The Use of Multiple Family Marathon as a Teaching Device

This paper discusses the rationale and methods for using a multiple family marathon as a teaching device in the context of an intensive group-supervision family therapy training program conducted by the authors. Procedures used in the marathon are described, as well as how the concept stimulates increased focus on issues common to family therapy and broadens the experience of the students. The effects of the marathon on the students' views of their therapy families and of themselves as family therapists are explored.     

Comparisons of marriage and family therapists, psychologists, psychiatrists, and social workers on job-related measures and reactions to managed care in Iowa

This study compares marriage and family therapists (MFTs) to psychologists, psychiatrists, and social workers on job-related measures, such as job autonomy, job satisfaction, burnout, and intention to stay in their present position, as well as on reactions to a managed care initiative in the state of Iowa. Findings indicate that MFTs scored significantly lower than other practitioners on job autonomy and intention to stay in their present position, but there were no differences in job satisfaction or burnout. Marital and family therapists also reported less dissatisfaction with the managed care initiative than psychiatrists, although virtually all practitioners were dissatisfied with the managed-care program. These findings indicate some dissatisfaction within the MFT profession and may be relevant to practitioners seeking to change or expand their practice, as well as to the needs of MFTs in their training programs.     

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.     

Considering justice: an exploratory study of family therapy with adolescents

Feminist approaches to therapy with adolescents emphasize an empowering focus on the strengths of adolescents while simultaneously insisting that therapists become aware of their own biases toward today's adolescents. However, a review of the family therapy literature finds little mention of feminist approaches for addressing injustices (e.g., family scapegoating, negative societal views of adolescents, and gender oppression) that arise in family therapy with adolescents. Therefore, this study explores clinical approaches and resources suggested by a surveyed group of self-identified feminist family therapists. In addition, we also recommend several approaches and resources that will aid family therapists in creating a more just climate for family therapy with youth.     

Depression,the Family,and Family Therapy

The potential contribution of family therapists to the treatment of depression remains underdeveloped. Family therapists need to articulate how changes in family functioning might benefit depressed persons, as well as how other problems in the families of depressed persons tend to go unrecognised. Furthermore, family therapists need to be alert to how undetected depression in adults and children may interfere with their ability to meet their goals with families who seek therapy for other persons. This article provides family therapists with (1) an overview of the nature and experience of depression; (2) an introduction to antidepressant medication; (3) a summary of research findings relating depression to its family context and (4) a brief overview of developments in the marital and family treatment of depression.     

Exploring the influence of the attachment organizations of novice therapists on their delivery of emotionally focused therapy for couples

Clinicians' own internal resources for understanding relationships--that is, their attachment organizations--have been found to influence the process and outcome of treatment. The current study addressed whether the attachment organizations of novice couple and family therapists were associated with couples' experiences of their therapists, therapeutic alliance, session impact, and emotionally focused couple therapy (EFT) fidelity (i.e., especially as related to targeting and working with attachment needs and overt and underlying emotions). Novice couple and family therapists delivered EFT, an attachment-based approach, to couples in a simulated session and an embedded multicase study design guided a cross-case analysis. Findings indicated that secure therapists, when compared to their insecure peers, were more competent at working with attachment needs, as well as the overt and underlying emotions of their clients. Secure therapists perceived themselves as being more skilled in emotion regulation, which may have contributed to their abilities to remain attuned to their clients' attachment needs and emotional expression, even in the face of emotional arousal in session. Couples of insecure therapists also reported greater alliance splits. Future research is needed to further explore the dyadic influences of both therapists' and clients' attachment organizations, as well as the training and supervision practices these findings implicate.     

Postmodern‐oriented practices and patient‐focused research: possibilities and hazards

In this article two streams of thought within family therapy, one representing a traditional research focus and the other postmodern oriented practices are brought together. A qualitative study is described that used standardised measures to monitor therapeutic practice and provide feedback on process and outcome to therapists. The opportunities and pitfalls concerning this approach are discussed and illustrated. The use of measures as conversational tools increases and expands opportunities for collaboration between children, parents and their therapists. However, in organisations these measures risk becoming tools of competition instead of conversation, which is helped when managers take responsibility for implementing and supporting a culture of feedback.     

How Do the Professional Lives of Family Therapists Affect their Private Relationships: A Qualitative Study

This article is based on a qualitative research project about how the professional lives of family therapists affect their private relationships. The overarching research question was: How does your professional work as a family therapist affect your private relationships? To answer this question, semi‐structured qualitative interviews were conducted with four therapists from two different Family Counseling Services. Through the use of interpretative phenomenological analysis, three main findings were identified: (1) family therapists’ knowledge and values are a basis for interpersonal encounters; (2) participants describe resonance in relation to clients’ stories; and (3) therapists can be challenged in managing confidential knowledge particularly where they belong to the same communities as clients. The study also explores societal expectations and discourses that accompany the role of therapist, which can affect therapists’ freedom of movement in their private lives. These issues are discussed in relation to family therapy theory and relevant research.     

Families in the Time of the Pandemic: Breakdown or Breakthrough?

The COVID‐19 pandemic has taken a toll on all individuals and their families around the world. Some suffer more adversely than others depending on their unique developmental needs, resources, and resilience. However, instead of breaking down, many families and therapists have hunkered down to cope with this ‘wicked’ situation as it continues to evolve. This article examines the unique challenges and opportunities of COVID‐19 for families at different life developmental stages, as well as the challenges and opportunities for systemic therapists as they venture into unfamiliar territory. Through a case example and by integrating recent literature related to this pandemic, we apply three key and interconnected systemic themes (unsafe uncertainty, family life cycle, and social diversity) to discuss the challenges and opportunities for families and therapists, respectively. We are optimistic that there are many possibilities as families and therapists draw on, and often reinvent, currently available resources to navigate their course in this pandemic. We also find that while the pandemic continues to present unsafe and uncertain situations, there are new ways of being and behaving, especially when families and professionals work together collaboratively. Despite formidable challenges, there are many opportunities, both within families and communities that cut through different social contexts related to family, culture, economics, and even politics. Families and therapists could endure better when they are more cognisant of how and what these contexts may impact and offer them.     

CHANGE, DISENGAGEMENT, AND RENEWAL: RELATIONSHIP DYNAMICS BETWEEN YOUNG ADULTS AND THEIR FATHERS AFTER DIVORCE

Little is known about children's perceptions of their parents' divorce or how children construct meaning around the divorce and their subsequent relationships with their parent. The focus of this was to learn about the experiences and the meanings young adults had constructed about the divorce process and their relationships with their fathers in the years after the divorce. The findings revealed a broad spectrum of experiences and several key issues that gave meaning to both the disengagement and the reengagement with their fathers. Loss, acceptance, availability, and support are a few of the vital issues addressed. Implications for family therapists are discussed.     

The theory,structure, and techniques for the inclusion of children in family therapy: a literature review

Many barriers prevent therapists from including young children in family therapy, despite the theoretical belief that every family member should be present. Although there is a wealth of literature describing how to include children, the information has not been compiled in a way that is easily accessible to therapists. In this article, we report the findings of an exhaustive and systematic literature review of 64 publications, published between 1972 and 1999, related to including children in family therapy. The purpose of this article is to offer therapists a succinct compilation of theoretical, structural, and practical aspects as well as a comprehensive listing of specific techniques for including children in family therapy.     

THE VOICES OF CHILDREN: PREADOLESCENT CHILDREN'S EXPERIENCES IN FAMILY THERAPY

Although family therapists often include children in therapy sessions, they rarely consider the child's wishes regarding participation or ask children for their impressions of therapy. In this study, 16 children between the ages of 5 and 13 who had participated in at least four family therapy sessions were interviewed to determine their perspectives on the experience. The children made it clear that they wished to be involved in a meaningful way in therapy and that they wanted to come to sessions even when they were not the focus. Feedback from these children is used to suggest ways family therapists might enhance their effectiveness with families with children.     

SPIRITUALITY AND FAMILY THERAPY: SPIRITAL BELIEFS,MYTHS, AND METAPHORS*

The field of marriage and family therapy is evolving toward theoretical and practical models with an ecosystemic focus which encourage an awareness of different levels of system interaction yet therapists have rarely been encouraged to explore the spiritual dimension of their clients' lives, even though doing so may enrich the understanding of the metaphors and meanings which inform their existence and perhaps, their problems. This paper challenges therapists to consider the spiritual belief systems of their clients which have contributed to the development or maintenance of the presenting problem. The authors present case examples and specific suggestions for clinical practice.     

Maintaining a family focus: Underlying issues and challenges

More therapists respect and support the idea of family therapy than actually practice it. Reasons have been proffered for this state, but none has considered the therapist's personhood as a variable. This paper explores the possible connection between worker's personality and tendency to underuse the family focused treatment modality. A relationship is made between the therapist's developmental experiences as a parentified child and their impact on choices for favoring less populated frameworks of treatment than family focused approaches. Areas of difficulty are identified and suggestions for assisting staff to increase family focused practice are made.     

Therapists’ Assessment and Treatment of Internet Infidelity Cases

In this study, we investigated through an Internet survey of 508 practicing marriage and family therapists which treatment decisions varied by gender of the client and background variables of therapists. The subjects responded to several typical Internet infidelity scenarios. We varied the gender of the person initiating the infidelity for half of one sample. We also asked the family therapy participants to respond to how they might assess and treat each presenting problem. They also evaluated problem severity, prognosis of the case, number of sessions necessary for treatment, and the extent to which a therapist would focus individually or relationally. Results indicate that there were differences in how therapists assessed and treated clients based on client gender, therapists’ age, therapists’ gender, how religious therapists reported they were, and the extent of therapists’ personal experience with infidelity.     

Condoms and Connection: Parents,Gay and Bisexual Youth,and HIV Risk

The family has long been considered a powerful influence on youth's high‐risk behaviors. However, little is known about preventive family influences for gay and bisexual youth, a group at high risk for HIV infection. For this study, qualitative interviews from a sample of 38 gay and bisexual youth and their parents/guardians underwent a thematic analysis. Youth described parent–child closeness, parental warnings, and urgings to use condoms as influences. Youth denying family influence came from families in which parent–child relationships were disrupted or HIV‐related discussion was lacking. Most families reported discomfort discussing HIV risk. These findings, along with a case example, suggest how family therapists can enhance parental influence by helping these families strengthen their relationships and discuss this important topic. Video Abstract     

Integrating gender on multiple levels: a conceptual model for teaching gender issues in family therapy

As the field of family therapy has evolved, there has been growing recognition as to the importance of gender in family therapy. To prepare the next generation of family therapists adequately, it is important that they recognize the many and complex ways in which gender permeates their work. In this article we present an integrative model to help educators teach family therapists about gender issues. The model examines how gender influences clinical work on multiple levels, including contextual levels such as society and the marriage and family therapy field. The model also acknowledges how gender can influence individuals, including clients, therapists, and supervisors. Finally, the model attempts to capture the complexity of how gender can impact the relational dynamics between two or more individuals.     

Becoming the Family Archivist

The author describes some of the ways in which conventional amateur family histories fail to portray the emotional realities of family life. Recent trends in biography and autobiography are explored briefly, and the possibility of a family history informed by systemic as well as psychoanalytic insights is considered. The author's own work, A Family in Time, attempts such a history. The author outlines his sources of information, both documentary and oral, and the special challenges posed by their interpretation. The decisions governing the ordering and selection of data for publication are explored, the author's aim being to present the facts in such a way that a systemic conception of family process over time will be implicit in the material. Implications for the author, for the family itself, and for therapists working with intergenerational process are briefly considered.     

The Supervision of Two Isolated Practitioners: It's supervision,Jim, but not as you know it

A supervisory format used over a four year period for two isolated family therapists is discussed. After an initial face to face meeting, in-person supervision took place quarterly. Between these meetings, supervision was by a combination of audiotapes and letters. Supervisees recorded their questions, comments and news on cassette tapes, often sending as well the tape of a client session, and the supervisor responded by letter. The particular difficulties and advantages of this format are discussed, and some attention is given to the special needs of isolated practitioners.