Journal of Family Therapy - 2003 - Allison

r The Association for Family Therapy 2003.
Published by Blackwell Publishing, 9600 Garsington

Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.
Journal of Family Therapy (2003) 25: 263–284
0163-4445
What the family brings: gathering evidence for

strengths-based work
Steve Allison,a Kathleen Stacey,b Vicki Dadds,c

Leigh Roeger,d Andrew Woode and Graham Martinf
Families attending child and adolescent mental health (CAMH) services

are often assumed to have problems in key areas such as communication,
belonging/acceptance and problem-solving. Family therapy is often
directed towards addressing these difficulties. With increasing emphasis
in family therapy and human services fields over the last decade on
identifying and building from strengths, a different starting point has
been advocated. This paper describes a large survey of the self-reported
pre-therapy functioning of children and families using a public CAMH
service (n 5 416). Before commencing family therapy parents identified
family strengths across a range of key areas, despite the burden of caring
for children with moderate to severe mental health problems. This
evidence supports theoretical and clinical work that advocates a strengths
perspective, and highlights how resilience framed in family (and social)
rather than individual terms enables a greater appreciation of how
strengths may be harnessed in therapeutic work.
Introduction
Despite the radical departure from individualistic approaches to
psychotherapy that family therapy represented, a problem-centred
focus pervaded most theoretical schools into the 1980s (Nichols and
Schwartz, 1998). With the advent at this time of earlier versions of
solution-focused brief therapies and narrative therapies, the transi-
tion into second order cybernetics and, a little later, the postmodern
a
Senior Psychiatrist and Regional Manager, Adjunct Faculty, School of
Medicine, Flinders Team, University of South Australia, Flinders Medical Centre,
Bedford Park, SA5041. E-mail: Steve.Allison@flinders.edu.au
b
Senior Research Officer, Flinders Team.
c
Research Officer, Flinders Team.
d
Research Manager, Flinders Team.
e
Regional Manager, Marion Team.
f
Professor, Child and Adolescent Psychiatry, Royal Brisbane Children’s
Hospital.
r 2003 The Association for Family Therapy and Systemic Practice

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264 Steve Allison et al.
and poststructural turns, family therapy began to embrace a strengths
orientation. Although advocated increasingly in family therapy (e.g.
Walsh, 1998) and related human services fields (e.g. Dunst et al.,
1988; Early and GlenMaye, 2000; Saleeby, 1992), a strengths
orientation is not represented uniformly in everyday contemporary
practice.
Although notoriously pathology based, in many countries the
mental health field has also begun reorienting to a strengths,
prevention and promotion perspective in the past decade (e.g.
[Australian] Commonwealth Department of Health & Aged Care,
2000; [UK] Department of Health, 1999; Joubert et al., 1997).
Notwithstanding steady progress, this shift to viewing mental health
as a resource for living remains relatively slow.
Child and adolescent mental health (CAMH) services are often a
meeting place for family therapy and the wider mental health field.
Both fields have become progressively more concerned with
evidence-based practice, in part to support new conceptual develop-
ments. Based on research work in a family therapy-oriented CAMH
service, this paper contributes evidence for the existence of family
strengths prior to entering therapy, even when families are dealing
with children experiencing moderate to severe mental health
problems.
The increasing influence of resilience

The notion of resilience has appeared increasingly in the mental
health literature over the past twenty years. It is viewed as a key
ingredient in efforts to promote mental health, whether in the
general population or among people experiencing difficulties.
Resilience may be defined as the capacity to ‘develop a high degree
of competence in spite of stressful environments and experiences’
(Garbarino et al., 1992, p.101). Werner (1984), one of the original
researchers on resilience in children, defined it as ‘the ability to
recover from or adjust easily to misfortune or sustained life stress’
(p.68). Walsh (1998) emphasized a shift in focus to resilience being
developed ‘through’ or ‘because’ of adversity. Popular language
would refer to resilience as ‘strength’ or the capacity to rebound from
adversity, whether from one-off traumatic events, cumulative stress
and/or chronic stress.
In a recent review, Rutter (1999) highlighted how multiple risk and
protective factors are involved in the concept of resilience. He

What the family brings 265
reminded us that the cumulative impact from a range of factors
applies equally to protective factors and risk factors and advocated for
attention to be paid to both. Risk factors gain most attention in mental
health fields. Rutter emphasized that ‘resilience does not constitute an
individual trait or characteristic’ (p.135); rather, children demonstrate
resilience in relation to particular contexts. A child’s ability to develop
and practise resilience in particular social settings can have strong
protective functions in withstanding the ongoing challenges of life,
whether they be expectable developmental challenges, challenges
presented by their sociopolitical context or unpredictable events.
Some factors that foster resilience in children appear inherent or
unique to the child, while some can be directly influenced and
encouraged in children. They are often grouped according to three
categories: constitutional child factors, family milieu, and social
support beyond the family (Fraser, 1997; Smith and Prior, 1995).
Despite listing factors dependent on interpersonal environments or
social-political contexts, resilience is often described in individual
terms (Walsh, 1998). Even though the strategies promoted may
include parenting education, support or community-based pro-
grammes, the focus is still on what this means for the individual child,
not necessarily for the wider systems in which she lives, such as the
family’s capacity to cope and interact constructively as a group – a
matter of concern in the practise of family therapy.
Factors that foster resilience in children which are described in
individual terms include (Fraser, 1997; Garbarino, et al., 1992; Masten
and Coatsworth, 1998; Rutter, 1999; Smith and Prior, 1995; Wallach,
1993; Walsh, 1998; Werner 1984):
an ability to perceive experiences as constructive, even if painful;
a calmer temperament;
an ability to use faith (not necessarily a religious faith) to maintain a
positive sense of a meaningful future;
confidence in their ability to shape or influence experienced events;
the ability to gain other people’s positive attention.
However, some suggest a more social base, for example:

the availability of alternative positive perceptions of themselves;
parents/caregivers who have developed their own sense of
resilience to stress and provide this as a model;

the encouragement given to develop positive relationships with
other people, particularly caring and knowledgeable adults who are
physically and emotionally available;
the provision of consistency, predictability, structure, and clear
expectations and boundaries in educational or recreational
programmes;
the opportunity for emotional expression in safe ways and places
(i.e. to tell their stories and be listened to with genuineness).
A central idea about resilience in the mental health field concerns
the child’s capacity to make use of family and social support factors.
While this reinforces important notions of having personal agency, its
unfortunate edge is to pathologize those children who do not ‘have
what it takes’ or appear to make use of resources, or those families
who do not provide such resources, without taking a wider pers-
pective regarding what might make this difficult (Saleeby, 1996;
Walsh, 1998; Weick and Saleeby, 1995). This can place resilience at
the service of a victim and parent-blaming discourse, which re-
emphasizes a pathological viewpoint, and does not represent a radical
departure from traditional practices in the mental health field. It
encourages us to expect its absence in families who present for
therapy, rather than using the work on resilience to look for its
presence so it can be harnessed for the betterment of both the child and
her family.
Fostering resilience – what part can family therapy play?

A key contribution of more contemporary versions of family therapy
to the overall therapy enterprise has been elevating the place of
existing strengths and people’s capacity to generate solutions
(Silberberg, 2001; Weick and Saleeby, 1995). This is particularly
evident in solution-focused approaches (de Jong and Miller, 1995;
de Shazer, 1982, 1991; Nichols and Schwartz, 1998), which are forms
of family therapy commonly practised in South Australian CAMH
Services, the context for this therapy work and research. Other
contemporary approaches, such as narrative therapy (Freedman and
Combs, 1996; White and Epston, 1990), are also strengths-based and
practised in South Australian CAMH Services. Nichols and Schwartz
(1995) stated that ‘the orientation toward solutionsyis an attempt to
create an atmosphere in which people’s strengths can move out of the
shadows and into the foreground’ (p.447).

Strengths-based approaches are usually conceptualized in two ways
(Lyons et al., 2000). The first is to identify assets, resources and
abilities and then harness them in the process of assisting a person to
develop in a direction she finds preferable or ‘healthier’. The second
is to develop strengths through service provision. Approaches
promoted as ‘evidence-based’ and ‘good practice’ in family therapy
are oriented more towards the second way, rather than actively, and
also, incorporating the first way (e.g. Carr, 2000). These ‘good
practice’ approaches can overlook the strengths that already exist as a
resource to the therapy process, thus minimizing the significant
contributions that clients make to therapy outcome (Miller et al.,
1997). Contemporary strength-focused family therapy work draws on
both approaches, viewing strength or resilience as a dynamic concept
rather than as a static resource that is either present or not.
Family therapy can effectively foster resilience at both individual
and family levels (Stacey et al., 2001), thus contributing to early
intervention and prevention goals in mental health. In terms of the
model for addressing ‘serious childhood social problems’ advocated
by Fraser (1997), family therapy is an early intervention option at the
‘family, school and neighbourhood’ systems level with the intention of
harnessing and developing further ‘social support, presence of
caring/supportive adults, positive parent–child relationships and
effective parenting’ (p.22).
Given the above, the questions we were interested to explore were:
What strengths do parents identify in their families prior to
therapy?
Are there differences in family strengths identified between families
with children who have problem scores in the ‘clinical’ vs. non-
clinical range of a common assessment tool?
Method
Our CAMH service has a network of community centres across the
southern metropolitan and country areas of South Australia. The
centres have an ‘open-door’ policy that enables services to be
provided for a wide range of children and families with mild to
severe mental health problems. The brief assessment via an initial
consultation for all new referrals has been described elsewhere
(Allison et al., 1999). On the basis of this initial consultation,

approximately one-third of families return to primary care, another
third receive brief therapy and the remaining third have ongoing
treatment for severe or very complex problems. CAMHS teams are
multidisciplinary and family therapy is supplemented with specialist
services such as school consultations, psychological testing and
psychiatric assessment as required.
During the study period parents of all clients having an initial
consultation with CAMHS were invited to participate in a
questionnaire study on pre-therapy status and therapy outcomes.
Very few declined participation and we are unaware of any factors
that may detract from its representativeness as a sample of
community-based child and adolescent mental health service con-
sumers. Parents who consented completed standardized question-
naires about their family functioning and child’s mental health
problems prior to their first visit to CAMHS. The parent most
involved with the child’s day-to-day care was asked to complete the
questionnaire. Parents were chosen as informants because they are
able to provide valid and reliable assessments of family functioning
and children’s mental health problems. Alternative methods of direct
observation or structured individual interviews with children were
not employed in this study due to the higher costs inherent in these
methods.
The evaluation team conducting the study did not provide direct
services to participants. Parents were informed that information
provided would remain confidential from their therapist and would
not influence their therapy in any way. Participation was voluntary
and participants could withdraw from the study at any time.
Questionnaires were selected to measure family functioning
(Family Assessment Device general functioning subscale (FAD) and
children’s mental health problems (Child Behaviour Checklist
(CBCL). The FAD (Epstein et al., 1983) is a widely used measure of
family functioning and comparison data is available from Australian
(e.g. Sawyer et al., 1988) and international studies (e.g. Byles et al.,
1988). The short general functioning subscale of the FAD contains
twelve items rating aspects of family communication, including
decision-making, sharing feelings and providing support. Each item
is rated on a four-point ordinal scale from strongly agree, agree,
disagree to strongly disagree. In the data analysis, FAD general
functioning subscale results were examined in two ways: (1) the
frequency of parents’ response to the twelve individual items was used
to give a description of their perceptions of family strengths and

weaknesses; (2) the total score was used for correlations with
children’s problem scores and gender comparisons.
The CBCL (Achenbach, 1991) is also a frequently used ques-
tionnaire for parents measuring the separate domain of children’s
mental health problems. The checklist has 112 questions about
children’s emotional and behavioural problems used to derive a total
problem score. This provides a general severity index of children’s
mental health problems for which international comparisons are
available (e.g. Alfons et al., 1997).
Study information also included parents’ ratings on four- or five-
point Likert scales for the following questions:
How worried are you about these problems?
How much of the time do these problems interfere with your family
life?
How hopeful are you that counselling will help with these
problems?
How do you think your family gets along?
How well do you get along with your child?
How well does your partner get along with the child? (if relevant).
Data were analysed using SPSS (Version 10.0), frequency tables,

Spearman and Pearson correlations.
Results
Overall, 416 parents returned questionnaires before their first
family session, with 354 completing all aspects of the question-
naire. The children’s main caretakers were generally mothers (93%)
with a minority of fathers (5%) and other carers (2%)
taking this role. The children’s average age was 9 years (range 4 to
17 years) with boys (63%, n 5 260) outnumbering girls (37%,
n 5 156). Table 1 outlines the distribution of responses to the six
ratings questions.
In summary, most of these parents reported being moderately or
extremely worried about the problems. They reported that problems
usually interfered in family life at least some of the time, although
most parents rated their family relationships quite positively. Parents
were generally quite hopeful that their children’s problems would
improve with family therapy.

270
TABLE 1 Percentages for responses to ratings questions (n 5 354)
Question 1 Extremely Worried Slightly Not at all

How worried are you about these problems? 46.0 46.0 7.9 0
Most of Some of the
Question 2 All the time the time time Hardly ever Never
Steve Allison et al.

How much of the time do these problems
interfere with your family life? 14.2 49.3 32.2 3.6 0.7
Question 3 Very Hopeful Some-what Not at all
How hopeful are you that counselling will
help with these problems? 45.2 42.3 11.5 1.0
Question 4 Very poorly Poorly OK Well Very well
How do you think your family gets along? 1.4 8.0 32.5 33.5 24.6
How well do you get along with your child? 1.0 6.5 27.7 31.3 33.5
How well does your partner get along with
the child (if relevant)?5 2.9 7.6 31.9 30.8 26.8
5
Eighteen per cent did not have a partner at the time of the survey.
The mean total problem scores for the CBCL were significantly
higher for boys (mean 5 57.2, SD 5 28.8) than for girls (mean 5 48.8,
SD 5 24.7) in the sample (F (1372) 5 8.4, po0.01). These total scores
are well above the means for the Australian community (Alfons et al.,
1997) and the boys’ mean score is similar to that of the original clinical
reference group (Achenbach, 1991).
The amount of worry that parents reported and the degree of
interference with family life were related to their children’s CBCL
total problem scores. Higher problem scores were related to greater
levels of parental concern (Spearman r 5 0.37, po0.01) and more
interference of children’s problems with family life (Spearman
r 5 0.54, po0.01). However, there was not a significant relationship
between the CBCL scores and parental hopefulness about therapy
(Spearman r 5 0.03, p 5 N/S). Modest relationships were found
between the severity of children’s problems and the parents’ global
ratings of the quality of family life. Higher CBCL scores were related
to poorer family relationships (Spearman r 5 0.25, po0.01), parent–
child relationships (Spearman r 5 0.25, po0.01) and partner–child
relationships (Spearman r 5 0.17, po0.05).
The mean FAD general functioning score was 2.05 (SD 5 0.53,
n 5 404), which is comparable with other Australian clinic samples
(Sawyer et al., 1988). FAD general functioning means were not
significantly different where boys (mean 5 2.07, SD 5 0.54) or girls
(mean 5 2.00, SD 5 0.50) were the identified clients.
On closer examination, responses to specific FAD general function-
ing items indicate that most parents regarded their families as
functioning well in a range of important ways (see Table 2). The
items are worded to alternate between positive and negative family
attributes. For each of the items, between 62% and 85% of parents
reported strengths in family functioning (strongly agreeing or
agreeing with positive attributes and strongly disagreeing or disagree-
ing with negative family characteristics). At these extremes, 85%
agreed or strongly agreed with the statement ‘Individuals are accepted
for what they are’, while 62% disagreed or strongly disagreed with the
statement ‘There are lots of bad feelings in our family’.
An investigation of the relationship between the FAD general
functioning scale and the CBCL total problem score for all
participants indicated a modestly significant relationship (r 5 0.29,
po0.01). Overall, there was a tendency for higher children’s problem
scores to be associated with poorer family functioning. To examine
this further, we compared FAD item responses for children with

272
TABLE 2 Percentages for responses to items on the FAD general functioning subscale (n 5 362)
Strongly
Strongly agree Agree Disagree disagree
(a) Planning family activities is difficult because we misunderstand each other. 5.7 19.9 49.1 25.3
25.6 74.4
(b) In times of crisis we turn to each other for support. 33.1 50.7 13.5 2.7
83.8 16.2
(c) We cannot talk to each other about the sadness we feel. 6.4 25.7 45.1 22.8
32.1 67.4
(d) Individuals are accepted for what they are. 30.4 54.6 11.6 3.5

84.9 15.1
(e) We avoid discussing our fears and concerns. 6.9 21.2 51.9 20.0
28.1 71.9
(f) We express feelings to each other. 25.6 53.1 18.4 2.9
78.6 21.3
(g) There are lots of bad feelings in our family. 8.1 29.7 39.3 22.8
37.9 62.1
(h) We feel accepted for what we are. 17.6 59.8 19.6 3.0
77.4 22.6
(i) Making decisions is a problem for our family. 4.9 23.8 49.9 21.4
28.7 71.3
(j) We are able to make decisions about how to solve problems. 14.1 55.6 26.7 3.7
69.6 30.4
(k) We don’t get along well together. 4.2 17.2 47.8 30.8
21.4 78.6
(l) We confide in each other. 19.7 54.1 22.9 3.2
73.8 26.1
CBCL scores in the clinical and non-clinical ranges. The cut-off scores
were derived from the original clinical sampled cited in the manual
for the CBCL (Achenbach, 1991) using the total behaviour problem
T-scores standardized for gender and age. On this basis, 41.4% of the
population fell into the non-clinical with 58.6% in the clinical range.
Table 3 summarizes the frequency distribution and outcomes of chi-
square comparison tests.
Significant differences were apparent for only five of the twelve
items. The items that proved to be more problematic for the clinical
compared to the non-clinical group were related to three main areas:
(1) ‘bad feelings’ that may have brought families to therapy (Item G),
and (2) difficulties with the associated issues of ‘planning’, ‘decision-
making’ and ‘problem-solving’ (Items A, I and J), all of which
interfered with (3) how they were ‘getting along’ as a family (Item K).
Discussion: orienting to strengths

The results indicate that although still experiencing problems that
regularly interfered with family life, most parents believed their
families were functioning reasonably well in a range of important
ways and identified strengths on which they and the therapist could
draw. For example, on the rating questions:
many parents were hopeful or very hopeful that family therapy
would contribute positively to addressing the problems they
experienced;
over half of the parents rated their families as getting along well or
very well, with one-third saying they got along ‘OK’;
parents reported that they got along well or very well with the
referred child in almost two-thirds of situations, over a quarter
judging their relationship as ‘OK’;
where partners were present (82%), almost half judged their
partners’ relationship with the child was going well or very well,
with a quarter reporting ‘OK’.
The FAD outcomes provided a contrast with common mental health
assumptions; rather than viewing their families as dysfunctional, most
parents identified family abilities to plan activities, support each other,
communicate their feelings, solve problems and get along well
together. This was consistent with the global ratings of their family
relations, parent–child and partner–child relationships. For example,

274
TABLE 3 Comparison between non-clinical and clinical group percentages for items on the FAD general functioning subscale (n 5 362)6
Strongly Strongly
agree Agree Disagree disagree Chi2

(a) Planning family activities is difficult
because we misunderstand each other. 3.9 14.8 47.1 34.2 11.6 o0.01
Clinical 7.5 23.6 48.1 20.8
(b) In times of crisis we turn to
each other for support. 35.5 51.6 11.0 1.9 0.9 NS
Clinical 32.9 50.7 13.6 2.8
(c) We cannot talk to each other about
the sadness we feel. 3.9 20.1 48.7 27.3 7.6 NS
Clinical 7.5 29.4 43.0 20.1
(d) Individuals are accepted
for what they are. 34.4 50.0 12.3 3.2 2.6 NS
Clinical 28.0 58.3 11.4 2.4
(e) We avoid discussing our fears
and concerns. 3.2 18.8 56.5 21.4 6.5 NS
Clinical 9.5 21.8 49.3 19.4
(f) We express feelings to each other. 28.1 56.2 13.7 2.0 4.5 NS
Clinical 24.8 50.5 22.0 2.8
(g) There are lots of bad feelings
in our family. 3.2 18.8 41.6 35.7 39.2 o0.001
Clinical 11.3 36.3 39.6 12.7
(h) We feel accepted for what we are. 23.2 59.4 16.1 1.3 7.0 NS
Clinical 13.9 61.2 22.0 2.9
(i) Making decisions is a problem
for our family. 2.6 14.8 50.3 32.3 25.4 o0.001
What the family brings

Clinical 6.1 31.3 48.1 14.5
(j) We are able to make decisions
about how to solve problems. 17.5 61.7 19.5 1.3 9.8 0.02
Clinical 12.8 52.1 30.8 4.3
(k) We don’t get along well together. 1.9 14.8 39.4 43.9 18.0 o0.001
Clinical 4.3 19.4 53.1 23.2
(l) We confide in each other. 22.9 54.9 20.9 1.3 1.9 NS
Clinical 18.7 54.1 24.9 2.4
6
The clinical group is indicated in shaded boxes with the non-clinical group in clear boxes. Items with a significant difference on the Chi-Square tests are
indicated in bold.
275
although there was a significant difference between the clinical and
non-clinical groups on Item K of the FAD, more than 76% of the
clinical group and over 83% of the non-clinical group believed that
they got along well together despite the existence of problems that
were serious enough to bring them to therapy.
In general, parents were not drawn to therapy because they
perceived their families as seriously incapacitated. Rather they were
presented with children’s mental health problems that they rated as at
least moderately challenging, and were seeking support and direc-
tion. Further, despite many children experiencing difficulties within
the clinical range (according to the CBCL), most parents remained
hopeful that their children’s problems would improve through
gaining assistance in therapy. Silberberg (2001) suggested that ‘the
very fact that a family is seeking outside assistance is a strength in
itself ’ (p. 55). Hopefulness represents a construct of resilience that
can be evident at an individual or family/group level (i.e. an ability to
use faith to maintain a positive sense of a meaningful future).
The present findings create some dilemmas for a family therapy-
oriented child and adolescent mental health programme. The mental
health literature predominantly emphasizes links between family
dysfunction and levels of children’s mental health problems;
problems are often seen as the product of various difficulties with
family structure and process. The reports given by most parents
before therapy are not consistent with this assumption. The majority
rated their families as functioning well in the key areas studied,
regardless of whether or not their reports of children’s problems fell
into the clinical or non-clinical range.
This is not to overlook those parents who rated their families as
having difficulties in key areas of family functioning. In particular,
parents were most concerned about the ‘bad feelings in our family’,
associated possibly with their decision to seek therapy. Responses to
the question on children’s problems ‘interfering’ with family life
suggest that parents could have viewed ‘bad feelings’ as a response
rather than a cause of mental health difficulties. This is consistent with
the concept of family burden presented below (Marsh et al., 1996) (i.e.
the impact of living with mental health problems rather than family
dysfunction causing children’s mental health problems).
Taking this further, the significant differences between the clinical
and non-clinical groups suggests that families with a child scoring in
the clinical range on the CBCL accepted family members but did not
appreciate aspects of their behaviour that were interfering with family

life. Despite being able to talk about concerns, they were unsure what
to do next, or had run out of options, leading to bad feelings that had
the potential to escalate. They came to therapy with the hope that it
would make a positive difference. Family resilience was being tested
in planning and deciding on how to solve problems, but not in
accepting family members and expressing feelings.
These results offer a response to critiques of strengths-based
approaches that suggest ‘the strengths perspective is just positive
thinking in another guise, simply reframes deficits and misery, is
‘‘Pollyannaish,’’ or ignores or downplays real problems’ (Saleeby, 1996,
p. 302).1 The existence of strengths in families is not merely a figment
of therapists’ imaginations or a result of their unfailing optimism. If
you ask the right questions, families can identify them. Therefore, the
results suggest that therapists can acknowledge inherent family
strengths to enhance resilience both in individuals and the family as a
whole. This is crucial in strengthening families’ abilities to manage
current and future adverse or challenging situations.
Beyond an individual focus for resilience

Studies beyond the mental health field documenting the develop-
ment and maintenance of resilience in the face of adversity take a less
individualized approach. These are writings regarding liberation,
rights and justice movements, human ecology/systems or community
health. These approaches acknowledge the ways in which groups at a
‘community’ or population level2 foster and value resilience as a
means to both survival and transcendence of oppressive or proble-
matic situations, as well as negotiating and striving for peaceful
co-existence. Fortunately, some of this work is beginning to influence
the mental health field (e.g. Fraser, 1997; Garbarino et al., 1992;
Lyons, et al., 2000; Marsh, et al., 1996; Saleeby, 1992, 1996; Stroul,
1996; Walsh, 1998; Weick and Saleeby, 1995).
Marsh et al.’s (1996) research on family experiences of mental
illness is an example of embracing family resilience within the mental
health field. They note that ‘families have their own restorative
powers, often surviving their crises and meeting their challenges with
1
See Saleeby (1996) for an outline of the ‘strengths perspective’, an account of criticisms
and a response to this critique.
2
A population may be defined by family, geographical, gender, cultural, national or
sexual identity characteristics.

mastery, dignity and empathy’ (p.4). Importantly, they point out that
‘resilience never occurs in isolation; it is universally accompanied by a
powerful family burden’ (p.5). They borrowed from McCubbin and
McCubbin’s (1988, cited in Marsh et al., 1996) work on characteristics
of resilient families, using two key concepts:
1 Family coherence: ‘a fundamental coping strategy employed in the
management of family problems; it is operationalised as the family’s
emphasis on acceptance, loyalty, pride, faith, trust, respect, caring
and shared values in the management of tension and strain’ (p.5).
2 Family hardiness: ‘the family’s internal strengths and durability; it is
characterised by an internal sense of control of life events and
hardships, a sense of meaningfulness in life, involvement in
activities, and a commitment to learn and explore new and
challenging experiences’ (p.5).
Models for the assessment of families have examined various

dimensions of family functioning from the perspective of ‘healthy’
functioning or family dysfunction. Although designed primarily to
describe ‘family pathology’, some of these models were far-sighted
enough to realize that family functioning was multidimensional and
family strengths were important in assessment. As our research results
demonstrate, the McMaster model (Epstein et al., 1983) can assess
positive dimensions such as problem-solving, communication, roles,
affective responsiveness, affective involvement and behaviour control.
In this study most parents from both clinical and non-clinical groups
identified aspects of family resilience in the face of the problems that
brought them to therapy:
They identified family strengths related to trust, loyalty, respect and
caring on the FAD – aspects of family coherence, e.g. turning to each
other in times of crisis, accepting individuals for what they are,
discussing fears and concerns, and expressing feelings.
They felt hopeful about the future – they had faith that issues were
resolvable, particularly if given some support through therapy, an
aspect of family hardiness.
As parents were able to identify family strengths, they had not
succumbed to an account of themselves as incompetent and
dysfunctional, also an aspect of family hardiness.
They had initiated a connection with a support service that would
provide an opportunity for safe emotional expression of concerns

about their current situation, as well as enable them to learn about
and respond better to the challenges they were facing – another
aspect of family hardiness.
In Marsh et al.’ (1996, p.8) terms, these features may also be

characterized as ‘family bonds and commitments’, and ‘family
strengths and resources’.
Limitations
Lyons et al. (2000) highlighted the limited amount of research on
family strengths, resilience and coping. With the incr-eased practice
of strengths-based, family-focused approaches in mental health areas,
research needs to explore how strengths are described, how they
relate to problems experienced, and how services can better
acknowledge and develop strengths. The research described here is
an initial response to this position, moving from an intra-individual
focus to a family focus in the context of brief family therapy.
There are significant difficulties in the measurement of family
functioning in empirical work with few theoretically sensitive
measures available. In fact, strengths- and solution-based work
has been oriented towards unique outcomes for each person and
many practitioners are sceptical about the normalizing influence of
standardized approaches (Allison et al., 2002). Hence, most schools of
strengths-based family therapy have not derived standard measures
of their constructs.
The questionnaire used in this study was a simple twelve-item
checklist. It is a valid and reliable measure of family functioning
(Byles et al., 1988), and is valuable as a short and relatively robust
measure of family strengths and difficulties. However, it is a brief
measure that can give only a limited amount of information about
family life. In addition, responses were predominantly from mothers:
this was to be expected because mothers were usually the main carers
and were more involved in the therapy process. Further efforts need
to be made to gain perceptions of other parents/guardians, young
people and independent observers.
Connections with practice

Given most parents’ reports in this study regarding family strengths
and their views on problems interfering with family life, an emphasis

on actively fostering family resilience is strongly advocated for family
therapy work.3 This would also foster a partnership approach to
therapy, rather than a one-way transfer of knowledge, expertise and
skill from therapist to client(s).
There is an increasing body of work in the psychotherapy
literature on the importance of ‘common factors’ that account for
variance in therapeutic outcome (Hubble et al., 1999; Miller et al.,
1997). It appears that variance may be divided as: extratherapeutic
factors of clients and their environments (40%); the therapeutic
relation-ship (30%); expectancy and hope (15%); and therapeutic
technique or orientation (15%). The concept of personal and family
strengths as a critical focus is repeated consistently throughout this
work: ‘The client’s view of the relationship is the ‘‘trump card’’ in
therapy outcome, second only to the winning hand of the client’s
strengths’ (Hubble et al., 1999, p. 412).
The importance of recognizing and acknowledging the strengths in
families also supports an understanding of therapy as a partnership
process, where the contributions of all parties are brought to bear on
the issues of concern. This includes the strengths families have as
resources for managing problems that trouble them. For those
familiar with the work of Reimers and colleagues (Reimers, 2001;
Reimers and Treacher, 1995), this aligns with ‘user-friendly therapy’.
In accordance with this work, it has been noted previously in a
qualitative follow-up study of the South Australian CAMHS brief
therapy programme (Stacey et al., 2001) that parents greatly valued
therapists who identified and built upon family strengths, or assisted
family members to develop new strengths and capacities. Further,
they viewed this as supportive in managing relapses or enhancing
their capacity to deal with other future issues. Similar themes were
also critical in influencing the level of satisfaction that parents
experienced in the therapy process (Stacey et al., 2002).
Collectively, previous and current work identifies the value of
taking a ‘strengths orientation’ into therapeutic conversations, rather
than leaving strengths as interesting features noted in an assessment
process.4 This suggests investing more heavily in ways of fostering
protective effects within family therapy practice: ‘Protection may also
3
An excellent resource to assist in this process is Walsh’s (1998) book ‘ Strengthening Family
Resilience.’
4
This does not need to be limited by adopting only particular theoretical orientations or
therapeutic models that specifically emphasize a strengths focus.

lie in fostering positive chain reactions, and these, too, need attention
in therapeutic planning’ (Rutter, 1999, p.136).
Future research
A strengths orientation is a relative newcomer to the literature in
mental health and intervention outcomes, which has long been
dominated by deficit-based models, and there are many rich seams to
mine for further research (Lyons et al., 2000; Walsh, 1998). Some
directions in relation to therapy work with families on which
outcomes research could be conducted include:
Asking families prior to therapy about the nature of their strengths,
how they have developed these strengths, how they are of
assistance to them in managing issues, what gets in the way of
them drawing on their strengths, as well as what challenges their
strengths and leads them to seek additional support. Then asking
families after therapy to discuss and/or rate to what degree they
believed therapists identified, drew upon and expanded their
strengths in managing the problems they faced, and what
difference this made to their experience and therapy outcomes.
Compare this with therapists’ accounts of therapies that use a
strengths orientation.
Compare the experience of and outcomes for families in therapy
approaches that actively or do not actively adopt a strengths
orientation. Compare this with therapists’ accounts of the therapy.
Compare family strengths reported by people receiving brief
versus longer term therapy both pre- and post-therapy.
Follow up families a year or more after therapy to see what
difference therapy with a strengths orientation has made to
maintenance of therapy outcomes, relapse prevention and dealing
with future problems or challenges (i.e. explore the preventive and
mental health promotion effects of strengths-oriented therapy).
Conclusion
This paper reports the findings of a large survey of parents attending
an Australian CAMH service and focuses on the existence of family
strengths prior to therapy. The study demonstrates that most parents
presenting for therapy perceive their families as having strengths,

despite the burden associated with supporting children experiencing
mental health problems. With the slow yet steady move towards doing
prevention and mental health promotion work over the past decade,
workers in the mental health field have become more aware of the
possibilities that taking a strengths perspective offers in terms of
fostering individual and family resilience. As awareness grows,
consideration must also be given to how a strengths orientation can
be employed actively in all mental health work, including therapy.
In the light of ongoing interest in evidence-based practice,
evaluating the outcomes of consistently adopting a strengths orienta-
tion to family therapy work in Australian CAMH services is important.
Within the mental health sector, family therapy continues to be at the
forefront of strengths approaches, yet it needs to increase its research
activity to inform the wider mental health field about the impact and
value of taking a strengths perspective. Hopefully, this will provide
further support for increasing the use of strengths approaches in the
wider mental health field.
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r The Association for Family Therapy 2003.

Published by Blackwell Publishing, 9600 Garsington

What the family brings: gathering evidence for

Steve Allison,a Kathleen Stacey,b Vicki Dadds,c

Families attending child and adolescent mental health (CAMH) services

r 2003 The Association for Family Therapy and Systemic Practice

The increasing influence of resilience

r 2003 The Association for Family Therapy and Systemic Practice

However, some suggest a more social base, for example:

r 2003 The Association for Family Therapy and Systemic Practice

Fostering resilience – what part can family therapy play?

r 2003 The Association for Family Therapy and Systemic Practice

r 2003 The Association for Family Therapy and Systemic Practice

r 2003 The Association for Family Therapy and Systemic Practice

Data were analysed using SPSS (Version 10.0), frequency tables,

r 2003 The Association for Family Therapy and Systemic Practice

Question 1 Extremely Worried Slightly Not at all

Steve Allison et al.

r 2003 The Association for Family Therapy and Systemic Practice

Steve Allison et al.

Discussion: orienting to strengths

r 2003 The Association for Family Therapy and Systemic Practice

Steve Allison et al.

What the family brings

r 2003 The Association for Family Therapy and Systemic Practice

Beyond an individual focus for resilience

r 2003 The Association for Family Therapy and Systemic Practice

Models for the assessment of families have examined various

r 2003 The Association for Family Therapy and Systemic Practice

In Marsh et al.’ (1996, p.8) terms, these features may also be

Connections with practice

r 2003 The Association for Family Therapy and Systemic Practice

r 2003 The Association for Family Therapy and Systemic Practice

r 2003 The Association for Family Therapy and Systemic Practice

r 2003 The Association for Family Therapy and Systemic Practice

r 2003 The Association for Family Therapy and Systemic Practice

r 2003 The Association for Family Therapy and Systemic Practice

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