RELEVANT LITERATURE GENERAL FINDINGS
The general literature
on engaging families in treatment is not very extensive. Much of it appeared as the importance of the father in the treatment process became more obvious. 16, 86 91. I ig Investigators began looking at treatment results with and without fathers and also at the means for recruiting and retaining fathers.
Fathers have been noted to be the most
difficult family members to engage,46 especially among lower classes,N8 yet they are pivotal both in the recruitmentn and continuation aspects of therapy.' 1" Berg
and Rosenblumi4 make the point that if
the therapist is not insistent and does not underscore how necessary the father is for treatment, the latter will feel confirmed in his supposition that he is not
important. Shapiro and Budman] 3- found that engaging the father is particularly
difficult for inexperienced
therapists, who tend to be less successful at it than their more seasoned
colleagues. L'Abates6 has proffered a number of ways for countering the father's resistance, including ( 1) reassuring him of his importance, (2) pointing out that
changes depend upon his participation,
(3) making him aware that he has the power to sabo-tage therapy, (4) noting that he has choices, such
as transferring to another therapist
who will work only with an individual, (5) placing responsibility for changes squarely on his
shoulders, and (6) getting him to consider realignment of his priorities (e.g.,
his family's hap-piness vs.
acquisition of more material goods).
More generally, however, both parents or spouses can be re-sponsible
for nonengagement in family therapy. Either can show the tendencies noted for
therapy refusers, that is, giving vague rationaliza-tions for
not becoming involved, or denying that a problem exists.14.'' In fact,
refusers tend to be resistant to any mode of therapy, whether family-
or individual-oriented.137 Sager and associates126 note, as we
have,18' that identified or -index- patients
(IPs) often tend to have expectations that are not consonant with family therapy and may grow
anxious or angry when the subject is broached. Thus the therapist
needs to stimulate motivation,' and the IP's experience of him in this effort
becomes all-important.' c Sometimes the process can be aided through an
involuntary influence. For examplejohnsorls found that family
intervention ordered by a juvenile court made it less difficult to involve families in a three-session
family "evaluation‑ program. Through a restructuring of the family
therapy intake proc‑ ess, Sager et al.'" were able to get 75% of
their families to come in; they did this by (1) streamlining the screening
interview so that an overly intense relationship did not develop between
client and intake
interviewer; (2) reducing the emphasis given to
family involvement within the screening interview; (3) occasionally
waiting until the first individual therapy session before broaching the
issue of family therapy; and (4) taking one or more therapy
sessions, as needed, to work through differences between the
expectations of client and agency as to involving the family. Slipp et al.' 38 also recruited 75% of their clients in a maritally
oriented program, partly because attend-ance by all family members
was required at the initial interview; the rate was lower (65%) for
cases with a severely disturbed IP than for those diagnosed as
moderately or mildly disturbed (85%). Finally, Berg and Rosenblum"
found that the success with which therapists were able to recruit whole
families was positively correlated with the number of family therapy
training experiences ( workshops, courses, etc.) they had had, implying
that therapist variables may be as important as family and IP characteristics.
