Alcohol abuse

We reviewed 38 controlled studies of marital and family therapy (MFT) in alcoholism treatment. We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, (a) Al-Anon facilitation and referral help family members cope better; (b) Community Reinforcement and Family Training promotes treatment entry; and (c) the popular Johnson intervention apparently does not effectively promote treatment entry. Once the alcoholic enters treatment. MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. BCT also reduces social costs, domestic violence, and emotional problems of the couple's children. Future studies need to specifically evaluate: MFT with women and with minority patients, mechanisms and processes of change, and transportability of evidence-based MFT approaches to clinical practice settings.     

What’s Wrong With These People? Clinicians’ Views of Clinical Couples

Marriage and family therapy (MFT) faculty and graduate students rated the "typical" or predictable behaviors of husbands or wives coming for therapy using the Georgia Marriage Q-sort. Scores were compared with previously published scores for both "ideal" couples (i.e., showing positive behaviors, attitudes, and problem-solving skills) and a sample of 136 nonclinical, community couples. A review of correlations between MFT raters' scores for clients and the scores for "ideal" or actual community husbands or wives indicated that clinicians have negative views of both clinical husbands and wives. Such negative views of clinical husbands and wives are particularly marked in scores by MFT faculty. MFT students had a similarly negative view of clinical husbands, but such views were not evident for clinical wives. Recommendations for MFT training and implications for future research are discussed.     

MARITAL THERAPY: QUALITIES OF COUPLES WHO FARE BETTER OR WORSE IN TREATMENT

To evaluate the effectiveness of couples therapy and determine the characteristics and qualities of couples who fare best in treatment, 139 couples presenting at a nonlaboratory sliding-fee clinic in Dallas, Texas, were evaluated. Observational and self-report measures of the Beavers Systems Model were taken at the first session and, for some subjects, at termination. Therapists also rated the couples on goal attainment and on dimensions of the therapeutic alliance. Not surprisingly, there was a direct association between number of sessions and goal attainment, with couples attending only one or two sessions having the lowest goal attainment. There were also significant family functioning qualities associated with success: more competent couples fared better in therapy. Another consistent finding was that couples with no children did better in treatment than those who were also parents. It is interesting that remarried couples without children did best in treatment, followed by first-married couples with no children, first-married couples with children, and, finally, remarried couples with children. Implications for screening and clinical work with couples are presented.     

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.     

Characteristics of effective providers of marital and family therapy in rural mental health settings

Characteristics of effective providers of marital and family therapy (MFT) in rural mental health settings were investigated. The survey sample included 74 members of the National Association for Rural Mental Health who, through a modified Delphi process, created a composite picture of effective MFT providers. The findings yielded six major rank-ordered characteristics of effective MFT providers in rural mental health settings, with effective skills in MFT ranked first. Rural community understanding, appreciation and participation ranked second. Specific competencies contributing to each major characteristic were also identified and are discussed. Recommendations for use of this information are provided.     

Reflecting on the Past: A Content Analysis of Family Therapy Research from 2000‐2015

In this content analysis, researchers examine articles published from 2000 to 2015 in three family therapy journals, yielding a total of 948 empirical articles. The purpose is to provide an overview of the research being published, assess who is publishing, and investigate the current state of clinical effectiveness research in marriage and family therapy (MFT). Most first authors were affiliated with MFT programs and primarily included diversity and couples in their research. There was a significant increase of research on clinical process—though the number of clinical outcome studies held steady. There were no significant changes with regard to research funding. Implications support the use of innovative research methods to provide evidence of clinical effectiveness.     

A Family Therapy Approach to Alcoholism*

Data accumulated from recent studies strongly suggest that family therapy is a promising method of treatment for alcoholism. In this paper a comprehensive treatment approach is proposed, based on known characteristics of alcoholic family systems and the author's clinical experiences in working with families of alcoholics. Specific strategies are described that can enhance treatment success by reducing resistances and maximizing changes in dysfunctional family interaction patterns. The relationship between the spouses is such as to perpetuate the need for alcohol. The major focus in therapy therefore is on understanding and changing the marital relationship.     

Meta-analysis of MFT interventions

This article briefly reviews 20 meta-analyses of marital and family interventions. These meta-analyses support the efficacy of both MFT for distressed couples, and martial and family enrichment. Those effects are slightly reduced at follow-up, but still significant. Differences among kinds of marital and family interventions tend to be small. MFT produce clinically significant results in 40-50% of those treated, but the effects of MFT in clinically representative settings have not been much studied. The article also introduces the concept of meta-analytically supported treatments (MASTs), which are treatments that meet certain criteria for efficacy in meta-analysis, and which remedy certain problems in the empirically supported treatment (EST) literature. The article concludes with recommendations for doing better meta-analyses.     

HOME-BASED MARITAL THERAPY FOR MULTIPROBLEM FAMILIES*

This paper describes a project designed to reach low-income, multiproblem families, utilizing couples therapy in the home. By targeting a population of young couples under the age of 30 and with children no older than 7 years, the project aimed at prevention of severe family dysfunctioning and child disturbances. The major characteristics noted in the literature on multiproblem families are reviewed here, as are the treatment goals and techniques with such families. Most programs working with multiproblem families have focused primarily on the parental functioning in family therapy, and little has been reported on work with the couple in multiproblem families. The project described here used home visits by a male-female therapist team, including frequent individual and couple sessions. Therapeutic techniques based on modeling, role playing and demonstration were emphasized. In addition, tasks which increased the individual and couple functioning of the spouses were designed and successful completion was reinforced. An attempt was made to integrate the couple into the community and to create a network of support outside of the family, including friends and community services.     

The Marriage and Family Therapy Practice Research Network (MFT‐PRN): Creating a More Perfect Union Between Practice and Research

This article describes the Marriage and Family Therapy Practice Research Network (MFT‐PRN). The MFT‐PRN is designed to build a professional community based on practice‐informed research and research‐informed practice, increase the diversity of participants in MFT research, and unify researchers and clinicians. Clinics choose measures from a list that best represent their clinic needs. Clients' outcomes are assessed regularly, and therapists receive immediate graphical feedback on how clients are progressing or digressing. Data are pooled to create a large and diverse database, while improving client outcomes. We will discuss advantages of the MFT‐PRN for researchers, therapists, clients, and agencies, and provide one model that we hope will inform other collaborative clinical‐research models in the field of marriage and family therapy. Video Abstract is found in the online version of the article .     

Multiple Family Therapy Systems

This paper investigates multiple family therapy (MFT), a treatment method which includes several families in a series of sessions with the therapist(s). A brief historical development of MFT is included as well as reports of multiple family therapy groups found in the literature. The characteristics of this treatment method are delineated with special attention to the elements of change attributed to MFT and the stages of development in MFT groups. The role of the therapist and special problems in MFT are also explored. Some implications for research are outlined, indicating that MFT is lacking adequate validation as a treatment modality. Possible advantages inherent in multiple family therapy systems, which have been suggested by therapists' clinical findings, are also reported.     

FAMILY THERAPY TREATMENT OUTCOMES FOR ALCOHOLISM

We conducted a meta-analysis of 21 studies of family-involved therapy for alcoholism, evaluating them for design adequacy, clinical significance, and effect size. The review is divided into studies of family involvement in three phases of treatement: (a) initiation of treatment, (b) primary treatment/rehabilitation, and and (c)aftercare. We conclude that family therapy is effective in motivating alcoholics to enter treatment. Once the drinker enters treatment, family-involved treatment is marginally more effective that individual alcoholism treatment. The data suggest that three factors may mediate the effect of treatment: gender, investment in the relationship, and perceived support from the spouse for abstinence. Modest benefits have been obtained in family-involved relapse prevention programs. The most recent studies are starting to address tese issues by developing treatment models specifically for women alcoholics and identifying factors that could be used to match appropriate treatments to alcoholics and their families. These efforts are just beginning, however, and we make a number of recommendations to support implementation of these and other efforts.     

Multifamily therapy in the community mental health network: A pragmatic randomized and controlled study

Multifamily therapy (MFT) is a psychotherapeutic group intervention for patients with severe mental disorders (SMDs) and their families. The present study is a multicenter, randomized, and controlled trial that analyzes the benefit of MFT during outpatient treatment. The recruited patients were randomly assigned to the experimental group (n = 26), which received 24 MFT sessions in addition to their treatment as usual (TAU), or to the control group (n = 29), which received only TAU (individual and family sessions). Six months after the inclusion in the MFT, the experimental group showed a significant decrease in number of visits to the psychiatric emergency services, number of psychiatric admissions, and the days of admission. The need for hospital care 6 months after recruitment was also lower in the experimental group compared to the control group. These results suggest that the implementation of MFT during outpatient treatment facilitates community management of people diagnosed with mental health problems.     

The State of Sex Research in MFT and Family Studies Literature: A Seventeen‐Year Content Analysis

The ability to conceptualize and treat sexual problems has been widely accepted as a crucial skill to master the MFT training. However, clients’ sexual relationships are often ignored by clinicians because of a lack of experience or training, or personal discomfort. In this content analysis, we review sex and sex therapy research within MFT and family studies journals since the turn of the century. Of the 13,919 articles published within the 15 journals, 137 focused on sexuality or sex therapy. The articles were divided into five themes: sexual and relational health, sexual diversity, treatment and contributors of sexual dysfunction, sex therapy practices, and sexual education and development. Implications for clinical practices, sex therapy integration, and future research are discussed.     

THE EFFICACY AND EFFECTIVENESS OF MARITAL AND FAMILY THERAPY: A PERSPECTIVE FROM META-ANALYSIS

This article reviews the major findings from a multiproject meta-analysis of the effects of marital and family therapy (MFT). Across 163 randomized trials, MFT demonstrates moderate, statistically significant, and often clinically significant effects. No orientation is yet demonstrably superior to any other, nor is MFT superior to individual therapy. Cost effectiveness information is scant in these 163 studies, but supportive. Randomized experiments yield very different answers from nonrandomized experimental studies of the effects of MFT, calling into question whether we should mix the two in reviews. We have also found several new differences in the ways that marital therapy (MT) and family therapy (FT) studies are conducted, making them harder to compare. Finally, important questions still exist about whether any psychotherapy, including MFT, yet has sufficient information about how well research generalizes to everyday clinical practice.     

Family Resilience Resources in Coping With Child Sexual Abuse in South Africa

The aim of this qualitative study was to identify resources of family resilience that help families cope with child sexual abuse. Data were collected from a purposeful sample of parents representing nine poor families living in the Western Cape Province, South Africa. The narratives of the participants were analyzed thematically. The results indicate that the families, despite adverse situations, utilized internal and external resilience resources. Internal resources were the parents’ relationship with their children, their own emotional functioning and attitudes, the children’s ability to cope with the abuse, boundaries in the family, insight into their children’s emotional needs, and sibling relationships. External family resources were the support of extended family members, friends, and a local community-based nonprofit organization working with child sexual abuse and schools. The empowering role of the identified resources for family resilience should be enhanced in interventions, while future studies could further explore these aspects in families confronted with child sexual abuse.     

Alcoholics Anonymous and Family Therapy*

Alcoholism affects the family of the alcoholic as well as the individual problem drinker. Change in drinking behavior is often brought about by change in the alcoholic's family members. There has been a natural evolution in the alcoholism field of self-help groups for mates and children of alcoholics. This development has paralleled the recent growth and development of family therapy as a major mode of psychotherapeutic intervention. Yet, crossfertilization of ideas and intervention strategies between the two fields has been slow in occurring. Arguments over whether one uses family therapy or A.A. and Al-Anon persist. This paper focuses on ways in which family therapy and the A.A. self-help groups add to, rather than detract from, one another. A note of caution about the misuse of family therapy when alcoholism is present is also provided.¹     

The family environment of married male pathological gamblers,alcoholics, and dually addicted gamblers

The family environments of married pathological gamblers, alcoholics, and alcoholic gamblers were measured with the Family Environment Scale (FES), a measure of 10 characteristics of family life. The total sample consists of 193 hospitalized patients, which includes 73 male alcoholics, 53 female alcoholics, and 67 male pathological gamblers, of whom 34 were alcoholics and 33 were not. All four treatment groups had a significantly lower degree of cohesion than normal controls. Male alcoholic gamblers reported significantly more conflict and less personal independence than controls, while male gamblers (nonalcoholics) reported less independence and intellectual-cultural orientation. Male alcoholics (nongamblers) reported more conflict, less independence, intellectual-cultural orientation, and active-recreational orientation than normals. Female alcoholics (nongamblers) also reported less intellectual-cultural orientation and active-recreational orientation than normals. Except for one comparison, treatment groups did not differ from each other. The implications of these findings for models of addiction are discussed as well as their contribution to understanding family issues for pathological gamblers.     

Marriage and family therapists and psychotropic medications: practice patterns from a national study

A national sample of marriage and family therapists (MFTs) was used to describe practice patterns of MFTs whose clients use psychotropics and to compare medicated and nonmedicated clients. Marriage and Family Therapists (n=283) reported on 195 medicated and 483 nonmedicated adult clients. Clients (n=375) rated their improvement and satisfaction with treatment. Results showed that 91% of MFTs treat medicated clients, and these clients accounted for 25% of MFT cases. Medicated clients were most often seen in individual therapy, had more serious medical problems, and showed greater cumulative improvement in relational functioning. Therapists from MFT educational backgrounds had fewer medicated clients than MFTs from other educational backgrounds.