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.     

ETHICAL DILEMMAS IN FAMILY THERAPY

A review of the literature in the area of ethical dilemmas facing family therapists revealed that there were a number of issues facing family therapists which are not included in the Principles for Family Therapists (1984) of the American Association for Marriage and Family Therapy. Seventy-five family therapists from across the nation responded to a questionnaire which asked what ethical dilemmas they face and how helpful the ethical guidelines are with these dilemmas. Results indicate that family therapists are encountering dilemmas which are not included in the Principles, significantly more often than those that are included. The ethical principles were found to be helpful for those ethical dilemmas attended to by the Principles.     

Hospitality in Family Therapy Practice: A Further Engagement with Jacques Derrida

Derrida's concept of hospitality has been proposed by some authors working from a collaborative perspective as an interesting tool to reflect on the therapeutic relationship as an ethical relationship in which the therapist develops a welcoming openness to the client. In this paper, we engage with this recent emphasis on the therapist's ethical position of welcoming the client's otherness and turn to Jacques Derrida's original texts with the aim of developing an in‐depth understanding of what exactly is at stake in this therapeutic position of hospitality. This reading evolves into an understanding of how Derrida's notion of hospitality invites clinicians to identify how the therapeutic position intricately intertwines healing and violence. The concept of hospitality calls on therapists to accept the complexity of therapeutic responsibility as a form of supportive presence that necessarily and simultaneously involves the violence of appropriation and power difference.     

Stages of Change Theory in Family Therapy for Sibling Sexual Assault

Family therapy understands the benefits of therapeutically supported dialogue amongst family members when there are challenging themes and topics that need to be discussed. This paper is an attempt to explore ways that family therapists can work with family members who are thrust into therapy rather than ‘voluntarily’ signing up for it. It applies ideas from the drug and alcohol field such as Stages of Change theory and Motivational Interviewing. The paper explores how these ideas and approaches might help family therapists to formulate a concept of resistance and to make helpful dialogue more likely. They are applied to families experiencing sibling sexual assault, where they become involved with a legal response that necessitates a therapeutic intervention.     

Reclaiming the Mother-daughter Relationship after Sexual Abuse

This paper seeks to provide direction to therapists working with mothers and daughters after a disclosure of father-daughter sexual abuse. The importance of the mother's belief in and support for the child's recovery is highlighted, as are some of the cultural assumptions about mothers and daughters which negatively impact on the relationship. Despite paying lip service to offender responsibility, there continues to be a culture of mother blaming in the child sexual abuse and family therapy literature on incest. Current research findings challenge some of the prevalent myths about mothers’ responses to their children's disclosures. Few clinical sources have addressed this issue, and therapists who reject the mother blaming literature are therefore left with little guidance as to how to work more effectively with mothers and daughters. Consequently they may unwittingly further undermine the relationship. Work with mothers and daughters as they recover from intrafamilial sexual abuse is discussed, and key therapeutic themes and guidelines for practice presented. We explore the significant theme of the rebuilding of trust between mothers and daughters and facilitate a process whereby the woman is able to bear witness to and acknowledge the trauma experienced by her daughter.     

Clients as Teachers: Reciprocal Influences in Therapy Relationships

The value of the continuing education industry for therapists is questioned, as is the usefulness of therapy books and journal articles, as a means of engaging therapists in life‐long learning. Instead, it is argued that our clients are our best teachers and that therapists learn most effectively from their clients. Drawing on research studies with prominent theoreticians and therapists, and on case studies from clinical work, a number of important themes are identified as ways in which therapists are influenced by their therapeutic encounters with their clients. The themes explored in this article include: (1) intimacy and high emotional arousal with clients as we witness profound change; (2) being challenged by clients; and (3) allowing for boundary ‘crossings’ in order to develop more flexible ways of working with clients. The implications for professional development are discussed.     

Marital Therapy — The Therapist

This article applies systems principles to an appreciation of the couple therapist. It offers an overview of the changing role of therapists and addresses the philosophical debate of the therapist as scientist or artist. It demonstrates how the worldviews, beliefs and values of clients and therapists are influenced by, and in turn influence, the therapeutic and wider social contexts to which they belong. The question of how a therapist simultaneously maintains personal values and neutrality is considered. The implications of examining the therapist's role from a systems framework are discussed. It is concluded that research needs to adopt a more holistic methodology and that impasses need to be analysed by examining beliefs at different levels within the systems involved. Finally, a personal account of the effect that therapy has on the therapist is offered.     

Group therapists' countertransference reactions to multiple deaths from aids

Group therapists for those with HIV Related Diseases are becoming the “professional” survivors of this world-wide epidemic. From their experiences we may learn a great deal more about the effects of multiple deaths on mental health care professionals. As therapists they are constantly eliciting and listening to the fears, hopes, agonies and terrors of those with this disease. They become the bereaved. Witnesses to the deaths of many of their group members, they struggle with a wide range of emotional responses while at the same time assisting surviving group members in their struggle to live with these deaths. Mourning reactions and countertransference phenomena are in abundance as these therapists grapple with these group processes. This article identifies and examines these therapists' responses by focusing on clinical illustrations drawn from their bi-weekly supervision sessions.     

Therapists’ Assessment and Treatment of Internet Infidelity Cases

In this study, we investigated through an Internet survey of 508 practicing marriage and family therapists which treatment decisions varied by gender of the client and background variables of therapists. The subjects responded to several typical Internet infidelity scenarios. We varied the gender of the person initiating the infidelity for half of one sample. We also asked the family therapy participants to respond to how they might assess and treat each presenting problem. They also evaluated problem severity, prognosis of the case, number of sessions necessary for treatment, and the extent to which a therapist would focus individually or relationally. Results indicate that there were differences in how therapists assessed and treated clients based on client gender, therapists’ age, therapists’ gender, how religious therapists reported they were, and the extent of therapists’ personal experience with infidelity.     

Using the Therapist's Inner Conversation in Teamwork with Novice Therapists

Peter Rober's work (2005a) on the therapist’s inner conversation (TIC) has been a significant contribution to understanding the therapist's 'here and now' experience that focuses on the emergence of different voices responding to what is said in the therapy session. Frediani and Rober (2016) conducted an investigation into the experience and TIC of novice therapists concerning emotions aroused and how they deal with them during family therapy. Their research prompted us to ask how this methodology could work with recent graduates and those in the last year of their undergraduate training. This was addressed in the adolescent psychotherapy team that is part of the Equipo de Trabajo y Asesoría Sistémica (Systemic Counselling and Teamwork) (eQtasis) of the Psychology Department of the University of Chile. An important characteristic has been developing an ethics for clinical practice and generating a collaborative reflexive approach as a central aspect of the clinical training. The paper aims to promote the legitimacy of the experience of novice therapists who despite limited professional experience have many stories that connect with what is said in therapy.     

Guiding the Acquisition of Therapist Ally Identity

Abstract

This paper suggests the appropriateness of adopting an ally identity for therapists who work with gay, lesbian, bisexual, and transgender (GLBT) stepfamilies. Using results from in-depth interviews, we demonstrate how research can assist those who wish to acquire knowledge regarding this marginalized group. Such scholarship can be helpful when therapists are acting as allies within therapeutic encounters, in interactions with colleagues, and in public discourse.     

Navigating Dual Relationships in Rural Communities

The literature examining dual relationships in rural communities is limited, and existing ethical guidelines lack guidelines about how to navigate these complex relationships. This study uses grounded theory to explore rural therapists' perceptions of dual relationship issues, the perceived impact of minority and/or religious affiliation on the likelihood of dual relationships, and the ways rural therapists handle inevitable dual relationship situations. All of the therapists who participated in the study practiced in small communities and encountered dual relationship situations with regularity. The overarching theme that emerged from the data was that of using professional judgment in engaging in the relationship, despite the fact that impairment of professional judgment is the main objection to dual relationships. This overall theme contained three areas where participants felt they most needed to use their judgment: the level of benefit or detriment to the client, the context, and the nature of the dual relationship. Surprisingly, supervision and/or consultation were not mentioned by the participants as strategies for handling dual relationships. The results of this study are compared with established ethical decision‐making models, and implications for the ethical guidelines and appropriate ethical training are suggested.     

Producing Family Problems: Organization and Uses of the Family Perspective and Rhetoric in Family Therapy

This article applies and extends literature on the micropolitics of trouble and family rhetoric perspectives by analyzing how therapists in a family therapy agency practicing the brief model used family rhetoric in defining and responding to client problems. Family rhetoric is the use of images of family (the family perspective) to (1) persuade others to one's preferred orientation to issues of mutual concern and (2) attribute identities to one's self and others. The article focuses on how the therapists rhetorically enacted and applied the family perspective in interactions with colleagues and clients to define and remedy client troubles. In general, troubles were defined and remedied by treating them as products of clients' family systems, defined as enduring roles, relationships, and perspectives. The therapists sought to remedy client troubles by initiating changes assessed as appropriate for their troubles and family systems. The article concludes by considering some of the implications of the findings and analysis for the sociological study of human service work.     

Reconstructing a Sense of Relational Agency in Family Therapy

The concept of agency is relevant in family therapy. As family therapists we approach each family member as a full agent, which means that what each person thinks and feels, makes sense, and that each person contributes in a significant way to the construction of a relationship. A person's sense of relational agency is constructed in relationships through processes of relational influence. Thus, agency is a relational construct and is dependent on bidirectional transactions in a relationship. A person's sense of relational agency refers to the belief a person has about being able to influence another person, that this influence is significant for the other, makes a difference for the other, and contributes to the construction of the relationship. Many family members who enter therapy have lost their sense of relational agency. In this paper we discuss ideas how to reconstruct family members’ sense of relational agency in therapeutic practice.     

Adoptees' and Birth Parents' Therapeutic Experiences Related to Adoption

ABSTRACT

This study examined adoptees' and birth parents' experiences in therapy, including the perceived level of helpfulness and preparation by therapists relating to adoption issues as a function of the year these experiences occurred. Participants consisted of 152 adoptees and 66 birth parents, with the majority (78%) of the respondents being female. Overall, adoption inquiry, addressing adoption issues, helpfulness, and preparedness by therapists increased from 1965 though the 1990s. Therapists who inquired about adoption (54%) or addressed adoption (72%) were perceived as being significantly more prepared and helpful compared to those therapists who did not inquire about or address adoption issues.     

Working with ‘The Welfare’ in Child-at-Risk Cases

This paper, the second in a series concerned with family therapy in cases involving children at risk of abuse, focuses on how to establish a workable relationship between therapists and child protection professionals and child protection professionals and parents. After overviewing the difficulties faced by therapists in working with ‘the Welfare', we propose guidelines to overcoming common obstacles to successful case management, concluding that therapy often fails when therapists attempt to deal with intrafamilial issues long before external relationships are resolved.     

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.     

AAMFT Master Series tapes: an analysis of the inclusion of feminist principles into family therapy practice

Content analysis of 23 American Association for Marriage and Family Therapy Master Series tapes was used to determine how well feminist behaviors have been incorporated into "ideal" family therapy practice. Feminist behaviors were infrequent, being evident in fewer than 3% of time blocks in event sampling and 10 of 39 feminist behaviors of the Feminist Family Therapist Behavior Checklist. These eminent therapists most often dealt with empowerment of male clients and management of power differentials in the therapeutic relationship in a relatively feminist manner, but they tended to hold women responsible for family issues, endorsed traditional rather than egalitarian relationships, and overlooked how the social context affects families. Several of the therapists were blatantly sexist in their treatment of female clients, communicating disrespect of and pathologizing them. The few tapes portraying effective incorporation of feminist principles in family therapy indicate that a handful of behaviors are key to this approach.