GROWTH BEHIND THE MIRROR:, THE FAMILY THERAPY CONSORTIUM'S GROUP PROCESS

An earlier paper (Wendorf, 1984) presented the pragmatic aspects and theoretical model of The Family Therapy Consortium, a group set up to provide supervision and continuing education in family therapy. The emphasis was on the development of each individual therapist's competency, the isomorphic relationship between the supervisor, group, therapist, and family levels of the therapeutic system, and the legitimacy of the term "peer supervision." Beginning under the leadership of an expert supervisor hired from outside the group, the Family Therapy Consortium has developed into a peer supervision group with a "floating," rather than fixed, supervisory hierarchy. The present paper charts this development and explores the peer supervision process as it currently works in the Consortium. The focus is on the growth of the individual behind the mirror as therapist, person, leader and group member, and on the growth of the group as a "mature sibling subsystem" no longer in need of outside supervision. Individual and group development are seen as complementary aspects of the same growth process.     

SUPERVISION IN FAMILY THERAPY: A DECADE RESTUDY*1

This paper reports on a 10-year replication of Everett's (1980) survey of Approved Supervisors of the American Association for Marriage and Family Therapy (AAMFT). Significant differences were found between today's supervisors and supervision, including an increase in female supervisors, a shift toward a systemic theoretical orientation, greater concentration of supervisors in formal training settings, a great increase in the use of video recordings, a decline in the popularity of personal psychotherapy as part of training, a greater inclination of supervisors to identify themselves as Marital and Family Therapists (MFTs) regardless of original education, and others. The Approved Supervisor system appears to be fulfilling AAMFT organizational goals; other results will be reported elsewhere.     

EXAMINING THE MULTIFACETED NOTION OF ISOMORPHISM IN MARRIAGE AND FAMILY THERAPY SUPERVISION: A QUEST FOR CONCEPTUAL CLARITY

The notion of isomorphism has been recommended as a comceptual framework to guide the practice of marrige and family therapy (MFT) supervision. The term is frequently cited in the MFT training literature but is often used in different ways. A panel of MFT supervirors rated the impotance and relevance to both therapy and supervision of a large pool of variables. The majority of variables were found to be a equally relevant or isomorphic to the domains of MFT and MFT supervisoin. A qualitative interview with a small subset of the panelists suggested that the concept, to varying degrees, has influenced their work as supervisors. The implications of the results for theory development, research, and supervisory practices are discussed.     

BEYOND THE CLINIC: IN-HOME THERAPY WITH HEAD START FAMILIES

Social workers and case managers have provided in-home services to families for some time. The field of Marriage and Family Therapy, however, has begun to do in-home work only recently. This paper describes the experiences of MFT interns who worked with families in their homes. Two university graduate MFT training programs conceptualized and practiced in-home therapy with families who had at least one child enrolled in the local Head Start program. This collaborative effort was part of the AAMFT-Head Start Training Partnership Project that had the goal of funding projects that demonstrated successful partnerships between MFT and Head Start. Six interns worked with 27 Head Start families in their homes. A model of the interns' transition from clinic-based to home-based therapy is discussed and applied to working with Head Start families. The framework of in-home therapy is expanded to conceptualizing larger systems and community-based interventions, and recommendations for family therapists in private practice and agency settings are made.     

ARE TRUSTWORTHINESS AND FAIRNESS ENOUGH? CONTEXTUAL FAMILY THERAPY AND THE GOOD FAMILY

The moral dimension of family therapy theory and practice has received increasing attention in recent years. Boszormenyi-Nagy was among the first to see that family therapy and moral questions are inseparable. His focus on relational ethics has helped us to reappropriate individual responsibility and accountability within a systemic context. Although contextual therapy has clearly enriched the field, we argue that its emphasis on trustworthiness and fairness provides a limited view of the good in family life and leads to three related problems. First, Boszormenyi-Nagy offers a compelling ethical vision of the family and then denies that he has done so, which undermines some of his key moral claims. Second, because fairness is defined subjectively, contextual therapy may not have the resources to deal with legitimate differences in family ideals. Third, the reliance on self-interest as the primary motive for trustworthy relating appears to be self-defeating. We offer a hermeneutic perspective that takes a broader approach to the good. It places greater emphasis on the social and historical context, deals squarely with different understandings of the good in family life, and recommends an approach to resolving these differences.     

THE NATIONAL MARITAL AND FAMILY THERAPY EXAMINATION PROGRAM

Examinations constitute one of the principal methods by which professions assess minimal competence in aspiring practitioners. The Examination in Marital and Family Therapy is used by most states which regulate the profession. This article provides the rationale for the examination program, describes its development and maintenance, and presents the knowledge base it samples. Administrative policies and procedures are also discussed as an aid to prospective licensure and certification candidates.     

FAMILY RESEARCH AND FAMILY THERAPY: A REUNION?*

This decade is witnessing the re-establishment of research in family therapy as an intrinsic component of the field. It is instructive to recall that family therapy actually had its most significant beginnings in the context of family research in the 1950s and that, three decades ago, family therapy and family research were fundamentally fused. In this paper, several of the most important forms of recent and current family research and family therapy research that are important to clinicians are identified, and it is suggested that this reunion of clinical and research interests signifies a new phase in the growth of the family therapy field.     

INFLUENCE OF THERAPIST SKILLS ON CLIENT PERCEPTIONS OF MARRIAGE AND FAMILY THERAPY OUTCOME: IMPLICATIONS FOR SUPERVISION

Clients seen in two marriage and family therapy training clinics were surveyed regarding treatment outcome. They rated their therapist's skill level on several therapist variables including "experience,""confident,""concerned," how well the treatment used seemed to "fit" their view of the problem and if the therapist seemed to "know how to deal" with their concerns. The variable of "fit" of treatment accounted for 35% of the variance in the client's perception of treatment outcome. "Concerned,""fit," and "knew how to deal" accounted for 36% of the variance in overall rating of the therapist. Suggestions for using these results in supervision of beginning therapists are given.     

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.     

EMPIRICAL VALUES AND THE CULTURE OF FAMILY THERAPY*

The research-clinical practice connection is weak in family therapy. Some have argued, in an inordinate ideological and political tone, that traditional research methods are inappropriate for family therapy. This position mischaracterizes modern day clinical researchers and research. In presenting 10 key dimensions of the research-clinical practice issue in family therapy, this paper addresses some of these misrepresentations. If research and practice are to interact more productively, a major commitment, the scope and implications of which have not yet been realized, will need to be made. Actualizing the research-practice link is a training problem and a fundamental professional issue. Progress in this realm would change the particulars of clinical practice as we know it. These processes will involve nothing less than remaking the culture of family therapy.     

AGAINST THE GRAIN: DECENTERING FAMILY THERAPY

This paper is an interpretive polemic. It has two aims: (a) to clarify the concept of "system" as it is employed in family therapy, and, by doing so, to undermine and call into question the practice that follows from, or is contained within, a systemic perspective,¹ (b) it will offer several suggestions towards the development of an alternative perspective which preserves the idea of system in a social network/diachronic framework. With respect to the first aim, an argument will be made that there are severe and insurmountable problems in attempting to maintain a systemic perspective, that the methodology of analysis is fatally flawed, and that the results of analysis imprisons the therapist in a framework, which though extremely powerful interpersonally, must be rejected as overly authoritarian and overly restrictive in the range of perceptions of social situations allowed. A position will be adopted advocating a move of decentering family therapy to a more peripheral space within a social network perspective. What immediately follows is a redefinition and repunctuation of what can only be considered as a highly problematic paradigm.     

MUSLIM FAMILIES AND FAMILY THERAPY

Muslim immigrant families living in the United States may well come to be attentiaon of mental health professionals. This article examines the applicability of the Anglo-American models of family therapy to Muslim immigrant families. The most significant difference in value systems between the Muslim and Anglo-American cultures is Muslim families' preference for greater connectedness, a less flexible and more hierarchial family structure, and an implicit communication style.
Systemic thinking, which deals with the pattern of relationships, is valid for all families regardless of cultural difference. However, the preferred directions of change for Muslim families need to be integrated into the assessment and goals for family therapy.     

FAMILY THERAPY AND IDEOLOGY*

Contemporary family therapy is examined in terms of its ideological content. The adoption of cybernetics and biological systems theory to the family has led to the erroneous belief that familytherapy is exclusively concerned with natural systems, is process oriented, content relative, and above ideology. This article argues that the family and the enterprise of family therapy are social systems and under the influence of the ideology particular to a given society. The strategic family therapy treatment of a family with a drug-addicted member serves as an example to clarify the ideological themes of contemporary family therapy. These themes are: (a) family reductionism and blaming; (b) the relabeling of personal injustice into communicational terminology; (c) the assumption that the nuclear family is optimal; (d) the conceptualization of therapy as a commodity; and (e) the model of human relatedness and intimacy supported by family therapy.     

THE CORRELATES OF HEALTHY FAMILY FUNCTIONING: THE ROLE OF CONSENSUS AND CONFLICT IN THE PRACTICE OF FAMILY THERAPY

The present study explores the relative importance of individual, dyadic and triadic measures of intrafamily functioning in predicting family health. Using self-report data from 78 families, it was found that dyadic measures pertaining to marital quality and parent-child relationships were more powerful predictors than either individual measures of emotional maturity, anxiety, self-esteem or locus of control, or triadic measures of the families' hierarchical alignments. The study also found that while mothers' and fathers' assessments of intrafamily functioning were more important than the childrens' (except for the childrens' view of parent-child relationships), the parents differed in that marital quality was more important to the mothers' evaluations of the family unit while parent-child relationships were more important to the fathers'. Compositely, the findings suggest that family health is a complex multidimensional phenomenon, and that change in a particular dimension of family life may not necessarily be greeted with consensual validation or repudiation by all family members.     

THE MARITAL AND FAMILY THERAPY EXAMINATION PROGRAM: A SURVEY OF PARTICIPANTS

Participants in the Examination in Marital and Family Therapy between November 1994 and May 1996 were surveyed to ascertain who took the examination, how they prepared for it, whether they thought that it was fair, and how these variables related to scores. Two-thirds of the respondents were female. Most were taking the examination for the first time, were relatively young, were Caucasian, and spoke English as their primary language. They primarily practiced marital and family therapy and had completed master's level university programs in marital and family therapy, counseling, and psychology. Most were sitting for the examination relatively soon after completing their training in marital and family therapy. Individual study was the preparation method of choice for half of the sample. Demographic variables had a modest but ambiguous effect on test score. Educational background had none. However, a relatively short latency between graduation and examination was related to a higher score, as was the use of multiple preparation procedures. With regard to fairness, the participants largely agreed that the examination was moderately difficult, but that the problems were realistic and they had enough time to complete the test.     

THE EFFICACY AND EFFECTIVENESS OF MARITAL AND FAMILY THERAPY: A PERSPECTIVE FROM META-ANALYSIS

This article reviews the major findings from a multiproject meta-analysis of the effects of marital and family therapy (MFT). Across 163 randomized trials, MFT demonstrates moderate, statistically significant, and often clinically significant effects. No orientation is yet demonstrably superior to any other, nor is MFT superior to individual therapy. Cost effectiveness information is scant in these 163 studies, but supportive. Randomized experiments yield very different answers from nonrandomized experimental studies of the effects of MFT, calling into question whether we should mix the two in reviews. We have also found several new differences in the ways that marital therapy (MT) and family therapy (FT) studies are conducted, making them harder to compare. Finally, important questions still exist about whether any psychotherapy, including MFT, yet has sufficient information about how well research generalizes to everyday clinical practice.