Therapeutic Alliance and Retention in Brief Strategic Family Therapy: A Mixed‐Methods Study

We explored how the therapeutic alliance contributed to retention in Brief Strategic Family Therapy by analyzing videotapes of eight‐first sessions in which four therapists worked with one family that stayed in treatment and one family that dropped out. Although behavioral exchange patterns between clients and therapists did not differ by retention status, positive therapist alliance‐related behavior followed negative client alliance behavior somewhat more frequently in the retained cases. In the qualitative aspect of the study, four family therapy experts each viewed two randomly assigned sessions and commented on their quality without knowing the families’ retention status. A qualitative analysis of the audiotaped commentaries revealed 18 alliance‐related themes that were more characteristic of either the retained or the nonretained cases.     

THE THERAPEUTIC ALLIANCE IN HOME‐BASED FAMILY THERAPY: IS IT PREDICTIVE OF OUTCOME?

This study examined the association between the therapeutic alliance in family therapy and changes in symptom distress, interpersonal relationships, and family coping. The participants (N = 81) were members of low socioeconomic status families referred to a university clinic for in-home family therapy. Participants completed the Outcome Questionnaire, Family Crisis Oriented Personal Evaluation, and the Family Therapy Alliance questionnaires. Regression analyses revealed that the therapeutic alliance explained 19% of the variance in symptom distress changes for mother, 55% for fathers, and 39% for adolescents. The implications of these findings for practicing and researching family therapy are presented.     

Naivety and Family Therapy An Interview with John Carpenter

Family therapists have been naive about families, the pressures on them and the contexts of therapy. Therapists should be clear about their roles, sensitive to families' experience of therapy, and resist the temptation to mystify therapy. John Carpenter is Senior Lecturer in Mental Health, University of Kent, Canterbury, England and Co-Editor of Journal of Family Therapy. He was a guest keynote speaker at the 1991 Australian Family Therapy Conference in Brisbane, and this interview took place shortly afterwards in Melbourne.     

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 .     

The effects of family therapies for adolescent delinquency and substance abuse: a meta-analysis

This meta-analysis summarizes results from k = 24 studies comparing either Brief Strategic Family Therapy, Functional Family Therapy, Multidimensional Family Therapy, or Multisystemic Therapy to either treatment-as-usual, an alternative therapy, or a control group in the treatment of adolescent substance abuse and delinquency. Additionally, the authors reviewed and applied three advanced meta-analysis methods including influence analysis, multivariate meta-analysis, and publication bias analyses. The results suggested that as a group the four family therapies had statistically significant, but modest effects as compared to treatment-as-usual (d = 0.21; k = 11) and as compared to alternative therapies (d = 0.26; k = 11). The effect of family therapy compared to control was larger (d = 0.70; k = 4) but was not statistically significant probably because of low power. There was insufficient evidence to determine whether the various models differed in their effectiveness relative to each other. Influence analyses suggested that three studies had a large effect on aggregate effect sizes and heterogeneity statistics. Moderator and multivariate analyses were largely underpowered but will be useful as this literature grows.     

Family Therapy's Coming of Age: Less Haste,More Speed

Responding to the question implicit in the title of the 1985 National Family Therapy Conference ‘Coming of Age’, the author argues that Australian family therapy still has a number of issues to face before it can be said to be a mature and independent adult. The paper focuses on three issues — ideology in family therapy, theory for practice, and practice itself— and raises questions about the adequacy of Australian family therapy's theoretical maturity, suggesting that there is still too much reliance on the ‘new’ and on the ‘guru’ rather than on a solid building on therapeutic experience.     

Therapeutic change in Colombian families dealing with violence: therapists, clients, and referring systems in conversation

There is a gap in the Marriage and Family Therapy literature regarding clients', therapists', and family judges' theories of change in relational therapy for family violence. We conducted in-depth interviews with eleven court-referred families, their therapists, and two family judges in Bogota, Colombia. Interviews focused on their expectations of therapy outcomes, their understanding of change, and their evaluation of individual and relational therapy outcomes. We followed a grounded theory approach to data analysis. Analyses showed that therapists, family judges, and clients hold different expectations and theories regarding therapeutic change. Findings are discussed based on existing research on clients' and therapists' ideas about change. Implications for future research and practice are presented.     

Some Central Ideas in the “Just Therapy” Approach

This paper comprises significant extracts from a plenary address on Family Therapy and Social Justice given at the Second Australia and New Zealand Family Therapy Conference, Melbourne, July 1992. It contains the language of the three cultures at the Family Centre, Maori, Samoan and English. The two writers give their perspectives, those of Samoan womanhood and Pakeha (white) manhood, as they address the development of “Just Therapy”. The paper is an unusually subjective account of historical vignettes that proved to be crucial to the original developments of therapy at the Family Centre. Through speech making, poetry, prose and song, the paper outlines the critical cultural, gender and socio-economic contexts central to the “Just Therapy” approach. “Belonging”, “sacredness” and “liberation” have become the essential themes in this unique approach to an anti-colonial, anti-sexist and anti-class therapy. To put it more positively, this paper outlines a history of struggle with issues of equity that have consistently attempted to create a therapy inclusive of women's experience, dominated cultures and low-income families marginalised in the market.     

How Routine Patient‐Centered Monitoring Relates to Therapeutic Gains in Family Therapy: A Single‐Case Study

As routine outcome monitoring systems develop, questions emerge about how therapists incorporate feedback into their practice, and how this relates to therapeutic gains. A case of covert grief was monitored in each session with the Personal Questionnaire and the Helpful Aspects of Therapy instruments. At 4 months follow‐up, the Change Interview was administered. Individualized items facilitated access to the private views and needs of each member, which was useful for case formulation and ongoing personalization of the intervention. Qualitative feedback of treatment experiences helped therapists confirm the impacts of interventions, monitor therapeutic alliance, reformulate clinical hypothesis, and plan sessions. Therapists followed a critical triangulation process to decide the clinical meaning of feedback, according to his/her intervention model, expertise, and case‐specific context.     

Therapeutic Alliance; A View Constructed by a Family Therapy Team

Therapeutic Alliance is a construct which may have value for a family therapy team and influence its day to day practice. This paper discusses whether family therapeutic alliance can be observed, described and measured, and gives an account of the development of the Family Therapeutic Alliance Scale (FTAS) by a brief strategic family therapy team. Our focus is on the use of statistical technique as a means of clarifying the team's construct of therapeutic alliance, informing the team process without being the final arbiter in development of the scale. The second stage outlines the investigation of the usefulness of the construct with a wider group of family therapists. In individual psychotherapies measures of therapeutic alliance have been shown to predict outcome. Our early work suggests this is also true for family therapies and the FTAS may be a predictor for outcome in family work.     

Clinician identified barriers to clinical research

Involvement of front-line clinicians in clinical studies is crucial for quality marriage and family therapy effectiveness research. To identify common barriers to clinical research, 326 clinical members of the American Association for Marital and Family Therapy from three geographically diverse states were asked to describe their willingness to participate in a hypothetical research project. Therapists cited time constraints, outside limitations, client concerns, and a lack of understanding about and involvement in the study as major reasons for refusal to participate. Recommendations for building collaborative relationships between clinicians and researchers as well as future research are addressed.     

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.     

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.     

Mitigating Intergenerational Trauma Within the Parent‐Child Attachment

Nine‐year‐old Ben was said to hate women. His mother was terrified he'd ‘grow up a woman basher’. This paper describes the work done with Ben and his family at the Hobart Child and Adolescent Mental Health Service. We drew predominantly on three therapeutic modalities: Theraplay, Family Attachment Narrative Therapy and Dyadic Developmental Psychotherapy. Our work enabled Ben's mother to navigate the aftermath of her own trauma history in order to heal Ben's attachment trauma.     

Sources of Influence in the Family Therapy Field: Publication Trends in Three Major Journals1

The institutional sources of all articles published in the three major marriage and family therapy journals through 1978 are identified. The journals reviewed include: Family Process, Journal of Marital and Family Therapy, and the American Journal of Family Therapy. While no single center emerges as dominating the published family therapy literature, a small number of institutions clearly have exerted a profound impact on the literature of the field. Moreover, the absolute number of centers influencing the field is rapidly increasing, and these centers are becoming particularly influential in the newer journals in the field.     

The Family Outreach Model: Tools for Engaging and Working With Families in Distress

The purpose of this article is to present a family intervention model to family service providers that builds on previous research in areas of social support and family problem solving. The Family Outreach Model provides a set of strategies for engaging and working with families in five phases of family coping at different points in time in the family's life. The strategies reflect intentional choices by family service providers about both collaborative and directive styles of therapeutic alliance and highlights ways to determine which style best fits with what specific families want and need, depending on the manner of family coping that it is using. Implications for programs and public policy are presented.