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.     

TRAINING THE PERSON OF THE THERAPIST IN STRUCTURAL FAMILY THERAPY

Structural Family Therapy needs a training model that integrates the existential, human mutuality of the therapeutic relationship with its technical elements. This paper offers a theoretical foundation for training structural family therapists in the use of self, discusses a model for training, and gives a case example illustrating personal training in a clinical context.     

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.     

AGING AND FAMILY THERAPY: PREVALENCE OF AGING ISSUES AND LATER FAMILY LIFE CONCERNS IN MARITAL AND FAMILY THERAPY LITERATURE (1986-1993)

To what extent are gerontological issues addressed in the marital and family literature? In answering this question, the authors conducted a content analysis of 873 articles published in the Journal of Marital Family Therapy, Family Process, Family Systems Medicine, and the Journal of Family Psychology during an 8-year period beginning in 1986. Only 3.2% (n = 28) of these articles contained explicit emphasis on aging issues and later life family concerns. Furthermore, there was no significant trend in the number of gerontologically focused articles published during this period. The paper describes the content of the 28 aging-focused articles, including the types of presenting problems mentioned, the relational contexts of these problems, and the types of family therapy theories represented. Included in the content analysis were the proceedings of the annual national conferences of the American Association of Marital and Family Therapy from 1986 to 1993. Only 2.3% (n = 37) of the regular conference sessions had an explicit aging focus, as did 1 of the 29 plenary sessions and 1 of the 40 Master Series® sessions. Used as a gauge of gerontological interest and awareness of late life issues, the implication of these findings is that the family therapy community is still engaged in “comming of age.”     

A FEMINIST FAMILY THERAPY SCALE*

This paper reports on the development and psychometric properties of a 17-item instrument intended to reflect the degree to which family therapists conceptualize the process of family therapy from a feminist-informed perspective. Items were adapted from those generated by 37 feminist-informed family therapists in a previous study. Factor analysis results on 383 subjects reflect a unidimensional scale. The Feminist Family Therapy Scale had a Cronbach Alpha of 83 and was found to discriminate between (a) self indentified feminists and nonfeminists, (b) women and men, and (c) subjects scoring higher on Scanzoni's (1975) Sex Role Modernity Scale and those scoring lower. Additional psychometric data are reported, and possible uses of this scale are discussed.     

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.     

EMPHASES OF THE MAJOR FAMILY THERAPY MODELS: A FAMILY FIRO ANALYSIS

This paper analyzes 13 models of family therapy according to their special emphases on the Family FIRO model's dimensions of inclusion, control and intimacy. We first examined chapters on each model in Gurman and Kniskern's Handbook of Family Therapy; we then sent our preliminary ratings to the authors of the chapters for comment. The final conceptual analysis of the models indicated that 4 family therapy models emphasize inclusion as a primary focus, 4 emphasize control, and 5 emphasize intimacy. We also rated the secondary and tertiary emphases of the models. This analysis provides a possible guide for therapists who wish to be eclectic or integrative in their work, specifically, by suggesting a way to match therapy techniques from different family therapy models to the presenting family issues that each model emphasizes most strongly.     

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.     

Audio-Video Reviews

Barbara Knothe, Consultant Psychiatrist, Bouverie Family Therapy Centre, has reviewed two videotapes, produced by Anita Morawetz. The tapes demonstrate Anita's work with two families, seen at the Bouverie Family Therapy Centre. In one tape, Anita supervised one of the trainees on the Training Programme and it is interesting to see how the work of the training group, family and supervisor evolves. The tapes were produced in 1988–1989 and are available from: Bouverie Family Therapy Centre, 31 Poplar Road, Parkville Vic 3052 Tel: (03) 389 2480. The contact person is Ms Kate Gerber, Clerical Officer. There is no charge for borrowing the tapes, although interstate borrowers must pay for postage (“Cash on Delivery” charges). People may borrow 2 tapes at a time, for a period of 2 weeks. Each borrower is asked to sign a form, which will be sent to them, stating they will accept responsibility for the tape and they will respect the confidentiality of the family. Thanks to Anita for producing the tapes and making her work available to other therapists and trainees, for their professional development. Thanks also to Barbara for her reviews and to Bouverie Family Therapy Centre for their generosity and for maintaining an excellent tape library. I would like to encourage other therapists in Australia and New Zealand to produce audio and/or videotapes of their work, on particular areas of interest. David Epston was one of the first therapists to do this — when he produced a videotape called “The Family who loved to stay at Home” which was reviewed by Jim Birch. Many “local” therapists are making recordings of their work and these provide an invaluable resource for training, supervision, consultation and research. If you are interested in producing some material for reviewing and “public” use, please contact me on: (Work) 03 550 130 (Home) 03 898 6983. You may feel overwhelmed by the task, but please don't abandon the idea. Call me and we can talk about this and your ideas. Making tapes for these purposes may not be as difficult or as daunting as you think.     

CRITIQUING THE NEW EPISTEMOLOGIES: TOWARDMINIMUM REQUIREMENTS FOR A SCIENTIFIC THEORY OF FAMILY THERAPY*

The purpose of this paper is to critically analyze the structures of the new epistemologies. Epistemology is a technical term within the field of scientific philosophy. When it is used looselyby family therapists, confusion results. The central argument of the present author is that the new epistemologies are, in fact, weak theories. It is suggested that the practice of using the term “epistemology” to denote theory or paradigm, be discontinued. A more limited and narrowly defined use for the term “epistemology” is proposed. Specifically, this paper presents: (a) a discussion ofthree areas of philosophy that serve as foundations for the construction of scientific theory, (b)a critical analysis of the new epistemologies, (c) a logical structure for scientific family therapy theory, and (d) minimum requirements for a scientific theory of family therapy.     

COMMON FACTORS ACROSS THEORIES OF MARRIAGE AND FAMILY THERAPY: A MODIFIED DELPHI STUDY

The Delphi methodology was used to explore common factors across theories of marriage and family therapy (MFT). Leading clinicians and researchers from the American Family Therapy Academy and select faculty members from MFT training programs accredited by the Commission on Accreditation for Marriage and Family Therapy Education were asked to achieve consensus regarding common factors. Respondents were asked to report on commonalities across the various MFT theories, as well as what they personally considered to be the core ingredients of change. A final profile of items was created from the responses. Qualitative interviews were conducted with selected panelists to clarify discrepancies as well as to add meaning to the data. Implications for the training and practice of MFTs as well as direction for future research are discussed.     

TREATING ADOLESCENT DRUG ABUSE: A COMPARISON OF FAMILY SYSTEMS THERAPY, GROUP THERAPY, AND FAMILY DRUG EDUCATION

The differential effectiveness of three models of adolescent drug abuse treatment was assessed in a controlled outcome study. Family Systems Therapy (FST) was compared to Adolescent Group Therapy (AGT) and Family drug Educations (FDE). FST appeared to be more effective in stopping adolescent drug abuse than AGT or FDE, registering twice as many apparently drug-free clients than FDE and three times as many as AGT. However, a number of possible confounds make this conclusion tentative. No tretment approach was superior in altering patterns of family functioning although all three conditions improved perceived intergenerational communication.     

THE USE OF HISTORY IN FAMILY THERAPY: A BRIEF REJOINDER TO SLUZKI*

The use of history by psychodynamically oriented family therapists is often misunderstood. In place of a traditional “lifting of repression” paradigm, contemporary psychodynamic family clinicians emphasize intervening in the transmission of emotional patterning over generations in families. This model has both diagnostic and therapeutic utility for family therapists. While differences exist between this model and “systems” approaches, it is argued that integration of the two is both possible and desirable.     

FAMILY THERAPY OUTCOME RESEARCH: POTENTIAL PITFALLS AND PROSPECTS*

This paper raises and attempts to resolve some significant and controversial issues in the design of family therapy outcome studies. First, the issue of clinical relevance is addressed. Much of psychotherapy research has little relevance for practicing clinicians; this paper discusses some partial explanations and proposes some changes in the way data are reported that would have a salutary effect. Second, inter-model comparative outcome studies are critiqued. Third, the necessary preconditions for internally valid outcome studies are delineated, along with conditions in which randomization and the use of control groups can be abandoned. Fourth, there is a discussion of a research strategy which examines the generalizability of treatment effects found in research settings to conditions which come closer to resembling clinical practice. Fifth, questions regarding the selection of therapists for family therapy outcome research are addressed, including the issue of optimal level of therapist experience, and the question of whether or not “therapists” should be treated as a randomized factor in the overall design. Finally, there is a brief discussion of outcome criteria, with a fairly clear-cut and straightforward recommendation for determining whether or not a family therapy has had a desirable effect.     

SUPERVISION IN FAMILY THERAPY: A DECADE RESTUDY*1

This paper reports on a 10-year replication of Everett's (1980) survey of Approved Supervisors of the American Association for Marriage and Family Therapy (AAMFT). Significant differences were found between today's supervisors and supervision, including an increase in female supervisors, a shift toward a systemic theoretical orientation, greater concentration of supervisors in formal training settings, a great increase in the use of video recordings, a decline in the popularity of personal psychotherapy as part of training, a greater inclination of supervisors to identify themselves as Marital and Family Therapists (MFTs) regardless of original education, and others. The Approved Supervisor system appears to be fulfilling AAMFT organizational goals; other results will be reported elsewhere.     

The development of core competencies for the practice of marriage and family therapy

In response to a series of national policy reports regarding what has been termed the "quality chasm" in health and mental health care in the United States, in January 2003, the American Association for Marriage and Family Therapy convened a task force to develop core competencies (CC) for the practice of marriage and family therapy (MFT). The task force also was responding to a call for outcome-based education and for the need to answer questions about what marriage and family therapists do. Development of the CC moves the field of MFT into a leading-edge position in mental health. This article describes the development of the CC, outcomes of the development process for the competencies, and recommendations for their continued development and implementation.     

THE NATIONAL MARITAL AND FAMILY THERAPY EXAMINATION PROGRAM

Examinations constitute one of the principal methods by which professions assess minimal competence in aspiring practitioners. The Examination in Marital and Family Therapy is used by most states which regulate the profession. This article provides the rationale for the examination program, describes its development and maintenance, and presents the knowledge base it samples. Administrative policies and procedures are also discussed as an aid to prospective licensure and certification candidates.     

THE MARGINALIZATION OF FAMILY THERAPY: A HISTORICAL AND CONTINUING PROBLEM

Family therapy, and marital and family problems, are mariginalized in the larger fields of mental and physical health care, which is a misfortune both for family therapy and for other mental health professions. The early family therapists, who had multidisciplinary backgrounds, attempted toestablish a new, nondisciplinary paradigm and also tried to expand the perspectives of the more traditional mental health disciplines. More recently, family therapists have exerted greater effortsto establish marriage and family therapy as a differentiated, autonomous profession. These alternatives each involve dilemmas for the family therapy field. The positive side of becoming a distinctive profession is greater internal strength and clear professional identy; the downside is the threat of increased marginalization in rlation to the other professions, a tendency toward intellectual isolation, and hence restricted opportunities for invigorating new challenges. Family therapy now needs to develop new modes of interchange, collaboration, and selective integration with otherhealth care professions. Such interchange will be beneficial both to family therapy and to other professions.