Strengthening the Systemic Ties that Bind: Integrating Common Factors into Marriage and Family Therapy Curricula

Specific models guide the training of marriage and family therapists (MFTs) as they offer both structure and organization for both therapists and clients. Learning models may also benefit therapists‐in‐training by instilling confidence and preventing atheoretical eclecticism. The moderate common factors perspective argues that models are essential, but should not be taught as “the absolute truth,” given there is no evidence for relative efficacy of one empirically validated model versus another, and no single model works in all instances. The following article provides a blueprint for infusing a common factors perspective into MFT programmes by reviewing innovations in course design, outlining specific teaching strategies, and highlighting potential implementation challenges.     

Every Dot has a Meaning

Family therapy in Australia has recently begun a conversation with the indigenous people of this country. Part of this dialogue has involved family therapists listening to the stories of violence and oppression perpetrated against the Aboriginal people under the name of “protection”. This article is part of the ongoing exchange between family therapists and Kooris documenting the suffering of “the stolen generation”. Here two young people removed from their families as small children and raised in the same Aboriginal children's home, speak personally through their art, of an agonising search for family and cultural identity.     

Family Social Work: The Past and the Present

SUMMARY

It is easy to blame the dysfunction of a family member on his or her behavioral patterns. I use the title, “It's the Relationship, Stupid!” not to talk down to family therapists, but to remind myself that the source of dysfunction is usually family relationships, especially the marriage relationship. This article gives several case studies for practical application of therapy techniques that focus on developing the “WE” of the family unit. One practical technique that I developed is a communication typology. The married couple (and family members) are divided into “Painters” and “Pointers.” This typology explains much of the conflict and mis-communication that leads to the breakdown of the “WE.” This article also presents dysfunction within the individual as a relationship problem and introduces the concept of the “spirit” of the individual as expressing the relationship the person has with self.     

WHAT IF FAMILY THERAPY WERE A KIND OF PSYCHOTHERAPY? A READING OF THE HANDBOOK OF PSYCHOTHERAPY AND BEHAVIOR CHANGE*

Editor's Note. This piece by Grunebaum is not an “original article,” although his approach to presenting Garfield and Bergin's Handbook to a family therapy audience is certainly original; it does not meet the usual requirements as apiece for the “Connections” section of the Journal, although it certainly does forge such connections with the mental health world beyond family therapy; and it is not a typical “book review,” and thus, is appropriately described in its subtitle as a “reading,” rather than a review. It is a most creative demonstration of the fact that family therapists can learn a good deal of practical value from their colleagues who are “outside” our field.     

WHY FAMILY THERAPY SHOULD GO BEYOND HOMEOSTASIS: A KUHNIAN REPLY TO ARIEL,CAREL AND TYANO

The thesis of “Beyond Homeostasis” is (a) that the discourse of family therapists unquestionably shows that family therapists have tended to see homeostasis as a trait of families; and (b) that such a view of homeostasis is inconsistent with the systemic paradigm. Therefore, family therapy should go beyond such an understanding of homeostasis. Ariel et al. may have failed to grasp this argument; they have certainly chosen to ignore it. Ariel et al. have provided a logical empiricist explication of the nonsystemic version of homeostasis which is portrayed in the discourse of family therapists. I still argue that family therapy should go beyond such an understanding of homeostasis.     

BASIC FAMILY THERAPY SKILLS,II: STRUCTURAL FAMILY THERAPY1

The Basic Family Therapy Skills Project has yielded empirically derived skills important for beginning family therapists. This article reports the results of ratings from the 103-member panel of experts who practice and teach Structural Family Therapy. A total of 100 competencies of Structural Family Therapy were rated in terms of importance on a 5-point Likert scale by the panel. Panelists were also given alternative responses such as “appropriate as a generic skill,”“inappropriate for beginning therapists,” and “don't understand what this means.” Rationale for the approach and results are discussed in terms of the importance of empirically based competencies for the practice of Structural Family Therapy.     

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.     

‘Bad Therapy’ as a Training Technique: An Empirical Analysis

The purpose of the present study was to gather empirical data to examine the usefulness of an intriguing training technique called “bad therapy”. The technique, developed by Lang (1980, 1982), is utilized in a role-play setting for experienced therapists who are having difficulty with specific clients showing little improvement. The therapist is instructed to disregard his or her usual style of treatment, and instead, within a role-play format with a colleague who plays the part of a client, to try an alternative style of treatment. This new treatment, termed “bad therapy”, instructs the therapist to try to make the client worse rather than better. Interestingly, reports from both the role-play therapist and client indicate that the “bad therapy” session was considered more beneficial than the therapist's usual mode of treatment. As well as empirically investigating Lang's assertion, the present study also attempted to look at different perspectives of bad therapy. Is “bad therapy” a directive to be harmful and destructive, or is it a suggestion to be more daring and to take more risks? Subjects were 56 therapists who formed twenty eight pairs of therapist-client dyads. First, each pair conducted a “session” where the therapist performed his or her typical therapy. Then, therapists in one group (N= 11) were given directives to try to make their clients worse rather than better (“destructive” set), while therapists in another group (N=11) were told to say and do things that they wished to, but never dared (“daring” set). Finally, six therapists were told to simply repeat their usual type of therapy (“control” set). Results indicated that clients perceived the destructive and daring groups differently with the daring group being perceived more favourably, yet more authoritarian. Similarly, therapists perceived the daring and control groups more positively than the destructive group. The results are discussed in terms of training techniques and current trends in psychotherapy.     

Cybersex and the E‐teen: What Marriage and Family Therapists Should Know

Adolescents who use the Internet regularly (the “e‐teen”) present a new set of challenges for marriage and family therapists. This article introduces marriage and family therapists to (a) the basic technological concepts and unique psychological characteristics of the Internet important in understanding and addressing adolescent online sexual behavior, (b) the appropriate developmental expectations for teens online, including risk‐taking behaviors and critical decision‐making skills, and (c) suggested strategies for assessment, prevention, and intervention when dealing with problematic online sexual behavior in adolescents. Marriage and family therapists cannot ignore the role the Internet plays in adolescent sexual development and its implication for the family. This article will serve as a primer for the marriage and family therapist when presented with adolescents who engage in online sexual behaviors.     

A Brief Report on the Ethical and Legal Guides For Technology Use in Marriage and Family Therapy

Marriage and family therapists (MFTs) use ethical codes and state licensure laws/rules as guidelines for best clinical practice. It is important that professional codes reflect the potential exponential use of technology in therapy. However, current standards regarding technology use lack clarity. To explore this gap, a summative content analysis was conducted on state licensure laws/rules and professional ethical codes to find themes and subthemes among the many aspects of therapy in which technology can be utilized. Findings from the content analysis indicated that while there have been efforts by both state and professional organizations to incorporate guidance for technology use in therapy, a clear and comprehensive “roadmap” is still missing. Future scholarship is needed that develops clearer guidelines for therapists.     

CRITIQUING THE NEW EPISTEMOLOGIES: TOWARDMINIMUM REQUIREMENTS FOR A SCIENTIFIC THEORY OF FAMILY THERAPY*

The purpose of this paper is to critically analyze the structures of the new epistemologies. Epistemology is a technical term within the field of scientific philosophy. When it is used looselyby family therapists, confusion results. The central argument of the present author is that the new epistemologies are, in fact, weak theories. It is suggested that the practice of using the term “epistemology” to denote theory or paradigm, be discontinued. A more limited and narrowly defined use for the term “epistemology” is proposed. Specifically, this paper presents: (a) a discussion ofthree areas of philosophy that serve as foundations for the construction of scientific theory, (b)a critical analysis of the new epistemologies, (c) a logical structure for scientific family therapy theory, and (d) minimum requirements for a scientific theory of family therapy.     

Audio-Video Reviews

Barbara Knothe, Consultant Psychiatrist, Bouverie Family Therapy Centre, has reviewed two videotapes, produced by Anita Morawetz. The tapes demonstrate Anita's work with two families, seen at the Bouverie Family Therapy Centre. In one tape, Anita supervised one of the trainees on the Training Programme and it is interesting to see how the work of the training group, family and supervisor evolves. The tapes were produced in 1988–1989 and are available from: Bouverie Family Therapy Centre, 31 Poplar Road, Parkville Vic 3052 Tel: (03) 389 2480. The contact person is Ms Kate Gerber, Clerical Officer. There is no charge for borrowing the tapes, although interstate borrowers must pay for postage (“Cash on Delivery” charges). People may borrow 2 tapes at a time, for a period of 2 weeks. Each borrower is asked to sign a form, which will be sent to them, stating they will accept responsibility for the tape and they will respect the confidentiality of the family. Thanks to Anita for producing the tapes and making her work available to other therapists and trainees, for their professional development. Thanks also to Barbara for her reviews and to Bouverie Family Therapy Centre for their generosity and for maintaining an excellent tape library. I would like to encourage other therapists in Australia and New Zealand to produce audio and/or videotapes of their work, on particular areas of interest. David Epston was one of the first therapists to do this — when he produced a videotape called “The Family who loved to stay at Home” which was reviewed by Jim Birch. Many “local” therapists are making recordings of their work and these provide an invaluable resource for training, supervision, consultation and research. If you are interested in producing some material for reviewing and “public” use, please contact me on: (Work) 03 550 130 (Home) 03 898 6983. You may feel overwhelmed by the task, but please don't abandon the idea. Call me and we can talk about this and your ideas. Making tapes for these purposes may not be as difficult or as daunting as you think.     

THE PROBLEM OF THE SIBLING AS THE REFERRING PERSON*

This paper is the first concerning observations gathered at our Center during studies of the treatment of families with a chronically psychotic member.' It draws the attention of family therapists to a danger not uncommon in such cases, one that arises when the person referring his family of origin is a sibling of the index patient and, in many ways, the most “competent” and prestigious family member. The theoretical part of the paper and the clinical example that follows are intended to demonstrate how this pitfall can be turned into a springboard for therapeutic success.     

THE TIME LINE AND THE “WHY NOW?” QUESTION: A TECHNIQUE AND RATIONALE FOR THERAPY,TRAINING, ORGANIZATION CONSULTATIONS AND RESEARCH

A method is presented for quickly and graphically clarfying the relationships between life cyle evnts and the onset of probles Its basic from involves laterally organizing events in terms of the points in time at which they ocurred. A structural version-expressed in two formate-elucidates the interaction between nodal events and changes in family/organization structure. The device can both tease out hypotheses and identify directoins for treatment. It addreses the “Why now?” question for therapists and trainees and can provide a normalizing, edifying, and encouraging experience for families. It is also adaptable for research and for use in organizational development and consultation with agencies and businesses.     

Giving Good Sermons in Therapy

SUMMARY

Social workers and other therapists often deliver “sermons” which are not heard by their clients. Like some preachers who lose their congregations with dull monologues, therapists can lose their audiences through ineffective preparation or poor delivery. The effective preparation and delivery of messages are addressed in the body of literature known as homiletics. This article begins a conversation between practitioners of homiletics and of family therapy. A discussion of the vital elements of an effective sermon as well as its preparation and delivery that makes sense to clients is offered. Vignettes to illustrate various uses of sermons in therapy are included.     

Incompletely Fractured Families

The modern family is increasingly isolated and increasingly unstable. As a result, family therapists are faced with a variety of problems in families where the parents have separated or divorced. One previously unrecognised problem occurs when the partners, although separated, covertly remain attached to the old alliance. Frequently a child, by becoming “ill”, remains as a bridge between them to prevent the final disintegration of the marriage bond. Three case histories are provided as an illustration of this phenomenon.     

PARADOX AND ORTHODOX: FOLIE À DEUX?*

In the recent family therapy literature, therapists have been cautioned to use paradoxical looking techniques as either a last resort, or else not to use such actions at all with specific problems. The paper argues that these stances arise from a rigid adherence to a set of orthodox views from which these actions appear contradictory. Similar to family systems, when such orthodox therapy systems do not question or alter their own premises in the face of contradiction, they tend to attribute either badness or madness to the action and either try to exorcise the badness, or banish the action. The literature which either prescribes “paradox as a last resort,” or which proscribes it altogether is reviewed and critiqued. Walter Buckley's process/adaptive system model is recommended as a positive alternative view from which such previously pardoxical actions may often be elected as a logical and effective first choice.     

IMPASSE AND CHANGE: A SYSTEMIC/STRATEGIC VIEW OF THE THERAPEUTIC SYSTEM*

This paper examines how clients and therapists, together, create impasses or change. First, the general concept of a “therapeutic system” (therapist-plus-client) is briefly reviewed. Second, a model is described that synthesizes systemic and strategic ideas about therapeutic systems. Third, a series of questions based on this model is proposed for analyzing and resolving impasses. Finally, application of this framework is illustrated with a case.     

An Empirical Assessment of the Goals of Family Therapy*

This study is an empirical assessment of the goals of family therapists. A list of goals was developed based on a theoretical clustering of the family therapy literature into the dimensions of communication, cohesion, and adaptability. Three hundred ten clinical members of the American Association for Marriage and Family Therapy (AAMFT) responded to a questionnaire about their use of these goals in family therapy. The findings indicate that the goals employed by this sample seem to reflect ideas from the literature which are not the property of any one “school” of family therapy. The goals that were rated and ranked highest included encouraging family members to relate caringly, responsibly, and creatively in negotiating their differences. Goals that were rated and ranked lowest included the more advanced or technical communication skills and some cohesion goals that may be interpreted as related to institutional aspects of family life.     

Same-Sex Marriage and the Boundaries of Diversity: Will Marriage and Family Therapy Remain Inclusive of Religious and Social Conservatives?

The expanding legalization of same-sex marriage in the Western World may pose significant challenges for the relationship between many religious and socially conservative marriage and family therapists and their professional associations. In the present analysis, I look to the field of moral psychology, particularly Haidt's Moral Foundations Theory, to provide greater clarity regarding the nature of this tension and a resultant tightening of the boundaries of acceptable diversity that could ensue. I then outline some concerning indicators from mental health associations relative to their potential willingness to tolerate conservative perspectives in meaningful ways and identify some specific areas of possible tension for conservative therapists trying to integrate their deeply held moral values into ethical practice with same-sex couples, with a specific reference to the viability of “conscience clauses” and values-based referrals. I conclude with some recommendations through which the field of marriage and family therapy can reduce the potential for conflicts and thereby reassure these clinicians that they continue to be welcomed even if their vision of marriage differs from that which is formally endorsed by their professional associations.