What Novice Family Therapists Experience During a Session… A Qualitative Study of Novice Therapists' Inner Conversations During the Session

“What do novice family therapists experience during a session with a couple or family?” This is the central question in this article. A videotape‐assisted recall procedure was used to study novice family therapists’ inner conversations. The therapists' reflections were analyzed using thematic analysis. This resulted in a coding system that distinguishes four main domains: (a) reflections concerning the self; (b) reflections about the therapy process; (c) reflections on emotions about the family members; and (d) managing the session as well as own emotions. The study furthermore revealed that during a session, novice family therapists experience strong emotions, such as self‐criticism and irritation. Both emotions may encompass dangers, as well as opportunities for the therapeutic alliance and the process.     

Essential elements of Internet infidelity treatment

As the worldwide usage of the Internet tops 1.6 billion people, problems related to its use such as online Infidelity are becoming widespread issues for couples and, consequently, for their therapists. The purpose of this qualitative study was to understand how practicing therapists treat Internet infidelity through exploring the basic themes used in Internet infidelity treatment. We conducted in-depth interviews of 15 therapists with experience in treating Internet infidelity. Our findings indicate that therapists go through a variety of steps in treatment, including: (a) develop physical boundaries, (b) develop psychological boundaries, (c) manage accountability, trust, and feelings, (d) increase client awareness around etiology of the Internet relationship, (e) assessment of the couple's context and readiness for change, (f) assess the presence of unique circumstances, and (g) work toward forgiveness. Implications and future research are discussed.     

Case report: a work simulation program for a manual worker with a fracture injury

Work rehabilitation programs targeting different client groups are available in nearly all major hospital occupational therapy departments in Hong Kong. Clients receiving work rehabilitation are referred from various out-patient clinics and other occupational therapists. Those clients experience limitation in work after their injuries or diseases and plan to return to work after rehabilitation. Program objectives are 1) to assist clients to reach maximum work capacity as rapidly as possible 2) to ensure clients return to work safely 3) to improve clients' work readiness. This case report describes an individualized work simulation program at a general hospital in Hong Kong provided for a typical client who is preparing to return to his worker role. Specific job analysis, goals and program rationale for the client are discussed.     

Disclosure of Child Sexual Abuse as a Life‐Long Process: Implications for Health Professionals

One of the aims of this research project was to develop a fuller understanding of the process of disclosure of child sexual abuse. Face‐to‐face in‐depth interviews were conducted with 22 men and women aged 25 to 70 years old, who had an early sexual experience at the age of 15 or under with someone of 18 or over. Narrative inquiry methodology was used and data was analysed using Rosenthal and Fischer‐Rosenthal's (2004) process of data analysis. Disclosure can be conceptualised as a complex and life‐long process, and most participants did not make a selective disclosure until adulthood. The findings extend Alaggia's (2004) model of disclosure to include the life stage and the person to whom the disclosure is being made. The main barriers to disclosure and possible gender differences are discussed. Family therapists need to manage the challenges inherent in disclosure of child sexual abuse at any age.     

Clients’ perceptions of marriage and family therapists’ way‐of‐being: a phenomenological analysis

Previous research highlights the influence of therapist factors on treatment outcomes. One therapist factor proposed as fundamental to the process of therapy is the therapist's way‐of‐being, a relational concept that refers to how the therapist regards a client—either as a person or object (Fife et al., [2014] Journal of Marital and Family Therapy, 40, 20–33). Although this case has been made conceptually, there is little empirical research on therapists’ way‐of‐being with clients. The primary purpose of this research is to investigate clients’ perceptions of their therapists’ way‐of‐being. Utilizing a common factors perspective, the study seeks to explore: (a) how clients experience their therapists’ way‐of‐being and (b) the influence therapists’ way‐of‐being has on clients’ engagement. Phenomenological methods were used to gain a nuanced understanding of the phenomenon. Qualitative data were collected through semi‐structured face‐to‐face interviews with clients (N = 10) who received individual therapy from a marriage and family therapist. Results were organized into two main themes: core tenets (attunement, congruency, and aligning with clients) and operational tenets (providing affirmation and validation, balancing flexibility and structure, and accomplishing goals). Findings are used to make a case for adding the concept of way‐of‐being as an overarching construct for several well‐established therapist factors. Clinical and training implications are discussed.     

The importance of volitional narrative in treatment: An ethnographic case study in a work progran

The revised theory of the model of human occupation expands the concept of volition to include volitional narrative. This paper focuses on the application of this theory of volition to a client's experience in a work program. This ethnographic case study describes the volitional narrative and life world of one client who attended the occupational therapy work based program. For fifteen months the client was the subject of narrative interviews, participant observation, videotapes and telephone contacts. The findings will illustrate how knowledge of a client's volitional narrative and life world can shed critical light on understanding treatment conflicts. Finally, the discussion will underscore how important it is for work based programs to be designed to encourage therapists to adapt their treatment approaches to maximize the opportunities to seek out the client's volitional narratives and to create meaningful experiences that are consistent with the client's life world.     

Innovative approach for the treatment of cumulative trauma disorders

Cumulative Trauma Disorders (CTDs) is the latest four-letter word for employees and employers. The purpose of this pilot study was to test the efficacy and cost effectiveness of ASTM, previously executed with Division I college athletes, in a work-related population. ASTM uses specially designed instruments to assist clinicians in rapid localization and effective treatment of soft tissue fibrosis/scar tissue. The protocol includes a flexibility and functional program that helps the worker adapt to the demands of the job. Physical and occupational therapists in both an outpatient clinic, and an industrial on-site setting, utilized ASTM. ASTM was considered successful, with symptoms resolved in over 70 percent of the patients. ASTM demonstrated impressive results in both settings and decreased medical and non-medical expenditures.     

Outpatient clinic structure as a complication to psychoanalytically-oriented treatment

Concepts of “adaptive context” and “holding environment” serve as a foundation from which to address the impact of typical outpatient psychotherapy clinic settings on the process of psychoanalytic therapy. Issues of transference and resistance, treatment boundaries, professional investment, and the patients' and therapists' perceptions of the therapy process are primary areas of consideration. The depth, intensity, and power of psychoanalytically-oriented psychotherapy is seen as potentially limited by the structure and policies to which clinic settings tend to adhere. Circumstances in private practice are used as a point of comparison and suggestions are made to minimize treatment complications.     

An innovative medical and dental hygiene clinic for street youth: Results of a process evaluation

Canada has a noteworthy reputation for high quality health care. Nonetheless, street youth are one of our most vulnerable yet underserved populations. Consequently, a medical and dental clinic was created in downtown Ottawa, Ontario to respond to their needs. The purpose of this study is to describe a process evaluation of the clinic during its first year of operation with a focus on program fidelity, dose, reach, and satisfaction. A mixed methods approach was used involving interviews with providers, focus groups with street youth, analysis of Electronic Medical Record (EMR) data, and supplemental information such as document reviews. The evaluation identified areas that were working well along with challenges to program implementation. Areas of concerns and possible solutions were presented to the management team that then helped to plan and make improvements to the clinic. Our evaluation design and working relationship with clinic management promoted the integration of real-time evidence into program improvements.     

Training Family Therapists: Creating a Learning Experience

This article describes the structure of a Three Day Residential Workshop for experienced therapists. We were concerned that workshops for family therapists often failed to provide a sense of continuity and movement from one interview to the next. We also felt that workshops, through their process, imply an expectation of uniformity in style that may inhibit the creativity and spontaneity of the therapists. We therefore chose the Growth Model of family therapy as we experimented with a format that: (a) used sequential interviews which broke some well established rules of role-playing, (b) utilized a team approach as a useful tool in furthering the learning experience, and (c) exposed the participants to a variety of therapy styles. In this article we seek to Illustrate those components of the workshop that proved successful and those areas which needed to be changed in order to make it a more effective learning experience. We conclude with specific recommendations regarding the structuring of such workshops.     

Developing a manualized couples treatment for domestic violence: overcoming challenges

This paper describes challenges faced in a four-year project to develop a manualized couples treatment program for domestic violence. The couples treatment program is an add-on to a male batterer program where the male partner has perpetrated mild-to-moderate violence, yet both partners want to remain together. The project involved the cooperation of a variety of community agencies and referrals from key domestic violence programs. While some anticipated challenges did not materialize over the course of the project, unanticipated challenges did. Qualitative data collected from therapists and clients throughout the project was used to refine the treatment approach.     

Correlates of Clients’ emotional and Behavioral Responses to Treatment Termination

This study investigates the associations between clients’ emotional and behavioral responses to treatment termination and eight sets of indepentent variables, covering the source of termination (client, therapist, external source); the termination process (speed, centrality, control, choice, and desire), and the perceived outcome (failure, goal achievement) of the therapy. Subjects were 92 student therapists and 40 professional therapists, who reported on their clients’ perceptions, experiences, and responses. All the variables examined were associated with one or another client response. The findings support the view of treatment termination not only as a loss experience but also as a transition. They highlight the need for therapists to pay careful attention to both the source and the process of treatment termination.     

Institutional transference: a new look at an old concept

In reviewing the early development of institutional transference, the concept was defined as the patient's identifying the treatment relationship with a clinic rather than with an individual therapist and a form of "distancing." More recently, the literature reflects a debate about whether the phenomenon is an outcome of patients' inability to maintain an individual relationship or their adaptation to changing therapists within a clinic over time. In our clinical experience, we have observed that institutional transference is strongly associated with the clinical outcome. In the clinical examples, we demonstrated that being aware of the potential for institutional transference and allowing it to develop can facilitate the development of a more trusting relationship between the patient and clinic staff. Institutional transference can coexist with individual transference and help facilitate rather than hinder the development of a therapeutic relationship. In our experience, the sense of a relationship with the clinic or treatment center is an important aspect of care. Therefore, recognizing institutional transference enables the clinician to pace the development of the relationship with the patient.     

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.     

Predictors of treatment outcome in a child and adolescent psychiatry clinic: A naturalistic exploration

We present data on predictors of treatment outcome for 3200 consecutive referrals to a child and adolescent psychiatry clinic. Using Reliable Change Index (RCI) methodology, we divided children into those who, between intake and discharge, improved, stayed the same, or got worse according to clinician-rated impairment. Most predictors of improvement were related to parent variables (marital status, maternal anxiety, and ethnicity), while those associated with deterioration were tied to child status (extent of psychiatric comorbidity, history of placement in a self-contained classroom, and a prior trial of psychotropic medications). The implications of these findings for data-driven program development, clinic management, treatment planning, and systems of care are discussed.     

Clinical and Supervisory Considerations for Transgender Therapists: Implications for Working with Clients

Transgender therapists have unique and valuable perspectives into how gender organizes the therapeutic process. Currently, in the MFT field, there is discussion of the cisgender therapist's experience in the therapy room, but no known articles on the transgender therapist's experience. This article provides insight into the experiences of transgender therapists around issues of self‐disclosure, social locations of both therapist and client, and clinical supervision. Drawing from our clinical experiences as transmen, we highlight special considerations for working with cisgender, queer, and transgender clients. Implications for supervision of transgender therapists are also discussed. As more gender diverse students seek MFT training, there is an urgent need to acknowledge their perspectives. This article is a call for beginning conversations in this direction.     

Current practices in residential treatment for adolescent sex offenders: a survey

A list of all treatment facilities for adolescent sex offenders that described themselves as inpatient or residential was requested from the Safer Society Foundation in Brandon, Vermont. A total of 203 such facilities were identified in this manner. Each was sent a questionnaire regarding their policies and practices. Of the 50 questionnaires that were returned, 49 were usable. Items on the questionnaire dealt with major phases of operating a residential program, including number of beds, average daily census, number of males and females in treatment, testing and assessment procedures, most frequent diagnoses, average IQ of patients, abuse history, therapeutic approaches used, number and types of individual/group treatment sessions per week, qualifications of therapists, average length of treatment, and follow-up research on treatment.     

Developing culturally competent marriage and family therapists: guidelines for working with Hispanic families

As the Hispanic population of the United States continues to grow, so will the need for therapists who have been trained to work with Hispanic families. This content analysis of the available treatment literature generated several specific guidelines that can be used in training and evaluating culturally competent therapists. Guidelines included: Use family therapy, act as advocate for the family, assess immigration experience, assess acculturation, respect father, interview family subsystems separately, do not force changes, provide concrete suggestions, and warmly engage the family. Empirical and conceptual support for each guideline is discussed and several conclusions are made regarding culturally competent therapy with Hispanic families.     

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     

The Use of Multiple Family Marathon as a Teaching Device

This paper discusses the rationale and methods for using a multiple family marathon as a teaching device in the context of an intensive group-supervision family therapy training program conducted by the authors. Procedures used in the marathon are described, as well as how the concept stimulates increased focus on issues common to family therapy and broadens the experience of the students. The effects of the marathon on the students' views of their therapy families and of themselves as family therapists are explored.