TREATMENT PRIORITIES IN A FAMILY-ORIENTED ALCOHOLISM PROGRAM*

In this paper it is recommended that family therapists not repeat a common error experienced in individual therapy: namely, seduction by the unfolding dynamics which lead to an exclusion of the very specific contributions to the family's malfunctioning by the process of alcoholism itself. There are clearly dynamic factors in alcoholism as a disease process which compromise the family's ability to face and alter its destructive effects. A family program, as part of a comprehensive alcoholism treatment program, is briefly described. The importance of providing cognitive input about the disease of alcoholism is emphasized. Combined individual and group intervention address the destructive family dynamics set in motion by alcoholism.     

DEVELOPING AN IDENTITY AS A FEMINIST FAMILY THERAPIST: IMPLICATIONS FOR TRAINING

Although feminists have profoundly influenced the field of family therapy, little has been written about the process by which these women came to identify themselves as feminist family therapists. This article reports the results of a qualitative research study that explored that process and suggests a model of feminist family therapy identity development. Implications for training programs are reveived.     

Exploring the influence of the attachment organizations of novice therapists on their delivery of emotionally focused therapy for couples

Clinicians' own internal resources for understanding relationships--that is, their attachment organizations--have been found to influence the process and outcome of treatment. The current study addressed whether the attachment organizations of novice couple and family therapists were associated with couples' experiences of their therapists, therapeutic alliance, session impact, and emotionally focused couple therapy (EFT) fidelity (i.e., especially as related to targeting and working with attachment needs and overt and underlying emotions). Novice couple and family therapists delivered EFT, an attachment-based approach, to couples in a simulated session and an embedded multicase study design guided a cross-case analysis. Findings indicated that secure therapists, when compared to their insecure peers, were more competent at working with attachment needs, as well as the overt and underlying emotions of their clients. Secure therapists perceived themselves as being more skilled in emotion regulation, which may have contributed to their abilities to remain attuned to their clients' attachment needs and emotional expression, even in the face of emotional arousal in session. Couples of insecure therapists also reported greater alliance splits. Future research is needed to further explore the dyadic influences of both therapists' and clients' attachment organizations, as well as the training and supervision practices these findings implicate.     

ETHICAL DILEMMAS IN FAMILY THERAPY

A review of the literature in the area of ethical dilemmas facing family therapists revealed that there were a number of issues facing family therapists which are not included in the Principles for Family Therapists (1984) of the American Association for Marriage and Family Therapy. Seventy-five family therapists from across the nation responded to a questionnaire which asked what ethical dilemmas they face and how helpful the ethical guidelines are with these dilemmas. Results indicate that family therapists are encountering dilemmas which are not included in the Principles, significantly more often than those that are included. The ethical principles were found to be helpful for those ethical dilemmas attended to by the Principles.     

Therapeutic Alliance and Retention in Brief Strategic Family Therapy: A Mixed‐Methods Study

We explored how the therapeutic alliance contributed to retention in Brief Strategic Family Therapy by analyzing videotapes of eight‐first sessions in which four therapists worked with one family that stayed in treatment and one family that dropped out. Although behavioral exchange patterns between clients and therapists did not differ by retention status, positive therapist alliance‐related behavior followed negative client alliance behavior somewhat more frequently in the retained cases. In the qualitative aspect of the study, four family therapy experts each viewed two randomly assigned sessions and commented on their quality without knowing the families’ retention status. A qualitative analysis of the audiotaped commentaries revealed 18 alliance‐related themes that were more characteristic of either the retained or the nonretained cases.     

Becoming the Family Archivist

The author describes some of the ways in which conventional amateur family histories fail to portray the emotional realities of family life. Recent trends in biography and autobiography are explored briefly, and the possibility of a family history informed by systemic as well as psychoanalytic insights is considered. The author's own work, A Family in Time, attempts such a history. The author outlines his sources of information, both documentary and oral, and the special challenges posed by their interpretation. The decisions governing the ordering and selection of data for publication are explored, the author's aim being to present the facts in such a way that a systemic conception of family process over time will be implicit in the material. Implications for the author, for the family itself, and for therapists working with intergenerational process are briefly considered.     

Compassion fatigue in marriage and family therapy: implications for therapists and clients

Given that marriage and family therapists are exposed to a wide range of circumstances that leave them uniquely vulnerable to experiencing compassion fatigue, it is important to examine the stresses and hazards they face and what those consequences mean for both themselves and clients. It is essential that they identify how compassion fatigue negatively affects the therapeutic relationship and overall treatment outcome as well as that of the personal life of the family therapist. The marriage and family therapist is responsible and ethically obligated to identify and implement ways in which he or she can prevent and remedy compassion fatigue.     

Therapists’ Assessment and Treatment of Internet Infidelity Cases

In this study, we investigated through an Internet survey of 508 practicing marriage and family therapists which treatment decisions varied by gender of the client and background variables of therapists. The subjects responded to several typical Internet infidelity scenarios. We varied the gender of the person initiating the infidelity for half of one sample. We also asked the family therapy participants to respond to how they might assess and treat each presenting problem. They also evaluated problem severity, prognosis of the case, number of sessions necessary for treatment, and the extent to which a therapist would focus individually or relationally. Results indicate that there were differences in how therapists assessed and treated clients based on client gender, therapists’ age, therapists’ gender, how religious therapists reported they were, and the extent of therapists’ personal experience with infidelity.     

The therapist who is perceived as "spiritually correct": strategies for avoiding collusion with the "spiritually one-up" spouse

Marital and family therapists who are perceived by the community as having a strong spiritual orientation face unique and difficult challenges. Clients who seek their help often bring a mix of expectations that can create a situation in which the therapist may struggle with multiple roles, some not of his or her choosing. These expectations are especially challenging when one spouse views him-or herself as "spiritually one-up" and wants the therapist to form a spiritually based coalition against the other partner. This paper describes the various dilemmas that therapists may face when clients perceive them as having spiritual expertise and presents strategies that can be used for avoiding these dilemmas. A case study illustrates the use of these approaches.     

User Involvement in Therapy: Couples' and Family Therapists’ Lived Experiences with the Inclusion of a Feedback Procedure in Clinical Practice

User involvement in therapy includes some form of feedback from the clients. The feedback guides the therapist and the clients toward a best possible result through a best possible therapy process. In recent years many different procedures for collecting feedback have been developed. In a previous study presented in this journal we explored the expectations therapists had before including the comprehensive clinical feedback procedure, Systemic Therapy Inventory of Change (STIC), in their clinical practices. Our aim with this present study is to explore couples' and family therapists’ experiences with STIC from the perspective of user involvement. We found that the term ‘using STIC’ represented many different variations both between therapists and between the families each therapist worked with. Likewise user involvement, combined with a feedback procedure like STIC, was also a many faceted area. We discuss how therapists’ experiences may relate to the different aspects of user involvement in therapy.     

PARADOX AND ORTHODOX: FOLIE À DEUX?*

In the recent family therapy literature, therapists have been cautioned to use paradoxical looking techniques as either a last resort, or else not to use such actions at all with specific problems. The paper argues that these stances arise from a rigid adherence to a set of orthodox views from which these actions appear contradictory. Similar to family systems, when such orthodox therapy systems do not question or alter their own premises in the face of contradiction, they tend to attribute either badness or madness to the action and either try to exorcise the badness, or banish the action. The literature which either prescribes “paradox as a last resort,” or which proscribes it altogether is reviewed and critiqued. Walter Buckley's process/adaptive system model is recommended as a positive alternative view from which such previously pardoxical actions may often be elected as a logical and effective first choice.     

Depression,the Family,and Family Therapy

The potential contribution of family therapists to the treatment of depression remains underdeveloped. Family therapists need to articulate how changes in family functioning might benefit depressed persons, as well as how other problems in the families of depressed persons tend to go unrecognised. Furthermore, family therapists need to be alert to how undetected depression in adults and children may interfere with their ability to meet their goals with families who seek therapy for other persons. This article provides family therapists with (1) an overview of the nature and experience of depression; (2) an introduction to antidepressant medication; (3) a summary of research findings relating depression to its family context and (4) a brief overview of developments in the marital and family treatment of depression.     

Engagement: A Critical Aspect of Family Therapy Practice*

Engagement must be appreciated as an integral ongoing aspect of therapy. It can provide therapists with a wealth of information about the structure and functioning of the family. Engagement/counter-engagement, assessment and interventions are essential, interdependent processes which occur throughout treatment. Ways of enhancing the engagement process are discussed.     

Uniqueness of family therapists as family business systems consultants: a cross-disciplinary investigation

The purpose of this study is to address how the consulting approaches of family therapists working with family businesses differ from those of business consultants. The logic of analytic induction was used to analyze qualitative data from family business consultants with and without training in family therapy. Consultants were asked to respond to two vignettes: one emphasized primarily family system problems, whereas the other emphasized business problems with influencing issues at the family/business intersection. Both similarities and differences were found in reference to problem assessment, consulting goal orientation, intervention strategy focus, consultant role and function, and consulting setting preference between consultants with and without family therapy training. Results indicate that consultants of each discipline provide a unique perspective and expertise that allow them to successfully address the spectrum of issues that family firms face. Further, findings highlight the unique contribution of family therapists to an interdisciplinary consulting team.     

FAMILY SYSTEMS THERAPY IN A PRIMARY CARE MEDICAL SETTING: THE ROCHESTER EXPERIENCE

Collaboration between family therapists and physicians has attracted increasing attention in the field of family therapy. Family therapists practicing in medical settings encounter many stimulating oppoutunities and challenges. This paper focuses on the experience of the authors providing family therapy in a primary care medical setting which is also a family medicine residency program. The authors discuss the role of physician and patient expectations in treatment as well as the influence of the medical context on the development of family therpists.     

Systemic Practice in the Time of COVID: Conversations Among Culturally Diverse Therapists

The COVID‐19 pandemic has changed the delivery of clinical services and education of health professionals, including family therapists. This paper distils two separate Zoom conversations between myself (as the lead author) and two eminent family therapists, Professors Maurizio Andolfi and Harry Aponte, where challenges and opportunities for the profession during and after the pandemic are discussed. Creativity and resourcefulness are two important elements therapists and educators have needed to access during the pandemic to find alternative ways to continue to provide clinical services and teaching. Most therapists have transitioned using online technology and various platforms such as Zoom and Skype; for some this has been a somewhat familiar experience, for most it has been a novel one. Key themes emerged from the conversations including the personal and professional ‘lived experiences’ of the pandemic; the financial impact on clients and students; the importance of touch for human social connection; the use of ‘self’ as an instrument of change and alternative platforms of service delivery and teaching. We reflected on what has been lost, such as the nuances inherent in face‐to‐face human interactions, and what has been gained, such as observing families in situ in their own environments.     

DO GENERAL TREATMENT GUIDELINES FOR ASIAN AMERICAN FAMILIES HAVE APPLICATIONS TO SPECIFIC ETHNIC GROUPS? THE CASE OF CULTURALLY‐COMPETENT THERAPY WITH KOREAN AMERICANS

To serve Korean American families effectively, marriage and family therapists need to develop a level of cultural competence. This content analysis of the relevant treatment literature was conducted to discover the most common expert recommendations for family therapy with Asian Americans and to examine their application to Korean Americans. Eleven specific guidelines were generated: Assess support systems, assess immigration history establish professional credibility, provide role induction, facilitate "saving face," accept somatic complaints, be present/problem focused, be directive, respect family structure, be nonconfrontational, and provide positive reframes. Empirical support (clinical and nonclinical research) and conceptual support for each guideline are discussed, and conclusions are reached regarding culturally competent therapy with Korean American families.     

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.     

Ethics and family therapy: the case management of family violence*

All family therapists, and especially Milan-style systemic therapists, have been trained to take a neutral stance regarding family issues, based on a circular causality model of family interaction. Therefore, when therapists deal with family violence, their ability to perceive individual responsibility for unethical behavior is weakened or suppressed. In fact, this ability is the primary tool in developing effective treatment planning in cases of family violence: The actively physically abusive man needs to be in individual and/or group therapy, not conjoint or family therapy. The ethical judgment of the therapist is what determines the limits of family therapy.