Book Reviews

Stepfamily Therapy: A 10-Step Clinical Approach

by Scott Browning and Elise Artelt
Review by Richard Niolon

Scott Browning and Elise Artelt present a well-reasoned and well-explained model of step-family treatment in their book Stepfamily Therapy: A 10-Step Clinical Approach. Although based on concepts of traditional family therapy, their model differs from traditional work in that they intervene primarily by stabilizing each of the stepfamily subsystems and move on to more integrative work with the stepfamily only afterward. They give many brief as well as detailed case examples to illustrate their 10-step model. The approach is grounded in clinical research, and the book is an excellent source for both established therapists and graduate students wishing to specialize in stepfamily therapy.

Conceptual Basis for Differences

In Chapters 1 and 2, the authors present a history of stepfamily therapy as a subspecialty of family therapy. They provide a thorough but easy-to-read summary of the past models of treatment, the current research on stepfamily risks and stressors, and the important differences between cohabitating and married couples. I appreciated this last distinction, as expectations of family priorities and goals can be quite different across married, single, and cohabitating parent homes (see, for example, Wu, Costigan, Hou, Kampen, & Schimmele, 2010). Through this discussion they create a framework to understand how assumptions based on traditional or "first- union" families can be harmful for stepfamilies.

For example, Browning and Artelt discuss the assumption that the therapist should see the entire stepfamily at once for treatment, which assumes that the subsystems of a family can work together well enough to communicate their needs, identify their strengths and weaknesses, and agree to therapeutic goals. This is a reasonable assumption for first-union families, as they have had many years to create and refine their own way of communication and collaboration, even when stressed.

Stepfamilies, however, have not had years to practice these skills. Seeing the entire stepfamily at once may exacerbate loyalty binds and feelings of guilt in biological parents. Further, such meetings can stir open conflict and emotional rejection between family members. As a result, seeing the entire stepfamily together can actually push members and subsystems further apart and weaken the stepfamily's structure and boundaries. Given our field's emphasis on efficacious therapy, this point in particular clearly demonstrates how an ineffective therapeutic approach can actually harm clients.

The authors discuss a second assumption: that the therapist should strengthen certain hierarchical processes and boundaries in order to stabilize the family structure. This assumes that there is a largely intact set of established family norms to build upon, and, as a result, therapy need only restore some boundaries or processes to stabilize the system. This is a reasonable assumption in first-union families, as, again, they have had many years to develop their own processes and boundaries. As the couple become parents and children become teens and young adults, the first-union family also has years to refine its processes through developmental challenges.

Stepfamilies, however, have not had years to develop their own processes. Consider that established family norms dramatically change when the family becomes a binuclear or two-home family; they dramatically change again when one or both of the binuclear families become stepfamilies. Although we might expect divorce to be the most stressful transition, some children find the remarriage of a parent to be more stressful (Ahrons, 2007). Stepparents enter the family scene with expectations of their own from their childhood families and prior relationships, and so stepparents' and stepchildren's expectations of family roles, especially parenting, may clash (Cartwright & Seymour, 2002; Fine, Coleman, & Ganong, 1998). As a result, there may be little in the way of a stable set of norms governing how to communicate and connect, what to expect, and how to get along with other stepfamily members.

Thus, first-union family members experiencing distress as one member moves into adolescence can face this stage with many years of stability and success working together as a family behind them. Stepfamilies, however, do not. Stepfamilies experience such normal developmental stages against a backdrop of stressful failures, periods of instability, and dramatic life transitions.

In short, Browning and Artelt present a well-reasoned argument that using first-union families as a norm or point of reference in stepfamily therapy is inappropriate. At best, it may hinder the stepfamily in forming its own developmentally appropriate processes; at worst, it may exacerbate the stepfamily's distress, fragmentation, and risk for dissolution. In these two chapters, the authors do a good job of preparing the reader to consider a more informed and sensitive model of stepfamily therapy.

The Stepfamily Therapy Model

In Chapter 3, the authors explain their 10-step model for assessment, subsystem- focused intervention, and finally collective stepfamily-focused work, giving brief examples of cases to highlight the points of each step. To their credit as scholars, they refer to published literature to support the concerns and possible interventions in each step but recognize that there is no evidence yet to confirm the effectiveness of the entire packaged model. They devote some thoughtful attention to the technique of normalizing, highlighting when and how clinicians can effectively use their knowledge of the research to normalize stressful stepfamily experiences.

In Chapters 4 through 6, Browning and Artelt give detailed case examples of three kinds of stepfamilies. These include the simple stepmother and simple stepfather families (one stepparent with one parent and biological children), and the complex stepfamily (two parents and their biological children with each other).

In Chapter 7 they add the involvement of extended family, especially "stepgrandparents," who can enter and interact with the stepfamily in several ways. The authors note that they encourage these connections. Although such relationships are often an additional complication in the stepfamily's life, grandparent relationships can have a positive effect on children's adjustment (see, for example, Bridges, Roe, Dunn, & O'Connor, 2007; Doyle, O'Dywer, & Timonen, 2010). This point is another good example of how the authors use solid clinical research as the foundation for their model of stepfamily therapy.

In Chapter 8, the authors focus on cultural diversity and present a simple framework for considering diversity in family therapy. They then briefly revisit many of the issues previously discussed (such as hierarchies and parenting) and frame them in a cultural context. They follow with a short discussion of three case examples, noting relevant cultural concepts and applying their model to work with an African American and a Latino American family. I particularly appreciated their broader conceptualization of cultural diversity, as they also include a case of a stepfamily with lesbian parents.

Through these case examples, Browning and Artelt artfully reveal the expert clinical reasoning process. At each step, they explain how thoughtful and culturally sensitive clinicians review the possible interventions, consider clinical research findings, and choose the intervention they will use and how they will implement it with a specific family. They further offer clear insights into the views and experiences of different stepfamily system members to help the clinician join and work effectively with all members and subsystems. In doing so, they offer very rich case presentations, which are helpful to more and less experienced family therapists alike.

Summary

Overall, Stepfamily Therapy: A 10-Step Clinical Approach would be a wonderful addition to any established family therapist's library. The strengths of the book rest in the solid link to clinical research supporting the design of the model and in the thoughtful and sensitive use of the model in clinical cases. As a result, the book would further be an excellent addition to a graduate family therapy course.

The only weakness is the absence of an afterword. There Browning and Artelt might have made recommendations for future researchers seeking to test the entire packaged therapy model. They also might have offered closing thoughts on the future of stepfamily therapy. They present a well-reasoned and well-explained case that effective stepfamily therapy requires specialized skills and techniques: A commentary sharing their insight into how this type of therapy will develop, as divorce and remarriage rates continue to rise, would have been a thoughtful closing to the book.

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