Levels of interventions for MFTs working with family businesses

Family businesses (FBs) are a significant population in the world and therefore part of most practicing marriage and family therapists (MFTs) clientele; however, little is mentioned about FBs in the training of MFTs. This article offers some guidance to practicing MFTs who service this population, as well as MFTs who wish to expand their practice into a focused consultation practices with FB systems. This article uses Doherty's Levels of Family Involvement Model as a road map for MFTs to organize the vast amount of literature on FB systems as well as the many ways in which MFTs might serve FBs. We also offer suggestions for the necessary skills, experiences, and levels of engagement required at each level of intervention provided by MFTs.     

Motivational,ethical, and epistemological foundations in the treatment of unwanted homoerotic attraction

A recent special section of the Journal of Marital and Family Therapy (October, 2000) focusing on the mental health needs of gay, lesbian, and bisexual individuals neglected to address the clinical needs of homosexual persons who desire to increase their heterosexual potential. This article attempts to correct this omission by outlining common motivations for pursuing change, updating the current state of knowledge regarding the effectiveness of change efforts, and providing some ethical guidelines when therapists encounter clients who present with unwanted homoerotic attraction. Finally, to assist marriage and family therapists (MFTs) in more deeply understanding divergent perspectives about reorientation treatments, an examination of the role of moral epistemology is presented and some examples of its potential influence are described. MFTs are encouraged to recognize and accept, rather than ignore or deny the valid needs of clients who seek to modify their same-sex attraction.     

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.     

A National Survey of Family Physicians: Perspectives on Collaboration With Marriage and Family Therapists

Recognizing the fit between family medicine and marriage and family therapy (MFT), members of both fields have made significant advances in collaborative health research and practice. To add to this work, we surveyed a nationwide random sample of 240 family physicians (FPs) and asked about their perspectives and experiences of collaboration with MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-related care, but their referral to and collaboration with MFTs were limited. Through responses to an open-ended question, we gained valuable information as to how MFTs could more effectively initiate collaboration with FPs.     

The role of family therapists in veterinary medicine: opportunities for clinical services, education, and research

Marriage and family therapists (MFTs) are applying their specific skill set in a variety of arenas. A new area for collaboration is veterinary medicine. The veterinary medical profession is emphasizing the importance of non-biomedical skills such as communication skills, acknowledging that human clientele are likely to view their pets as family members, and discussing veterinarian personal well-being. Each of these trends has clear application for intervention by MFTs. A discussion of how MFTs may be uniquely positioned to assist veterinary medicine is presented. An example of collaboration between MFT and veterinary medicine at Kansas State University is highlighted. Recommendations are made for development of effective educational relationships and possible private sector collaborations.     

The Experiences of Couple/Marriage and Family Therapists of color: A Survey Analysis

The family therapy literature documenting the experiences of couple/marriage and family therapists (C/MFTs) of color as a group is limited. The purpose of this study was to assess the status of C/MFTs of color in their clinical training programs, clinical work, and related areas of professional challenges and opportunities. Participants (N = 113) completed a one‐time, anonymous electronic survey on SurveyMonkey consisting of demographic questions, closed‐ and open‐ended questions about their experiences. Key findings are reported related to C/MFTs of color experiences in training programs, areas of professional need, and working with racial and/or ethnic minority clients. These findings shed light on how social justice principles and practices upheld in our field are experienced from the emic perspectives of C/MFTs of color. These voices help to broaden our understanding of how we might move forward in advocating for and advancing a more culturally responsive agenda within our profession.     

Burnout among mental health professionals: special considerations for the marriage and family therapist

Burnout is a syndrome consisting of physical and emotional exhaustion resulting from negative self-concept, negative job attitudes, and loss of concern for clients. This research study explores potential predictors and prevalence of burnout among marriage and family therapists (MFTs). It evaluates the Maslach Burnout Inventory (MBI) to establish its applicability to MFTs. Our sample of 116 Clinical Members of the American Association for Marriage and Family Therapy responded to a mailed questionnaire including demographic information and the MBI. Overall, our sample reported low-to-moderate ranges of burnout. Differences were noted in degrees of burnout across job settings. Predictors of clinician burnout include hours worked per week and job setting. Factor analysis indicates that the MBI is an appropriate assessment tool for measuring burnout among MFTs. Implications for clinical practice are discussed.     

Nonmedication Treatments for Adult ADHD: Evaluating Impact on Daily Functioning and Well-Being

Abstract

Professor J. Russell Ramsey has written a short book aimed at practicing mental health clinicians, describing various non-medication approaches to the treatment of adult attention-deficit/hyperactivity disorder (ADHD). It includes a variety of strategies, some of which are validated and others of which are currently being developed but do not yet demonstrate effectiveness, alongside the documented effectiveness of medications for the treatment of core symptoms of ADHD, especially inattention, hyperactivity and impulsivity. He includes an up-to-date bibliography and critical evaluations of effectiveness for each treatment, especially functional outcomes. Given the high rate of postsecondary students with ADHD, the book should be helpful for college health professionals who are trying to assist such students.     

From Private Practice to Academia: Integrating social and political advocacy into every MFT Identity

While advocacy was essential to establishing the field of marriage and family therapy, at present a social and political advocacy skill set is lacking for the typical marriage and family therapist (MFT). This article reviews the importance of being active in social and political advocacy and highlights the attributes of MFTs’ professional identity that uniquely position us for success in these areas. Other mental health fields’ pedagogical approaches to training and education are explored, and recommendations are made for how MFTs can begin to increase their competency in advocacy. Ideas for incorporating advocacy into a professional identity are presented for MFTs at every level of professional experience. Finally, the concept self‐of‐the‐advocate is introduced and discussed.     

Attention deficit/hyperactivity disorder's effects on individuals' scan paths during a simulated drive

Individuals who have Attention Deficit/Hyperactivity Disorder (ADHD) experience adverse effects relating to driving; additionally, they experience deficits in scanning ability. The present study examined the effects of ADHD on eye tracking while driving. This study consisted of ten participants, of which, five have ADHD. It was hypothesized that individuals who have ADHD will make more saccadic eye movements and thus shorter fixations than individuals without ADHD (Control). Furthermore, it was hypothesized that despite the fact that individuals who have ADHD will make more saccadic eye movements than individuals without ADHD, those individuals with ADHD will commit more traffic violations including collisions compared to the control group. Findings indicated that hypothesis one was not supported by the data, whereas hypothesis two was supported in that ADHD individuals' had more collisions and committed more traffic violations than the control group. Additionally, a significant difference was found in the spatial distributions of the fixations between the ADHD and Control groups. The findings of this study could help better understand the factors involved in ADHD driving and could be used to train individuals with ADHD to become more aware of their surroundings and driving habits and thus become safer drivers.     

The Relationship Between Problem Gambling and Attention Deficit Hyperactivity Disorder

Recent studies indicate that treatment-seeking problem gamblers display elevated rates of ADHD and that adolescents who screen positive for ADHD are more likely to engage in gambling, develop gambling problems, and experience a greater severity in gambling problems. This study aimed to (a) compare the prevalence of ADHD in treatment-seeking problem gamblers to the general population; (b) investigate the relationships between ADHD and problem gambling severity, cluster B personality disorders, motor impulsivity, alcohol use, substance use, gender, and age; and (c) investigate the degree to which these factors moderate the relationship between ADHD and problem gambling severity. Participants included 214 adults (154 males, 58 females, 2 unspecified) who sought treatment for their gambling problems at a specialist gambling agency in Melbourne, Australia. Almost one-quarter (24.9 %) of treatment-seeking problem gamblers screened positively for ADHD, which was significantly higher than the 14 % prevalence in a community sample. ADHD was significantly positively correlated with problem gambling severity, motor impulsivity, and cluster B personality disorders, but was not associated with alcohol and substance use, gender or age. None of the factors significantly moderated the relationship between ADHD and problem gambling severity. These findings suggest that a considerable proportion of treatment-seeking problem gamblers report ADHD and that their clinical profile is complicated by the presence of high impulsivity and cluster B personality disorders. They highlight the need for specialist gambling agencies to develop screening, assessment, and management protocols for co-occurring ADHD to enhance the effectiveness of treatment.     

Gambling Behavior Among Adolescents with Attention Deficit/Hyperactivity Disorder

Impulsivity is inherent to both problem gambling and ADHD. The purpose of this study is to examine ADHD key symptoms, and gambling behaviors and problem severity among adolescents. Additionally, internalizing and externalizing behaviors exhibited among these individuals and the role of these symptoms in gambling are examined. We used a cross-sectional study design and survey 1,130 adolescents aged 12–19. Results indicated that adolescents who screened positive for ADHD were significantly more likely than non-ADHD adolescents to engage in gambling and significantly more likely to develop gambling problems. Those who screened positive as predominantly inattentive and those who screened positive for ADHD Combined (Inattention and Hyperactivity–Impulsivity) were equally likely to gamble, but the latter were twice as likely to have gambling problems. However, we found no significant interaction between the key ADHD symptoms and gambling as the severity of hyperactivity–impulsivity or inattention did not significantly differ with respect to gambling pathology. Emotional problems and depressive affect were the only variables that could significantly differentiate the ADHD types and gambling severity. Our Results highlight the clinical importance of considering the subtype of ADHD among gamblers and the greater association of depressive affect and emotional problems with gambling among adolescents.     

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.     

When therapists do not acknowledge their moral values: Green's response as a case study

In this rejoinder to Green's (this issue) commentary on my article, I clarify several points of agreement and divergence with his critique. The failure of Green to be forthcoming about the sociopolitical and moral framework that infuses his response is unfortunately all too common in this literature. This places a limitation on the degree to which his comments can be contextually evaluated, though they remain didactically useful. Marriage and family therapists (MFTs) must realize that their underlying belief systems exact a profound influence on their conceptions about what constitutes mental health, valid treatment goals, and the best means to achieve these aims. These value frameworks may or may not be shared by religiously conservative and other clients who seek to develop their heterosexual potential. This has important, but often unrecognized, implications for clinical practice.     

Approaching ADHD as a chronic condition: implications for long-term adherence

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common chronic conditions of childhood. Although evidence-based treatments for ADHD, including stimulant medication and behavior modification, have long been established, and guidelines for care of ADHD in primary care settings have been developed, adherence to long-term therapy is poor among youth with ADHD. This article proposes use of the Chronic Care Model for Child Health, the purpose of which is to develop informed, activated patients who will interact with a prepared, proactive health care team. Six "pillars" make up the model: decision support, delivery system design, clinical information systems, family and self-management support, community resources and policies, and health care organizations. Each of these is discussed, and an individual example is described. Adopting the Chronic Care Model for Child Health has the potential to improve the quality of care for ADHD.     

The construction of fear: Americans' preferences for social distance from children and adolescents with mental health problems

Debates about children's mental health problems have raised questions about the reliability and validity of diagnosis and treatment. However, little research has focused on social reactions to children with mental health problems. This gap in research raises questions about competing theories of stigma, as well as specific factors shaping prejudice and discrimination toward those children. Here, we organize a general model of stigma that synthesizes previous research. We apply a reduced version of this model to data from a nationally representative sample responding to vignettes depicting several stigmatizing scenarios, including attention-deficit/hyperactivity disorder (ADHD), depression, asthma, or "normal troubles." Results from the National Stigma Study-Children suggest a gradient of rejection from highest to lowest, as follows: ADHD, depression, "normal troubles," and physical illness. Stigmatizing reactions are highest toward adolescents. Importantly, respondents who label the vignette child's situation as a mental illness compared to those who label the problem as a physical illness or a "normal" situation report greater preferences for social distance, a pattern that appears to result from perceptions that the child is dangerous.     

The Development of a Physician Vitality Program: A Brief Report

We describe the development of an innovative program to support physician vitality. We provide the context and process of program delivery which includes a number of experimental support programs. We discuss a model for intervention and methods used to enhance physician resilience, support work‐life balance, and change the culture to one that explicitly addresses the physician's biopsychosocial‐spiritual needs. Recommendations are given for marriage and family therapists (MFTs) who wish to develop similar support programs for healthcare providers. Video Abstract     

Studying marriage and family therapists in the 21st century: methodological and technological issues

In this article, I present data from two waves of research on demographic characteristics and practice patterns of marriage and family therapists (MFTs) conducted in 2000 and 2002. The research focuses on the methodological and technological issues in studying this population. Specifically, an online survey with MFTs obtained lower response rates and was therefore more expensive relative to phone and mail methods. Questions about evidence-based therapies (EBTs) were asked two different ways with significantly different results based on how the questions were phrased. A discussion of the relative advantages and disadvantages of using different survey methodologies and consideration of issues pertinent to studying EBTs are included.