Attachment‐Based Family Therapy With a 13‐Year‐Old Girl Presenting With High Risk for Suicide

This article describes the application of Attachment‐Based Family Therapy (ABFT) to the treatment of a 13‐year‐old female adolescent presenting with high risk of suicide, complicated by a history of depression and sexual trauma. The article begins with an overview of ABFT, including (a) how attachment theory guides treatment; (b) the structure of the clinical model; and (c) the data that provide empirical support. A case example is then presented that exemplifies the primary clinical procedures used to reach therapeutic goals in ABFT, including attachment repair and autonomy/competence promotion. Weekly changes in suicide ideation and depression scores are presented. The article concludes with a discussion about implications for family‐based treatment of suicidal youth.     

Seeking Connection Versus Avoiding Disappointment: An Experimental Manipulation of Approach and Avoidance Sexual Goals and the Implications for Desire and Satisfaction

Previous correlational research has demonstrated an association between people’s reasons for having sex (i.e., their sexual goals) and their sexual desire and sexual and relationship satisfaction. Across two studies of people in romantic relationships (N = 396) we extend previous research and demonstrate, for the first time, that manipulating the salience of approach sexual goals (i.e., engaging in sex to pursue positive outcomes, such as enhanced intimacy) compared to avoidance sexual goals (i.e., engaging in sex to avert negative outcomes, such as a partner’s disappointment) or a control condition leads people to feel higher sexual desire for their romantic partners and to report higher sexual and relationship satisfaction. In addition, in Study 2 we demonstrate that focusing on approach sexual goals over the course of a week leads people to report more satisfying sexual experiences during that week, as well as higher desire and overall relationship satisfaction, compared to a control group. The current findings advance approach–avoidance theory by providing evidence that it is possible to manipulate people’s sexual goals and, in turn, impact their feelings of desire and satisfaction. Results are promising for the development of interventions to promote sexual and relational well-being.     

The effects of family therapies for adolescent delinquency and substance abuse: a meta-analysis

This meta-analysis summarizes results from k = 24 studies comparing either Brief Strategic Family Therapy, Functional Family Therapy, Multidimensional Family Therapy, or Multisystemic Therapy to either treatment-as-usual, an alternative therapy, or a control group in the treatment of adolescent substance abuse and delinquency. Additionally, the authors reviewed and applied three advanced meta-analysis methods including influence analysis, multivariate meta-analysis, and publication bias analyses. The results suggested that as a group the four family therapies had statistically significant, but modest effects as compared to treatment-as-usual (d = 0.21; k = 11) and as compared to alternative therapies (d = 0.26; k = 11). The effect of family therapy compared to control was larger (d = 0.70; k = 4) but was not statistically significant probably because of low power. There was insufficient evidence to determine whether the various models differed in their effectiveness relative to each other. Influence analyses suggested that three studies had a large effect on aggregate effect sizes and heterogeneity statistics. Moderator and multivariate analyses were largely underpowered but will be useful as this literature grows.     

Three perspectives on clients' experiences of the therapeutic alliance: a discovery-oriented investigation

To deepen our understanding of the therapeutic alliance in conjoint treatment, we interviewed clients in four families about their individual, private experience of the alliance after an early session. These qualitative data were triangulated with family members' scores on Pinsof's Family Therapy Alliance Scale-Revised and observational ratings of their behavior on the System for Observing Family Therapy Alliances. This discovery-oriented investigation focused on three interrelated aspects of the alliance: the family's shared sense of purpose about the needs, goals, and value of therapy (i.e., within-system alliance), split alliances with the therapist, and felt sense of safety within the therapeutic context. Results were highly consistent across the three perspectives and congruent with idiographic, therapist-rated outcomes.     

Conduct disorder and delinquency

Overviews evidence-based family treatments for adolescent conduct problems. Three treatments succeed in meeting recommendations for treatment development set forth in recent evaluations by reviewers and federal entities. These treatments (Functional Family Therapy, Multisystemic Therapy, and Oregon Treatment Foster Care) have achieved their success by using the science base of known risk factors, providing an effective alternative to restrictive placements, and using scientific methods to evaluate effectiveness. Major features of these three treatments are presented, including clinical and quality assurance procedures, controlled outcome research support, cost analyses, and process research. Bases of treatment success and parallels among the three approaches are summarized, as is their transport and dissemination to practice settings. Finally, suggestions for future research and clinical implications are discussed.     

Abstracts

Gerson, M. J. & Barsky, M. For the new family therapist: A glossary of terms. American Journal of Family Therapy .
Gunderson, J. G., Kerr, J. & Englund, D. W. The families of borderlines. Archives of General Psychiatry .
Mandelbaum, A. Family characteristics of patients with borderline and narcissistic disorders. Bulletin of the Menninger Clinic .
Liddle, H. H. On teaching a contextual or systemic therapy: Training content, goals and methods. American Journal of Family Therapy .
Pope, K. S., Schover, L. R. & Levenson, H. Sexual behavior between clinical supervisors and trainees: Implications for professional standards. Professional Psychology .
Robinson, B. & Thurnher, M. Taking care of aged parents: A family cycle transition. The Gerontologist .
Watzlawick, P. & Coyne, J. C. Depression following stroke: Brief, problem-focused family treatment. Family Process .     

Internship training in marriage and family therapy: a survey of doctoral program objectives and implementation

This article presents the results of a survey that examined the implementation of the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) internship requirement by accredited doctoral Marriage and Family Therapy (MFT) programs. Representatives from each of 10 doctoral MFT programs provided responses to questions regarding program objectives for internship training. Respondents also provided subjective impressions regarding the effectiveness with which established internship goals are accomplished, associated benefits and difficulties, and adequacy of the standards. Results suggest that although most programs perceive the internship requirement as beneficial, many express concern regarding the effects of the internship requirement on other aspects of training and in relationship to the overall goals for doctoral MFT education. Conclusions and recommendations are offered based on the mixed findings.     

Student-faculty perceptions of multicultural training in accredited marriage and family therapy programs in relation to students' self-reported competence

Although the marriage and family therapy field's recent attention to multicultural issues is laudable, there appears to be little clarity on what constitutes an effective multicultural training program and the impact of the effects of such training on trainee multicultural competence. The field continues to be challenged at different levels-training, practice, research, the setting of the standards and the work of the Commission on Accreditation for Marriage and Family Therapy Education, and the goals and strategic plan of the American Association for Marriage and Family Therapy Board. This study focused on assessing the extent of multicultural integration at different levels of training and the relationship between such training and students' perception of their own multicultural competence.     

Abstracts

Fritz, G. S., Stoll, K. and Wagner, N. N. A comparison of males and females who were sexually molested as children. Journal of Sex and Marital Therapy , 1981, 7 , 54–59.
Baisden, Major J., Jr. and Baisden, Joanna. A profile of women who seek counseling for sexual dysfunction. American Journal of Family Therapy , 1979, 7, 1 , 68–76.
Murphy, G. J., Hudson, W. W. and Cheung, P. Marital and sexual discord among older couples. Social Work Research Abstracts , 1980, 16, 11 , 11–16.
Chesney, A. P., Blakeney, P. E., Chan, F. A., and Cole, C. M. The impact of sex therapy on sexual behaviors and marital communication. Journal of Sex and Marital Therapy , 1981, 7 , 1, 70–79.
Price, S., Heinrich, A. G., and Golden, J. S. Structured group treatment of couples experiencing sexual dysfunctions. Journal of Sex and Marital Therapy , 1981, 6 , 4, 247–257.
Zilbergeld, B. and Rinkleib-Ellison, C. Social skills training as an adjunct sex therapy. Journal of Sex and Marital Therapy , 1979, 5, 4 , 340–350.     

Incorporating sexual orientation into MFT training programs: infusion and inclusion

Many authors have questioned the preparedness of family therapists to deal with sexual minority clients. Even though the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) has called for the integration of sexual orientation into the curriculum of marriage and family therapy training programs, the subject continues to be marginalized. The purpose of this article is to encourage trainers to examine their programs' curricula for evidence of heterosexist bias and introduce ways that they might integrate issues related to same-sex affectional and sexual orientations into their programs via the classroom and the clinic.     

Abstracts

Colapinto, J. The relative value of empirical evidence. Family Process,
Frank, H. Psychodynamic conflicts in female law students. American Journal of Psychoanalysis .
Riskin, L.L. Sexual relationships between psychotherapists and their patients: toward research or restraint. California Law Review ,
Verhulst, J. & Heiman, J.R. An interactional approach to sexual dysfunctions. American Journal of Family Therapy ,     

Sexual functioning and self-reported depressive symptoms among college women

We conducted an exploratory study comparing 47 college-aged women reporting depressive symptoms but not receiving antidepressant medication to 47 age-matched controls. We examined various dimensions of sexual functioning, including sexual desire, arousal, orgasm, pain, pleasure, and satisfaction. The women with depressive symptoms reported more inhibited sexual arousal, more inhibited orgasm, more sexual pain problems, and less sexual satisfaction and pleasure than control participants. Novel to this study, the women with depressive symptoms reported greater desire for sexual activity alone (masturbation) than the nondepressed women. The findings are discussed in terms of primary reinforcers and depressive symptomology.     

THE POLITICS OF FUNCTIONAL FAMILY THERAPY: A FEMINIST CRITIQUE*

This paper examines the political processes inherent in Functional Family Therapy (FFT). It argues that this model of family therapy takes a covert political stance which reinforces traditional gender roles in both family and therapist. Of particular interest are FFT's affirmation of existing interpersonal functions in the family, as well as suggested therapist use of self. The implications of this stance are discussed, as well as recommendations for change.     

An Empirical Assessment of the Goals of Family Therapy*

This study is an empirical assessment of the goals of family therapists. A list of goals was developed based on a theoretical clustering of the family therapy literature into the dimensions of communication, cohesion, and adaptability. Three hundred ten clinical members of the American Association for Marriage and Family Therapy (AAMFT) responded to a questionnaire about their use of these goals in family therapy. The findings indicate that the goals employed by this sample seem to reflect ideas from the literature which are not the property of any one “school” of family therapy. The goals that were rated and ranked highest included encouraging family members to relate caringly, responsibly, and creatively in negotiating their differences. Goals that were rated and ranked lowest included the more advanced or technical communication skills and some cohesion goals that may be interpreted as related to institutional aspects of family life.     

Interactive Family Music Therapy: Untangling the System

Interactive Family Music Therapy can have a unique role to play when working as part of a multidisciplinary team by demonstrating a capacity to ‘surprise’ a client/patient when they least expect it. It provides a positive shared experience that can add to multidisciplinary assessment and treatment planning. This article will illustrate the role Interactive Family Music Therapy has at Redbank House and includes case material.     

The implementation and the cultural adjustment of functional family therapy in a Dutch psychiatric day-treatment center

Because of the increasing severity of adolescent problem behavior, evidence-based practices are becoming of interest as an alternative to traditional treatment with the behavior problems of adolescents in juvenile justice settings. Despite interest in evidence-based practices, questions exist regarding whether or not evidence-based intervention models can be successfully transported to cultures other than those in which they were developed. This article describes the transportation process of an American evidence-based family therapy (Functional Family Therapy [FFT]) into the service delivery system of a psychiatric day treatment center for juvenile delinquents in Amsterdam. The characteristics of FFT that make it cross-culturally sensitive are discussed. Results from the changes in service delivery suggest FFT can be successfully implemented in international settings with adjustments to make the model fit the culture(s) of The Netherlands without changing the model of FFT itself.     

Multi-family group therapy for sexually abusive youth

Although Multi-Family Group Therapy (MFGT) has been a researched intervention for nearly 40 years, clinicians working with sexually abusive youth and their families have only more recently begun to utilize the intervention. We believe MFGT for a sexual offense-specific treatment population is a sophisticated and powerful clinical intervention with unique advantages including economical use of clinician resources, family-to-family transfer of knowledge and mentoring, community-based resourcefulness, and accelerated catalyzing of emotions. This article will provide direction on establishing the MFGT format as well as discuss its goals, curriculum, facilitation priorities, and strategies.     

The Implementation of Functional Family Therapy (FFT) as an Intervention for Youth Probationers in Singapore

Family functioning is predictive of youth recidivism in Singapore. However, there is a lack of family based interventions for youth offenders on community probation. Evidence‐based family interventions developed in Western populations, such as Functional Family Therapy (FFT), have been found to be effective in mitigating subsequent youth criminal behavior. However, no study has examined whether such interventions can be implemented and adapted for use in Eastern cultures. Thus, this paper sought to detail the implementation of FFT in Singapore. Rationale for the adoption of FFT is discussed, and key activities undertaken during the first 18 months of implementation are described. Preliminary data suggest that initial implementation efforts were successful. Challenges encountered, and implications in relation to the broader literature are discussed.     

Conscious Regulation of Sexual Arousal in Men

The goals of this study were to examine the effectiveness of emotional reappraisal in regulating male sexual arousal and to investigate a set of variables theoretically linked to sexual arousal regulation success. Participants first completed a series of online sexuality questionnaires. Subsequently, they were assessed for their success in regulating sexual arousal in the laboratory. Results showed that the ability to regulate emotion may cross emotional domains; those men best able to regulate sexual arousal were also the most skilled at regulating their level of amusement to humorous stimuli. Participants, on average, were somewhat able to regulate their physiological and cognitive sexual arousal, although there was a wide range of regulation success. Whereas some men were very adept at regulating their sexual arousal, others became more sexually aroused while trying to regulate. Age, sexual experience, and sexual compulsivity were unrelated to sexual arousal regulation. Conversely, sexual excitation, inhibition, and desire correlated with sexual arousal regulation success. Increased sexual excitation and desire were associated with poorer regulatory performance, whereas a propensity for sexual inhibition due to fear of performance consequences was related to regulatory success.     

Family therapist comfort with and willingness to discuss client sexuality

Limited empirical information exists on whether or not marriage and family therapists are having sexuality-related discussions with their clients. When helping professionals ignore client sexuality, the potential for unintended negative outcomes increases. The researchers surveyed 175 clinical members of the American Association for Marriage and Family Therapy to assess how their clinical training and education, their perceived sexual knowledge, and their comfort with sexual material influenced their willingness to engage in sexuality-related discussions with their clients. The results indicate that sexuality education and supervision experiences are the cornerstone for a therapist's base level of comfort. It is through sexuality education and supervision that sex knowledge is acquired and comfort levels are increased. Once comfort with sexual discussions increases, then therapists are more likely to engage in sexuality discussions with their clients.