The therapist who is perceived as "spiritually correct": strategies for avoiding collusion with the "spiritually one-up" spouse

Marital and family therapists who are perceived by the community as having a strong spiritual orientation face unique and difficult challenges. Clients who seek their help often bring a mix of expectations that can create a situation in which the therapist may struggle with multiple roles, some not of his or her choosing. These expectations are especially challenging when one spouse views him-or herself as "spiritually one-up" and wants the therapist to form a spiritually based coalition against the other partner. This paper describes the various dilemmas that therapists may face when clients perceive them as having spiritual expertise and presents strategies that can be used for avoiding these dilemmas. A case study illustrates the use of these approaches.     

THE FEMINIST CRITIQUE IN EPISTEMOLOGICAL PERSPECTIVE: QUESTIONS OF CONTEXT IN FAMILY THERAPY

Family therapy's neglect of social context as a factor in its continuing distortion of women's issues has led feminist critics to wonder if systems-based psychotherapy truly serves women. Rather than heralding the demise of family therapy, however, the feminist critique is here taken to open up concerns central to the epistemological discussion underway in the field. At first, these have to do with the functions of "punctuation,""boundary" and "closure" in systemic epistemology. Later, the central question becomes that of the place given to context in systems epistemology generally, as well as family therapy in particular. Several implications of a more lively interest in context for family therapy's work are explored. These are discussed with respect to women's issues, clinical epistemology, and the challenge to raise novel questions in family therapy.     

Cultural Issues in Therapy: On the Fringe

This paper argues that issues of culture have occupied a fringe position in the thinking and practice of most Australian family therapists. Starting with a definition of culture as epistemology, it examines factors pertaining to government policy, demography and the experience of migration to argue the relevance of a cultural perspective in mainstream family therapy discourse. The paper then looks at two central consequences for family therapy and training — cultural oppression and maintaining the status quo — if a cultural perspective continues to be neglected. It then proposes ways that therapists can introduce a cultural perspective in their thinking and clinical work. The paper concludes with a case vignette which illustrates some of the ideas.     

Working with African American clients: considering the "homeplace" in marriage and family therapy practices

In this article, we discuss perspectives on the "homeplace" that are important to consider in marriage and family therapy involving African American clients. The homeplace comprises individual and family processes that are anchored in a defined physical space that elicits feelings of empowerment, rootedness, ownership, safety, and renewal. Critical elements of the homeplace include social relationships that shape individuals' and families' sense of social and cultural identity. We draw on our ethnographic and clinical research with African American families in urban and rural settings to describe typical schisms between therapists and African American clients when communicating about the homeplace. We also explore the impact of homeplace disruptions on experiences of "yearning." Recommendations for integrating a homeplace perspective into therapy practices are provided.     

Social Constructionism and Supervision: Experiences of AAMFT Supervisors and Supervised Therapists

A phenomenological research process was used to investigate the supervision experience for supervisors and therapists when supervisors use a social constructionist perspective. Participants of the one‐to‐one interviews were six AAMFT Approved Supervisors and six therapists providing counseling to individuals, couples and families. The findings suggest supervisors were committed to their self‐identified supervision philosophy and intentionally sought out congruence between epistemology and practice. The shared experience of therapists indicates they associated desirable supervision experiences with their supervisors’ social constructionist perspective. Our findings also indicated that supervisors’ and therapists’ understanding of social constructionism included the more controversial concepts of agency and extra‐discursiveness. This research has taken an empirical step in the direction of understanding what the social constructionist supervision experience is like for supervisors and therapists. Our findings suggest a linkage between epistemology and supervision practice and a satisfaction with the supervision process.     

CRITIQUING THE NEW EPISTEMOLOGIES: TOWARDMINIMUM REQUIREMENTS FOR A SCIENTIFIC THEORY OF FAMILY THERAPY*

The purpose of this paper is to critically analyze the structures of the new epistemologies. Epistemology is a technical term within the field of scientific philosophy. When it is used looselyby family therapists, confusion results. The central argument of the present author is that the new epistemologies are, in fact, weak theories. It is suggested that the practice of using the term “epistemology” to denote theory or paradigm, be discontinued. A more limited and narrowly defined use for the term “epistemology” is proposed. Specifically, this paper presents: (a) a discussion ofthree areas of philosophy that serve as foundations for the construction of scientific theory, (b)a critical analysis of the new epistemologies, (c) a logical structure for scientific family therapy theory, and (d) minimum requirements for a scientific theory of family therapy.     

FAMILY THERAPY WITH INTELLECTUALLY AND CREATIVELY GIFTED CHILDREN

Few family therapists have expertise in the psychology of giftedness, and little research has been conducted to determine the effectiveness of family therapy with talented children and their families. The purposes of this paper are: (1) to provide family therapists with information on the unique psychosocial stressors associated with giftedness and (2) to stimulate further research and development on the efficacy of family therapy in alleviating distress and actualizing potential in gifted and talented children and their families. The paper provides a critical overview of the existing research literature on gifted children and their families. First, current conceptualizations of giftedness are described. Then the research literature on the characteristics of intellectually and creatively gifted children and their families is reviewed with an emphasis on the endogenous (individual) and exogenous (systemic) factors that can create or exacerbate psychosocial problems. Finally, we suggest an eclectic, eco-systemic approach to three common concerns that bring gifted children and their families to therapy.     

Supervision in Family Therapy: A Developmental Perspective

A group model of supervision of family therapy was implemented by a team of three supervisors with doctoral students in counseling psychology. It was believed that such an approach would provide students with more opportunity to work as therapists with families and to observe a greater variety of families, therapists, and therapeutic styles than in other models. Interchange in supervisory sessions focused on co-therapy issues, observation skills, family dynamics, differing therapeutic techniques and approaches, and planning and goal setting in therapy. This experience contributed to the professional and personal growth and development of students.     

Basic family therapy skills, I: conceptualization and initial findings

This is the first report on a program of research designed to identify the most important characteristics of the beginning marriage and family therapist. The paper first surveys the literature in family therapy, social work, and psychology and finds that, although these factors are discussed for beginning psychotherapists, no set of skills are derived empirically. This study recruited all available members of the American Family Therapy Association (AFTA) and Approved Supervisors of the American Association of Marriage and Family Therapy (AAMFT) who were experienced educators and trainers of family therapists. After nominating the most important generic-type characteristics for beginning family therapists, the participants rated the items, yielding a list of not only the most important skills, but also personal traits of beginners based on mean scores of the ratings. The final section of the paper discusses the implications of these findings and notes the current and future activities of the research program.     

AN ALTERNATIVE TO MANAGED CARE: A "GUILD" MODEL FOR THE INDEPENDENT PRACTICE OF PSYCHOTHERAPY

As health care is reconfigured by HMOs and managed care organizations, family therapists often have to decide whether or not to cooperate with the new power structures and their ways of doing things. The chief concern of many therapists is the ehtical bind created when the managed care orgranization demands breaches of confidentiality or makes decisions about the course of treatment that may not, in the therapist's opinion, be in the best interest of the family. Associations of independent, nonmanaged care psychotherapists are springing up in response to these dilemmas. This paper describes the philosophical evolution and organizational development of one such association.     

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.     

WHAT'S IN A NAME? SOME CONFUSIONS AND CONCERNS ABOUT CONSTRUCTIVISM

As discussions about so-called 'epistemology' have receded within family therapy, discussions about te doctrine of constructivism have emerged to carry on the underlying impulse of those earlier discussions. This article contends that a constructivist epistemology is not a new doctrine in family therapy, but, rather, reflects a shift in emphasis in that discipline from a nontraditional use to the traditional use of the term "epistemology" uses that coexisted during the 'epistemology' debates of the early 1980s and that were the source of many confusions and logical contradictions. The articale also demonstrates how recent articulations of cosnstructivism have resulted in the same logical contradictions tht were committed during the earlier 'epistemology'; debates. The logic and utility of applying constructivism in particular, and epistemological analysis in general, to the practice of psychotherapy are questioned and considered.     

Action-oriented evaluation of an in-home family therapy program for families at risk for foster care placement

The purpose of this study was to conduct an action-oriented evaluation of an in-home family therapy program serving families deemed at risk for the placement of children in foster care. In this study, feedback was solicited from both clients and therapists. Results indicate "duality" associated with several aspects of in-home family therapy, including the opportunity to observe families in their own homes versus the vulnerability some families feel when therapy is conducted in-home; therapists suggesting that sufficient training is required for in-home family therapy to be effective versus clients' opinions that therapists' lived experiences are more relevant; and the importance of the therapeutic alliance versus feelings of abandonment upon termination. Implications for researchers and practitioners are discussed.     

Cultural and Class Values In Family Process

Based on the sociological research of Kohn (1977), several clinical and theoretical perspectives on the family are criticized for paying insufficient attention to class and cultural distinctions both in constructing normative images of the family and in conceptualizing therapeutic intervention. It is suggested that the "democratic" model of healthy family interaction is, to some degree, class- and culture-specific so that sociologically undifferentiated views of the family are likely to prove ethnocentric. Family therapists are therefore urged to be attentive to sociodynamic as well as psychodynamic factors present within both family and therapeutic interactions.     

BIOLOGICALLY BASED DEFICIT IN THE IDENTIFIED PATIENT: INDICATIONS FOR PSYCHOEDUCATIONAL STRATEGIES

The phrase "identified patient" has attracted a wide following among family therapists representing a variety of approaches to family therapy. It is based on the assumption that persons referred for psychotherapeutic treatment are often incorrectly labeled "patients" when, in fact, their symptoms are manifestations of family, not individual, dysfunction or pathology. It is the thesis of this article that when biologically based deficits in the identified patient are a salient determinant of interpersonal dysfunction, such reframing is inappropriate. Psycho-educational strategies for treating families of persons with such physically based conditions as learning disability, attention deficit disorder, epilepsy, autism, and various medical illnesses and handicaps, are recommended.     

Personality theory and clinical social work practice

This paper investigates the relevance of personality theories for clinical social work practice. Writings in comparative personality theory and the epistemology of clinical psychology and social work are sources. Clinical action, the time with a client, and clinical reflection, the thinking about or presenting of the client, are seen as importantly different moments in practice. Clinical action is characterized by humanistic, narrative forms of thought more than scientific, paradigmatic ones. Formal theory informs action indirectly through its shaping of the clinician's philosophy, attention, and priorities. Clinical reflection is shaped more directly by formal theories and benefits from the holding of multiple theories.     

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.     

Same-Sex Marriage and the Boundaries of Diversity: Will Marriage and Family Therapy Remain Inclusive of Religious and Social Conservatives?

The expanding legalization of same-sex marriage in the Western World may pose significant challenges for the relationship between many religious and socially conservative marriage and family therapists and their professional associations. In the present analysis, I look to the field of moral psychology, particularly Haidt's Moral Foundations Theory, to provide greater clarity regarding the nature of this tension and a resultant tightening of the boundaries of acceptable diversity that could ensue. I then outline some concerning indicators from mental health associations relative to their potential willingness to tolerate conservative perspectives in meaningful ways and identify some specific areas of possible tension for conservative therapists trying to integrate their deeply held moral values into ethical practice with same-sex couples, with a specific reference to the viability of “conscience clauses” and values-based referrals. I conclude with some recommendations through which the field of marriage and family therapy can reduce the potential for conflicts and thereby reassure these clinicians that they continue to be welcomed even if their vision of marriage differs from that which is formally endorsed by their professional associations.