The Use of E‐mail in the Therapy Process

The therapeutic letter has a long history, with roots in psychoanalytic work and continuing application in family therapy. The advent of e‐mail has allowed another form for therapeutic written communication which, while incorporating the benefits of therapeutic letters, adds to these. It has also opened up some potential risks. This article incorporates a brief review of the literature covering therapeutic written communication and offers a case example where e‐mail was used as an adjunct in face‐to‐face therapy with a client who experienced attachment difficulties. This therapy was informed by systemic and psychoanalytic traditions. The authors explore a variety of technical matters including the timing and crafting of e‐mail responses, the integration of written communication with face‐to‐face therapy, impact on the therapeutic relationship and management of crisis. Ethical issues such as confidentiality and duty of care are also considered.     

Clinician Perspectives on Relationship,Therapeutic Strategy,and Gender Responsiveness in Child Welfare Substance Abuse Settings

There is a growing acknowledgment of client–provider relationship as a determining factor within evidence-based practice implementation. This collective case study of 20 service providers examined the approaches used by clinicians working with substance-abusing mothers involved in child welfare to shed light on their use of empirically informed, gender-specific interventions. Analyses revealed that clinicians struggle to articulate specific evidence-based frameworks, and their approach relies on an intuitively driven client–provider relationship. Clinicians report little institutional support for integration of empirically supported practices into settings where workforce stress plays a critical role, and thus rely on relationship skills to frame practice approach.     

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.     

Ethical Considerations in Sex Therapy

The most ethical sex therapy is that which cures the symptom and improves the marital relationship in the briefest time at the least cost. Neither insight therapy, nor direct sexual interaction with the client satisfy these criteria. Examples are given of effective ethical therapies, useful in male and female sexual dysfunctions.     

Persons and Hypotheses: The Use of the Therapist in the Hypothesising Process

Although hypothesising has been strongly criticised by postmodern and narrative theorists, it plays a major role in any therapy. This article aims to investigate the hypothesising process, first revisiting the concept of hypothesis in semiotics and Schön's theory of the professions, then examining some features of hypothesising within systemic therapy. The article takes into account the relationship between hypotheses and therapists' basic theories, to arrive, finally, at an examination of the role of the person (both therapist and client) in shaping hypotheses within the therapeutic interaction.     

Engagement: Who's Engaging Whom?

A definition of ‘engagement’ in therapy is developed, based upon the proposition “the client engages the therapist”. Engagement is then distinguished from ‘joining’, and a consideration of the relational power between client and therapist, implied by this definition, shows it to be consistent with systemic theory for therapy.     

The treatment of sexual problems in marital and family therapy

With the proliferation of new research data and clinical practice techniques for dealing with sexual dysfunction, many family and marital therapists whose patients express sexual complaints experience the need to integrate this knowledge into their practice. For many couples and therapists, the rapid treatment approaches to sexual difficulties are inappropriate or ineffectual, yet the current literature addresses itself to either sex therapyper se or marital therapy and rarely deals with an integration of the two. This paper presents guidelines for assessing the sexual difficulties in the context of the relationship and outlines techniques for addressing the sexual difficulties directly while maintaining a more traditional marital therapy approach.     

The Reflecting Team Process In Training

The process of evolution of a reflecting team in live supervision sessions is discussed. Theoretical ramifications for systemic training of systemic family therapy are explored and feedback from trainer, trainees and client families about the use of the reflecting team is presented.     

This is Common Factors

Common factors are conditions and processes present in, among, and surrounding participants in clinical work. In the past 20 years, increasing attention and research on common factors has generated a great deal of discussion in clinical psychology, psychiatry, marriage and family therapy, and to a lesser extent, social work. While there is no single definition of common factors, they are generally discussed as the non-technical aspects of therapeutic work—such as the relationship between the practitioner and client and the expectancy of the client—that have been shown to be associated with successful outcomes. Common factors also include attributes of the practitioner and client, the support system of the client, the institutional and organizational conditions in which the practitioner practices, and also the strategic actions employed by the practitioner, client, and all those involved in the work that promote change. This paper will discuss key concepts in a common factors practice perspective and how evidence is used by common factors practitioners, highlight features of common factors practice, and suggest implications for developing a common factors practice approach.     

Diversity,Social Justice,and Intersectionality Trends in C/MFT: A Content Analysis of Three Family Therapy Journals, 2004–2011

In this study, we analyzed the amount of attention given to diversity, social justice, and an intersectional approach to social inequalities over an 8‐year period (769 articles) in three family therapy journals. Overall, 28.1% of articles addressed at least one diversity issue, and a social justice framework was utilized in 48.1% of diversity articles. A systemic, intersectional approach to conceptualizing and analyzing multiple social inequalities was utilized in 17.6% of diversity articles. The most common goals addressed in diversity articles, articles using a social justice framework, and articles using an intersectional approach are also identified. Findings indicate that, despite important work being carried out, more work remains to further identify how addressing diversity issues can improve client outcomes.     

The influence of the Milan approach: Five decades of intergenerational change. A conversation with Matteo Selvini

The ‘Milan Approach’ made an enormous contribution to psychotherapy and psychiatry and has been viewed as a bedrock in the family therapy field. Mara Selvini-Palazzoli made a revolutionary shift in the early 1970’s to abandon individual therapy and adopt family therapy to treat anorexia in young women. The goal of the three systemic principles; hypothesising, circularity and neutrality, proposed by the Milan Team is to elicit a useful method to interview families which encourages the production of meaningful information. The Milan group took special care of language. Rather than overly focusing on the label and referring to schizophrenia as a diagnosis, for instance, they used the term ‘families in schizophrenic transaction’. This perspective more realistically explored the origin of problems while looking at ways how to effectively generate change. In the early stages of its development, heavily influenced by the work of the MRI, the team adopted a pragmatic and strategic approach, however the focus gradually shifted towards semantics and the story of the system. While the ‘systemic identity’ was the principal guiding principle, the model was also influenced by social constructionism. This paper is a distillation of a conversation held with Matteo Selvini, son of Mara Selvini Palazzoli. We discussed the four key influential figures who developed the ‘Milan approach’, Selvini Palazzoli, Boscolo, Cecchin and Prata. The focus of the conversation is on Mara and on her influence shaping the approach, its evolution through the years leading to the creation of the Scuola di Psicoterapia Mara Selvini Palazzoli. Matteo also shares his own influence in the evolution of the school through the intervening years. He explains the adapted version of the Milan approach and the amalgam of the original and emerging therapeutic concepts. His key messages to therapists are the importance of working in teams and client follow-ups.     

The Devil is in the Detail: Clinicians,Academics and Researchers Resolving the Problems of Clinical Research

The difficulties associated with conducting valid family therapy research within a clinical practice discourage many potential researchers. This article will describe collaboration between a group of academics, researchers and clinicians who decided to explore the process and efficacy of systemic family therapy conducted within a working private practice. The specific questions we are addressing are, whether the requests clients bring to their first session of therapy can be reliably classified by practitioners, whether these requests change over time, and whether the nature of the request is associated with therapist and client ratings of therapeutic outcome. Additional questions about the form and nature of the therapeutic alliance as experienced by both client and practitioner are also being explored. This paper will map the passage of the work from inception to its current state where over 140 clients are active participants. In doing so attention will be paid to the obstacles encountered: practical, financial and ethical, and the solutions devised to address these.     

The Role Of Empathy in Brief Therapy: The Overlooked but Vital Context

Brief therapy is widely perceived to be a very technique oriented and outcome focused endeavour, with limited interest in the fluidity of the relationship between the therapist and client. This perception exists despite the absolute priority brief therapy has always placed on building a cooperative relationship between therapist and client. Certainly, the brief therapy tradition has almost completely avoided talking about ‘empathy’ and the emotional realm, almost as if it is inappropriate for a brief therapist to discuss them. This paper suggests firstly that brief therapy is enhanced, rather than diminished, by engaging with both empathy and affect, and secondly, that the conception and practice of empathy can itself be enhanced by the rich tradition of skills and experience that brief therapy offers. Case material is used throughout this paper to illustrate the authors’ views.     

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.     

C. H. Patterson on Client-Centered Career Counseling: An Interview

C. H. Patterson discusses career counseling as it can be accomplished within the client-centered approach. He notes the importance of the core conditions, the relationship of career counseling to therapy, the difficulty of counselor or therapist role change, the use of interpretation of tests, and the role of the client in the process. Included at the end of this article is a list of relevant publications authored by C. H. Patterson.     

Interpretation and the Therapeutic Relationship: An Attempt at Integration

The term integrative psychotherapy can have a range of meanings. It can refer to integration between therapeutic approaches grounded in different theoretical frameworks as exemplified in Wachtel’s (Psychoanalysis and behavior therapy: toward an integration. Basic Books, New York, 1977) Psychoanalysis and Behavior Therapy. Many therapists informally practice this sort of integration when, in response to problems and issues presented by the patient, they intuitively borrow from a variety of approaches in their clinical work. Therapeutic integration can also refer to attempts at integration within a single broad therapeutic approach such as psychoanalytic or psychodynamic. This is the direction I will take in this article. My goal in this paper is to contribute to the possibility of integration among different theoretical approaches within psychoanalysis in a delimited area. The delimited area that I will focus on is the tension between an emphasis on interpretation and insight versus an emphasis on the therapeutic relationship as the primary agent of therapeutic change. Rather than an “either-or” position, I will show that integrating theories about both aspects of this process leads to a richer, more complex picture of what happens in psychodynamically-informed therapy.     

Exploring the Therapeutic Relationship A Case Study

This paper is focused on the topic of the therapeutic relationship in systemic therapy. It is structured around the discussion of my experience of work with a particular family where the engagement issues were complex, and where there was the potential for a negative therapy sequence. The psychoanalytic concepts of transference, countertransference and projective identification are chosen to discuss my dilemmas — however, the differences between the analytic and systemic contexts of work are noted. Through the discussion of this case study, the potential benefits of using these analytic ideas to understand the therapeutic relationship in specific situations in systemic therapy are identified.     

BOOK REVIEWS

Book Reviewed in this article:
Becvar, Dorothy S. & Becvar, Raphael J. Family therapy: A systemic integration .
Clarkin, John F., Haas, Gretchen L., Glick, Ira (Eds.). Affective disorders and the family: Assessment and treatment .
Robin, A. L. & Foster, S. L. Negotiating parent-adolescent conflict: A behavioral family systems approach .
Scharff, Jill Savege (Ed.). Foundations of object relations family therapy .     

CSV Protective Services as an Agency of Change?

This paper describes a systemic team approach that has been used successfully with a young statutory client at risk, in reuniting him safely with his family of origin. The approach provides an opportunity to move away from a restrictive view of statutory intervention toward utilising the legal framework, to assist families and protective workers to co-operate in the young person's safe return home.     

‘The Worst Thing is the Screwing’ (1): Consumption and the Management of Identity in Sex Work

This paper reviews qualitative data from academic research into prostitution, accounts from prostitutes themselves in the UK and Australia, and data from one of the authors' own research in New South Wales to analyse the ways in which female sex workers negotiate and construct their sense of themselves. This analysis is informed by the suggestion that, in the act of commercial sex, the prostitute's own body is being consumed by the client, which can be seen to place certain pressures on the relationship between sex workers' professional and personal identities. Our review suggests that individual workers' tactics for managing the contradictions of working as a prostitute and preserving self‐esteem are both similar and different, even within two broadly culturally commensurable contexts, and, moreover, that not all prostitutes necessarily want to maintain a strict divide between work sex and non‐work sex in every encounter. Moreover, even for those who do, the trials of maintaining the divide are considerable, as is the permeability of boundaries between work and intimate sex.