate the clinician in the stages of family development and related tasks such as the new couple’s effort to differentiate from the family of origin. Helpful content on situational stress, poverty, and discrimination and assessment complete the chapter. Four case examples are included in this chapter.
Chapters 4 and 5 provide excellent foundation knowledge on family interaction and structure and in assessment and intervention with families in a multicultural world. In Chapter 4, Constable and Lee offer a wealth of information on family structures based on perceptions and interactions by using a reflective, historical approach that leads to a discussion of behavioral research on couples’ relationships over the last 30 years. In a case example that illustrates this content, Drs. Constable and Lee discuss the four negative patterns of communication that Gottman labeled the “four horsemen,” criticism, defensiveness, contempt, and stonewalling that, “ … if prolonged, almost unfailingly predict marital split” (p. 81).
Methods that repair communication interactions are highlighted as are issues of bonding, role development, the structural perspective in family therapy, and relational change through interaction and communication. Chapter 4 includes three case examples that illustrate the concepts this chapter probes.
Chapter 5 supports the book’s transcultural perspective by discussing the assessment intervention with families in a multicultural world. The very informative section on the importance of culture leads into an examination of the transcultural perspective. “The transcultural perspective assumes that culture is diverse, active, and adaptable, building on its own core assumptions, rather than being static and monolithic” (p. 117). The chapter includes very helpful content on the seven case examples as it explores transcultural assessment and intervention. The authors also offer a very helpful and insightful discussion on working with couples in same-sex relationships while also offering a “Resource List for Work with GLBTQ Couples.”
Chapters 6 through 9 form the next major section of this book, where the focus is on interventions with couples and families during the beginning and middle phases of development.
Chapter 6 begins with content on the newly married couple that seeks a secure relational base by discussing personal and couples tasks. Two case examples are included in this section. The chapter continues with interesting content on helping couples with family of origin and communication issues while also giving the reader an in-depth orientation to how a clinician begins his or her work with couples by analyzing the dynamics and content of the first contact, the opening phase of intervention, creating a suitable holding environment, assessment, and problems in developing commitment to treatment. The authors are fairly directive in educating the clinician in what skills the worker should develop. A total of seven case examples are provided in this chapter.
Chapter 7 describes middle stage work with couples that help them improve problem-solving skills and relational capacities. Some of the issues in this chapter are intimacy, boundaries, communication, and empathic accuracy. The bulk of the chapter details middle stage work with six different couples via the case examples that Constable and Lee provide. The chapter closes with the authors discussing the needs of families, the social worker as a person, and the helping process.
Chapter 8 shifts its focus from working solely with couples to working with couples and families of two or more generations. The types of families Constable and Lee present range from a couple with children to families, where the parents are divorcing and blending with another family by remarriage and the family in late adulthood. Constable and Lee guide the reader on the initial tasks of working with these types of families by including content on beginning with families with children and middle stage work with families that have school-aged children and families that include adolescents. Families in the later stage of life are discussed as are the issues of separating from the family and generational tasks. There are nine case examples in this chapter, and they present “real-world” examples of families that instruct and challenge the social worker in preparing to effectively intervene with these diverse family types.
Chapter 9 discusses issues of radical family reconstruction that may occur during middle stage interventions. The family may benefit from interventions to reconstruct the family as a result of membership losses and transitions such as divorce and creating a new family form by blending. Constable and Lee discuss the dangers of triangulation, dysfunctional beliefs and cognitions, and underorganized families. Four case examples are included in the chapter as is a discussion of family life education for postdivorce families.
Constable and Lee highlight work with families that include community organizations in Chapters 10 and 11. Chapter 10 probes clinical work between families and institutions such as schools, child welfare, and the juvenile court. The authors adopt a systems perspective on their approach to this content, and one can readily appreciate this content if one is familiar with resources such as an ecomap. Chapter 10 opens with a discussion of the relationships a family may experience with social institutions such as those agencies related to health, education, religion, and the judicial system. Families that are dealing with the child welfare and judicial systems are profiled in the chapter as they confront issues related to family preservation, substitute care arrangements, and juvenile court proceedings. Six different cases are presented in the chapter to illustrate the predicaments the families in the chapter confront and the social workers seek to mediate.
Chapter 11 is similar to Chapter 10 in format but deals with the outside social institutions of health care, mental health, and community resource networks. Constable and Lee sensitize the reader to the impacts illness and disability have on the family. The authors wisely include information on the family’s response to and interaction with the health-care system in order that one has a broad perception of care, appreciates the transactions between illness and care, is aware of the predictable illness sequences one may experience, and maintains a strengths perspective on families as they respond to crises of health and wellness. The chapter closes with content on mental health issues such as psychoeducation for families that have a member diagnosed with schizophrenia, posthospital work in mental health, and outpatient work in mental health. A closing section discusses working between families and community resource networks. Six case examples are included in this chapter.
Chapter 12 discusses closing processes with families and the work of evaluating the effectiveness of couple and family work. Helpful information on social workers and the ending process leads to a return to nine families that are presented in earlier chapters in order that the reader can learn how the clinician ends his or her work and relationships with these families. Constable and Lee discuss the timing of endings, difficult and complex endings, incomplete or premature endings, and time as a medium for the helping process. The authors also discuss research findings on the outcomes and effectiveness of couple and family work, research on components of the helping process, and social work outcomes on these issues.
Constable and Lee discuss the work of Hubble, Duncan, and Miller (1999) and the four therapeutic factors that account for client improvements through the helping process: (1) client extratherapuetic factors account for 40% of outcomes (e.g., client strengths and needs); (2) relationship factors (e.g., the interpersonal connectedness of the therapeutic relationship) account for 30% of the outcome; (3) placebo, hope, and expectancy factors (i.e., a belief that change can occur) account for 15% of the outcome; (4) model-specific factors (i.e., the philosophical underpinnings, goals, techniques, and anticipated outcomes of the intervention model) account for 15% of the outcome.
Constable and Lee also summarize the five factors associated with positive client outcomes applied to social work practice that Cameron and Keenan (2010) describe. These five factors are (1) social network factors: supportive values, client social support, and whether the client’s social support views social work practice as credible; (2) social worker/helper factors: the worker’s well-being, acceptance, empathy, warmth, and genuineness; (3) client factors: for example, distress, hope, and expectation of change; (4) relationship factors: engagement in the relationship, communication, and agreement on problems, goals, and collaboration; and (5) practice strategies: developing a rational for change, modeling, feedback, and knowledge within the context of skillful use of strategies and skills relative to the person(s), process, and the situation of all five factors.
Constable and Lee conclude Chapter 12 by noting studies that support the effectiveness of couples’ and family work. Supporting the effectiveness of couples’ work are studies by Gurman and Knishkern (1986) and Lebow (2013) among others. These studies state that “Positive outcomes are realized in about two thirds of couples, and this overall improvement rate affirms that the average treated couple is better off at termination than about 70 percent to 80 percent of untreated couples, paralleling the rates for most individual psychotherapy” (pp. 313–314).
Constable and Lee also note that couple therapy has a positive effect among adult disorders such as anxiety, alcoholism, and depression that also occur amid couple conflict. In discussing the effectiveness of family work, Constable and Lee return to the three studies they cite in Chapter 1 to discuss the efficacious nature of family systemic therapy. Little empirical data are cited other than the outcomes, which note that 42 of 47 RCTs, 33 of 38 RCTs, and 34 of 38 RCTs show that systemic therapy is more efficacious than a control group and more efficacious than other evidence-based interventions such as Cognitive Behavior Therapy (CBT), psychodynamic therapy, behavioral family therapy/parent training, and other approaches. The content that explores the efficacious aspects of systemic family therapy serves as a fitting conclusion to the entire book, since a summative conclusion or epilogue is not included in this text.
This book is a very informative source for advanced undergraduate and graduate social work students who seek to develop skills in social work practice with families. Constable and Lee use a developmental, linear approach to the book’s structure and content. Each chapter progressively educates the reader as he or she develops clinical skills in social work practice with families.
This textbook’s format is extremely useful due to the depth of the content; thoughtful discussion questions at the end of each chapter that compel the reader to apply the chapter’s content; a very useful, comprehensive reference list for each chapter; and a number of well-developed case examples that illustrate the content in the chapter. On a practical note, the book for this review easily fits into a book bag without adding much weight as a paperback; in essence it is a book that students could bring to class with very little effort.
The publisher’s website makes a sample syllabus available to faculty who use this textbook, but there are no other support materials unless this content is available via a special website for those who use the book in class.
This is a wonderful textbook that ends one’s search for a scholarly resource to educate students in the art of social work practice with families. The book is filled with excellent content, challenges the reader to build clinical skills in this area of practice, and comes in a very user-friendly, hard-copy format.