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Book Forum   |    
Families that Flourish: Facilitating Resilience in Clinical Practice
Reviewed by ALISON HERU
Am J Psychiatry 2007;164:530-530. doi:10.1176/appi.ajp.164.3.530

by Dorothy S. Becvar. New York, Norton Press, 2006, 320 pp., $34.00.

This book provides a unique window into the development of a family therapist, from receiving her Ph.D. in family studies to the present day. In the process, Dr. Becvar gives an historical overview of the development of family therapy, a useful journey for those in need of a quick refresher course.

Part One reviews the contributions of Edmund Husserl and Gregory Bateson, postmodernism and family development theorists, to her current views on working with families. Dr. Becvar describes the importance of positive talk about family atmosphere and a positive approach to problems and challenges. She includes attention to communication, enrichment and nurturance, and spirituality. She defines flourishing and resilience.

Part Two is devoted to Practices: “putting principles into practice, assessing, analyzing and perturbing to achieve solutions, supporting a positive self-concept, encouraging effective parenting and creating supportive contexts.” She includes narrative therapy, reflecting team, solution-oriented therapy, solution-focused therapy, and therapeutic conversations. She then provides a case example on her preferred method called “selecting perturbations.” Dr. Becvar discusses her therapeutic stance as suspending judgment, becoming sensitive to language, exploring the client’s context, co-creating realities, supporting and validating, and reflecting on the process as a whole. Her interventions include supporting a positive self concept, encouraging success, acknowledging accomplishments, searching for talents, changing negative self talk, and becoming sensitive to professional language, i.e., no discussion of DSM diagnoses. She encourages effective parenting, expands the meaning of discipline, chooses responses rather than reacting, acknowledges children’s wisdom, creates supportive contexts, celebrates and has fun, and encourages the practice of random acts of kindness and finding meaning and purpose in life.

Dr. Becvar’s approach is summarized in her own words:

I attempt to respond in the moment in ways that seem most appropriate for each client system, seeing each individual, each couple, and each family as unique…believing that in therapy I am taking part in the cocreation rather than the discovery of realities, I also might reflect on queries such as “Can I recognize how I am participating in creating problems?” Or “Can I see how I am participating in creating solutions?” (p. 25)

I felt more and more uneasy as the book progressed. In Dr. Becvar’s world, patients, or should we call them clients or fellow travelers, are supported and nurtured with the expectation that good things will happen if everybody plays nice. People are inherently good, didn’t you know? I have a darker view of the world, in which working effectively with families means completing a full assessment, especially assessing where power and control lies. A full assessment includes assessing the division of labor, both instrumental and affective, rules and enforcement of rules, the management of anger, sadness and fear, and how the family resolves or does not resolve its problems. It means assessing family violence. Dr. Becvar suggests searching for assets where there is domestic violence rather than focusing on destructive patterns. I strongly disagree with this stance. Failure to assess a family fully and accurately is negligence, and failure to manage violence appropriately can have serious consequences for the family.

This book does not present a mainstream approach and does not cover what needs to be known by a general psychiatrist. A general psychiatrist must have knowledge of the extensive research on families, including evidence-based family treatments such as psychoeducation. In our field, we must be knowledgeable about assessing and alleviating the burden experienced by caregivers of the chronically mentally ill. We must be able to recognize and enhance family strengths, but not as a sole therapeutic stance, as Dr. Becvar is suggesting. Resilience can be taught to families that do not yet have it. We know what family factors make up family resilience (good problem solving, clear and direct communication, good family organization, and a cohesive set of family beliefs) (1). Dr. Becvar, in an attempt to correct the pathologizing of families that has occurred over the past century, goes too far, although she reminds us that we need an attitude of respect and compassion toward families.

1.Walsh F: Strengthening Family Resilience, 2nd ed. New York, Guilford Press, 2006
 
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References

1.Walsh F: Strengthening Family Resilience, 2nd ed. New York, Guilford Press, 2006
 
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