Expanding the Horizons of Forgiveness Therapy: A Cross-Cultural Application with a Bedouin-Arab Woman

This paper highlights forgiveness therapy, a therapeutic approach that has received limited attention in the social work literature. This study represents a beginning exploration of its cross-cultural application. Theoretical and empirical perspectives on forgiveness and forgiveness promoting psychotherapy are provided, and Enright’s pioneering process model is delineated. A case study of the utilization of forgiveness therapy with an Israeli Bedouin-Arab woman who experienced a traumatic interpersonal injury within the polygamous family is presented. LaRoche and Maxie’s guidelines for conducting cross-cultural psychotherapy are utilized to examine important dynamics that emerge in the case study. These authors’ recommendations, which are consistent with a process-oriented conceptualization of culture, as well as intersectionality, appear potentially useful for informing the transcultural application of forgiveness therapy. Future research questions and directions related to the utilization of forgiveness promoting psychotherapy with diverse populations are considered.     

Designing useful evaluations: The stakeholder survey

The failure of program evaluations to provide policy decision-makers with useful information is a familiar complaint. This paper discusses an approach towards designing and implementing more useful evaluations — the stakeholder survey. Stakeholders are individuals, or groups, who have a direct interest in the program being evaluated. The central premise of the paper is that the information needs of stakeholders should be incorporated directly into the formulation of evaluation objectives, and the design of the evaluation to achieve those objectives. The paper presents a rationale for the stakeholder survey, describes its major components, and reports on the application of the approach in a large program evaluation. Key issues involved in applying the approach are also considered. The evidence from this study suggests that such surveys are not only feasible, but also of considerable value to the evaluation team.     

The influence of the Milan approach—Part 2. The legacy of Boscolo and Cecchin and their Paduan connection: A conversation with Andrea Mosconi

The Milan approach, pioneered by Selvini-Palazzoli, Boscolo, Cecchin, and Prata, has significantly contributed to the field of psychotherapy, particularly in the realm of systemic and family psychotherapy. While rooted in systemic principles and concepts, over time the original Milan group demonstrated differences in their clinical orientations and practices which led to their regrouping into two teams. The paper explores the divergences in their views and directions on family dynamics and the role of symptoms within the system. It delves into the influence of Boscolo and Cecchin, two of the ‘Milan Four’ on the Centro Padovano di Terapia della Famiglia. Drawing from a conversation with Andrea Mosconi, a mentee and collaborator of Boscolo and Cecchin, the paper examines the reconfiguration of the original ‘Milan Four’ team and its impact on their clinical approach. Key Milan principles and concepts such as hypothesising, circularity, and neutrality are examined with particular emphasis on the work of Boscolo and Cecchin's systemic work. These principles, intertwined and interconnected, provide a fertile ground for the construction of multiple hypotheses and circular questioning. The paper also highlights the concept of reflexivity, which originates from Bateson's work and plays a crucial role in family relations and communication while explaining the birthplace of paradox taking place when two levels of meaning are ‘confused.’ The Milan approach continues to be highly regarded, as its early concepts and ideas have evolved and left a lasting impact on the field of family therapy. By reflecting on the distinct contributions of Boscolo and Cecchin, and using examples, Mosconi offers valuable insights into the rich legacy and ongoing relevance of the Milan approach to contemporary therapeutic practice.     

Planning and implementing group supervision: a case study from homeless social care practice

ABSTRACT

Effective clinical supervision is increasingly recognised as essential in supporting staff who are working in the field of social care. Using a case study approach, this paper illustrates the processes involved in planning and implementing a group supervision pilot with a team working in a homeless service. The supervision models used to inform and guide this initiative are described and the style and structure of the supervision sessions are discussed. The paper additionally provides a reflective analysis of group dynamics and group processes observed during this work. Subsequent conclusions identify the key features of this process and may provide guidance for other practice settings.     

Creating Dialogic Contexts for Multidisciplinary Clinical Reviews: The Reflecting Team Process

When multidisciplinary teams review their work, it is common for clinicians to hypothesise about their clients from the perspective of their role or theoretical model. The outcome of this review process may depend on the team's views. Here the epistemological position taken by team members about reality and objectivity can lead to starkly different pathways. There can either be a dialogue about different hypotheses, with the team jointly constructing new meanings; or, conversely, there can be a monologic exchange based on competition between different hypotheses. This paper explores why teams may struggle with coordinating different theoretical approaches and models. It suggests the dialogic nature of a reflecting team process offers one approach for helping teams to find ways of ‘putting their differences to work’. Ideas for implementing this process within multidisciplinary teams are illustrated with comments provided by teams who have begun to experiment with this approach.     

Multi‐Family Therapy with a Reflecting Team: A Preliminary Study on Efficacy among Opiate Addicts in Methadone Maintenance Treatment

In this study, we evaluate the efficacy of multi‐family therapy at reducing the addiction severity and at improving the psychological and family dynamics of opiate addicts receiving methadone treatment at a public treatment center. The study compares multi‐family therapy with a reflecting team (MFT‐RT) and a standard treatment following a methadone maintenance treatment program. The results show that multi‐family therapy with a reflecting team effectively reduces the addiction severity in several of the areas evaluated and noted that this effect is superior to standard treatment. The psychotherapy patients showed improvement in the areas of employment and social support; their drug use diminished and their psychiatric condition improved. At the same time, they needed a lower daily dose of methadone. In addition, the group undergoing standard treatment showed a noteworthy deterioration in their medical condition. Both groups showed a significant increase in their alcohol use. When applied to family treatments, the systemic‐constructivist approach by the reflecting team offers combined techniques that can help improve care for the families of patients with addiction problems.     

The team as a secure base: Promoting resilience and competence in child and family social work

This paper outlines research findings on the relevance of the Secure Base model (Schofield & Beek, 2014) for developing supportive teams in child and family social work. When the social work team functions as a secure base, this can help workers cope with the emotional demands of the role. The concept of the secure base comes from attachment theory (Bowlby, 1969) in which our relationships with significant others, who are available, sensitive to our needs and reliable, provide us with a secure base to return to when life is stressful and provide us with comforting internal mental models when we are physically away from them. This ‘secure base for exploration’ reduces anxiety and enables us to engage with the world, consider the internal world of others (empathy) and remain resilient when life is stressful. Using data from 52 phone interviews with child and family social workers across eight local authorities in the UK, we show how the Secure Base model has relevance for emotion regulation and resilience for child and family social workers. Data were analysed using Theoretical Thematic Analysis (Braun & Clarke, 2006). In the context of the emotional demands of social work, our data indicate that the supervisors and teams provide a work related secure base across five dimensions by behaving in ways which instil these beliefs: Availability -‘People are there for me’; Sensitivity - ‘My feelings are manageable’; Acceptance - I don't always have to be strong’; Cooperation - ‘I can work with others to find a solution’; Team belonging - ‘I am valued and I belong’. Implications for practice are proposed to help supervisors and team members reflect on beliefs and behaviours which can help provide a secure base for their teams.     

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.     

Psychotherapy of a preschool cancer survivor: Promoting mastery and understanding

The prolonged and invasive treatment common to cancer therapy protocols may lead to precocious defenses which impede the future development of preschool-aged cancer survivors. Focal play therapy offers the young cancer survivor a chance to understand and master the cancer experience. At present there are no accounts in the literature of the psychotherapy of young cancer survivors. This paper presents a detailed account of the therapy of a preschooler who survived a brain tumor, emphasizing the child's perspective on the cancer experience and an intervention approach which stresses mastery of developmental impasses, rather than psychopathology.     

Landscaping: teamwork and integration into inter-individual coordination as a learning situation

One of the dimensions of work that is not well known in training is teamwork and the work of the team leader. The team leader is the personne who provides local supervision. Teachers and trainers, as well as business employers aknowledge the place and importance of teamwork and the role of the team leader. However, most consider themselves, insufficiently prepared to offer training in line with these elements. This paper thus aims to present the results of an analysis of group work in the field of landscaping conducted from the perspective of team work and team leader learning and training.     

The influence of the Milan approach: Five decades of intergenerational change. A conversation with Matteo Selvini

The ‘Milan Approach’ made an enormous contribution to psychotherapy and psychiatry and has been viewed as a bedrock in the family therapy field. Mara Selvini-Palazzoli made a revolutionary shift in the early 1970’s to abandon individual therapy and adopt family therapy to treat anorexia in young women. The goal of the three systemic principles; hypothesising, circularity and neutrality, proposed by the Milan Team is to elicit a useful method to interview families which encourages the production of meaningful information. The Milan group took special care of language. Rather than overly focusing on the label and referring to schizophrenia as a diagnosis, for instance, they used the term ‘families in schizophrenic transaction’. This perspective more realistically explored the origin of problems while looking at ways how to effectively generate change. In the early stages of its development, heavily influenced by the work of the MRI, the team adopted a pragmatic and strategic approach, however the focus gradually shifted towards semantics and the story of the system. While the ‘systemic identity’ was the principal guiding principle, the model was also influenced by social constructionism. This paper is a distillation of a conversation held with Matteo Selvini, son of Mara Selvini Palazzoli. We discussed the four key influential figures who developed the ‘Milan approach’, Selvini Palazzoli, Boscolo, Cecchin and Prata. The focus of the conversation is on Mara and on her influence shaping the approach, its evolution through the years leading to the creation of the Scuola di Psicoterapia Mara Selvini Palazzoli. Matteo also shares his own influence in the evolution of the school through the intervening years. He explains the adapted version of the Milan approach and the amalgam of the original and emerging therapeutic concepts. His key messages to therapists are the importance of working in teams and client follow-ups.     

Cross-Cultural Empathy and Training the Contemporary Psychotherapist

The diversity of today's client population has required that psychotherapy training confront the importance of cultural competence in graduates. Approaches in this area of education create dynamic tensions between stressing therapist openness to diversity and therapist knowledge of clients' cultures. This paper proposes that this attitude-knowledge dilemma in psychotherapy education can be reconciled by helping trainees develop an empathic response capable of transcending cultural differences. Cross-cultural empathy helps provide the therapist with a coherent and familiar means of maintaining affective receptivity in the therapeutic encounter with clients while making use of a repository of information about clients' cultures. Such empathy can also be a base for building the skills needed to develop collaborative relationships with clients who are often disempowered and distrustful. The paper examines approaches and resources for training psychotherapists in cross-cultural empathy.     

Community Residents as Lay Health Educators in a Neighborhood Cancer Prevention Program

Abstract

This paper describes a lay health educator model used to provide cancer education in an urban community. Using existing community-university partnerships, the project team identified and trained community residents as health educators. This paper then discusses implications of this model for promoting community-based health prevention and practice.     

The place of “think family” approaches in child and family social work: Messages from a process evaluation of an English pathfinder service

Findings are reported from a process study of an English multi-disciplinary team working with families with long standing and complex problems. The approaches and methods of the team are described and placed in the context of UK policy developments and of UK and USA research on professional practice with families facing multiple difficulties. Basic data are provided on all families referred in the first year and analysed with respect to the first 100 completed cases. A broadly ethnographic research approach is used for the observational study of the team interactions and decision-making on individual cases. For a one-third sub-sample of 33 cases, process and interim outcome data are analysed from information systematically extracted from case records. These are complemented by qualitative data from interviews with managers and caseworkers and by observation of ‘team around the family’ and professionals' meetings. The researchers conclude that the service succeeds in engaging a majority of the referred families who have been hard to reach or hard to change in the past and whose children are either ‘on the edge of care’ or likely to be significantly harmed without the provision of an intensive service. The researchers concluded that improvements were made in the life chances of children in 75% of the families. Aspects of the service identified as associated with more positive outcomes are: the allocation of two key workers (one for the child/ren and one for the parent/s); the centrality of relationship-based practice and flexibility of the approach rather than strict adherence to any particular practice model; the fact that the service is firmly embedded within the statutory children's services department, allowing for continuity of relationships with team around the family members when the intensive service ends; and flexibility about case duration and intensity.     

An Examination of the Historical and Current Perceptions of Love in the Psychotherapeutic Dyad

Since the initial dialogues on the treatment relationship began, a hierarchical structure of our profession was set forth. This was largely created by Sigmund Freud, often considered the initiator of psychotherapy and psychoanalysis. Our profession was characterized by a neutral, distant practitioner who performed his work upon an unknowing patient. The reality of the multiple complexities of this relationship has become clearer over time. This paper seeks to examine the steps that have taken us from the initially distant and non-mutual psychotherapeutic relationship to the more egalitarian and co-created format that many clinicians are working in today. Love, in both its absence and presence, is examined as a central concept and tenet of psychotherapy.     

A "READER'S THEATER" INTERVENTION TO MANAGING GRIEF: POSTTHERAPY REFLECTIONS BY A FAMILY AND CLINICAL TEAM

The sudden and accidental death of a child can be one of the most devastating events in the life of a family. This paper describes one couple's reflections of their grief and mourning following the death of their adolescent son as well as the clinical team's reflections of therapy. The uniqueness of this paper is that it offers a "reader's theater" intervention that enabled further change to occur. The clinical team used a belief model, emphasizing that altering constraining beliefs is at the heart of healing from such tragedies as sudden death (Wright, Watson, & Bell, 1996). This approach is operationalized through therapeutic conversations between family members, clinician, and clinical team. Interventions such as reflecting teams, therapeutic letters, and "homework tasks" were used to modify or challenge constraining beliefs of both the family members and the clinical team members. However, the intent to co-author a paper with this couple provided the serendipity intervention of a "reader's theater" that further served to identify, affirm, and solidify facilitating beliefs.     

The team approach: Developing an experiential knowledge base for the treatment of the pathological gambler

It is not surprising that developing professional competence in treating the pathological gambler is a major problem today, given the scarcity of treatment programs for pathological gambling. This paper explores a learning model which weaves together the experiential knowledge of the recovering pathological gambler with the skills of professional mental health clinicians. An example of this model is the team approach originated at the Johns Hopkins Compulsive Gambling Counseling Center in 1979 and which was evolved into an interdisciplinary treatment model at Taylor Manor Hospital. An examination of this evolving treatment approach is analyzed, reviewed and updated with a focus first on the use of the team approach as a paradigm for developing an experiential knowledge base in the treatment of selected disorders, and second, its use as a model for newly developing treatment programs.