Developing culturally competent marriage and family therapists: guidelines for working with Hispanic families

As the Hispanic population of the United States continues to grow, so will the need for therapists who have been trained to work with Hispanic families. This content analysis of the available treatment literature generated several specific guidelines that can be used in training and evaluating culturally competent therapists. Guidelines included: Use family therapy, act as advocate for the family, assess immigration experience, assess acculturation, respect father, interview family subsystems separately, do not force changes, provide concrete suggestions, and warmly engage the family. Empirical and conceptual support for each guideline is discussed and several conclusions are made regarding culturally competent therapy with Hispanic families.     

Issues in African-American family preservation

This article is concerned with African-American family preservation. The authors' assumptions are that (1) child welfare service takes place in a cultural context; (2) effective work with African-American families requires a culturally relative "nondeficit" perspective on African-American culture; (3) this begins with helping service providers to acquire an analytical approach to culture and factual knowledge about the cultural behavior of clients; and (4) staff members must be prepared through training to implement a cultural knowledge base in transactions with African-American families and must have the supervisory and policy supports to do this. The several practice issues central to African-American family preservation are highlighted.     

Developing culturally effective family-based research programs: implications for family therapists

Recently, some family scholars have developed greater sensitivity to the relative neglect of families of color in clinical and empirical research. Consequently, a proliferation of research elucidating many nuances of ethnic families has come to the forefront, containing a wealth of knowledge with useful implications for family therapists and other mental health providers. The findings of these studies hold enormously important implications for how family therapists can better engage and accommodate families of color in therapy. In this article we discuss some of the etiological and methodological issues associated with planning, conducting, and disseminating family-based prevention and intervention research programs with ethnic minority families.     

Adolescent and parent alliances with therapists in Brief Strategic Family Therapy with drug-using Hispanic adolescents

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent, adolescent) and family level (within-family differences) for families that either dropped out or completed family therapy. Participants were 31 Hispanic adolescents and their family members who received brief strategic family therapy for the treatment of adolescent drug use. Videotapes of first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that Completer cases had significantly higher levels of alliance across all family members than Dropout cases, and Dropout cases had significantly higher unbalanced alliances than Completer cases. Clinical implications are discussed.     

Kin Keeper

Abstract

Cancer mortality issues for African-American women are undeniably real. It is also apparent that to address the issue of this unequal burden, different intervention approaches are necessary. Employing a family systems approach for African-American women and their families holds benefits for both cancer prevention and cancer treatment. The Kin Keeper Modelis based on the premise that the natural ways African-American women communicate various health messages to females in their family can be used to influence their cancer prevention and screening behaviors. This paper reports empirical research that demonstrates significant familial influence on African-American women's cancer prevention screening behaviors. Findings indicated that family influence provides insight into the intersection of family altruism with cultural familial decision-making. In addition, the findings underscore the strong influence family has on African-American women's propensity to     

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.     

The wisdom of family therapists

This qualitative research study explored the ways in which family therapists (MSWs) perceive the family treatment process. A purposive sample of eight practicing clinical social workers were selected for face to face interviews which explored the workers' perceptions of the family treatment process. Findings revealed that although certain consistent themes appear to exist among family therapists, family therapy practice may well be much more idiosyncratic than commonly believed.     

A survey of homework use, experience of barriers to homework, and attitudes about the barriers to homework among couples and family therapists

Homework is a therapeutic process that has strong theoretical and empirical basis, but existing research has focused on "compliance" rather than considering the broader and more clinically meaningful construct of "engagement." Absent in the literature is empirical study of the barriers to engagement or study of homework use among couple and family therapists (CFTs). The current study investigates the frequency and type of homework, as well as the influence of homework compliance, quality of compliance, and experience of barriers to compliance on CFTs' attitudes and beliefs toward barriers to homework completion for couples and families. Results indicated CFTs (N=226 AAMFT Clinical members) use homework more often with couples than with families, and CFTs report greater homework compliance and quality of compliance for couples when compared to families. A path analysis examining compliance, quality of compliance, and barriers to compliance as predictors of attitudes/beliefs toward barriers revealed no significant findings. A discussion presents implications for future research and practice for homework in couple and family therapy.     

Walk-in Together: A pilot study of a walk-in online family therapy intervention

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk-in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof-of-concept study investigating the acceptability and short-term effectiveness of an online walk-in family therapy service, Walk-in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk-in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre-session, post-session, and at 6 weeks follow-up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi-structured interview data. Post-session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post-session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well-received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk-in delivery model. This proof-of-concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk-in, telehealth model to meet the rising demand for therapeutic support for families in distress.     

Working with families living with autism: potential contributions of marriage and family therapists

This article introduces marriage and family therapists (MFT) to some of the common issues faced by families that have a child with autism spectrum disorder (ASD). First, autism is defined and common myths surrounding it are discussed. Next, relational challenges are presented that families report experiencing during early childhood through the elementary school years, adolescence and the transition into adulthood, and the later years of the family life cycle. Real-life stories are included to illustrate the potential contributions that MFTs can make to families that have a child with ASD.     

A view from 1991: Crisis: Home-Based Family Therapy

Originally prepared for publication in 1991, but now appearing for the first time, this article discusses home-based family therapy in the context of families experiencing psychiatric crises. Strategies of engagement, interventions and safety issues related to this form of family therapy are outlined. The advantages of home-based family therapy in terms of direct observation and intervention and the minimisation of the need to transfer learning are discussed. Reflecting from the perspective of the present, the author notes with regret that most crisis teams today do little more than gatekeeping; a great opportunity for effective home-based treatment appears to have been lost.     

Marriage and family therapists working with couples who have children with autism

Current research about families and couples who have children with autism is discussed using the Double ABCX model as a guide. A case study is presented along with recommendations for therapists who work with couples who have children with autism. Marriage and family therapists are encouraged to use the Double ABCX model as both an assessment tool as well as for intervention. More research and effective therapists in this area are needed in order to keep up with the rising rates of families that include children diagnosed with autism.     

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.     

Family Therapy: A Phenomenological and Active Directive Approach

Because the most popular forms of family therapy, psychodynamic and systems-oriented therapy, appreciably fail to consider family members as individuals in their own right, a phenomenological-humanistic view of families who come for therapy would serve to correct this oversight. The particular phenomenological view espoused by those who do client-centered family therapy, however, is too passive and neglects some of the realities of human disturbance. A "third force" in family therapy is therefore outlined in this paper, which combines a phenomenological-humanistic approach with a highly active-directive attempt to help family members surrender their misperceptions of themselves and others and to make profound philosophic changes in their intrapersonal and interpersonal attitudes and behaviors. As an example of this kind of phenomenological and active-directive approach, some of the principles and practices of rational-emotive therapy (RET) are outlined and applied to family counseling.     

Ethical dilemmas faced by family therapists

This study explores the reactions of 202 randomly selected clinical members of the American Association for Marriage and Family Therapy (AAMFT) to a variety of ethical dilemma situations which examine what family therapists are doing in their work when confronted with these difficult situations. Eight of the issues studied have been discussed in the literature and eight are included in the AAMFT's Ethical Principles for Family Therapists (1984). In addition to showing how clinical members responded to dilemmic vignettes that reflect these dilemmas, results indicated that family therapists are facing these dilemmas, have a high rate of consensus of what they would and would not do in each situation and almost all the situations were seen as being ethically significant by the majority of respondents.     

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.     

The fragility of therapists and clients as a generative context

This article describes our work at the interface between the legal and the psychosocial in relation to mental health needs arising in families. Working at the legal–psychosocial interface, interventions and treatment strategies are not given in advance but are built with all those involved, including the family and those who may be significant for the family as well as family therapists and judicial practitioners. In addition, psychology students from the UBA (Universidad de Buenos Aires, Argentina) who are engaged for their professional practice in the area of Justice—Working with Families in the Legal Field—observe and actively participate in this process. The work at the legal–psychosocial interface is interdisciplinary and requires a permanent dialogic effort among all practitioners of the different disciplines in order to promote alternatives that generate innovative solutions.     

Straight therapists working with lesbians and gays in family therapy

This article uses a cultural literacy model to sensitize straight marital and family therapists (MFTs) to work with gays, lesbians, and their families. While most MFTs number gays and lesbians among their clients, differences in sexual orientation between therapist and clients are often insufficiently addressed, closing off therapeutic possibilities. Marital and family therapists are asked to systematically assess homophobic and heterosexist assumptions in both personal attitudes and professional theory and practice and to educate themselves about gay culture and family life. The role of disclosure, trust, and collaborative meaning making in creating a therapeutic relationship that is culturally sensitive, clinically effective, and ethically responsible is examined.     

A Therapist's Perspective on Jewish Family Values

Family therapy has been deficient in accounting for the impact of ethnic, religious and racial values on success or failure in treating families. Jews do well in family therapy, and they readily become engaged in it. The favorable response of Jewish families is due to a set of values. This set is composed of high familism, high egalitarianism, high secularism, maternal intrusive-ness, verbal rather than physical aggressiveness, an assertive stance toward problem-solving, and the maintenance of a scapegoat theme. In treating Jewish families it is important to keep the entire set in mind rather than any one particular value.     

THE INVISIBLE MIRROR: IN-HOME FAMILY THERAPY AND SUPERVISION

Home-based family therapy intervention programs, designed as a preventive strategy for multi-problem, at-risk families, are a rapidly growing phenomenon in mental health agencies. However, a review of the literature reveals little information on clinical supervision, which is a major component of home-based family intervention. The purpose of this article is to provide an alternative supervisory approach, in-home supervision, for training therapists who do home-based intervention.