Way of being and the therapeutic pyramid: Expanding the application of a common factors meta‐model

Common factors proponents have suggested the need for principle‐based meta‐models to explain how various factors interact with each other to produce change. The therapeutic pyramid is a common factors meta‐model that outlines how therapeutic skills and techniques, the therapeutic alliance, and a therapist's way of being interactive to produce therapeutic change. Skills and techniques occupy the smallest top portion of the pyramid, with the therapeutic alliance in the middle and a therapist's way of being forming the foundation of the pyramid. The success of any layer rests on the quality of the immediately underlying layer. This study illustrates the broad applicability of common factors meta‐models by applying the therapeutic pyramid to couples therapy, family therapy, training and supervision, and professional ethics.     

What clients of couple therapy model developers and their former students say about change, part II: model-independent common factors and an integrative framework

Proponents of the common factors movement in marriage and family therapy (MFT) suggest that, rather than specific models of therapy, elements common across models of therapy and common to the process of therapy itself are responsible for therapeutic change. This article-the second of two companion articles-reports on a study designed to further investigate common factors in couple therapy. We used grounded theory techniques to analyze data from interviews with MFT model developers Dr. Susan M. Johnson, Dr. Frank M. Dattilio, Dr. Richard C. Schwartz, former students of Dr. Johnson and Dr. Schwartz, and each of their clients who had been successful in couple therapy. This article reports model-independent variables, that is, general aspects of therapy that are not directly related to the therapist's model. Model-independent categories include client variables, therapist variables, the therapeutic alliance, therapeutic process, and expectancy and motivational factors, each with several subcategories. We also present a conceptual framework that outlines how model-dependent and model-independent common factors may interact to produce change. We discuss our findings and proposed framework in relation to the current common factors literature in psychology and MFT. We also discuss clinical, training, and research implications.     

Targeting Threats to the Therapeutic Alliance: A Primer for Marriage and Family Therapy Training

Although theory and research highlight the importance of the client–therapist relationship, marriage and family therapy (MFT) training has historically centered on specific models, consisting of proprietary language and techniques, instead of common factors like the therapeutic alliance. In this article, we begin by making an argument for explicitly focusing on the therapeutic alliance in MFT training programs. Next, we highlight common alliance threats experienced by both faculty members and student therapists. We then integrate research‐informed principles with clinical wisdom to outline specific recommendations and concrete skill‐building exercises for MFT educators and supervisors to use with their students to address these threats and advance training on the therapeutic alliance.     

The Multisystemic and Multilevel Investigation of the Expanded Therapeutic Alliance‐Psychological Functioning Relationship in Individual Therapy

The expanded therapeutic alliance, consisting of multiple interpersonal alliance relationships, is a common factor inherent to the practice of all systemic therapies. The following study has three specific aims: (a) Bring an expanded, multisystemic emphasis to the study of the therapeutic alliance in individual therapy; (b) Understand better the session‐by‐session relationship between alliance and psychological functioning, including distinguishing within‐person from between‐person variability by using multilevel modeling techniques; and (c) Explore the role of early attachment relationships and family‐of‐origin experiences in moderating the alliance‐psychological functioning relationship. Instead of taking only one or two alliance measurements throughout treatment like in the majority of previous research, we measured both alliance and psychological functioning continuously at each session for 296 subjects.     

Resource Dependence and Community Well‐Being in Rural Canada*

Abstract The well‐being of residents of resource dependent communities is a question of traditional interest to rural sociologists. The label “resource dependent” obscures how this relationship may vary between particular resource industries, regions, or indicators of well‐being. Few analyses have compared the relationship between well‐being and resource dependence across different industries, nor tested competing theories about the relationship between resource dependence and well‐being. Our paper presents an overview of the relationship between resource dependence—agriculture, fisheries, mining, energy, forestry—and human well‐being in Canada. Analysis of 1996 Statistics Canada data revealed a great deal of variation in the effect of “resource” dependence on indicators of well‐being (e.g., human capital, unemployment, income): some industries exhibit fairly positive outcomes (e.g., agriculture), others more negative outcomes (e.g., fishing). Consistent with analyses conducted in the United States, these relationships vary by region, suggesting the need for models that incorporate the particulars of place and industry.     

Systemic alliance in individual therapy: factor analysis of the ITAS-SF and the relationship with therapy outcomes and termination status

Clients providing systematic feedback to therapists via self-report measures of psychological distress and working alliance have been shown to increase therapy outcomes. However, there are few systemic-based measures that are feasible for therapists to use. Recently, Pinsof et al. (Family Process, 2008, 47, 281) developed a brief systemic alliance measure (ITAS-SF) for individual therapy. The current study tested the factor structure of this measure and examined whether the subscales related to clients' therapy outcomes and termination status (N = 570). The results demonstrated supported a 3-factor model for the ITAS-SF (as compared to the seven factors proposed by Pinsof et al.). In the first factor, content combined the goals for therapy, the tasks or methods to reach those goals and bond between the client and therapist. The second factor reflected how clients perceive the relationship with the therapist (i.e., interpersonal dimension-self/therapist), and the third factor reflected how clients perceive the alliance between their social network and the therapist (i.e., interpersonal dimension others/therapist). The two interpersonal factors were related to therapy outcome and termination status.     

Clients’ perceptions of marriage and family therapists’ way‐of‐being: a phenomenological analysis

Previous research highlights the influence of therapist factors on treatment outcomes. One therapist factor proposed as fundamental to the process of therapy is the therapist's way‐of‐being, a relational concept that refers to how the therapist regards a client—either as a person or object (Fife et al., [2014] Journal of Marital and Family Therapy, 40, 20–33). Although this case has been made conceptually, there is little empirical research on therapists’ way‐of‐being with clients. The primary purpose of this research is to investigate clients’ perceptions of their therapists’ way‐of‐being. Utilizing a common factors perspective, the study seeks to explore: (a) how clients experience their therapists’ way‐of‐being and (b) the influence therapists’ way‐of‐being has on clients’ engagement. Phenomenological methods were used to gain a nuanced understanding of the phenomenon. Qualitative data were collected through semi‐structured face‐to‐face interviews with clients (N = 10) who received individual therapy from a marriage and family therapist. Results were organized into two main themes: core tenets (attunement, congruency, and aligning with clients) and operational tenets (providing affirmation and validation, balancing flexibility and structure, and accomplishing goals). Findings are used to make a case for adding the concept of way‐of‐being as an overarching construct for several well‐established therapist factors. Clinical and training implications are discussed.     

Therapeutic Alliance; A View Constructed by a Family Therapy Team

Therapeutic Alliance is a construct which may have value for a family therapy team and influence its day to day practice. This paper discusses whether family therapeutic alliance can be observed, described and measured, and gives an account of the development of the Family Therapeutic Alliance Scale (FTAS) by a brief strategic family therapy team. Our focus is on the use of statistical technique as a means of clarifying the team's construct of therapeutic alliance, informing the team process without being the final arbiter in development of the scale. The second stage outlines the investigation of the usefulness of the construct with a wider group of family therapists. In individual psychotherapies measures of therapeutic alliance have been shown to predict outcome. Our early work suggests this is also true for family therapies and the FTAS may be a predictor for outcome in family work.     

How to Compare Apples and Oranges: Infants' Object Identification Tested With Equally Salient Shape,Luminance, and Color Changes

What kind of featural information do infants rely on when they are trying to recognize a previously seen object? The question of whether infants use certain features (e.g., shape or color) more than others (e.g., luminance) can only be studied legitimately if visual salience is controlled, as the magnitude of feature values—how noticeable and interesting they are—will affect results. We employed a novel methodology, interdimensional salience mapping, that allowed us to quantify and calibrate salience changes along shape, luminance, and color feature dimensions. We then compared 9‐month‐old infants' identification of objects, employing feature changes that were equally salient. These results show that infants more readily identify objects on the basis of color and shape than luminance. Additionally, we show that relative salience changes rapidly in infancy—in particular, we found significantly higher salience thresholds for color in younger (6.5‐month‐old) infants—but that individual differences within an age group are remarkably modest.     

Beyond common factors: multilevel-process models of therapeutic change in marriage and family therapy

A number of scholars have proposed the common factors perspective as the future direction of marriage and family therapy (MFT). Although intuitively appealing, the case for the common factors perspective is not as clear-cut as proponents portray. In its current form, the common factors perspective overlooks the multilevel nature of practice, the diversity of clients and settings, and the complexity of therapeutic change. In contrast, comprehensive process-based change models are an alternative to the limitations of common factors. In this article, we consider the limitations of the common factors perspective and propose the necessary and sufficient components and processes that might comprise comprehensive, multilevel, process-based therapeutic change models in MFT.     

Using Attachment to Better Understand the Therapy Alliance: The Attachment Based Alliance Questionnaire

Questionnaires on the therapeutic alliance are available, but most show inflated scores, limited variability, and few significant findings on the bonds domain. Results of a study of 251 clinical couples, on the development of an Attachment Based Alliance Questionnaire (ABAQ), are presented. Factor analysis (EFA and CFA), show that a one‐factor or two‐factor structure fit the data, with more support for a one‐factor model. Both models map closely with attachment constructs. Results also show that the ABAQ is predictive of changes couples make early in therapy and demonstrated adequate reliability and validity. The ABAQ provides a tool for clinicians as they learn how to attune to relationships in couple therapy and is helpful to researchers in understanding the alliance.     

Therapist Differentiation and Couple Clients' Perceptions of Therapeutic Alliance

Therapeutic alliance has been acknowledged as one of the catalysts for change within a therapeutic relationship. The contributions of therapists' characteristics to alliance are not often studied. From a Bowen System's Theory perspective, the therapist's level of differentiation would be highly relevant to the development of a therapeutic alliance. The hypothesis for this study was that therapists who are able to take a more differentiated stance in therapy will build a stronger therapeutic alliance. To test this hypothesis, multilevel modeling procedures were performed, using data from nine therapists and 93 couple cases collected at a large, Midwestern university. Therapist differentiation of self was found to be weakly associated with the clients' perception of therapeutic alliance across the early sessions of therapy, but not in the expected direction. Although the results were unexpected, this study provides an example of the potential of examining therapist characteristics from within one model of therapy, that can be applied across various clients and various models of therapy.     

Engaging Fathers in Family Therapy with Violent Adolescents

Violent behavior in adolescents can often signal profound distress or pain arising from family conflicts, hostile marital separations, sudden losses and other family turmoil. By circumventing blame the therapist engages the family in a constructive process that allows adolescents to change and grow and parents to share pain and sorrow about their own issues and responsibilities for their children. This re‐establishes healthy generational boundaries, produces a clearer co‐parenting alliance (e.g. after divorce) and creates sibling support. This paper describes an experiential approach, for working with violent adolescents in family therapy influenced by the pioneer work of Satir and Whitaker. It integrates systemic and developmental theories linking the presenting problem to relevant family events. The therapist: (1) explores adolescent development in the family and social context; (2) establishes a therapeutic alliance through understanding the interpersonal context for violent behavior, and (3) re‐directs negative actions into positive connections with family members. Segments of family therapy sessions with two adolescent boys and their families from different cultural backgrounds illustrate the impact of paternal absence for adolescent well‐being and the need to actively engage fathers in family therapy. Mario, the father's ‘tumor’, and Juan with his despairing violence are two problematic adolescents brought to therapy because of their aggressive behavior at home and/or in the school. The paper describes how to give them a different voice and build a therapeutic alliance with the family.     

“Swapping” Families: Serial Parenting and Economic Support for Children

The claim that fathers “swap” families when they form new ones—that is, they shift allegiances from nonresident children to new residential children (e.g., Furstenberg, 1995 )—has not been directly evaluated empirically. Drawing on data from the two waves of the National Survey of Families and Households, we test Furstenberg's argument in terms of child‐support transfers to nonresidential children, and we also test an elaboration of his approach that distinguishes between resident biological children and stepchildren. Using static‐score models, our findings indicate that fathers do swap families but only when the trade‐off is between new biological children living inside fathers' households and existing biological children living outside fathers' households. Even though our analytic sample is small, our findings have important implications for child well‐being, child‐support policy, and the meaning of fatherhood.     

Predicting Developmental Change in Healthy Eating and Regular Exercise Among Adolescents in China and the United States: The Role of Psychosocial and Behavioral Protection and Risk

This article reports a cross‐national study of developmental change in health‐enhancing behavior—healthy eating and regular exercise—among adolescents in China and the United States. The application of a conceptual framework comprising psychosocial and behavioral protective and risk factors—both proximal and distal and at both the individual and social contextual level—is shown to provide a substantial account of variation in change in those behaviors over a 2‐year interval. The explanatory account has generality across gender, the 3 grade cohorts, and most importantly, across the 2 markedly diverse societies.     

Most and Least Meaningful Learning Experiences in Marriage and Family Therapy Education

Marriage and family therapy educators increasingly emphasize training competencies. What we know less about is what makes family therapy education meaningful to marriage and family therapy (MFT) graduate students and what does not. In this study, through an Internet survey, we explored the most and least meaningful learning experiences of 68 MFT graduate students and recent graduates of Commission on Accreditation for Marriage and Family Therapy Education—accredited programs. We used thematic analysis to identify and illustrate resulting themes, which included the importance of experiential and personal components to learning, the professor‐student alliance, tying theory to practice, and the experiences of students with their clients, among others. We discuss the implications of these findings to support family therapy education and offer tentative suggestions for formative discussions both within and across programs. Video Abstract is found in the online version of the article .     

The Maudsley Model of Family Therapy for Children and Adolescents with Anorexia Nervosa: Theory,Clinical Practice,and Empirical Support

The aim of this paper is to present the Maudsley model of family therapy for children and adolescents with anorexia nervosa, one that integrates principles and skills from a variety of models. The Maudsley model is of prime importance because of its non‐pathologising approach to families, because its techniques have been published in sufficient detail for standardised application by clinicians, and because of its strong history of empirical support. It is also a model that integrates both modernist and constructivist influences from the history of family therapy.     

Insider/Outsider: A Muslim Woman's Adventure Practicing ‘Alongside’ Narrative Therapy

The following paper centres on my unique experience as a white Australian therapist who is able to sympathise with a Western world view while being immersed in an Islamic world view. The goal is to share my journey as a Muslim Australian via an auto‐ethnography reflexive method. Using diaries, intentional reflexive positioning, and multiple modes of supervision, I contemplate an Islamic identity and value system while negotiating poststructural therapies such as solution‐focused collaborative, and in particular, narrative therapy as viable approaches to working with the Muslim community. There are two inquiries which are of interest. The first is to reflexively describe the experience of being a Muslim practitioner and wondering whether core differences in epistemological views between social constructionism and Islamic doctrine can be overcome. Secondly, this enquiry explores Quranic guidelines about how to perceive ‘problems’ in life, based on the premise that understanding how an Islamic world view addresses life's troubles may add to deeper conceptions of the role of difficulties. I propose that adherent Muslims have a natural metaphorical way of thinking that connects with some of the poststructural therapeutic skills and techniques and at the same time draw on past Quranic solutions for contemporary problems. Little has been written on narrative therapy as a suitable approach to working with Muslim clients. In the current paper I review my personal experience as a veiled Muslim therapist striving to implement narrative therapy alongside an Islamic epistemology.     

Dimensions of Job Quality,Mechanisms, and Subjective Well‐Being in the United States

How does job quality predict subjective well‐being in the United States? Prior research suggests that various job quality dimensions such as job security and individual task discretion affect subjective well‐being, but the theoretical mechanisms are implied rather than tested and aspects of job quality are rarely tested together. I use structural equation modeling and General Social Survey data to assess the impact of five job quality dimensions—individual task discretion, monetary compensation, job security, low work intensity, and safe work conditions—on subjective well‐being. Then, I show that job quality influences subjective well‐being by improving social life, altering class identification, affecting physical health, and increasing amounts of leisure time. Finally, while I find that job quality dimensions do have statistically significant effects on subjective well‐being, the way in which job quality affects subjective well‐being differs by job dimension. In other words, job quality has a statistically significant impact on subjective well‐being, but different job quality domains are connected to subjective well‐being in different ways.