BASIC FAMILY THERAPY SKILLS, IV: TRANSGENERATIONAL THEORIES OF FAMILY THERAPY

This pape focuses on the basic skills and compentencies of transgenerational approaches to family therapy, the fourth report of a program of research surveys by the Basic Family Therapy Skills Project. In the first survey, a panel of family therapy educators listed the most critical or basic skills or compentencies of beginning family therapist with a transgenerational orientation. In the third survey, self-selected respondents rated these items according to degree of importance for beginning family therapists. Rankings of the items according to mean scores of the Likert responses indicate that transgenerational family therapy skills are founded in theory and can be identified behaviorally. The most important skills are those that use the self of the therapist to understand and utilize transgenerational family therapy skills for both therapist and client. Also listed are skills that many raters deemed "generic" rather than specifically related to transgenerational family therapy. Other findings and their implications for the future training of family therapists are discusses. Although the paper is intended for family therapy educators interested in their colleagues' ideas about critical skills in trans-generational family therapy, theorists and clinicians may also find it useful.     

An Empirical Approach to Supervision and Training of Relationship Therapists

This paper presents an empirical approach to supervision and training of marriage and family therapists. Advantages from the use of the empirical approach include a systematic investigation of the skills and competencies of the therapist and establishing the basis for the scientific study of supervision. A Counseling Problems Worksheet is presented to help in developing multiple hypothesis related to counselor skill deficiencies. Two case studies are given to demonstrate the use of the empirical approach .     

Basic family therapy skills, I: conceptualization and initial findings

This is the first report on a program of research designed to identify the most important characteristics of the beginning marriage and family therapist. The paper first surveys the literature in family therapy, social work, and psychology and finds that, although these factors are discussed for beginning psychotherapists, no set of skills are derived empirically. This study recruited all available members of the American Family Therapy Association (AFTA) and Approved Supervisors of the American Association of Marriage and Family Therapy (AAMFT) who were experienced educators and trainers of family therapists. After nominating the most important generic-type characteristics for beginning family therapists, the participants rated the items, yielding a list of not only the most important skills, but also personal traits of beginners based on mean scores of the ratings. The final section of the paper discusses the implications of these findings and notes the current and future activities of the research program.     

Factor analyzing the “ASK” cultural competency self-assessment scale for child protective services

This study explored the development of a short version of “ASK” (Attitude–Skills–Knowledge) Scale — a tool for caseworkers and supervisors self-assessing cultural competency in a training context. The goal was to determine the validity and reliability of the 97-item long form and find factors to consolidate the items to create a shorter tool for training and practice use. In a state project, 171 caseworkers and supervisors rated the level of importance of 97 areas of attitudes, skills, and knowledge competency in terms of self-assessing their readiness to work in a culturally diverse environment. Attitude, skill, and knowledge domains of the instrument were tested with high reliability (.93 for the 30 “attitude” items, .95 for the 40 “skill” items, and .92 for the 27 “knowledge” items). Factor analyses indicate that this scale can be efficiently applied to categorize the 30 attitude items into eight factors, the 40 skill items into nine factors, and the 27 knowledge items into seven factors. With these 24 factors, a short ASK version was constructed for future research to encourage continuous self-assessment.     

INFLUENCE OF THERAPIST SKILLS ON CLIENT PERCEPTIONS OF MARRIAGE AND FAMILY THERAPY OUTCOME: IMPLICATIONS FOR SUPERVISION

Clients seen in two marriage and family therapy training clinics were surveyed regarding treatment outcome. They rated their therapist's skill level on several therapist variables including "experience,""confident,""concerned," how well the treatment used seemed to "fit" their view of the problem and if the therapist seemed to "know how to deal" with their concerns. The variable of "fit" of treatment accounted for 35% of the variance in the client's perception of treatment outcome. "Concerned,""fit," and "knew how to deal" accounted for 36% of the variance in overall rating of the therapist. Suggestions for using these results in supervision of beginning therapists are given.     

Selecting a family therapy model: the role of personality attributes in eclectic practice*

The expanding knowledge and skill bases within the interdisciplinary family therapy profession pose a significant challenge for evolving practitioners, at whatever stage along the professional development process they find themselves. This challenge raises a basic question regarding whether there are any constraining forces to the level of eclecticism in practice towards which one can aspire. This paper empirically explores the role played by the personality attributes of the family therapist in facilitating and/or inhibiting one's adherence to a variety of approaches to family practice.     

WORKING WITH MEN IN FAMILY THERAPY: AN EXPLORATORY STUDY*

The results of this exploratory research provide a beginning formulation of a gender-sensitive approach to working with men in family therapy. A panel of 36 family therapists endorsed 131 interventions as appropriate and effective ways to work with men. The results suggest the importance of therapist awareness of gender issues and socialization in working with male clients. Interventions were highly endorsed in the areas of developing therapist perceptual and conceptual skills regarding gender, promoting mutual responsibility, and challenging stereo-typical behaviors and attitudes. Surprisingly few interventions pertaining to structuring treatment and encouraging affective expression in men had sufficient consensus to be included in the final results.     

Training family therapists to work with children and families: a modified Delphi study

This study examined child inclusion issues and training marriage and family therapists (MFTs) to treat children. This modified Delphi study utilized a panel of experts, and gathered data through questionnaires and qualitative interviews. Panelists believe children should participate in family therapy sessions for both child and adult problems, except when parents are discussing sex or sensitive issues. Child-focused courses should emphasize developmental issues, engaging techniques, theoretical issues, play therapy theory, MFT treatment for child disorders, and specific child/family problems. Panelists suggest numerous child-focused references, but reached consensus for only one. Key therapist attributes and skills were identified. Deductive and inductive training methods and the role of supervision were highlighted. Although therapist playfulness and creativity were emphasized, few play techniques were included in the final profile.     

Cognitive-Behavioral Family Therapy with a Family in High-Conflict Divorce: A Case Study

Children who live in families with high-conflict divorce situations are increasingly coming to the attention of clinicians. This paper explains the nature of the impasse of high-conflict divorce. It presents a brief theoretical overview of cognitive-behavioral family therapy as an effective approach to treatment for high-conflict divorce families. A case study that successfully utilized a cognitive-behavioral approach to family therapy is presented. Specific techniques such as parent training, communication and empathy skills, problem-solving skills, assertiveness training, role-modeling on the part of the therapist and application of the concept of reciprocal inhibition were included in the cognitive-behavioral family treatment. An N=1 research design is graphically illustrated for evaluation purposes.     

BASIC FAMILY THERAPY SKILLS,II: STRUCTURAL FAMILY THERAPY1

The Basic Family Therapy Skills Project has yielded empirically derived skills important for beginning family therapists. This article reports the results of ratings from the 103-member panel of experts who practice and teach Structural Family Therapy. A total of 100 competencies of Structural Family Therapy were rated in terms of importance on a 5-point Likert scale by the panel. Panelists were also given alternative responses such as “appropriate as a generic skill,”“inappropriate for beginning therapists,” and “don't understand what this means.” Rationale for the approach and results are discussed in terms of the importance of empirically based competencies for the practice of Structural Family Therapy.     

Observing the Delivery of a Domiciliary Support Service

This paper describes a study of the work of domiciliary support services which have been developed under the All-Wales Strategy for services to people with learning difficulties. The study employed direct observation methodology to describe the pattern of activities of domiciliary support workers and their clients. Twenty-eight sessions were observed, with the work of the domiciliary support worker with each client being observed twice. The pattern of work observed broadly fell into four categories: physical care in the family home, sitting-in, support for skill development and support in community activities. The results revealed that while support workers worked with skill and sensitivity in the family home they require further guidance and support if they are to assist successfully in skill development and community integration activities.     

EVALUATING FAMILY THERAPY: DIVERGENT METHODS, DIVERGENT FINDINGS

This study reports on a triangulation strategy for assessing family interaction, involving family members, their therapist and coders independently viewing videotapes. Utilizing a standardized scale, the Beavers-Timberlawn Model of Family Competence, the study found weak agreement between paired assessments within the family triad, and within the therapist-coder dyad. In addition, more complex scaling techniques such as composite "family scores" or discrepancy scores between family member dyads added no predictive power. The findings suggest that a "limit of concordance" may exist when comparing varying raters' assessments of a given family, and that methodological and/or scaling strategies designed to maximize agreement may be both fruitless and diversionary.     

Technology and labor relations in the construction industry

Conclusions It is clear that a great array of new job titles and a profusion of semiskilled categories of construction work have developed which were not represented by unions when unions established the labor structure that dominated the industry for many years. They have come about because technology has compressed skill requirements away from the extremes and towards the center: fewer craftsmen with highly refined, broadly based skills are needed, but more who have limited or specialized skills are needed, and more who can apply some lesser degree of skill than either, but enough to be able to follow their leads, are also needed. At the same time, there is less need for lift-and-carry work unassisted by mechanical advantage, so there is decreased demand for laborers in the old sense—workers who were allowed to use the tools of no trade.     

The role of family therapists in veterinary medicine: opportunities for clinical services, education, and research

Marriage and family therapists (MFTs) are applying their specific skill set in a variety of arenas. A new area for collaboration is veterinary medicine. The veterinary medical profession is emphasizing the importance of non-biomedical skills such as communication skills, acknowledging that human clientele are likely to view their pets as family members, and discussing veterinarian personal well-being. Each of these trends has clear application for intervention by MFTs. A discussion of how MFTs may be uniquely positioned to assist veterinary medicine is presented. An example of collaboration between MFT and veterinary medicine at Kansas State University is highlighted. Recommendations are made for development of effective educational relationships and possible private sector collaborations.     

DO WE REALLY UNDERSTAND? AN EXPERIENTIAL EXERCISE FOR TRAINING FAMILY THERAPISTS

This paper presents an experiential exercise for training beginning marriage and family therapists, as well as several adaptations of the format. The basic exercise consists of role playing a therapy session in which the people playing the clients speak a language that is not understood by the therapist-in-training. Although the therapist cannot understand the clients, the clients can understand the therapist. This exercise assists students to become more cognizant of the need to be cautious and curious in the cocreation of meaning in therapy. In addition, this exercise builds confidence and clinical skills, such as learning about nonverbal communication while observing process.     

COMPLEMENTARITY AS A FUNCTION OF STAGE IN THERAPY: AN ANALYSIS OF MINUCHIN'S STRUCTURAL FAMILY THERAPY

The level of family therapist complementarity in the early, middle and late stages of therapy was explored. A micro-analysis of Salvador Minuchin with one family in successful therapy was conducted using the Structural Analysis of Social Behavior (Benjamin, 1974). Interactions from videotapes representing the three stages were coded. An ANOVA was used to compare sequences that occurred at least 5 times within any given stage. Level of therapist complementarity was significantly greater in the early and late stages than in the middle stage. Furthermore, level of therapist complementarity was significantly correlated with client change. Further research is needed to explore whether these findings can be generalized to other therapists and families.     

A condom skill scale: assessing condom skills among female drug users

Use of latex condoms is a primary form of sexual risk reduction, and consequently many intervention programs have focused efforts on increasing condom use among high-risk populations. Use alone, however, will not fully protect the individual if condoms are not used correctly. The objective of this study was to describe the development and properties of a scale measuring demonstrated condom use skill using a sample of 261 drug-using women. Guttman's coefficient of reproducibility and Jackson's Plus Percentage Ratio (PPR) were used to determine the scalability of the Condom Skill Scale (CSS). Analysis of scale scores revealed high levels of condom skill among the population, although there was reduced performance for three items. Preliminary analysis suggests that the CSS is a potentially valid and reliable instrument, and may have application as a tool assessing condom skill level.     

Ratings of social functioning in outpatients with schizophrenia: Patient self-report versus caregiver assessment

Patients with schizophrenia often have deficits in day-to-day functioning that are central to their disability. The ability of patients to rate their own social functioning, however, has not been established. In this study we examined the concordance between the ratings on the Social Functioning Scale of 58 outpatients with schizophrenia and their caregivers. We found a high level of overall concordance between the self and informant ratings. Items measuring the frequency of behaviors were among those with the highest concordance, while ratings of ability or social skill showed lower correlations. On only nine of 73 items did patients rate themselves significantly higher than did caregivers. There was no difference in concordance between family and nonfamily caregivers. These findings indicate that outpatients with schizophrenia can provide self-report ratings that are consistent with the ratings of their caregivers.