Toward a More Optimal Selfobject Milieu: Family Psychotherapy from the Perspective of Self Psychology

This paper applies the theory of self psychology to the understanding and treatment of families. The healthy family is viewed as a reliable source of selfobject experience for its members, while problems in or between family members are seen as due to a lack of adequate selfobject experience for one or more members. Causes of selfobject failures or misattunements in the family are examined, with an emphasis on the influence of previous relational experiences on current needs, capacities, and experiences of others. Curative factors in this form of family therapy are then outlined, and a treatment approach designed to help family members become better able to provide empathically attuned responses to each other is described, with a case example used to illustrate key points.     

Adolescents with Gambling Problems: From Research to Treatment

Considerable interest in the area of youth gambling has prompted an increase in empirical investigations examining the correlates associated with youth experiencing severe gambling problems. Based upon the current state of knowledge and our clinical experience, the development of the treatment program for youth with serious gambling problems employed at the McGill University Youth Gambling Research and Treatment Clinic is described. The major tenets, underlying philosophy, and therapeutic processes are presented. A case study is included to illustrate the therapeutic approach. The authors present the need for greater funding for more basic and applied research and the necessity for further scientifically validated treatment and prevention programs.     

Marriage and family therapists and psychotropic medications: practice patterns from a national study

A national sample of marriage and family therapists (MFTs) was used to describe practice patterns of MFTs whose clients use psychotropics and to compare medicated and nonmedicated clients. Marriage and Family Therapists (n=283) reported on 195 medicated and 483 nonmedicated adult clients. Clients (n=375) rated their improvement and satisfaction with treatment. Results showed that 91% of MFTs treat medicated clients, and these clients accounted for 25% of MFT cases. Medicated clients were most often seen in individual therapy, had more serious medical problems, and showed greater cumulative improvement in relational functioning. Therapists from MFT educational backgrounds had fewer medicated clients than MFTs from other educational backgrounds.     

Treating Serious Emotional and Behavioural Problems Using Multisystemic Therapy

Multisystemic therapy (MST) is a family‐ and community‐based treatment of serious emotional and behavioural problems presented by adolescents. The development of this model began in the late 1970s, and today MST is a leading evidence‐based treatment of serious antisocial behaviour in youths, with programs transported to more than 30 states in the United States and 12 nations, including Australia and New Zealand. This article rerviews the theoretical rationale that underlies MST and presents the central clinical features of the intervention model. In addition, the training and quality assurance protocols used to promote MST program fidelity and treatment adherence are described. Finally, findings from approximately 15 published randomised and two quasi‐experimental clinical trials with youths presenting serious clinical problems (e.g., violence, substance abuse, serious emotional disturbance, sexual offending, and chronic illness) are summarised.     

Two Case Studies on Family Work with Eating Disorders and Body Image Issues

This article highlights the need for clinicians who work with eating disorders and body image problems to address the deeper family issues underlying these symptoms. The authors propose an eclectic approach including family systems, structural and experiential family therapy theory as a guide. The paper begins with an overview of family therapy theories currently used in the treatment of eating disorders, and goes into greater detail about the three theories highlighted in the eclectic model proposed. The authors present two cases with actual case dialogue, demonstrating how they used this composite model. This article has both theoretical and practical implications for clinicians working in the field.     

Tracking the Sexual Behavior-Specific Effects of a Foster Family Treatment Program for Children with Serious Sexual Behavior Problems

Few treatment programs exist for very young children with serious sexual behavior problems. Fewer still have produced data relating to their effectiveness, and the sparse data that have emerged have focused on global social adjustment or improvement rather than on sexual behavior- specific changes. This study tracked both frequency of problem sexual behaviors and care giver estimates of the propensity to re-offend of six initial clients referred to a treatment-intensive foster care program for sexually reactive children and pre-adolescent sexual offenders. A simple pre-post (basepoint-treatment) design was used, and in-treatment data gathered over a two-year interval are presented. Initial results indicate that the problem sexual behaviors of most of these youthful clients were effectively and immediately suppressed in the context of their treatment intensive foster placements, but that the program's impact on the clients' propensity to re-offend given the opportunity—a crude measure of treatment internalization—was much less immediate, less pronounced, and less predictable across clients. Recommendations based on these data are offered concerning the viability of foster care intervention for sexualized and offending children, as well as optimal durations for such treatments. The strengths and weaknesses of the novel progress tracking method are discussed.     

Family Support Groups for Family Members of Mentally Ill Offenders: Therapeutic Factors

This study investigates therapeutic factors of a Family Support Group (FSG) intervention for family members of mentally ill offenders. Seventeen family members completed the ‘Group Therapeutic Factors‐Client Questionnaire’ (GTF‐CQ‐28) during four sessions of two FSGs. Results indicate that family members experienced the following therapeutic factors over the course of treatment: the relational climate, interactional confirmation, expressing and experiencing mutual positive feelings, forgetting own problems, hope from seeing progress in others, guidance from therapists, and getting interpersonal feedback treatment. The therapeutic factors, including learning by observation, support from the group, and universality of problems, correlated with a decrease in self‐blame, improved emotional well‐being, and experiencing less loss of control over one's life, respectively. Further, family members were satisfied with what the FSG has provided for them personally and for the relation with their relative. Finally, clinical implications of the FSG are discussed. The study sheds light on valuable therapeutic factors within an FSG and the important role of therapists.     

Life Stress and Depression in University Students: Clinical Illustrations of Recent Research

Abstract

Through the use of case vignettes, this paper demonstrates the clinical relevance of findings from previously reported research conducted at the University of Toronto. These published studies link life stress to depression in university students. Three psychosocial factors—a family history of psychiatric illness, stressful life events, and lack of social support—are found to be significantly related to depressive symptoms. A fourth psychosocial factor, childhood or adolescent loss of a nurturing person, was not significantly related to the occurrence of depression. However, that factor remains an important therapeutic focus for a number of depressed students. In addition, the absence of at least a single confidant and certain life events (recent loss of a significant person, changes in living arrangements or academic situation, and financial problems) were identified as specific risk factors for depression. Although depression experienced by students is often serious enough to warrant professional intervention, only a minority seek professional help. The majority of those who do seek help are women; male students are less likely to associate somatic symptoms with emotional problems and are less willing to seek psychiatric help. The four case studies presented illustrate the clinical relevance of these research findings.     

A comparison of email networks and off-line social networks: A study of a medium-sized bank

Recently there has been a surge in the availability of online data concerning the connections between people, and these online data are now widely used to map the social structure of communities. There has been little research, however, on how these new types of relational data correspond to classical measures of social networks. To fill this gap, we contrast the structure of an email network with the underlying friendship, communication, and advice seeking networks. Our study is an explorative case study of a bank, and our data contains emails among employees and a survey of the ego networks of the employees. Through calculating correlations with QAP standard errors and estimating exponential random graph (ERG) models, we find that although the email network is related to the survey-based social networks, email networks are also significantly different: while off-line social networks are strongly shaped by gender, tenure, and hierarchical boundaries, the role of these boundaries are much weaker in the email network.     

The Social Relationships and Social Support of Aging Mothers Whose Adult Daughters Are Mentally Ill

Guided by a conceptual framework highlighting multiple facets of social relationships and social support, this study examined the extent to which aging mothers of adult daughters with a serious mental illness were socially integrated with members of their network. It further examined the relational content of these mothers’ social ties as tangible or intangible support and the nature of their supportive exchanges with network members, particularly their adult daughters with mental illness. A structured face-to-face interview was conducted with 22 aging mothers of these adult daughters. Two methods of analysis were used to analyze data: counting and content analysis. Findings showed aging mothers of daughters with mental illness were socially integrated with relatives and nonrelatives, evidenced relational content of tangible and intangible support in their social ties and engaged in bidirectional and asymmetrical support exchanges with network members, including their daughters with mental illness. These findings suggest that social resources in the form of social relationships and support are embedded in the networks of aging mothers who have adult daughters with serious mental illness. Practitioners should assess support contributions to the aging mothers of adult daughters with serious mental illness from a wide range of social relationships including their daughters.     

EFFICACY OF FAMILY THERAPY FOR DRUG ABUSE: PROMISING BUT NOT DEFINITIVE

Drug abuse is an enormous public health problem with consequences not only for individuals using drugs but also for families, communities, and society. Moreover, research evidence and clinical experience agree that drug abuse is one of the more difficult problems to treat. Despite considerable research on the connection between family factors and drug use, and the existence of family therapy models for drug abuse, comparatively few controlled efficacy studies have been conducted. This article presents a critical review of controlled treatment outcome research in the area of family therapy for drug abuse in both adults and adolescents. A number of studies from different clinical research groups demonstrate that different versions of family intevention can engage and retain drug users and their families in treatment, significantly reduce drug use and other related problem behaviors, and enhace particular domains of prosocial functioning. Moreover, a smaller number of comparative efficacy studies have shown family therapy to be more effective than nonfamily therapies. Family therapy of adolescent drug abuse is more developed at present than family therapy of adult drug abuse. Although the results of the reviewed studies are promising, a blanket confirmation of family therapy's efficacy for drug abuse cannot be made at this time because of the relatively small number of studies and the noted methodological limitations of the studies published to date. Nonetheless, substantial progress in this clinical research area has occurred, and if research and funding support continue or can expand, significant breakthroughs in the treamtment of drug abuse with family-based treatments are possible.     

DEFINING WHO WE ARE AND WHAT WE DO: CLINICAL PRACTIVE PATTERNS OF MARRIAGE AND FAMILY THERAPISTS IN MINNESOTA

The clinical practice patterns of a representative sample of marriage and family therapists (MFTs) were studied. AAMFT clinical members from Minnesota ( N = 76 ) were surveyed for demographic characteristics, educational beckground, and practice-related issues. subjects also reported empirical data from 119 treatment cases involving 351 clients, a first in the MFT field. Among the major findings were: (a) MFTs practic relatively short-term therapy with the average case involving 11 sessions over a 4-month period; (b) therapy with families (average of 8 sessions) and couples (10 sessions) is briefer than individual therapy (14 sessions); and (c) NFTs treat a wide range of serious problems. Overall, MFT clinical practice patterns were comparable to those of other established mental health professions.     

From Practice Evaluation to Agency Evaluation

Abstract

This paper describes the efforts that a family service agency undertook to develop a workable evaluation program as part of a United Way demonstration project. Integrating basic elements from single subject design and goal attainment scaling with program logic modeling, a simple system for collecting and compiling data on clinical outcomes was created that could provide feedback on the progress of individual cases to workers, and agency wide improvement rates to clinic administrators and funding agencies. The model that evolved is manageable because it is simple, was developed by the clinical staff, serves a clinical purpose, meets the expectations of funding sources, and actively engages clients, workers and supervisors in an ongoing process of monitoring progress. Sample forms used to gather data are presented along with the results and next steps for the evaluation process.     

Linked Lives: Adult Children's Problems and Their Parents' Psychological and Relational Well-Being

This study examined associations between adult children's cumulative problems and their parents' psychological and relational well-being, as well as whether such associations are similar for married and single parents. Regression models were estimated using data from 1,188 parents in the 1995 National Survey of Midlife in the United States whose youngest child was at least 19 years old. Participants reporting children with more problems indicated moderately poorer levels of well-being across all outcomes examined. Single parents reporting more problems indicated less positive affect than a comparable group of married parents, but married parents reporting more problems indicated poorer parent-child relationship quality. Findings are congruent with the family life course perspective, conceptualizing parents and children as occupying mutually influential developmental trajectories.     

Relational Ethics,Depressive Symptoms,and Relationship Satisfaction in Couples in Therapy

The purpose of this study was to examine depressive symptoms and relationship satisfaction as problems related to relational ethics in one's family of origin and current partner relationships in a sample of 68 other‐sex couples seeking therapy at a large university clinic. We used the Actor Partner Interdependence Model to analyze dyadic data collected prior to beginning therapy. Specifically, we found significant actor effects between relational ethics in one's family of origin and depressive symptoms, as well as between depressive symptoms and low relationship satisfaction for both male and female partners. We also found significant partner effects for relational ethics in current partner relationship, depressive symptoms, and low relationship satisfaction. Clinical application of contextual therapy theory is discussed.     

Mitchell's Relational Conflict Model: An Analysis of Its Usefulness in Clinical Social Work

This article examines the relational conflict model developed by Stephen A. Mitchell. The main concepts of Mitchell's relational conflict model are discussed, particularly early patterns of connection to parental figures and the interactive treatment approach to understanding and changing those relational patterns. The model is contrasted with classical drive and developmental arrest theories in the psychodynamic treatment of psychopathology. We explain how Mitchell's model, in keeping with a social work perspective, takes into consideration the social, cultural, and environmental factors as well as the intrapsychic. We discuss how patterns of relating are reworked throughout the life course, and we explore the potential for individual agency in constructing new patterns of relating. We also highlight the social constructivist aspects of Mitchell's approach which are congruent with current contemporary trends in social work theory. A case vignette is presented to illustrate the viability of this model for clinical social work practice.     

Good Country Living? Exploring Four Housing Outcomes Among Poor Appalachians

In the wake of welfare reform, many poor people have exhausted their benefits and must now live with less government support. While all of these former welfare recipients are struggling, some are experiencing housing problems that are quite severe. This article uses survey data on former welfare recipients who have used up the maximum time limits for receiving welfare to better understand three core explanations for rural housing problems among the poor: community, individual, and family factors. We estimate models to weigh the relative effects of these factors on the likelihood of experiencing several housing outcomes, finding that rural location is the most consistent predictor of housing outcomes, predicting home ownership, and whether families reside in low‐quality housing. We also find that individual and family factors affect the type of housing one has. We conclude that housing policies must be tailored to improve specific housing outcomes.     

Transference,Countertransference, and Mutuality in Relational Social Work with College Students

The college experience represents a major life transition from adolescence to adulthood, which is often fraught with challenges in relationships, identity formation, and communal belonging. Steady generational changes in self and relational identity have led to younger generations that increasingly embody a more interpersonal and less individualistic conception of the human person, with less rigid norms and greater openness to diversity. These characteristics make college students an appropriate target population for interpersonal psychotherapies based on mutuality of process. Relational therapy is a particularly fitting treatment modality for college students, as it focuses on these very qualities. This article reviews the current literature on relational theory in psychological and social work practice, describing its principal tenets and concepts, and applying this theory to clinical work with college students to reveal applications for constructive practice with this population.