Adapting enactments to couple reactivity: five developmental stages

Interest in change interventions that are common to different models of relationship therapy has spurred investigation of enactments as one such candidate. In change-focused enactments, therapists structure and coach couple/family interaction, as opposed to channeling interaction through the therapist. Still, varying levels of couple/family distress, volatility, and reactivity mean that readiness for enactment intervention varies along a broad continuum and changes over the course of therapy. This suggests the need for differentiated enactments. Currently, however, no model exists for adapting enactments to changing relationship conditions. We propose a five-stage developmental model of clinical operations in couple therapy that adapts the process and structure of enactments to changing levels of relationship distress, interactional volatility, and emotional reactivity. The model increases the possibility for therapists to use enactments successfully over the entire course of couple therapy. Issues to be considered in using the couple enactments model as a template for the development of enactment models for other relationship systems are noted.     

Enactments in Emotionally Focused Couple Therapy: Shaping Moments of Contact and Change

Emotionally focused couple therapy (EFT) uses enactments to shape responsive attachment‐significant contact and to change couple interaction. In this article, we show how EFT enactments differ from enactments in other therapy approaches, present a theory of EFT enactments, a model for creating EFT enactments, and an extended case example of an EFT enactment. Video Abstract     

SEXISM IN FAMILY THERAPY: DOES TRAINING IN GENDER MAKE A DIFFERENCE?

The purpose of this study was to investigate the clinical decision making of marriage and family therapists who had no training in gender compared to those who had such training, either through a separate course or by having gender issues integrated throughout the curriculum. Specifically, levels of feminism and sexism in the clinical assumptions and interventions of therapists were evaluated using clinical vignettes. Participants for this study included 150 beginning or entry-level therapists from marriage and family therapy training programs in academic settings. Of the 102 participants with some training in gender isues, 64% reported having received gender training from a faeminist perspective. contrary to expectations, a multivariate analyssis of variance revealed that training in gender issues alone did not significantly influence levels of feminism and sexism in clinical decision making. However, the levels of sexism in clinical interventions were significantly lower if therapists had received gender coursework from a feminist perspective, whether in a separate course or integrated throughout the curriculuim. These findings raise a question as to the wtility of teaching gender issues if what is taught and how it is taught are not also considered.     

DOES ACADEMIC TRAINING BACKGROUND MAKE A DIFFERENCE AMONG PRACTICING MARRIAGE AND FAMILY THERAPISTS?

Using a national sample of practicing marriage and family therapists (MFTs) and their clients, this study investigated whether academic training background is associated with differences in pracice patterns and client outcomes. Clinical members of the American Association for Marriage and Family Therapy with academic training in psychology, social work, counseling, and marriage and family therapy were compared on a wide range of clinical practice variables, and their clients were surveyed about thier satisfaction and outcomes. Results showed highly similar practice patterns and client outcomes across all four disciplinary groups. Although the findings showed little evidence for the uniqueness of academic marriage and family therapy training among experienced MFTs, they also refute the notion that therapists trained in MFT degree programs practice in unusual or inferior ways compared to MFTs trained originally in other mental health disciplines.     

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.     

CURRICULUM CHANGES TO MEET CHALLENGES: PREPARING MFT STUDENTS FOR MANAGED CARE SETTINGS

Fledgling therapists who graduate from family therapy traning programs will have to navigate the world of managed care. In this article, faculty of University of San Diego share changes in its accredited training program that prepare students for practice in an increasingly multidisciplinary world where health maintenence organizations and other versions of managed care predominate. The paper touches on contextual issues, provides a detailed outline of coursework presenting basic knowledge and skills involved in clinical pracice in a managed care environment, and comments on clinical placements and the challenge of helping the next generation of clinicans "fit" into the future of health care delivery while maintaining their unique identity as family therapists.     

EXPOSURE TO MARITAL AND FAMILY THERAPY IN MEDICAL SCHOOL: A STUDENT PERSPECTIVE

Most marital and family therapists, both medically and nonmedically trained, regularly interact with physicians on a professional basis. Though some physicians receive specific training in marital and family therapy in their postgraduate residency programs, (notably those in psychiatry and family medicine), for many, the only academic exposure they receive to this field comes during a 6- to 10-week clinical clerkship in psychiatry during their third or fourth year of medical school. No study could be located which examined marital and family therapy training in undergraduate medical education. The purpose of this study was to gain a better understanding of the level of marital and family therapy training in medical school and to provide information concerning physicians who are not family therapists, and how much knowledge about the field they can be expected to have.     

The Digital Divide: Couple and Family Therapy Programs’ Integration of Teletherapy Training and Education

The mental health field is increasingly integrating and growing a teletherapy presence, and couple and family therapists are uniquely situated to offer these services based on our history of innovative approaches to therapeutic services. To do so successfully, careful consideration of training and education must occur. To evaluate current teletherapy training and education opportunities of COAMFTE accredited couple, marriage, and family therapy programs, an inductive qualitative content analysis was conducted on the responses of 95 faculty at COAMFTE accredited programs. Findings indicate that more than two thirds of the participants were in favor of teletherapy integration in training programs; however, most programs currently do not offer such opportunities. Barriers that prevent such integration were highlighted as well as existing concerns to training graduate students in teletherapy. Implications for training programs, policies, and regulations are discussed.     

Making space for racial dialogue: our experience in a marriage and family therapy training program

Marriage and family therapy (MFT) training programs need to create opportunities for all students to develop cultural competency by raising their racial awareness and sensitivity. Likewise, therapists of color need to be offered space in MFT programs to voice their experiences and venues for their voices to be heard. This article reports on the efforts within a master's level, accredited MFT training program to create space, through participatory action research, for the unique experiences of therapists of color and White therapists who are deeply committed to racial sensitivity.     

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.     

Clinical and Supervisory Considerations for Transgender Therapists: Implications for Working with Clients

Transgender therapists have unique and valuable perspectives into how gender organizes the therapeutic process. Currently, in the MFT field, there is discussion of the cisgender therapist's experience in the therapy room, but no known articles on the transgender therapist's experience. This article provides insight into the experiences of transgender therapists around issues of self‐disclosure, social locations of both therapist and client, and clinical supervision. Drawing from our clinical experiences as transmen, we highlight special considerations for working with cisgender, queer, and transgender clients. Implications for supervision of transgender therapists are also discussed. As more gender diverse students seek MFT training, there is an urgent need to acknowledge their perspectives. This article is a call for beginning conversations in this direction.     

DO WE REALLY UNDERSTAND? AN EXPERIENTIAL EXERCISE FOR TRAINING FAMILY THERAPISTS

This paper presents an experiential exercise for training beginning marriage and family therapists, as well as several adaptations of the format. The basic exercise consists of role playing a therapy session in which the people playing the clients speak a language that is not understood by the therapist-in-training. Although the therapist cannot understand the clients, the clients can understand the therapist. This exercise assists students to become more cognizant of the need to be cautious and curious in the cocreation of meaning in therapy. In addition, this exercise builds confidence and clinical skills, such as learning about nonverbal communication while observing process.     

Human Sexuality Education in Marriage and Family Therapy Graduate Programs

Given the likelihood that marriage and family therapists will encounter clients with sexual concerns, it is important to know how graduate training programs are preparing future clinicians to work with this domain of life. Sixty‐nine marriage and family therapy (MFT) program directors completed an online survey to examine how sexual health education is integrated into graduate training programs. Findings indicate that while the majority of program directors value sexuality curriculum, and most programs require at least one course in this area, there are barriers to privileging sex topics in MFT graduate programs. Barriers include few MFT faculties with expertise in human sexuality and marginalized sexual health topics. Implications for training MFT graduate students and their work with future clients are discussed.     

Attachment-based family therapy: adherence and differentiation

This study examined the fidelity of attachment-based family therapy (ABFT) for depressed adolescents. Trained observers used the therapist behavior rating scale (3rd version) to code therapist behaviors in 45 sessions of ABFT and 45 sessions each from two empirically based treatments for adolescent substance abusers: multidimensional family therapy (MDFT) and cognitive-behavioral therapy (CBT). Results indicate that ABFT therapists employed essential ABFT interventions, such as focusing on vulnerable affect, highlighting attachment-related themes, and promoting adolescent-parent reattachment through in-session enactments. In accordance with the sequential nature of the treatment, these interventions were used more extensively during the early stage of treatment, when there is a greater focus on reattachment. ABFT was perfectly discriminable from CBT, with ABFT therapists using more restructuring and reattachment interventions and CBT therapists using more signature CBT interventions, such as cognitive monitoring and homework. ABFT was also discriminable from MDFT, with ABFT therapists placing a greater emphasis on reattachment. These results suggest that ABFT is a viable and differentiated treatment. Together with prior findings supporting its efficacy, ABFT should be considered a promising new approach for working with depressed adolescents and their families.     

DEVELOPING AN IDENTITY AS A FEMINIST FAMILY THERAPIST: IMPLICATIONS FOR TRAINING

Although feminists have profoundly influenced the field of family therapy, little has been written about the process by which these women came to identify themselves as feminist family therapists. This article reports the results of a qualitative research study that explored that process and suggests a model of feminist family therapy identity development. Implications for training programs are reveived.     

Integrating Family Therapy Training in a Clinical Psychology Course

Teaching family therapy to clinical psychology trainees is not common practice in Australian clinical psychology training programs. There is sparse discussion in the literature. Family therapy is an evidence based intervention that complements a diversity of established theories and psychotherapies and would complement the intervention skills of trainee clinical psychologists. The aim of this paper is to illustrate how family therapy training may be integrated into a postgraduate clinical psychology course. The literature on core family therapy knowledge, skills and training methods will form the backdrop to a review of specific family therapy training courses for clinical psychology trainees. This will then be mapped against a consideration of accreditation requirements of clinical psychology courses in Australia and suggestions made for integrating family therapy into their training curriculum. Anecdotal feedback from students provides an initial step toward evaluation.     

“Being a Therapist Doesn't Exclude You From Real Life”: Family Therapists’ Beliefs and Barriers to Political Action

A crucial and overlooked facet of social justice in family therapy is political and policy advocacy. Family therapists have unique insight into how social policies and political discourse shapes clients’ lives and the life of our profession. Such knowledge can inform policymakers and political debate, yet few family therapists are trained to engage in political action. In this randomized, national survey of licensed family therapists’ (N = 174), we explore beliefs about and barriers to engagement in political and policy processes. The findings suggest that there are significant barriers and uncertainties surrounding family therapists’ engagement, including time, feelings of efficacy, and interest. Given these barriers we discuss practical suggestions for clinicians and family therapy training programs.