The Three Fallacies: Evaluating Three Problematic Trends in Clinical Practice

In an era of condensed treatment and managed care, three trends are gaining prevalence in some graduate training programs and in some circles of the practicing community, limiting clinicians from utilizing the therapeutic techniques needed to help a client achieve long-standing intrapsychic change, a precondition for maintaining therapeutic gains post treatment. The first trend, the equation of empathy with sympathy, hinders the therapeutic dyad from truly understanding a client’s internal experience and implicitly conveys the message that anxiety-provoking material is less welcome in the consulting room. The second trend, prizing cognition over affect, results in a primary focus on secondary thought process, discounting the affective experience that unconsciously steers behavior and thought. This trend is, in large part, due to the widespread dissemination of cognitive-behavioral therapy efficacy research and the belief by some individuals that psychodynamic forms of treatment lack empirical support. The last and most problematic trend, the rigid utilization of treatment manuals, tends to result in a reductionistic approach to treatment, limiting psychotherapy to a set of techniques while also overlooking salient aspects of treatment that can predict positive outcomes. Treatment manuals oversimplify the process of therapy; as a result, the therapeutic dyad is less likely to uncover and discover the multiple origins of one’s suffering, contributory factors that are not always readily available to conscious awareness. This paper discusses each trend and the therapeutic implications that result.     

Fundamentals of Theory and Practice Revisited: Sex Therapy: Historical Evolution,Current Practice. Part 2

This is the second of a two‐part series on the treatment of sexual difficulties. It presents a systemic approach to sex therapy and uses illustrative case histories to explore: the interrelationship between the presenting person or couple; the ‘sexual’ as part of the relationship; the symptom; the medical considerations; the cultural context; and the framework and thinking of the therapist.     

Theory and Practice of Systemic‐Dialogical Therapy

Systemic‐dialogical therapy originates from an evolution of Milan systemic therapy, through a reflection on Bakhtinian dialogue and on power and knowledge dynamics in therapeutic sessions. The model considers both emergent patterns in human interaction and the dialogical nature of human exchanges in which emotions play a relevant part. Such theoretical considerations prompted the creation of specific practices, such as emotional micro‐hypothesising, considering heteroglossia in the session, dialogue with the context, finding one's place in the relational network, and fostering relational responsibility in both therapist and clients. The practice of systemic‐dialogical therapy is illustrated by a clinical case study.     

Frameworks for Practice in the Systemic Field: Part 1 — Continuities and Transitions in Family Therapy Knowledge

This is the first of two articles to map the landscape of practice theory in systemic family therapy. In this first article, the representation of knowledge for practice is explored, and an argument is made that while frameworks remain important, the relationship to them is now more conditional and pragmatic. A particular chronology is offered of the development of family therapy practice theory frameworks, beginning with the frameworks that emerged in the 1960s to the 1970s. An analysis is given of the important transitions in the 1980s and three sets of influences in this decade — ecosystemic epistemology, the feminist challenge and postmodernism — are identified. This reading emphasises hidden continuities in the transition, despite the seemingly discontinuous shifts in practice theory from the beginning of the 1980s to the beginning of the 1990s. Context and relationship are identified as the enduring parameters of systemic family therapy knowledge, though understandings of context and relationship have been recast in the contemporary (post‐1990s) practice theory. The second article will explore the four contemporary influential approaches in Australian family therapy — the Milan‐systemic, narrative and solution‐focused frameworks, and the dialogical perspective — and point to intersections in practice ideas and integrative movements.     

Responsive Persistence Part I: Therapist Influence in Postmodern Practice

Feminist and social constructionist developments in family therapy highlighted the importance of attending to therapist–client power relations and incorporating clients' understandings and preferences as a part of therapy. Significantly, less attention has been given to how postmodern therapists do use their power and influence. This is an important topic because it is therapists who have the major responsibility for guiding the interaction with clients and persisting in this so that change is facilitated. Therapist persistence in various forms and across dimensions of therapy process is examined to expand understanding of therapist influence in postmodern and collaborative work. An analysis of responsive persistence in a session with Karl Tomm as the therapist is presented to illustrate this conceptual framing.     

Frameworks for Practice in the Systemic Field: Part 2 — Contemporary Frameworks in Family Therapy

This is the second of two articles to map the landscape of practice theory in systemic family therapy. The first article gave a particular chronology of the development of family therapy practice theory, beginning with the frameworks that emerged in the 1960s‐1970s and then tracing the transitional decade of the 1980s. The convergences of three sets of influences — ecosystemic epistemology, the feminist challenge and postmodernist ideas — led to the changed landscape of post‐1990 practice theory. This second article picks up at this point, mapping four contemporary influential approaches in Australian family therapy — the Milan‐systemic, narrative and solution‐focused frameworks, and the dialogical perspective. Social constructionist and narrative ideas together constitute the dominant common theory influence in the post‐1990 practice frameworks, although intersected and used in different ways in the different frameworks. Throughout the history of the development of practice theory, context and relationship remain the enduring parameters of the systemic family therapy field.     

Integrative Family Therapy With Childhood Chronic Illness: An Ethics of Practice

A challenge for contemporary family therapists is negotiating differences between modern and postmodern frameworks in the practice context. Modernists espouse a systemic metaphor; use evidence‐based and interventive approaches, including strategic, structural‐ or solution‐focused techniques, and believe in the therapist's knowledge, expertise and power to influence individuals or families to change. On the other hand, postmodernists follow a social constructionist, dialogical or narrative paradigm, which identifies the main ingredient of therapy as language, conversation, understanding and the therapist's ‘not knowing’ stance in eliciting a person's expertise and story Yet many practitioners adopt a middle way between these paradigm polarities, one that is less theory‐driven and more pragmatic, flexible, integrative and practice‐based. This is consistent with evidence‐based practice and research demonstrating common factors across all therapies. The value of preserving systemic thinking in family therapy is recognised while reaching forward to a postmodern social constructionist and dialogical approach. The article describes this integrative stance in family therapy as paramodern based on an ethics of practice. This is illustrated by a detailed case study of integrative family therapy, which addresses anxiety, anger and sleeping issues associated with a chronic childhood illness called Perthe's disease.     

Bowen Family Systems Theory and Practice: Illustration and Critique

This paper will give an overview of Murray Bowen's theory of family systems. It will describe the model's development and outline its core clinical components. The practice of therapy will be described as well as recent developments within the model. Some key criticisms will be raised, followed by a case example which highlights the therapeutic focus of Bowen's approach.     

Allies in Learning: Critical-Reflective Practice On-line with Allied Mental Health Practitioners

This paper is a reflection in action using personal examples of student feedback to guide teaching. In 2003, a post-graduate course was developed at Victoria University in New Zealand for occupational therapists and social workers employed in the mental health services. The aim of the programme is to provide opportunities for on-the-job learning while recruiting and retaining a skilled allied mental health workforce. The programme is publicly funded for students as part of a national workforce development strategy for mental health professionals. In this article, I reflect upon my first year as co-ordinator of the programme in 2007–2008. Due to my background as a social worker and my familiarity with social work theories of practice, I focus on my theories of teaching from a social work perspective while returning to reflect on themes for the student cohort as a whole. The programme is delivered using distance methods supported by nine days of on-site learning throughout the academic year. A problem-based learning (PBL) approach delivered on the Internet platform, ‘Blackboard’, enables students to study from their workplaces. The conceptual model of teaching evolved is a process of ‘creative attunement’ to the learner's world. I conclude by providing examples of the key elements of my teaching/learning model as a ‘work in progress’.     

Computer-Assisted Sensate Focus: Integrating Technology with Sex Therapy Practice

It is well established that computer technology can be ethically, legally, usefully, and efficaciously integrated with the psychosocial treatment of mental health conditions such as anxiety and depression. There is, however, a paucity of literature regarding how these applications could be applied to sex therapy. This article will briefly review the adaptation of computer technology to mental health treatment, provide a rationale for using computer applications in sex therapy, and demonstrate how computer technology could be applied to Masters and Johnson's sensate focus technique. The Sensate Focus Prototype (an Internet-delivered therapeutic module) presented is a working application designed for use by psychotherapists and researchers.     

Couple Counselling Outcomes in an Australian Not for Profit: Evidence for the Effectiveness of Couple Counselling Conducted Within Routine Practice

Over 30 randomised controlled trials have shown the efficacy of couple therapy under controlled conditions. However only four studies explore effectiveness of couple therapy as commonly practised in the community (i.e., routine practice). These studies suggest effectiveness is about half that reported in randomised controlled trials. Further, there are no published couple therapy effectiveness data currently from Australia or New Zealand. This is troubling because (1) couple distress has negative effects on individual adults, couples, and families; (2) funders increasingly want proof of return on financial investment; and (3) clients want hope that their emotional investment in therapy is worthwhile. The first aim of this paper is to report the outcomes of a milestone multi‐centre study of over 1,500 Relationships Australia clients attending couple counselling. It outlines a simple, intuitive method for assessing effectiveness of couple counselling in routine practice that may motivate others to conduct effectiveness studies. The study used a cross‐sectional design and assessed current couple satisfaction and retrospective recall of couple satisfaction before attending counselling. Results revealed a moderate effect size improvement in relationship satisfaction. The results support previous published studies of couple therapy effectiveness in routine practice. The second aim of the paper is to increase interest in others doing similar research by addressing key barriers to the implementation of effectiveness studies within routine practice. These barriers include administrative burden, integration across services, and conceptual buy‐in by practitioners. The use of the retrospective measure of ‘pre counselling’ couple satisfaction measure overcomes these barriers in part. The paper concludes with a discussion of design limitations and suggestions for counselling agencies seeking to conduct their own effectiveness studies.     

The Origins of Family Work: The Theory and Practice of Family Social Work Since 1880

This paper provides a detailed literary and historical account of the earliest beginnings of family theory and practice by social workers, beginning in the 1880's. The paper argues that the first widespread practice of family work’ by the helping professions was carried out by social workers, primarily women, despite this being rarely acknowledged in the family therapy literature. An analysis of gender and its place in the development of professional status and the ownership of ideas is provided.     

Best Practice Options: Turkey

At the ninth Migration Dialogue seminar, held 29–31 March 2001 in Istanbul, Turkey, opinion leaders discussed the major immigration and integration issues facing emigration, transit, and immigration countries. Several major issues regarding Turkey were discussed. 1 This report was prepared after the seminar for participants and others interested in migration and development issues. It has not been approved by participants, and thus should not be considered a consensus document.
First, the effect of the Turkish Government’s modernization effort, which began in the 1920s. In the 1960s the government began to promote the export of surplus labour, with the hope that sending workers abroad from less– developed parts of the country would bring remittances and returned workers with skills needed for modernization. Among the governments of labour–exporting countries, Turkey’s has been unique in its high hopes for recruitment, remittances, and returns. They were expected to bring about a transformation of the country. These high expectations help explain the widespread frustration with migration’s actual effects. Second, the Turkish Government’s current goal of gaining full membership in the European Union (EU). Ankara stresses that the EU should embrace full Turkish membership for a variety of reasons, including the country’s strategic position between Europe and Asia, and to send a signal to other Muslim societies, such as those of North Africa, that the EU will include Muslim societies that are secular and democratic. Third, Turkey’s fear that EU membership would lead to another wave of migration. Many Europeans fear that Turkish EU membership would lead to another wave of migration. Turkey hopes that admission to the EU will bring EU assistance and foreign direct investment (FDI) that creates jobs and pushes up wages, thus making migration insignificant. Finally, Turkey’s position as an emigration, transit, and immigration country. There are 3 to 4 million Turks abroad, 3 to 4 million foreigners living in Turkey (perhaps half Iranians), and tens of thousands who move through Turkey to Europe. Turkey is revising its asylum law in a manner that will allow persons fleeing persecution outside Europe to be considered refugees in Turkey, to establish for the first time a support system for refugees.     

Ethical Practice and Narratives of Resistance to Violence: Becoming Resilient Part 2

This paper is the second part of a previous publication in this journal and is based on a plenary address at the 30th Australian Family Therapy Conference in 2009. It develops the idea of ethical practice in therapy for men and boys with a history of significant violence and abuse. This fosters a connection with resilience that resists or refuses to participate in historical narratives that support violence and its effects. In the paper, I provide several therapeutic examples of working with narratives of violence and present a theory of resilience and ethical practice drawing on the ideas of Deleuze. This helps to understand resilience as a process of ethical agency, creative renewal, and the production of expansive difference.     

Changing Practice

This article is based on a keynote address given on the last day of the 2011 International Society for Culture & Activity Research (ISCAR) Congress in Rome. The first part reflects on the kind of work being presented at the conference. It was exciting and stimulating to learn about a rich range of new research in many different venues during the week. It also seemed important to reflect on what seemed to be missing, omissions that were common across the many themes and discussions. The second part of the article explores concrete examples of research, both in theory and in practice, which I hope may suggest to ISCAR participants some unusual possibilities for changing their own research practices between now and the next ISCAR congress in three years.     

The Theory and Practice of Therapeutic Error

This paper looks at the issue of errors made in therapy which compromise the therapist's leverage and jeopardize the therapy's continuity. A case where such errors were made is outlined and theoretical points arising from the case are discussed and considered in the light of dealing with error. The importance of maintaining a ‘meta’ perspective is discussed and some warning signs of error are pointed out. Preliminary guidelines for the therapists faced with the ramifications of their own inelegance are suggested. The necessity of recognizing and working with patterns of interactions as opposed to dealing with specific actions is noted. The paper underlines the critical learning afforded by the acknowledgment of mistakes and their resolution in therapy.     

Integrating Reflective Practice in Family Therapy Supervision

This paper discusses how to integrate reflective practice in the family therapy supervisory relationship. This enables family therapists to think creatively, be insightful, and develop a range of perspectives regarding systemic formulation and practice. It encourages review of the past and promotes understanding in the present with the aim to improve therapists work with families in the future. Reflective practice encourages independent thinking and learning and helps therapists to develop a systemic process of critical enquiry to investigate and critique their own practice. It encourages therapists to be self‐reflective and develop confidence to think hypothetically regarding change. This allows them to pose questions for exploration, construct a new lens to conceptualise therapy and the therapeutic relationship and develop awareness of the personal as well as the professional self.