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A Filial Therapy Model Through a Family Therapy Lens : See the Possibilities
Nick Cornett
The Family Journal 2012 20: 274
DOI: 10.1177/1066480712449128
The online version of this article can be found at:
http://tfj.sagepub.com/content/20/3/274
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Nick Cornett1
Abstract
The call for family-centered therapeutic services, especially for families of young children, has come from governmental organizations, professional associations, practitioners, and families. Play therapists and family therapists are prime candidates to provide
such services, but professional research and literature suggest that practitioners within these fields tend to exclude members of
the family system. This had led some to propose filial therapy, an outgrowth of child-centered play therapy, as a means of meaningfully integrating parents and children in treatment. However, play therapists may have difficultly conceptualizing from a family
systems lens, while family therapists may struggle to see the theoretical compatibility of filial therapy with their systemic views.
This article demonstrates the conceptual overlap between filial therapy and the major family therapy models with the goal of
encouraging play therapists and family therapists to answer the call to provide family-centered services.
Keywords
play therapy, family therapy, filial therapy, family-centered child services, young children
The Call for Family-Based Services for Families With Young Children
Over recent years, there has been a resounding call for those in
the helping professions to provide family-based services for
families with young children. This call has come from governmental organizations, such as the U.S. Public Health Service
(2000), who published a national action agenda underscoring
the importance of researching, developing, and utilizing
evidence-based, family-centered treatment in addressing the
mental health of children. A similar call for involving families
in therapeutic services is evident in the ethical codes of major
professional associations (American Association for Marriage
and Family Therapy [AAMFT], 2001, 6.8; American Counseling Association [ACA], 2005, A.1.d.; American Psychological
Association [APA], 2010, 10.02; National Association of
Social Workers [NASW], 2008, preamble) and in the APAs
(2005) policy statement on evidence-based practice.
Across helping professions, practitioners have emphasized
the need for and the importance of family-centered assessment
and treatment (Perry, 2007; Pritchett et al., 2010; Reeves &
Anthony, 2009; Reinherz, Giaconia, Paradis, Novero, & Kerrigan, 2008; Tomlin & Viehweg, 2003; Wallander, Dekker, &
Koot, 2006). Research buttresses the importance of familycentered treatment in that caregiver involvement in the mental
health treatment of children is associated with better outcomes
(Bratton, Ray, Rhine, & Jones, 2005; Richards, Bowers,
Lazicki, Krall, & Jacobs, 2008).
Finally, families themselves seem to be actively seeking
such services. Research conducted by Sax (2007) reveals that
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Table 1. Integration of Family Therapy Approaches and ChildParent Relationship Therapy (CPRT)
Theory
Focus
Intervention
Systems
Identifying
systemic
patterns
Interactional
patterns
Brief strategic
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The Family Journal: Counseling and Therapy for Couples and Families 20(3)
have noted that parents reported improved parentchild relationships (Bavin-Hoffman, Jennings, & Landreth, 1996;
Edwards, Ladner, & White, 2007; Edwards, Sullivan, MeanyWalen, & Kantor, 2010; Foley, Higdon, & White, 2006; Garza,
Kinsworthy, & Watts, 2009; Kinsworthy & Garza, 2010; Lahti,
1992; Sangganjanavanich, Cook, & Rangel-Gomez, 2010;
Solis, Meyers, & Varjas, 2004; West, 2010; Wickstrom,
2009). In addition, qualitative studies conducted by BavinHoffman, Jennings, and Landreth (1996), Lahti (1992), and
Wickstrom (2009) have resulted in findings that are suggestive
of potential changes occurring in the family as a whole.
As illustrated through the theoretical arguments of its proponents and its growing research base, filial therapy appears to
provide a treatment context that brings about change within
children and parents, between children and parents, and
between the relationships of others in the family system. The
rationale within these conceptual arguments and the research
should encourage play therapists and family therapists to consider how filial therapy might promote the best interests of the
families with whom they work.
Two relevant issues, however, come to the forefront that
may impede the ability for play therapists and family therapists
to integrate a filial therapy approach into their therapeutic
repertoire. For play therapists primarily trained to conceptualize within a framework of the individual, the challenge in realizing the full potential of filial therapy may be limited by their
ability to find a means for framing the systemic implications of
the approach. Without a systemic framework, play therapists
may have greater difficulty in conceptualizing and working
with families and their unique dynamics.
For family therapists primarily trained to conceptualize
within a framework of the system, the challenge in realizing the
full potential of filial therapy may be limited by their ability to
see the compatibility of the components of an approach that is
still largely explained through the language of child-centered
play therapy. Without an understanding of the conceptual compatibility between family therapy and the components of filial
therapy, family therapists may struggle to see how a consistent
integration is possible.
In light of the potential epistemological issues that exist in
the utilization of filial therapy for play therapists and family
therapists alike, I present a popular model of filial therapy
known as childparent relationship therapy (CPRT; Landreth
& Bratton, 2006) and discuss its components within the lens
of several categories of approaches to family therapy: briefstrategic, structural, experiential, integernerational, and postmodern. I will also incorporate research from the field of filial
therapy that are suggestive of changes in the family system and
that appear to align with the goals of these family therapy
approaches. Although this is by no means an exhaustive coverage of either CPRT or family therapy, the following presentation provides play therapists with the opportunity to consider
filial therapy through family systems frameworks. In addition,
family therapists have the opportunity to consider how the
components of filial therapy might merge with familiar concepts from the major approaches to family therapy.
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277
filial therapy affirms that parents have within them the psychological and emotional wherewithal to make a major contribution
to the positive development of their children (Guerney, 2000,
p. 7). Guerney (2000) identified that a major task of filial therapy
is to identify and utilize strengths and build on them in therapy (p. 12). Through CPRT, therapists consistently encourage
parents to focus on the donut, not the hole (Landreth & Bratton, 2006, p. 131), to see and affirm the strengths in their children, to have a future focus, and to see their own growth
through positive supervisory feedback regarding their play sessions. All these contribute to cultivating resourceful interactions
within the family. As in the brief-strategic family therapy
approaches, there is a similar emphasis in CPRT on initiating
small changes within the familys interactions. For instance, parents only do one weekly 30-min play session, limiting the utilization of the skills that they learn for these times in order for
parents to experience success in applying new skills (Landreth
& Bratton, 2006, p. 26). In addition, parents have short, experiential homework exercises where they practice the specific skill
of CPRT for that week. Experiencing these incremental positive
shifts in behavior within the context of the parentchild relationship facilitates resourceful sequences of interaction.
Despite its heavy emphasis on building upon the strengths of
the parentchild relationship, CPRT also provides the opportunity to focus on the problematic patterns within the family. For
instance, in session 9, time is set aside for the parents and therapists to address any problematic interactions that they are still
experiencing with their children (Landreth & Bratton, 2006).
This allows parents and therapists to determine how they may
generalize the skills they learned in CPRT to interrupt these
problematic patterns. By seeking to interrupt these
problematic interactional patterns and eliciting resourceful
interactional patterns, CPRT mirrors the basic thrust of briefstrategic family therapy.
One extensive qualitative research study on filial therapy by
Winek et al. (2003) offers support for this notion that filial therapy highlights problem-maintaining sequences of interaction
between parents and children and generates resourceful
sequences of interaction. They identified behaviors on the part
of children and parents that both facilitated and inhibited progress. For example, for one of the inhibitive behaviors, they
identified that parents directiveness, such as making controlling statements, detracted from play sessions as did childrens being oppositional (Winek et al., 2003, p. 99).
Taken together, it is probable that these inhibitive behaviors
interact with one another, so that as the parent is more directive,
the child is more oppositional, and as the child is more oppositional, the parent is more directive. For one of the facilitative
behaviors, they identified encouraging in parents and following rules in children as behavioral categories that contributed to positive play sessions. It is reasonable to assume that
these problematic and resourceful interactions within play
sessions reflect possible interactions that occur outside of play
sessions. This research highlights how filial therapy may provide a means to assess and intervene within these interactive
sequences.
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increased awareness of their level of influence in their relationships with their children, and creating developmentally appropriate equality with children. Bavin-Hoffman et al. (1996) also
found in their qualitative study of 20 married couples who participated in CPRT that participants reported improved partner
communication and increased unity within the marriage. In
an ethnographic study of the process and effects of CPRT,
Lahti (1992) too reported the finding of improved marital relationships and increased communication. Winek et al. (2003)
found that some of the behaviors of parents that facilitated play
sessions were when they set limits, redirected children toward
appropriate behaviors, and joined in the fantasy play led by
their children. Parents tended to inhibit play sessions when they
were too directive, threatening, or did not enforce limits. These
findings demonstrate how filial therapy can assist families in
establishing appropriate parentchild hierarchies, foster the
development of parental coalitions, and facilitate clear boundaries that allow for developmentally appropriate interaction
between parents and children.
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279
experiences. Despite the possibility for generating multiple meanings, individuals tend to have problem-saturated narratives that
preclude talking about concerns in other ways (Gehart & Tuttle,
2003, p. 214). Postmodern family therapists, because of their
belief that problems are a reflection of language, believe that
people are separate from their problems and the person is not
the problem (Gehart & Tuttle, 2003, p. 215). Through conversations, postmodern family therapists aim to co-generate new meanings with family members that promote their preferred
narratives and the construction of new possibilities.
Through the group-processing component of CPRT, parents have the opportunity to share their problem-saturated
narratives within the context of a supportive group environment. Landreth and Bratton (2006) noted, It is common
that the discussion of relationship skills elicits parents current and/or long-standing intense feelings and reactions
about their children. Parents need time to process these feelings (p. 49). At the same time, CPRT also emphasizes that
the problem is not the problem, and therapists are
encouraged to keep the focus on the relationship between
parents and children rather than spending time focusing on
the problems that parents talk about (Landreth & Bratton,
2006, p. 201). This intentional redirection of the conversations away from problems and toward the possibilities of the
parentchild relationship represents an opportunity for new
meaning making, perceptions, and experiences of reality to
occur. For instance, in the first session, parents are asked
what they would like their children, when they are adults,
to remember most about their relationship with them. In
addition to exercises like these, Landreth and Bratton
(2006) encourage therapists to close filial sessions with a
motivational poem, book, or story, which stimulate renewed
meaning for parents. Because play is a means of communication and parents are verbally active in the way they track,
reflect, and respond to their children, the play sessions can
also be seen as a means for creating new conversations and
narratives between parents and children.
The qualitative studies of filial therapy by Winek et al.
(2003) and Wickstrom (2009) offer evidence that parents leave
filial therapy with new meanings about their family issues and
relationships and new ways of communicating with one
another. For instance, Wickstrom (2009) found that filial therapy challenged parents dominant discourses: that prizes
quick results over the process of relational change (p. 204),
regarding the polarization of gender roles (p. 202), and
regarding their expectations for themselves as parents
(p. 204). Winek et al. (2003) identified that parents narrating, verbally reflecting the childs behavior or feeling in the
moment, helped in facilitating play sessions with their children, which gives credence to the idea that play sessions within
themselves provide new means for communication between
parents and children (p. 97). In addition, one of the most common findings in qualitative studies regarding changes in the
parentchild relationship is improved parentchild communication (Bavin-Hoffman et al., 1996; Garza et al., 2009; Lahti,
1992; Solis et al., 2004; West, 2010).
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Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
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