A FAMILY THERAPY INTERNSHIP IN A MULTIDISCIPLINARY HEALTHCARE SETTING: TRAINEES' AND SUPERVISOR'S REFLECTIONS

Family therapy doctoral students from American Association for Marriage and Family Therapy-accredited programs are required to complete a full-time clinical internship. The literature provides little information about these internship experiences. Two doctoral-level marriage and family therapists summarize their professional and personal experiences in their internships located within a multidisciplinary healthcare setting. In addition, their supervisor reports on her experiences working with marriage and family therapy doctoral interns. We hope that this case report will stimulate all interns and their supervisors to provide feedback to their internship sites and graduate programs about their clinical training and the extent to which the programs prepared them for their marriage and family therapy careers in the larger health and mental health community.     

Basic family therapy skills, I: conceptualization and initial findings

This is the first report on a program of research designed to identify the most important characteristics of the beginning marriage and family therapist. The paper first surveys the literature in family therapy, social work, and psychology and finds that, although these factors are discussed for beginning psychotherapists, no set of skills are derived empirically. This study recruited all available members of the American Family Therapy Association (AFTA) and Approved Supervisors of the American Association of Marriage and Family Therapy (AAMFT) who were experienced educators and trainers of family therapists. After nominating the most important generic-type characteristics for beginning family therapists, the participants rated the items, yielding a list of not only the most important skills, but also personal traits of beginners based on mean scores of the ratings. The final section of the paper discusses the implications of these findings and notes the current and future activities of the research program.     

Common pitfalls of beginning therapists utilizing enactments

Empirical data, clinical observation, and theoretical rationales support use of enactments as a fundamental mechanism of change in relationship therapies. Yet beginning therapists may lack an adequate conceptual framework and operational training essential to effectively utilize enactments. Inadequate training may contribute to ineffective execution, and in turn to negative results, which could lead to abandonment of enactments. This study sought to identify proficiencies and nonproficiencies of beginning therapists in conducting enactments. Twenty beginning therapists from three Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE)-accredited programs were briefly trained in an indirect therapy style that incorporates enactments. Twenty-six therapist enactments were coded using a comprehensive observational measure designed to assess proficiencies and nonproficiencies in executing enactment phases, component tasks, and subcomponent operations. Results suggest that beginning therapists struggle with numerous clinical operations conceptually linked to the successful engagement of relationships in marriage and family therapy. In light of these findings, specific recommendations for additional enactment training in COAMFTE-accredited programs are offered.     

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.     

Student-faculty perceptions of multicultural training in accredited marriage and family therapy programs in relation to students' self-reported competence

Although the marriage and family therapy field's recent attention to multicultural issues is laudable, there appears to be little clarity on what constitutes an effective multicultural training program and the impact of the effects of such training on trainee multicultural competence. The field continues to be challenged at different levels-training, practice, research, the setting of the standards and the work of the Commission on Accreditation for Marriage and Family Therapy Education, and the goals and strategic plan of the American Association for Marriage and Family Therapy Board. This study focused on assessing the extent of multicultural integration at different levels of training and the relationship between such training and students' perception of their own multicultural competence.     

FOLLOW-UP SURVEY OF GRADUATES FROM ACCREDITED DEGREE-GRANTING MARRIAGE AND FAMILY THERAPY TRAINING PROGRAMS

This article reports the results of a mailed survey of 1980, 1983, and 1986 graduates (n = 205) from degree-granting marriage and family therapy training programs accredited by the Commission on Accreditation for Marriage and Family Therapy Education. The graduates considered themselves (a) sufficiently to quite well prepared in marital/couple therapy, family therapy, and individual therapy with adults and (b) minimally to moderately well prepared in individual therapy with children and adolescents, individual diagnosis, and individual psychological assessment. The presenting problems for which graduates most strongly recommended increased emphasis in their MFT training program were alcoholism, other substance/drug abuse, incest/sexual abuse, and domestic violence.     

Most and Least Meaningful Learning Experiences in Marriage and Family Therapy Education

Marriage and family therapy educators increasingly emphasize training competencies. What we know less about is what makes family therapy education meaningful to marriage and family therapy (MFT) graduate students and what does not. In this study, through an Internet survey, we explored the most and least meaningful learning experiences of 68 MFT graduate students and recent graduates of Commission on Accreditation for Marriage and Family Therapy Education—accredited programs. We used thematic analysis to identify and illustrate resulting themes, which included the importance of experiential and personal components to learning, the professor‐student alliance, tying theory to practice, and the experiences of students with their clients, among others. We discuss the implications of these findings to support family therapy education and offer tentative suggestions for formative discussions both within and across programs. Video Abstract is found in the online version of the article .     

Becoming a Marriage, Family and Child Counselor: Notes from a Chicano

Becoming a licensed Marriage, Family and Child Counselor (MFCC) in California is presented from a Chicano's perspective based on the author's own training. He reports that 1) there is a need for Chicanos trained extensively in marriage and family counseling to serve the large Mexican American population; 2) MFCC is a growing profession yet few Chicanos are entering it; 3) few Chicano professionals are involved in the training, teaching and supervision of marriage and family counselors; and 4) the state licensing board and the two marriage and family counselors' associations do not identify minority counselors nor those who provide Spanish speaking services .     

Incorporating sexual orientation into MFT training programs: infusion and inclusion

Many authors have questioned the preparedness of family therapists to deal with sexual minority clients. Even though the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) has called for the integration of sexual orientation into the curriculum of marriage and family therapy training programs, the subject continues to be marginalized. The purpose of this article is to encourage trainers to examine their programs' curricula for evidence of heterosexist bias and introduce ways that they might integrate issues related to same-sex affectional and sexual orientations into their programs via the classroom and the clinic.     

Training family therapists to work with children and families: a modified Delphi study

This study examined child inclusion issues and training marriage and family therapists (MFTs) to treat children. This modified Delphi study utilized a panel of experts, and gathered data through questionnaires and qualitative interviews. Panelists believe children should participate in family therapy sessions for both child and adult problems, except when parents are discussing sex or sensitive issues. Child-focused courses should emphasize developmental issues, engaging techniques, theoretical issues, play therapy theory, MFT treatment for child disorders, and specific child/family problems. Panelists suggest numerous child-focused references, but reached consensus for only one. Key therapist attributes and skills were identified. Deductive and inductive training methods and the role of supervision were highlighted. Although therapist playfulness and creativity were emphasized, few play techniques were included in the final profile.     

Intervening in Family Systems with Observer Messages*

This article presents an approach to family therapy in which a group of observers becomes part of a therapeutic team by introducing strategic messages into the sessions. The observers, who operate from behind a two-way mirror, are thus able to effect change in both the family system and the therapeutic system consisting of family and therapist. Messages are described in terms of five components: function, target, timing, content, and delivery. Some guidelines for effective team functioning are given and three examples illustrate the approach. Finally, implications for training are discussed.     

COMMON FACTORS ACROSS THEORIES OF MARRIAGE AND FAMILY THERAPY: A MODIFIED DELPHI STUDY

The Delphi methodology was used to explore common factors across theories of marriage and family therapy (MFT). Leading clinicians and researchers from the American Family Therapy Academy and select faculty members from MFT training programs accredited by the Commission on Accreditation for Marriage and Family Therapy Education were asked to achieve consensus regarding common factors. Respondents were asked to report on commonalities across the various MFT theories, as well as what they personally considered to be the core ingredients of change. A final profile of items was created from the responses. Qualitative interviews were conducted with selected panelists to clarify discrepancies as well as to add meaning to the data. Implications for the training and practice of MFTs as well as direction for future research are discussed.     

A Preliminary Investigation of a Telephone Administration of the Quality of Marriage Index

Follow‐up data collection presents many challenges for longitudinal research. Validating paper‐and‐pencil assessments for use via telephone may alleviate these issues. This study evaluates psychometric properties of the Quality of Marriage Index (QMI; Norton, 1983, Journal of Marriage and the Family, 45, 141) when administered by telephone and compares scores with the paper‐and‐pencil version. Participants included women with major depressive disorder and dyadic discord and their male spouses (n = 24 couples). Results suggest excellent scale reliability for the verbal QMI. However, a significant mean difference was found: participants scored on average 3 points higher on the telephone‐administered QMI than on the written QMI. Recommendations for future research and clinical implications are discussed.     

Preparing marriage and family therapy students to become employee assistance professionals*

While the number of Employee Assistance Programs (EAPs) has grown tremendously, opportunities for marriage and family therapists in EAP settings have not been adequately described. This paper addresses issues pertinent to training Marriage and Family Therapy (MFT) students to develop the skills needed to become EAP professionals. Qualifications for becoming an EAP professional are described and suggestions are made as to how these skills may be taught within the framework of an academically based MFT training program.     

Group Training in Family Therapy—The Student's Perspective*

This paper examines the experience of learning family therapy in a group training model from the trainees perspective. Five significant aspects of this learning experience are discussed. Supervision of family therapy and training within a group setting, multiple supervision, training with a peer co-therapist, using audio-visual feedback in group supervision of family therapy, and the impact on the trainee of doing family therapy for the first time. The trainees found that their learning experience was enhanced by this training approach. (Editors Note: The program referred to in this paper was described in Stier, Serena & Goldenberg, Irene, Training Issues in Family Therapy, Journal of Marriage and Family Counseling, 1975, 1, 63–68.     

BOOK REVIEWS

Book reviewed in this article:
Commitee on the Family of the Group for the Advancement of Psychiatry. The family, the patient, and the psychiatric hospital: Toward a new model .
Segal, Lynn. The dream of reality: Heinz von Foerster's constructivism .
Combrinck-Graham, Lee (Vol. Ed.). Treating young children in family therapy
Hafner, R. Julian. Marriage and mental illness: A sex-roles perspective .
Schultz, Stephen J. Family systems therapy: An integration .
Nerin, William F. Family reconstruction: Long day's journey into light .
Wallas, Lee. Stories for the third ear .
Beavers, W. Robert. Successful marriage: A family systems approach to couples therapy .
Bornstein, Philip H. & Bornstein, Marcy T. Marital therapy: A behavioral-communications approach .
Slipp, Samuel. Object relations: A dynamic bridge between individual and family treatment .