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.     

“Mental Health” Power and Its Effects: A Commentary on Battling Against Inter‐Faith Relations in Israel

Hakak ( 2016 ) provides an opportunity to examine how mental health and therapy systems in the United States operate to maintain current social and political structures. This commentary suggests that practitioners, including family therapists, participate in and support practices that do not serve the interests of marginalized social groups, despite our best intentions. Discourse theory offers a lens through which such practices become visible and thus open to revision.     

Towards Developing a Family Therapy for Melanesia

Our principal objective is to call the attention, primarily of Australian‐New Zealand family therapists, to the relevance and the urgency of developing, promoting and providing family and/or couple therapy in the Melanesian context. We emphasise the need to take into consideration Melanesian worldviews, values and social systems. We discuss a traditional ‘mediation‐reconciliation ritual’ model of solving family or couple conflicts, and also point to some of the immediate situations in which a family therapist could intervene. A few recommendations are also made for how the academic context could be utilised to develop Melanesian family therapy.     

Personal Reflections of A Family Therapist*

In this informal paper I discuss my personal evolution as a family therapist, developments in the field, the politics of a systems approach in conventional settings, resistances to family and marital therapy by other professionals, some still puzzling aspects of family therapy, whether family or marital therapy works and what do we mean by working, directions my own work has taken, some comments about the nature of family life, the satisfactions and frustrations and stresses of being a family therapist, some hidden agendas of family therapy practices, how one's own personal family relationships affect and are affected by this kind of work, the casualties among family and marital therapists, and, finally, whether family therapists should have family therapy for themselves and their own families.     

Case‐Based Research in Family Therapy

Traditionally, case‐based research has not been considered as scientific by many in the field due to the lack of controlled conditions and objectivity. However, case‐study material may be more effective than once believed in educating family therapists. Future implications of the role of case studies in family therapy research are considered, including the manner in which case studies might be designed to be more rigorous so that they can serve as the basis for drawing causal inferences in clinical cases, and at the same time, provide family therapists with useful information to improve their skills. A discussion section highlights the future direction of case‐based research in the family therapy literature and how it may be used as an effective learning tool.     

The Divide Between “Evidenced‐Based” Approaches and Practitioners of Traditional Theories of Family Therapy

Evidenced‐based approaches continue to grow in the field of family therapy. However, practicing family therapists do not always embrace these approaches. In this article, we explore factors contributing to practitioners' concerns with evidence‐based treatments and suggest a broader, more clinically palatable view of evidenced‐based treatment. We also suggest how family therapy researchers, practitioners, and educators might begin to close the researcher–clinician divide in the best interest of all concerned.     

Surviving in Psychiatry as a Systemic Therapist

Although family therapy was born to deal with problems posed by severe mental disorders, systemic therapists today tend to drift away from the field of psychiatry The author refers to his own experience in psychiatry to argue in favour of the presence of the systemic model within the field: systemic understanding might be precious to counterbalance the tendency toward too easy a reliance on bio‐psychiatry and pharmacology. In turn, keeping close to psychiatry and to its problems can be useful to systemic therapists, by involving them in social and epistemological queries that are otherwise extraneous to professionals mainly devoted to private practice.     

Global Mental Health in Action: Reducing Disparities One Community at a Time

There are great disparities in mental health care around the world. Traditional approaches to mental health care have not been found to be transferrable to many parts of the world and are inadequate to address these disparities. Unconventional approaches are needed that match the traditions of care‐seeking and care‐giving within the communities where they are delivered. The authors review the global mental health literature and discuss how marriage and family therapists are in a particularly good position to have worldwide impact on mental health disparities. Five principles of global mental health are presented along with an example of how these principles are applied through the Reducing Mental Health Disparities One Community at a Time (RD1CT) model.     

Integrating gender on multiple levels: a conceptual model for teaching gender issues in family therapy

As the field of family therapy has evolved, there has been growing recognition as to the importance of gender in family therapy. To prepare the next generation of family therapists adequately, it is important that they recognize the many and complex ways in which gender permeates their work. In this article we present an integrative model to help educators teach family therapists about gender issues. The model examines how gender influences clinical work on multiple levels, including contextual levels such as society and the marriage and family therapy field. The model also acknowledges how gender can influence individuals, including clients, therapists, and supervisors. Finally, the model attempts to capture the complexity of how gender can impact the relational dynamics between two or more individuals.     

THE MARGINALIZATION OF FAMILY THERAPY: A HISTORICAL AND CONTINUING PROBLEM

Family therapy, and marital and family problems, are mariginalized in the larger fields of mental and physical health care, which is a misfortune both for family therapy and for other mental health professions. The early family therapists, who had multidisciplinary backgrounds, attempted toestablish a new, nondisciplinary paradigm and also tried to expand the perspectives of the more traditional mental health disciplines. More recently, family therapists have exerted greater effortsto establish marriage and family therapy as a differentiated, autonomous profession. These alternatives each involve dilemmas for the family therapy field. The positive side of becoming a distinctive profession is greater internal strength and clear professional identy; the downside is the threat of increased marginalization in rlation to the other professions, a tendency toward intellectual isolation, and hence restricted opportunities for invigorating new challenges. Family therapy now needs to develop new modes of interchange, collaboration, and selective integration with otherhealth care professions. Such interchange will be beneficial both to family therapy and to other professions.     

Preserving Family Therapy's Legacy

Originating as a plenary address, this article reviews the enduring contribution of family therapy, and asks how it might best be preserved into the future, given that family therapy itself is no longer seen as ‘newsworthy’. The author makes three recommendations: that all future social workers be trained to conduct a three‐session structured family assessment; that all future family therapists be required to participate in a Yalom‐type group therapy experience; and that one member of every child mental health and child protection team be trained to convene and chair interagency case conferences capable of building trust and working towards open communication. A rationale for the three recommendations is provided, in terms of key principles common to family and group work.     

The Marriage and Family Therapy Practice Research Network (MFT‐PRN): Creating a More Perfect Union Between Practice and Research

This article describes the Marriage and Family Therapy Practice Research Network (MFT‐PRN). The MFT‐PRN is designed to build a professional community based on practice‐informed research and research‐informed practice, increase the diversity of participants in MFT research, and unify researchers and clinicians. Clinics choose measures from a list that best represent their clinic needs. Clients' outcomes are assessed regularly, and therapists receive immediate graphical feedback on how clients are progressing or digressing. Data are pooled to create a large and diverse database, while improving client outcomes. We will discuss advantages of the MFT‐PRN for researchers, therapists, clients, and agencies, and provide one model that we hope will inform other collaborative clinical‐research models in the field of marriage and family therapy. Video Abstract is found in the online version of the article .     

Engaging suffering: towards a mindful re-visioning of family therapy practice

The myth of problem-free living is easily identifiable in Western culture through its childhood fairy tales and modern love stories. Even if inadvertently, the field of mental health perpetuates this myth with the very concept of "mental health," which implies a state without suffering. Using mindfulness, Buddhists assume an alternative stance towards suffering: rather than eliminate it, they compassionately engage it. This article explores the potentials of mindfulness as an alternative approach to suffering within the context of marriage and family therapy. Family therapists can integrate mindfulness principles into their work to help clients shift how they relate to the unique forms of suffering that one encounters in intimate relationships, such as abuse, divorce, rejection, and loss.     

Dsm-iii-R and the family therapist: ethical considerations

DSM-III-R has gained popularity in many segments of the mental health field. Family therapists have generally not found its approach to assessing problems to be helpful in the planning of therapy, yet, are often forced to use it due to the requirements of third-party payers. This raises several ethical and practical concerns, e.g., the incompatibility of orientations between DSM-III-R and family therapy, the stigma associated with diagnosing, being asked to misrepresent diagnoses to third-party payers, and the competency of some family therapists to make DSM-III-R diagnoses. Short- and long-term strategies to deal with these ethical dilemmas are also presented.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

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.     

Integrative Systemic Therapy: Lessons on Collaboration and Training for the 21st Century

The field of couple, marital, and family therapy (CMFT) is at an important juncture of identity development and synthesis. Integrative Systemic Therapy (IST) is a problem‐centered metaframeworks approach that meets the growing needs of family therapists working with diverse and complex family systems and restores the field to its original focus on collaboration. This paper describes the process by which IST developed featuring anecdotes from live interviews with the founders. We briefly outline IST's theoretical pillars and the essential way IST practitioners deliver treatment including a blueprint for therapy. Finally, we propose that IST is a comprehensive, systemic guide uniquely beneficial to CMFT training and discuss our approach to integrating IST into our training of students in a COAMFTE accredited program.     

Treating mental health problems in primary care: Discrepancies between therapist expectations and clients’ attendance

ABSTRACT

Models of collaborative primary health care were introduced in Ontario in 2005 with the goal of providing comprehensive care, including that of mental health, to patients. While the success of this model of health care delivered through Family Health Teams (FHT) has been established, evidence based guidelines to guide mental health therapists regarding the number of sessions needed to treat common issues such as depression and anxiety seen within this model is lacking. The goal of this study was to gain a better understanding of how therapists conducted therapy, including type of intervention, under a physician determined eight session cap. Questionnaires completed by the therapists after the first session and again when therapy ended, a focus group and a chart review were conducted over an eight month period involving a total of 147 patients. Several key findings were identified including the unanticipated outcome of a discrepancy between how many sessions were initially thought to be required by the mental health therapist compared to how many sessions were determined helpful by the patient. Conversely, it was also identified that eight sessions was insufficient to treat more severe mental health issues such as trauma. Such results suggest that the treatment of mental health issues within Family Health remains a little understood and explored issue, with the authors suggesting better ways of negotiating session caps reflective of mental health issues addressed within this model of care.