Treatment of the
IN THE PRECEDING chapter, we presented data to illustrate that the disconnected family has many interactional characteristics similar to those of the high-intensity family, but that it differs in important ways along the dimension of attachment and bonding between the patient and the parents, and between the parents and their own parents. In our own clinical work with families of young adults and adolescent patients, we have found that treating patients from disconnected families often poses formidable challenges to the family therapist, regardless of the diagnosis of the patient, or index family member. Patients from these families are at high risk for a poor course of functioning when the attachment-caregiving deficits in the family are not adequately addressed.
For treatment purposes it is useful to distinguish between two subgroups of families within the disconnected group: (1) the hostile, critical, disconnected family, in which one or both parents are especially hostile or pervasively critical in their remarks during family interaction, and (2) the low-key disconnected family, in which criticism is benign and somewhat understated. Disconnected families can also be further divided into those in which intergenerational attachment problems exist, and those in which the parents' attachments to their own parents are relatively benign. Treatment issues become more complex, and intervention becomes more challenging, when families are pervasively hostile or critical and/or have intergenerational disturbances in attachment. In such cases, the intergenerational difficulties are usually accompanied by similar disturbed attach