A growing evidence-base shows that family therapy works, but many gaps in our knowledge remain about the conditions under which family therapy is effective and how it works. In this paper, ten critical research questions about family therapy that need to be addressed are considered. In short these are:

1. 1. Is family therapy as effective in community settings as it is in specialist clinics?

2. 2. For what problems is family therapy cost-effective?

3. 3. Does family therapy work for under-researched problems and populations?

4. 4. Do social-constructionist and narrative approaches to family therapy work?

5. 5. Can family therapy protocols be enhanced for non-responders?

6. 6. Can family therapy be combined with other psychotherapies to effectively treat specific problems?

7. 7. Can family therapy be combined with pharmacotherapy to effectively treat specific problems?

8. 8. What specific factors contribute to the effectiveness of family therapy with particular problems?

9. 9. What common factors contribute to the effectiveness of family therapy?

10. 10. What therapist and client factors contribute to the effectiveness of family therapy?

Single parent families sometimes represent specific challenges to family therapists. In this article a dialogical frame with important concepts such as voice and positioning is proposed to reflect on family therapy practice. This frame is used to reflect on a common invitation in family therapy with single-parent families: the invitation to take the place of the absent parent. A case of family therapy with a single-parent family is presented in order to illustrate the importance of flexibility in the therapist's positioning and the way the therapist's experiencing can be used as an empathic bridge to create a dialogical space in which the important issues at stake can be addressed.

Yes, I have heard about family psychotherapy — but opinions are no substitute for data. (Garfield, 1982)

MDFT is a family-based intervention for adolescent substance abuse and associated mental health and behavioural problems (Liddle, 2010). Integrative in several ways, MDFT uses an ecological or contextual conceptual framework to understand the developmental tasks of teens and their families. Research-derived knowledge about risk and protective factors, and proximal causes, correlates and contributors to adolescent drug and related problems inform clinical thinking and interventions with every case. A multisystems approach, MDFT assesses and intervenes in four areas: (1) the adolescent as an individual and a member of a family and peer network; (2) the parent(s), both as individual adults and in his or her role as mother, father or caregiver; (3) the family environment and family relationships, as manifested in day-to-day family transactional patterns; and (4) extrafamilial sources of influence such as peers, school and juvenile justice. Interventions are made within and coordinated across domains. Progress in one area or with one person has implications for and use in others. Individual meetings with parent(s) and teen set the stage for family sessions, and family meetings may offer content and new outcomes that need to be brought to extrafamily meetings with juvenile justice or school personnel. MDFT was developed and tested as a treatment system rather than a one-size-fits-all approach. A treatment system offers different versions of a clinical model that vary according to factors such as clinical sample characteristics (older versus younger adolescents, juvenile justice involved versus no involvement in juvenile justice systems), and treatment parameters (type of clinical setting and treatment dose).

The value of the continuing education industry for therapists is questioned, as is the usefulness of therapy books and journal articles, as a means of engaging therapists in life-long learning. Instead, it is argued that our clients are our best teachers and that therapists learn most effectively from their clients. Drawing on research studies with prominent theoreticians and therapists, and on case studies from clinical work, a number of important themes are identified as ways in which therapists are influenced by their therapeutic encounters with their clients. The themes explored in this article include: (1) intimacy and high emotional arousal with clients as we witness profound change; (2) being challenged by clients; and (3) allowing for boundary ‘crossings’ in order to develop more flexible ways of working with clients. The implications for professional development are discussed.

Australian gay men have only recently become parents through surrogacy arrangements. They have had to overcome a discriminatory legal, social, political, cultural and financial environment. A cooperative inquiry action research group was formed, with seven two-father families conceived via surrogacy, to explore their journey to parenthood and their consequent politicisation as gay fathers. This article reveals how that experience of the cooperative inquiry process strengthened their resolve to be intentionally ‘out’ in their communities to overcome discriminatory and conservative social attitudes. They embraced the political reality of their parenting and were stimulated to create improved support structures for themselves and future parents. This transformed the legal, social, political and cultural environment for their families.

This case study demonstrates the challenges and possibilities of working on a sexual relationship with a single client and provides an example of integration of sex therapy within the ethical and theoretical framework of a collaborative systemic approach. It illustrates the author's view on the therapeutic relationship involving the expertise of both the client and the therapist. A model for integration of systemic approach and sex therapy is proposed.

This is the first of two articles to map the landscape of practice theory in systemic family therapy. In this first article, the representation of knowledge for practice is explored, and an argument is made that while frameworks remain important, the relationship to them is now more conditional and pragmatic. A particular chronology is offered of the development of family therapy practice theory frameworks, beginning with the frameworks that emerged in the 1960s to the 1970s. An analysis is given of the important transitions in the 1980s and three sets of influences in this decade — ecosystemic epistemology, the feminist challenge and postmodernism — are identified. This reading emphasises hidden continuities in the transition, despite the seemingly discontinuous shifts in practice theory from the beginning of the 1980s to the beginning of the 1990s. Context and relationship are identified as the enduring parameters of systemic family therapy knowledge, though understandings of context and relationship have been recast in the contemporary (post-1990s) practice theory. The second article will explore the four contemporary influential approaches in Australian family therapy — the Milansystemic, narrative and solution-focused frameworks, and the dialogical perspective — and point to intersections in practice ideas and integrative movements.

Multisystemic therapy (MST) is a family- and community-based treatment of serious emotional and behavioural problems presented by adolescents. The development of this model began in the late 1970s, and today MST is a leading evidence-based treatment of serious antisocial behaviour in youths, with programs transported to more than 30 states in the United States and 12 nations, including Australia and New Zealand. This article rerviews the theoretical rationale that underlies MST and presents the central clinical features of the intervention model. In addition, the training and quality assurance protocols used to promote MST program fidelity and treatment adherence are described. Finally, findings from approximately 15 published randomised and two quasi-experimental clinical trials with youths presenting serious clinical problems (e.g., violence, substance abuse, serious emotional disturbance, sexual offending, and chronic illness) are summarised.

Family-based treatment has for at least two decades now come to be seen as the treatment of choice for adolescents with anorexia nervosa (AN). Yet, involving the parents in the treatment for adolescents with bulimia nervosa (BN) have remained largely unexplored. We have recently adapted manualised family-based treatment for adolescent AN (FBT-AN) to a large group of adolescents with BN (FBT-BN). This manuscript will highlight the key tenets of manualised FBT-BN, briefly describe the three treatment phases, and summarise the main differences of this model in its application for AN versus BN. Finally, reference will be made to the first randomised controlled trial of FBT-BN showing preliminary support for the parents' involvement in the treatment of adolescent BN.

The primary aim of the three Milan principles of hypothesising, circularity and neutrality was to proffer an effective methodology for interviewing families, with a secondary aim of casting off the stereotypical personal therapist qualities such as intuition, charisma and concern. The progression of the principles from the original Milan model through to contemporary approaches is intriguing. The following article consists of two sections. First it tracks the progression of the three principles through the Milan, post-Milan and postmodern approaches to family therapy. Given their recursive nature, they are revealed as responsive to developments in theory and practice, as well as the influence of the wider societal context. The second section of the article explores hypothesising, circularity and neutrality in the contemporary approach of dialogical family therapy. The relevance of the three principles to the therapeutic process, the therapeutic role and the therapeutic relationship is considered. Such an exploration does not seek definitive answers or ‘truths’, but seeks to conceptualise a vague ‘knowing’ that there is continual learning and growth in grappling with the tensions in this field, in remaining ever curious, in asking the questions …

This case study is an account of a post-traumatic family attempting to come to terms with life after violence, and the effectiveness of family therapy in supporting this transition. The fighting between two young girls had maintained the violence in the family dynamic and their highly anxious adolescent brother remained unable to let go of his protective position and move forward with his own life. The backdrop of the case was a novice family therapist and a mother with borderline traits who found it difficult to keep the therapeutic work within the bounds of the therapy sessions. Despite these difficulties meaningful change could be seen after only seven sessions of family therapy.

Coming out to their children is a dilemma that concerns many gay, bisexual, and lesbian parents with children from previous heterosexual relationships. How children found out about having a father who identified himself as gay, and their feelings about their father's sexual identity, were explored through qualitative analysis of semi-structured interviews with 36 sons and daughters (aged 19 to 36 years) whose gay fathers participated in the Gay & Bisexual Parenting Survey (Barrett and Tasker, 2001). Interpretative Phenomenological Analysis revealed that awareness of their father's sexual identity was often left unspoken for various reasons, and that acceptance came about through gradual understanding as well as direct discussion. Interview data indicated the complexity of the relationship between the young adult's personal acceptance of their father's gay identity and their consideration of social context when deciding how open to be to others about their father's sexual identity. This research has varied implications for therapeutic work with gay and bisexual fathers coming out to their children from previous heterosexual relationships.

This case report, drawn from an American hospital, explores a phenomenon best described as ethics anxiety, a feeling of uncertainty as to what is ethically required or permitted, leading to clinical delay and confused decisions. In the specific clinical situation presented, the clinicians find themselves confronting, under severe time constraints, a complex, multidimensional problem with ethical and legal implications. The situation deteriorates as the clinicians find themselves unable to find what they perceive as the expert advice, either clinical or ethical, that would enable them to resolve the problem presented. In the discussion section of the case report, some attention is given to the role that the bioethics movement itself has had in creating these situations and undermining clinical decision-making.

This article explores the process of family therapy with a Turkish-speaking single-parent family with four children in which suicidal behaviour and family violence have become the norm. The following example describes a pivotal experience early within my career as a family therapist. The universality of first, being a beginner family therapist, and second, receiving a referral of a daunting, difficult case has led me to share my experience here. Central to this article is the focus on therapeutic process as a means to navigate beyond impasse. It is my hope that those who read this article will consider taking the risk to prioritise the therapeutic relationship, even when anxiety about ‘doing something’ to fix the problems is high.

This research project explored the ongoing process of constructing a narrative, following childhood sexual abuse. Twenty-two men and women aged 25–70 were interviewed about their childhood sexual experiences with adults using narrative inquiry methodology. These experiences occurred in different social and historical contexts, when the theoretical understandings and treatment of the issue of child sexual abuse were significantly different from the present. Many factors made disclosure even more difficult then than it is now including: respect for authority; rigid gender roles; the taboo surrounding sexual issues; lack of supportive adults; and lack of language to describe what was happening. Participants told four differing narratives about their experiences: narratives of silence; narratives of ongoing suffering; narratives of transformation; and narratives of transcendence. These narratives were examined in relation to the changing social and historical context and the current dominance of the victim and survivor paradigm in the child sexual abuse literature.