Television as a diagnostic indicator in child therapy: An exploratory study

This paper explores the relation between television viewing and clinical indicators for the mental health profession. Television viewing is seen from a systemic process perspective, based on data about children in therapy from therapists and parents. Family viewing patterns appear to be related to certain types of clinical indicators, especially attention deficit disorder and acting out. Of particular interest is the finding of a strong association between parental viewing habits and ADD on the part of children. The results suggest that television may be a useful indicator of family health for mental health practitioners and researchers.     

Family Law and Family Systems: Multidisciplinary Training for Professionals

The Family Court in New Zealand has become the crucible for the mixing of legal and mental health professionals. Low key workshops convened by family therapists for multidisciplinary groups have made successful use of family therapy models and expertise to provide a base for the conciliation and mediation alternative to the adversary system so common in law and in earlier family litigation. Enhanced cross-disciplinary understanding and morale appear to have accompanied the more formal learnings in family therapy, and the programme as detailed is included as one possible structure on which such experiences might be offered by other therapists in other places.     

Treating mental health problems in primary care: Discrepancies between therapist expectations and clients’ attendance

ABSTRACT

Models of collaborative primary health care were introduced in Ontario in 2005 with the goal of providing comprehensive care, including that of mental health, to patients. While the success of this model of health care delivered through Family Health Teams (FHT) has been established, evidence based guidelines to guide mental health therapists regarding the number of sessions needed to treat common issues such as depression and anxiety seen within this model is lacking. The goal of this study was to gain a better understanding of how therapists conducted therapy, including type of intervention, under a physician determined eight session cap. Questionnaires completed by the therapists after the first session and again when therapy ended, a focus group and a chart review were conducted over an eight month period involving a total of 147 patients. Several key findings were identified including the unanticipated outcome of a discrepancy between how many sessions were initially thought to be required by the mental health therapist compared to how many sessions were determined helpful by the patient. Conversely, it was also identified that eight sessions was insufficient to treat more severe mental health issues such as trauma. Such results suggest that the treatment of mental health issues within Family Health remains a little understood and explored issue, with the authors suggesting better ways of negotiating session caps reflective of mental health issues addressed within this model of care.     

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.     

Walk-in Together: A pilot study of a walk-in online family therapy intervention

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk-in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof-of-concept study investigating the acceptability and short-term effectiveness of an online walk-in family therapy service, Walk-in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk-in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre-session, post-session, and at 6 weeks follow-up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi-structured interview data. Post-session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post-session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well-received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk-in delivery model. This proof-of-concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk-in, telehealth model to meet the rising demand for therapeutic support for families in distress.     

A FAMILY THERAPY INTERNSHIP IN A MULTIDISCIPLINARY HEALTHCARE SETTING: TRAINEES' AND SUPERVISOR'S REFLECTIONS

Family therapy doctoral students from American Association for Marriage and Family Therapy-accredited programs are required to complete a full-time clinical internship. The literature provides little information about these internship experiences. Two doctoral-level marriage and family therapists summarize their professional and personal experiences in their internships located within a multidisciplinary healthcare setting. In addition, their supervisor reports on her experiences working with marriage and family therapy doctoral interns. We hope that this case report will stimulate all interns and their supervisors to provide feedback to their internship sites and graduate programs about their clinical training and the extent to which the programs prepared them for their marriage and family therapy careers in the larger health and mental health community.     

DOES ACADEMIC TRAINING BACKGROUND MAKE A DIFFERENCE AMONG PRACTICING MARRIAGE AND FAMILY THERAPISTS?

Using a national sample of practicing marriage and family therapists (MFTs) and their clients, this study investigated whether academic training background is associated with differences in pracice patterns and client outcomes. Clinical members of the American Association for Marriage and Family Therapy with academic training in psychology, social work, counseling, and marriage and family therapy were compared on a wide range of clinical practice variables, and their clients were surveyed about thier satisfaction and outcomes. Results showed highly similar practice patterns and client outcomes across all four disciplinary groups. Although the findings showed little evidence for the uniqueness of academic marriage and family therapy training among experienced MFTs, they also refute the notion that therapists trained in MFT degree programs practice in unusual or inferior ways compared to MFTs trained originally in other mental health disciplines.     

Public Participation: Moving Beyond the Four Walls of Therapy

Family therapists have an ethical responsibility for public participation, to work toward creating a better society. Serving the public interest and developing laws to promote the profession and the public good can be achieved through policy advocacy and political participation. Political and policy work are important but overlooked aspects of family therapy, which is significant given the consequences differing policies have for clients and the profession. This paper reports on results from a random, national survey of licensed family therapists’ (N = 174) advocacy actions. Findings indicate family therapists have overarching policy concerns yet lack proactive legislative and activist engagement. The exploration of therapists’ actions and beliefs presented in this paper, serves as a springboard for therapists’ movement into the public arena. Video abstract accessible by clicking here .     

“Being a Therapist Doesn't Exclude You From Real Life”: Family Therapists’ Beliefs and Barriers to Political Action

A crucial and overlooked facet of social justice in family therapy is political and policy advocacy. Family therapists have unique insight into how social policies and political discourse shapes clients’ lives and the life of our profession. Such knowledge can inform policymakers and political debate, yet few family therapists are trained to engage in political action. In this randomized, national survey of licensed family therapists’ (N = 174), we explore beliefs about and barriers to engagement in political and policy processes. The findings suggest that there are significant barriers and uncertainties surrounding family therapists’ engagement, including time, feelings of efficacy, and interest. Given these barriers we discuss practical suggestions for clinicians and family therapy training programs.     

Family Focused Care for Refugees and Displaced Populations: Global Opportunities for Family Therapists

Recent global crises have created a significant increase in the number of people leaving their countries. Distress experienced by these refugees often leads to posttraumatic stress disorder and depression and can also result in psychotic disorders, substance abuse, and interpersonal violence. The World Health Organization leads the organizing of refugee services as part of a larger initiative to provide mental health services to citizens in low‐ and middle‐income countries. The World Health Organization has identified challenges in providing care, including a provider shortage, issues with how refugees access and receive care and a lack of uniformity in mental health services. By applying the values and systemic orientation of the profession, family therapists can address some of the challenges in treating mental health concerns of these at‐risk populations.     

THE EFFECTIVENESS OF FAMILY INTERVENTIONS IN THE TREATMENT OF PHYSICAL ILLNESS

Although a large body of research demonstrates that the family has a powerful influence on physical health, the evidence for the effectiveness of family interventions in physical illness is less conclusive. Family therapy and other family interventions appear to be most effective in chronic childhood illnesses such as asthma and diabetes. Family interventions have also been shown to be effective in the management of some cardiovascular and neurologic disorders and for the treatment of obesity. Family therapy appears to be more effective than individual therapy for some groups of patients with anorexia nervosa. This research supports the increasingly important role of medical family therapy in the new health care system. Recommendations for future research are discussed.     

Evaluation,Accountability and Clinical Expertise in Managed Mental Health Care

In this article, the author identifies a number of policies and practices of managed mental health care organizations that, if allowed to continue unchecked, will have deleterious effects upon the American family. Since this industry is not regulated by either state or federal statutes, managed care organizations have had free reign to disallow coverage for a variety of DSM-III-R diagnostic categories and V-Code conditions. Some organizations severely limit the number of collateral contacts their therapists can schedule with clients' family members and others prohibit their therapists from working with more than one family member at any given time. The author also highlights the complex relationship that exists among insurance companies, managed care organizations, the medical profession and the pharmaceutical industry. He then offers some hypotheses about the nature of these relationships and the reasons for their existence. Finally, the author calls for social work to take an active role in bringing these issues to public awareness and suggests that social workers become advocates for the American family in this era of managed care.     

Dsm-iii-R and the family therapist: ethical considerations

DSM-III-R has gained popularity in many segments of the mental health field. Family therapists have generally not found its approach to assessing problems to be helpful in the planning of therapy, yet, are often forced to use it due to the requirements of third-party payers. This raises several ethical and practical concerns, e.g., the incompatibility of orientations between DSM-III-R and family therapy, the stigma associated with diagnosing, being asked to misrepresent diagnoses to third-party payers, and the competency of some family therapists to make DSM-III-R diagnoses. Short- and long-term strategies to deal with these ethical dilemmas are also presented.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

Developing culturally effective family-based research programs: implications for family therapists

Recently, some family scholars have developed greater sensitivity to the relative neglect of families of color in clinical and empirical research. Consequently, a proliferation of research elucidating many nuances of ethnic families has come to the forefront, containing a wealth of knowledge with useful implications for family therapists and other mental health providers. The findings of these studies hold enormously important implications for how family therapists can better engage and accommodate families of color in therapy. In this article we discuss some of the etiological and methodological issues associated with planning, conducting, and disseminating family-based prevention and intervention research programs with ethnic minority families.     

DEFINING WHO WE ARE AND WHAT WE DO: CLINICAL PRACTIVE PATTERNS OF MARRIAGE AND FAMILY THERAPISTS IN MINNESOTA

The clinical practice patterns of a representative sample of marriage and family therapists (MFTs) were studied. AAMFT clinical members from Minnesota ( N = 76 ) were surveyed for demographic characteristics, educational beckground, and practice-related issues. subjects also reported empirical data from 119 treatment cases involving 351 clients, a first in the MFT field. Among the major findings were: (a) MFTs practic relatively short-term therapy with the average case involving 11 sessions over a 4-month period; (b) therapy with families (average of 8 sessions) and couples (10 sessions) is briefer than individual therapy (14 sessions); and (c) NFTs treat a wide range of serious problems. Overall, MFT clinical practice patterns were comparable to those of other established mental health professions.     

SYSTEMS CONSULTATION AND HEAD START: AN ALTERNATIVE TO TRADITIONAL FAMILY THERAPY

As Marriage and Family Therapists (MFTs) enter Head Start programs, systems consultation emerges as a viable alternative to providing therapy to enrolled children and families. As systems consultants, family therapists can offer organizational consultation, training, and support to Head Start staff, classroom interventions, and direct work with families. This article describes a multidimensional model for providing comprehensive mental health consultation to Head Start programs. It explores the skills necessary for MFTs to work effectively as systems consultants. Finally, recommendations are made for applying the model in both university and private settings.     

Enhancing Family Therapy's Relationships With Research

The contention of this article is that systemic family therapy has much to gain from a realistic appraisal of its research base, which is as positive as possible. And that through such an appraisal we can find ways of developing the scope of family therapy to the benefit of the profession and thereby, of our clients. Family therapy will benefit if practitioners can present an informed view of research. As a preliminary approach to this objective, I review reasons why perceptions of family therapy underestimate its research base, and why therapists might resist involvement with research. The article then explores the reasons for regarding randomised controlled trials as a ‘gold standard’, and why they are not well fitted for the purpose of evaluating or developing a relational therapy. Next is a consideration of alternative approaches to research, including a consideration of what clients actually want from their therapy, then a brief review of the positive findings of outcome research. Greater emphasis on researching processes in therapy is proposed, and consideration of the ‘common factors’ debate is shown to support priorities that are specific to systemic therapies. The article concludes with suggestions for increasing the involvement of family therapists with research, both as consumers and as research practitioners.     

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.     

Help-seeking behavior among mental health practitioners

The purpose of this exploratory study was to collect self-report data on willingness to seek personal therapy among therapists in Utah, and to discover if group trends occur among marriage and family therapists, psychologists, and social workers. Self-report background characteristics such as age, gender, marital status, number of children, and practice site, served as independent viriables. Responses from 421 therapists were obtained from a mail survey. Results showed that number of children, years in private practice, number of client contact hours per week, gender, marital status, religion, profession, and practice site were significant in willingness to seek personal therapy. Specific gender data and differences across the professions are presented.