Introduction

The last two decades of the twentieth century brought with them not only drastic changes in the policies governing the delivery of health and welfare services, but also changes in the conditions and lifestyles of individuals and families.

The need to produce ever more, the existence of differentiated working hours, the pressure produced by multiple and sometimes conflicting obligations, changes in the composition of families and the presence of many socio-economic problems are so many realities that have left their mark on family communication styles, typology, functions and rituals, and that have given rise both to new problems and to different emotional needs. Reality has become more unpredictable than ever. Individuals feel a pressing need to adapt, to compete, to succeed or, simply, to survive. Violence and addictions now function as a kind of existential cave in which many seek shelter from their feelings of inadequacy, thus trying to locate themselves, in order to exist, in a more predictable psychological space. Notions such as love, peace and harmony are ever more distant and elusive. The dream of “making it in life” has become increasingly difficult to define and to attain. The world is moving at a highly accelerated pace and many feel they have been abandoned to their fate.

This is a new era, in which people can find self-therapy guides on supermarket shelves. Survivors of sexual abuse openly tell their story and receive, on air, the advice of radio or television hosts. Meanwhile, therapists face not only the bureaucracy of managed care, which sets limits for them and defines and prescribes their therapeutic restrictions and rules of conduct, but also an increasingly sceptical clientele, demanding faster and more effective results. Reality presents us with a new set of situations and challenges that lead to the conclusion that, quite clearly, therapeutic styles and goals can no longer be formulated as before. If, forty years ago, the need to look at the individual in the context of his family system was recognised, the new century brings us the need to operate from a broader platform, thereby widening the field of therapeutic intervention.

Community family therapy: an approach for the present time

Community family therapy (CFT) was born of the need to look for a method that would make it possible to link clinical questions and social questions within one and the same therapeutic frame of reference. Fundamentally, CFT is oriented towards the production of power through intervention. Although this need to produce power through therapy has been widely recognised, interventions have always been linked more to the generation of intrinsic than of extrinsic power. Although the importance of working with family and social networks in order to produce extrinsic power continues to be acknowledged, in practice this work has been left in the hands of other professionals. Several occupations, such as case managers or community outreach workers (workers who deliver services to clients in their own community), have emerged and become commonplace. CFT recognises the importance of these interventions and the need for therapists to be trained in these areas.

CFT operates at two levels. On the one hand, it works on situations by integrating the individual into his family and into the social frame of reference that concerns it; on the other, it builds working teams whose objective is to obtain changes in the extended family and in the community environment.

Jennifer’s case is one example among the many families who, day after day, face countless social problems in the poor neighbourhoods of American cities. Many of these families live almost under siege from street violence, imprisoned in unhealthy flats and surrounded by the cruel realities of socially toxic environments, almost entirely isolated from the benefits of modern society. Often, they must also deal with the emotional residue of past traumatic experiences, a situation which in itself affects their mental state. Frequently, despair takes hold of them and they seem to have neither the motivation nor the energy needed to struggle to improve their lives.

Faced with this situation, a key question arises, and imposes itself:

are these situations to be addressed from within family therapy? Do we therapists have a service to offer these families? One can answer yes, optimistically. It is clear, however, that in order to be effective with this type of situation, we need to widen the field of action of family therapy and to operate outside traditional therapeutic formats. Developed in Hartford, Connecticut, the model presented here, community family therapy, has proved useful in situations such as this one. In this approach, therapists must show great flexibility in order to be able to establish types of therapeutic relationship other than those they learned in traditional training.

Why do clients get better? The factors linked to clinical improvement

A limited piece of research, carried out in Hartford, Connecticut, analysed the situations of twenty-five clients, four or five years after their participation in therapy. All had experienced an improvement in the symptoms for which they had sought consultation and had moreover dramatically improved their general living conditions. In individual interviews, they were asked what had been the most important factors in that improvement. To our surprise, it was found that they hardly mentioned therapy as an important variable, but cited other factors as the causes of their greater well-being. The most frequently mentioned factors were the following:

Variables

• the support of close family;
• the support of the social network;
• the presence of good mentors;
• a positive experience of love;
• belonging to religious groups;
• belonging to cultural groups;
• altruism;
• a leadership position;
• the use of community resources;
• raising one’s level of education;
• taking part in vocational training;
• obtaining a good job;
• an increase in income;
• the disappearance of stress factors;
• a change of home;
• the experience of success.

While some of these variables were associated with the therapeutic intervention, in the majority of cases it was the clients who, by their own means, had developed other initiatives or obtained additional resources. The conclusion drawn from this research was simple: if these variables have such a positive impact on the emotional state and on the lives of clients, then it is logical to incorporate them into therapeutic interventions from the outset. Conceptually, this is one of the fundamental pillars of community family therapy. If reality shows us that the sixteen factors mentioned have curative effects, then it is worth including them in the therapeutic process. Take altruism, for example. It was found to be one of the most powerful factors among those mentioned. Not only is it useful as a generator of self-esteem, but it also induces a sense of personal responsibility in clients. As soon as one helps others, one begins to be looked upon as a model. This factor introduces a positive pressure to display positive behaviours or to produce higher levels of achievement. Knowing this, the therapist can, in session, suggest opportunities to exercise altruism or help connect the client to them. Another example: work. Obtaining a good job can certainly produce symptomatic improvement, for many understandable reasons. Therapists can therefore be in contact with employment agencies, thus helping to open doors and to create new opportunities for clients.

We cannot dream of a static psychology, decontextualised from current events and from external reality. The person’s position in the world has now itself widened the family system. We can no longer speak only of the nuclear or the extended family. The idea of the “global village” now has its representation and its impact in individual and family psychology. The individual is no longer only a “member” of the family, but also a “citizen of the world”. Mastering resources and knowing how to operate in this global village are needs that did not appear before, but that are now pressing at this end of the century.

Two new needs have emerged. One: the need to know and to use available resources effectively; the other: the need to operate globally. The need to control the external environment and the need to produce power now take on considerable scope. CFT actively seeks to produce or to increase power: this is one of its fundamental therapeutic objectives.

The therapeutic proposal

More than a specific technique, CFT is a therapeutic template. It is a macro-formulation that makes it possible to look at the situation as a whole. CFT is visionary in the sense that it sets itself high goals, while knowing that these goals may not be attainable in their entirety. It is considered, however, that one must at least try. A simple metaphor is used for this: a vessel about to take off needs several things – a clear runway, a precise navigation chart, a powerful engine, a source of energy – and the vessel’s captain must also have good skills and the desire to sail. Although it seems very simple, this metaphor becomes highly complex once transposed onto the therapeutic plane, as was to be expected. What is good about it is that it allows the therapist not to be cut off from the overall view of the situation. Very often, therapists become so deeply involved in particular situations that they may lose sight of the fact that there are elementary and fundamental principles that people are seeking. On principle, for example, people seek to be happy. People do not come to therapy because they want to settle a problem they have. The problem is formulated that way because we have acquired a negative way of looking at the profession. People do not go to the doctor to have an illness cured: they go to have removed an obstacle that prevents them, or may prevent them, from having a long, happy and high-quality life. The final objective is not to remove obstacles, but personal and/or family satisfaction and fulfilment.

The community family therapy model offers a platform for action. Presented in a simple, almost simplistic way, this approach is a combination of family therapy, community organisation interventions, case management and leadership programmes. This approach also widens the focus of systems theory, taking it from mono- or two-dimensional levels to a global and multidimensional perspective.

A therapy oriented towards action and development

CFT defines the therapist as the facilitator of a process of personal and family self-development. It is postulated that part of the solution to any problem that presents itself lies in development, personal or family, and in the development of new initiatives, competencies or resources. CFT is based on the principle that all human beings wish to live a high-quality life and that they always have goals for the future. In some cases, it may be discovered that people once had goals, but that they gave them up and resigned themselves to no longer pursuing them, judging them impossible or unrealistic. It is postulated that we all have achievement motivations. CFT seeks to clarify or redefine these goals. In the process of motivating the client to strive for these goals, certain specific difficulties are encountered which must be dealt with therapeutically. It may be, for example, that a forty-year-old woman has been through several negative experiences in her couple relationships. In the CFT style, one does not first ask: “Did your couple relationships go badly?”, but: “What was your ideal of a couple relationship?”. One works by always putting vision, aspiration and desire to the fore. Frustrations or other negative feelings are allowed to appear in the course of the process. Reaching negative feelings by the positive route has great clinical advantages. Because it is a therapy of action and movement, CFT works on negative aspects from the following perspective: “we need to remove these mental obstacles in order to be able to get what we want”. A no is not so easily accepted as an answer.

Clinical experience tells us that the great majority of clients appreciate this optimistic stance, even if they sometimes strongly oppose the therapist. Logically, this attitude is received with mistrust, sometimes with anger, and at other times with a touch of cynicism. In other cases, carried away by the moment, some clients may react with a falsely triumphalist attitude. What is sought is a kind of measured optimism. It is assumed that everyone we see has a personal version of how they have functioned in relation to their personal goals. This is nothing new: we have all, in the past, tried to struggle with ourselves to push ourselves forward. Reviewing this history will give us the line to follow in order to be more effective in our interventions.

Three types of bonds

In the search for more effective and less rigid paradigms and methodologies of action, it becomes necessary to revisit the concept of the therapeutic bond. From a broadened conceptual point of view, the therapeutic relationship between the therapist and the family can be seen as a first-order bond. In this type of connection, the therapist practises his “art” within the limits of his consulting room. There he practises what we might call “transparent” or “neutral” interventions. Developed by Salvador Minuchin, the introduction of the technical concept of joining into the field of family therapy was a real advance in its time. Through this concept, Salvador Minuchin gave therapists an articulated way of operating and of bringing systems theory from the conceptual plane to the reality of clinical practice, establishing moreover the method for developing a therapeutic relationship with the family as a whole. According to Minuchin, just as the anthropologist must first join a new culture before being able to study it, so the family therapist must bond and integrate himself as part of the system before being able to intervene.

This joining is practised as an art in which the therapist “dances” with the whole family, joining each member at the same time as the system as a whole.

However, a quarter of a century later, reality teaches us that bonds established only in consulting rooms and with the members who come to the sessions are not enough to help effectively those families who live in complicated situations and environments. Clearly, the establishment of other types of connection with other systems is absolutely indispensable. Community family therapy proposes to extend the concept to other planes. When working with a broadened conception of the family system, going beyond the nuclear family and the extended family, two other types of bond (joinings) are necessary in order to be able to relate to the service delivery systems and to the community in general. The community family therapist intervenes over a wider territory, where an analysis and an intervention plan are drawn up in the family’s immediate environment.

Second-order bonds

Second-order bonds allow culturally competent therapists to come closer to the realities that families live in. In this type of encounter, they meet families in their homes, forge alliances with other service providers in the community and thus form a community team for the benefit of the family. Here the therapist establishes a bond with the extended family system of his clients. In the second-order bond, the therapist is expected to establish an effective relationship with the agencies, institutions, centres, programmes, family or social networks in general that are needed in order to produce real change in the life of the client and/or his family. As a routine part of the intervention, the community family therapist builds a working team that helps him in the process. Basing himself on the needs of the client and on the availability of other systems, the therapist builds with the client (the family) a specific support network that we may call the community family therapy team.

The third order

The third-order bond is established with the community in general. Here, the therapist is not merely a service provider, but an active member of the community. This type of professional, whom one might call citizen therapists, voices opinions not only at an intellectual level far from the noise of the world, but from the ground, in neighbourhood meetings, thus advocating in order to obtain collective solutions to the problems that simultaneously surround many of their clients. They are expected to help clients establish bonds with their immediate community. For this, it becomes necessary to offer some form of leadership training, since people traditionally kept away from decision-making processes cannot be expected to start speaking publicly and acting in the struggle for their fundamental rights from one day to the next.

Individual and family development: permanent change

Individual and/or family development follows a historical course while going through four movements over time, namely:

Individual and family behaviours must be understood as the result of multiple levels of combination and interaction between these four processes, which are moreover in themselves perpetually changing. From this point of view, behaviours are “circumstantial stances” produced by the interaction between internal and external realities. While permanently going through these four movements, individuals and families adopt the “stances” best suited to each specific moment. From this perspective, there are no static personalities or behaviours. Behaviours that seem unique, styles of functioning that seem intrinsic to certain individuals or certain families are always in constant transformation, products of constant interaction with and reaction to systemic, historical or environmental circumstances.

On the basis of this theory, it is postulated that if an intervention can shape both the external environment and the internal process of adaptation, then it can also obtain fundamental changes in individual behaviour or in family functioning. This change can be maintained and consolidated if clients become at the same time the leaders of their own therapeutic process.

Within this normal process of adaptation, the following mechanisms are necessary for the maintenance of good mental health:

an objective self-reflector; a processor of misfortunes; a healer of wounds; a sublimator of pains; a pacifier of conflicts; a compensator of voids; an impulse controller; a communication facilitator; a generator of solutions; an environment manipulator; a developer of resources; a booster of self-esteem; a social acculturator; and a generator of joys.

Seen from the family-systemic point of view, it is understood that at different moments of the life cycle the family helps individuals by offering them these functions or by helping them to develop these mechanisms. At the same time, in healthy families, different members function as leaders in each of the areas mentioned. In highly functional systems, a mechanism of complementarity comes into action and each helps the other in these adaptive tasks. When this group process does not exist or is impaired, CFT sessions help families to develop a balanced system of complementarity. It is postulated that family success is obtained in three ways: 1) if the system is capable of helping the children to develop the competencies mentioned; 2) if it offers its members opportunities to develop leadership; and 3) if the majority of the members are willing to act in order to get by as a family.

Assessment

CFT assesses the family as a whole, taking into account not only the psychological aspects of human existence, but also the sociological, cultural and adaptive dimensions. Using this approach, practitioners can integrate all these factors holistically, and also from a developmental point of view. It is accepted that history and specific environmental experiences not only shape certain behaviours and certain individual styles of communication, but that they moreover give rise to an adaptive dimension (a structure) resulting from the constant interaction between individuals and their milieu. Sociological conditions, stress factors, traumatic experiences, cultural variables and spiritual values constantly influence individual and family psychology. The adaptive dimension results from the need to acculturate or to overcome specific situations; it is the personal or family structure in which therapists intervene.

The adaptive dimension

Working on the adaptive dimension brings with it a new style of clinical intervention. It is a matter of seeking to have individuals take their own destiny in hand. To achieve this, it is indispensable that they take their own processes of adaptation in hand. Other types of therapeutic strategy place the client in a passive position: they are techniques applied to them in the hope that “the technique” will produce results on people. In the worst case, the individual is only a witness waiting for the intervention to take effect. CFT works in another style, in which the client is the main protagonist. One works by building on the competencies that already exist. The intervention focuses on competencies rather than on deficiencies. Past experiences in which the family succeeded by using its own resources are revisited, and one builds on that basis. One operates by strengthening the mechanisms of adaptation, by exposing people to complementary positive experiences.

The therapist allies himself with the client’s adaptive dimension, operating first from within, then gradually withdrawing. The aim is to generate capacity and autonomy constantly, always trying to prevent the production of dependency.

The variables linked to emotional problems

Below is the way CFT conceptualises mental health or emotional disorders. The variables mentioned are written in negative form. If they are written in positive form, it is then understood that they are the aspects necessary to good mental health.

• a distressing autobiographical version;
• inadequate or extremely complicated life plans;
• a failure of the navigation chart;
• incomplete processes of education or enrichment;
• oversaturation or deficiencies of the adaptive mechanisms;
• extremely toxic social environments;
• negative balances between needs and resources;
• deficiencies in the sources of energy or in the feedback systems;
• an existentially uncomfortable position in the immediate social constellation;
• past and/or present imprisonment in alienating contingencies;
• shortcomings in the experience of acceptance and/or love;
• physical variables that compromise the integrity and/or the disposition of the central nervous system.

These factors are not ranked in order of importance and, for the most part, they are described metaphorically. This type of presentation in fact offers a way of constructing the story. This formulation is expected to have three basic components:

1. that it should not be blaming; 2. that it can be well understood and assimilated; and 3. that it should invite action. Given that the community family therapist always seeks to build a working team with the client, the development of a common language is indispensable.

Without neglecting the importance of biological factors (factor 12), CFT explores the other eleven factors in each situation. If difficulties are found in one or more of them, an intervention plan is drawn up. For example, working with low-income people in urban environments, it is very common to find that part of the problem lies in the fact that clients are constantly exposed to factor 6 (toxic social environment). If that is the finding, then part of the intervention must be directed towards eliminating or reducing this negative factor.

Therapeutic strategies

Community family therapy works at three levels simultaneously: 1. individual and/or family therapy; 2. access to and use of community resources; 3. leadership development. The general objectives of each level of intervention are set out in summary form in the following table:

First-order interventions

These include the application of traditional and non-traditional techniques of individual, group or family therapy. In this area, CFT lays down no prescriptions as to the method of intervention to be used: each therapist is free to use the strategies or techniques he prefers. It is held, on the other hand, that whatever the method used, the fundamental aim of this intervention is to create healthy paradigms that facilitate and invite action. This is an area in which many therapists have worked over the years. Many techniques have proved effective in producing transformations in what are called belief systems, paradigms, myths, images, values, themes or family descriptions. These first-order interventions are necessary in order to remove the conceptual obstacles that hinder the development of self-esteem or of the motivation to act. In many cases, we see urban families whose mental state is characterised by a combination of sadness for what happened before, anxiety for what is happening now and paranoia for what may happen. Likewise, inadequate conceptualisations of historical events or of environmental circumstances certainly paralyse families or tend to produce additional conflicts. Interventions that facilitate the development of healthier and more functional descriptions are always on the agenda. For example, a person who has been through several problems and traumas in her life may see herself as a “victim”. Even if she has really been victimised, the perception of her whole being as a victim certainly has consequences for the way she functions socially or professionally. If the person is redefined as a “survivor”, this description tells us about the individual competencies or resources that helped this person to survive. The first description invites passivity and helplessness; the second invites action and achievement.

It is necessary to revisit themes linked to unresolved grief, to losses, to shame, to suffering, to resentments, to frustrations or to feelings of despair. In all these cases, new descriptions must be developed which not only help to deal with past situations, but which also invite people to move forward.

One of the techniques used in the CFT repertoire is what is called videotherapy. This technique consists in recording a person’s whole story on a videotape. The whole story is expected to be told in summary form in forty-five or at most sixty minutes. The camera frames the client alone. Behind the camera, the therapist conducts the interview by asking sequential and precise questions, as if he were a reporter filming the chronicle of a person’s life. The interview takes place after two or more sessions, when the therapist already knows the person a little. In the following sessions, the two of them, therapist and client, review the tape in order to re-edit the biography. Then, if necessary, another video is recorded with a better version of the story. Seeing oneself telling one’s own story in a video has proved to have a very great impact on clients: it gives them the feeling of having a grip on their life. If the events of the past cannot be changed, one can at least control the way the story is interpreted. One can moreover increase self-knowledge and plan the future better.

Second-order interventions

In the second-order bond, the therapist is expected to establish an effective relationship with the agencies, institutions, centres, programmes or family or social networks in general that are needed in order to produce real change in the life of the client and/or his family. As a routine part of the intervention, the community family therapist builds a working team that helps him in the process. Basing himself on the needs of the client and on the availability of other systems, the therapist builds with the client (the family) a specific support network that we may call the community family therapy team.

Even if each new situation requires a particular team, it may be that some members are constant. It is expected that over time the therapist will have established relationships with other service providers in the community; in other words, the therapist is expected to devote time to building his own support network. Whether they be members of the police department, probation officers, social workers, welfare workers, health staff or other providers, the therapist needs to build his own base. In this group of “partners”, he chooses those he needs and adds to them the members of the extended family system who are willing to help.

For example, in Jennifer’s case, the therapist recognised that he had two options for helping the little girl: either he got the gang to leave the neighbourhood, which seemed a mad undertaking, or he advocated in an attempt to obtain safer housing for the family. He opted for the second and set a process of action in motion by joining forces with a housing department official who, impressed by the therapist’s account of the girl’s situation, decided to treat the file as an emergency. In the meantime, at the mere idea that the problem was going to be solved, the girl had already started going back to school. Four weeks later, the family was settled in a better flat, on a quieter street. When the therapist went to visit the family in their new home, the girl came up to him affectionately and thanked him for his intervention. At a later interview in the consulting room, it was concluded that the follow-up should be closed, with the possibility of coming back for consultation in future if necessary.

Building the CFT team

Let us examine the concept of teamwork through an example.

Mr Brown and his son were brought to consultation by Ms Porter, a worker from a community agency that provides services in a local school. Johnatan, an eleven-year-old boy, had once again been excluded from the school, where he is in fourth grade, for fighting in class. This story has already repeated itself so many times over the past five years that the family and the school team are very much at a loss and do not know what to do.

During the session, the therapist tells himself that he needs Ms Porter as a member of the team. Besides working in several schools, including Johnatan’s, Ms Porter lives in the same neighbourhood as the family: she can therefore potentially be very useful to them. Before the session, the therapist had already invited Teresa, a student trainee in family therapy who works at the city’s development centre for women, in the same building as the one where the session is taking place. While Ms Porter waits outside, the session proceeds normally. We learn that the mother feels very frustrated. Johnatan explains that he is frequently provoked in order to push him into fighting and that he “has to” respond. It seems that the boy is caught in a system, at school, in which the other children amuse themselves by getting him to fight on a regular basis. But the situation is getting worse, because the appointment is taking place in October, barely six weeks after the start of the school year, and the child has already been excluded for a total of ten days. If he were to be excluded for five more days, he would immediately lose the year. This reality means that there is a real sense of urgency in the consultation. It is for this reason that the therapist made ready to build a working team that would start operating immediately. Besides recruiting Teresa and Ms Porter, the child was put in contact with Kevin, a worker from the municipal recreation department, who was asked to spend a few hours with him to show him the possibilities for having fun available to him in his own neighbourhood.

By the end of the day, the family already had four new network members, who were to serve as additional resources. Teresa was given the task of working with Ms Brown, of establishing an alliance with her and of helping her to manage the situation; Ms Porter was given the mission of maintaining general oversight of the file, making sure that the family attended the necessary appointments; Kevin was given the task of connecting Johnatan with a youth centre where he could play and be with other children of his age in a more suitable way.

At the end of this initial intervention, if the problem was not solved, Ms Brown at least seemed happier. She was no longer alone: she had a working team that was going to help her with her difficulties.

The equation is simple. To solve serious situations, high-voltage systems are needed, stronger than the problems. It is a matter of balancing the loads. In this case, the scale of the problem exceeded the strength of Ms Brown, a woman abandoned by her husband, struggling with four children and a full-time job. The loads therefore had to be counterbalanced by producing more voltage, more positive energy in the family.

CFT also seeks to give more power to the therapist. It is important to take into account the need to resolve the loneliness of a therapist in his office or in his consulting room, facing difficult situations in isolation. Any interpretation or any recommendation made once a week will not be enough to change difficult situations. The work becomes lighter if working teams are built, which must be led by the client himself.

The true family, or nuclear network

From the earliest age, and as part of the natural process of socialisation, a new “family system” begins to be part of every individual’s life. This is more palpable in the case of adults who, once grown up, find themselves faced with the reality that they can no longer expect – and sometimes no longer wish – to be supported by the members of their family of origin. In practice, we all develop what we may call the “adult’s family” or the “nuclear network”. Relations with the members of this new “family” may reproduce earlier relational styles, or prove far more powerful and more influential than those previously maintained in the home of origin. Sometimes, these relations fill voids that have existed for many years.

These nuclear networks, or “true families”, fulfil the following functions: facilitating and helping to meet basic needs; offering emotional support; offering a friendly and enriching social circle; offering good company for pleasure and entertainment; facilitating opportunities for self-fulfilment; and providing experiences of affection and/or love.

In seeking to develop the family’s power, work with the nuclear network can be one of the most useful tools available to us. Much has been written about the power of love or of friendship. Frequently, friends become the most significant and most useful relationships people have. In the case of low-income communities, relations between professionals and clients have a major impact, particularly for those living in very precarious conditions. For example, a nurse at a clinic, a priest or a pastor can easily become “members of the adult family” of a given client. CFT intervenes not only by helping people to build or to develop their nuclear network, but also by seeking to increase its use and access to it.

Third-order interventions

Analysing the twenty-five situations in the research mentioned above, it was found that almost all the people who had managed to change their lives in one way or another had developed leadership positions in their community. These situations show that there might be a direct correlation between the degree of mastery exercised over the immediate environment and the ability to control one’s own emotions or to solve personal or family problems. This finding may explain why it is so difficult to motivate some clients to follow therapeutic recommendations, or even simply to come to appointments. It seems that people feel so “defeated” by the realities of their environment that they have already lost hope that things could really change. They then have neither the energy nor the will needed to try to improve their lives. However, the exercise of altruism and compassion can constitute an internal force that generates the motivation to do something. In a certain way, it is easier to help others than to help oneself. When a person begins to help someone, her social position automatically changes: at that moment, she ceases to be someone dysfunctional and becomes someone who reaches out a hand to others.

As we have seen, programmes are needed in which people are formally trained as leaders, thus learning to produce solutions to the problems of the community. The curriculum of such training must include: communication, interpersonal relations, public speaking, programme development, project management, citizens’ rights, effective self-management, group organisation, the conduct and coordination of meetings, and other similar subjects.

These leadership programmes, which do exist in many communities, were developed for professionals or members of the middle and upper classes, the only ones able to access them. CFT recommends that such opportunities be developed for other segments of the population. By working in collaboration with various people, agencies or institutions, therapists can help to create these opportunities in their community. For example, in Hartford, we had the opportunity to create the Parent Leadership Training Institute. This institute has today become a successful programme, which has already been transposed to thirteen cities in the state of Connecticut and to ten other states in the country. The institute offers a six- to eight-month training course, in four-hour weekly sessions. In classes of around twenty students, parents learn the skills mentioned above in a warm and harmonious atmosphere. In Connecticut alone, more than five hundred parents have already graduated. What is impressive is not only that many of them have taken up active leadership positions in their community, but that many others have reported an impressive improvement in their emotional state. It seems that this type of training has positive effects on the mental health of individuals, even when they have had no access to therapeutic services.

Final reflections and recommendations

As has been shown in many cases, community family therapy is a style of intervention that produces positive results with very diverse people and situations. It is important, however, to stress that the effective practice of this therapy requires not only theoretical and practical training: it also requires a change of attitude towards the field of mental health and towards the way of relating to clients in general. According to CFT, these are seen as the main partners of the working team and as the protagonists of their own lives. It is also necessary to recognise the limits of the reach of our traditional interventions and the need to ally ourselves with others in order to obtain good results.

A good community family therapist works hand in hand with clients, their family and their community. Likewise, a good citizen therapist, from his own street corner and in various ways, becomes a community leader. Someone who firmly believes in the potential of the human being and who is always willing to struggle to obtain a better world for all.