BASIC FAMILY THERAPY SKILLS, IV: TRANSGENERATIONAL THEORIES OF FAMILY THERAPY

This pape focuses on the basic skills and compentencies of transgenerational approaches to family therapy, the fourth report of a program of research surveys by the Basic Family Therapy Skills Project. In the first survey, a panel of family therapy educators listed the most critical or basic skills or compentencies of beginning family therapist with a transgenerational orientation. In the third survey, self-selected respondents rated these items according to degree of importance for beginning family therapists. Rankings of the items according to mean scores of the Likert responses indicate that transgenerational family therapy skills are founded in theory and can be identified behaviorally. The most important skills are those that use the self of the therapist to understand and utilize transgenerational family therapy skills for both therapist and client. Also listed are skills that many raters deemed "generic" rather than specifically related to transgenerational family therapy. Other findings and their implications for the future training of family therapists are discusses. Although the paper is intended for family therapy educators interested in their colleagues' ideas about critical skills in trans-generational family therapy, theorists and clinicians may also find it useful.     

THE EVALUATION PHASE OF SYSTEMIC FAMILY THERAPY*

The initial, evaluation phase of family therapy is of decisive importance within the systemic perspective. Contacting a therapist is always a complex action for a family. The therapist's evaluation must include the possibility that continued contact may influence the family negatively and limit their potential for change. If there appears to be a logical context in which continued therapy can be justified, it will be necessary to use the first three or four sessions to collect essential data and to organize them meaningfully. It is essential to clarify the circular interaction that is maintaining the symptom, as well as the presence of specific family structures and traditions, and the kind of relationships the family attempts to establish with the therapist. On the basis of this information, the therapist can build models of the family's functioning. These models, according to general system theory, make possible logical intervention in complicated, living systems, without distorting them by artificially splitting them into their component parts. Two models that are important to our treatment perspective—the phenomenological and the mythical—are presented.     

MODES OF EXPRESSION IN FAMILY THERAPY: A PROCESS STUDY OF ROLES AND GENDER*

Twenty-two two-parent families with a referred adolescent were seen by 11 male and 11 female trainees in family therapy. Mothers, fathers, adolescents, and therapists were rated for verbal expression in affective, behavioral, and cognitive! attributional modes during the first session. Results clearly point to role and content difference in modes of expression. Of particular importance are differences by role which occured as a function of therapist gender. These differences suggest that therapist gender has an impact on family therapists' and family members' verbalizations in first sessions of family therapy.     

INFLUENCE OF THERAPIST SKILLS ON CLIENT PERCEPTIONS OF MARRIAGE AND FAMILY THERAPY OUTCOME: IMPLICATIONS FOR SUPERVISION

Clients seen in two marriage and family therapy training clinics were surveyed regarding treatment outcome. They rated their therapist's skill level on several therapist variables including "experience,""confident,""concerned," how well the treatment used seemed to "fit" their view of the problem and if the therapist seemed to "know how to deal" with their concerns. The variable of "fit" of treatment accounted for 35% of the variance in the client's perception of treatment outcome. "Concerned,""fit," and "knew how to deal" accounted for 36% of the variance in overall rating of the therapist. Suggestions for using these results in supervision of beginning therapists are given.     

THE POLITICS OF FUNCTIONAL FAMILY THERAPY: A FEMINIST CRITIQUE*

This paper examines the political processes inherent in Functional Family Therapy (FFT). It argues that this model of family therapy takes a covert political stance which reinforces traditional gender roles in both family and therapist. Of particular interest are FFT's affirmation of existing interpersonal functions in the family, as well as suggested therapist use of self. The implications of this stance are discussed, as well as recommendations for change.     

THE CLINICAL AND THEORETICAL IMPACT OF A CONTROLLED TRIAL OF FAMILY THERAPY IN ANOREXIA NERVOSA

The paper discusses the practical and theoretical implications of the results of a controlled treatment trial. Family therapy was compared with individual, supportive psychotherapy for the management of severe eating disorder. Family therapy was markedly more effective in achieving improvement in one of four subgroups of patients: (a): those with early onset, short duration; (b) early onset, duration more than 3 years; (c) late onset, after the age of 18 years; (d) those with bulimia nervosa. The therapies used are described, as are the changes in clinical practice arising from the study. Theoretical considerations concerning notions of family structure, the family life-cycle and symptomatic and family change are also discussed.     

THE SOCIAL CONTROL OF EMOTIONS IN THE DEVELOPMENT OF THERAPY RELATIONS

A study of therapy relations demonstrates how emotions are shaped by the more powerful member, the therapist. Emotional expressions are encouraged and regulated by the therapist in such a way that they support the nascent commitment structure. The targets of emotional expression shift as the therapeutic relationship takes shape until, in the final stage, they construct a shared sentiment regarding the relationship itself. This analysis identifies emotions as more than an indicator of power in a relationship, but as a tool in the development of power and commitment.     

DIFFERENT LENSES: VARIATIONS IN CLIENTS' PERCEPTION OF FAMILY THERAPY BY RACE AND GENDER

Race and gender have been given extensive theoretical and clinical attention in family therapy in the last decade. However, little empirical work has focused on their effect on therapy. The present study examines the effect of clients' race and therapists' race and gender on male and female partners' assessments of an initial and subsequent family/marital therapy session. One hundred twenty-six individuals, comprising 63 heterosexual adult couples, evaluated both the first and the fourth therapy session using the Session Evaluation Questionnaire (Stiles, 1980). Results indicated a strong effect for race, with black females rating initial sessions more negatively than white females when seeing a white therapist. Black men, however, had a more positive response than white men to the initial session, regardless of the race of the therapist. Over time, these differences decreased. The results suggest not only that race and gender may contribute to differences in partners' perceptions of the same session, but also that these differences are not static.     

EFFECTS OF SOLUTION FOCUSED THERAPY'S "FORMULA FIRST SESSION TASK" ON COMPLIANCE AND OUTCOME IN FAMILY THERAPY

This study investigated the immediate impact of a "solution focused" family therapy intervention on both the family and the therapist. Specifically, the study examined the differential effects of the formula first session task (FFST) recommended by de Shazer (1982, 1985), as well as the FFST plus solution focused therapy, as compared to a standard problem focused structural-strategic intervention. After one week, the groups receiving the FFST were significantly higher on measures of family compliance, clarity of treatment goals, and improvement in the presenting problem. However, there were no significant differences among groups on family optimism or on outcome after 10 sessions. The implications of these results are discussed.     

PREDICTORS OF SUCCESS IN EMOTIONALLY FOCUSED MARITAL THERAPY

This study examined client variables expected to predict success in emotionally focused marital therapy (EFT), now the second most validated from of marital therapy after the behavioral approaches. The relationship of attachment quality, level of emotional self-disclosure, level of interpersonal trust, and traditionality to the therapy outcome variables, marital adjustment, intimacy, and therapist ratings of improvement, was examined. These variables were chosen for their relevance to the theory and practice of EFT and to intimate relationships in general. Overall, therapeutic alliance predicted successful outcome; the task dimension of the alliance in particular predicted couples' satisfaction. More specifically, one dimension of female partners' trust, their faith in their partner, predicted couples' satisfaction at follow-up. Females' faith also significantly predicted males' level of intimacy at follow-up. Males who were most likely to be nondistressed at termination indicated higher levels of proximity seeking on an attachment measure at intake, and older males and males whose partners had higher levels of faith in them were more likely to be nondistressed at follow-up. Traditionality was not found to be significantly related to outcome. Couples who made the most gains at follow-up also indicated lower initial marital satisfaction and included males who indicated lower levels of use of attachment figure on the attachment measure at intake. Males who made the largest gains at termination were older and were rated as less expressive by their partner on self-disclosure measures at intake. Age was the only variable significantly related to males' gains in satisfaction at follow-up, Implications for the practice of marital therapy and future research are delineated.     

Family Therapy Retention: An Observation of First‐Session Communication

This study examined the relationship between communication patterns and retention among families (n = 18) receiving family therapy. Those that attended 12 sessions were labeled completers (n = 6), 4–8 sessions were middle dropouts (n = 6), and 1–3 sessions were early dropouts (n = 6). Audiotape recordings of the first therapy session were transcribed. The content (positive or negative) and total percentage of communications by the parent, adolescent, and therapist were coded. Completer and middle dropout parents (but not adolescents) showed higher talk time proportions than parents in the early dropout group. Completer families had higher percentages of therapist‐to‐parent communications, while early dropout families had higher percentages of therapist‐to‐adolescent communications. There were no significant differences between middle dropouts and completers in either content or total communications. These findings demonstrate the potential utility of examining within‐session communication patterns and suggest that within‐session processes may determine therapy retention.     

WORKING WITH MEN IN FAMILY THERAPY: AN EXPLORATORY STUDY*

The results of this exploratory research provide a beginning formulation of a gender-sensitive approach to working with men in family therapy. A panel of 36 family therapists endorsed 131 interventions as appropriate and effective ways to work with men. The results suggest the importance of therapist awareness of gender issues and socialization in working with male clients. Interventions were highly endorsed in the areas of developing therapist perceptual and conceptual skills regarding gender, promoting mutual responsibility, and challenging stereo-typical behaviors and attitudes. Surprisingly few interventions pertaining to structuring treatment and encouraging affective expression in men had sufficient consensus to be included in the final results.     

INFLUENCES ON THEf INCLUSION OF CHILDREN IN FAMILY THERAPY BRIEF REPORT

This study examined factors that influence family therapists to include children in or exclude them from therapy sessions. We hypothesized that therapist comfort, child problem type (internalizing vs. externalizing), family composition (one- vs two-parent families), and presenting problem (child-oriented problem vs. adult-oriented problem) affect therapists' inclusion of children. A survey of clinical members of AAMFT found that half of the therapists excluded children on the basis of their comfort and that those who felt more comfortable were more likely to include children in sessions. Therapists included children more frequently in cases of an internalizing vs. an externalizing child, more with single-parent than two- parent families, and more often when the presenting problem focused on a child than on an adult. Implications of the findings are discussed.     

POSITIVE PRACTICE IN FAMILY THERAPY

Positive practice, a brief integative approach to consultation with families, is described in this paper. A clear distinction is made between the stages of planning, assessment, therapy, and disengagement. Guideliness for progression from one stage to the next are provided. Frameworks for deciding who to invite to preliminary sessions and methods for planning and organizing lines of inquiry are incorporated into this approach to practice. A three-column model is used to construct formulations. The model allows therapists and clients to map information about the pattern of interaction around the presenting problem, beliefs that constrain family members from altering their roles in these problem-maintaining patterns, and factors that have predisposed family members to hold these beliefs. Positive practice offers methods for evolving new behavioral patterns and belief systems within sessions and for arranging homework tasks for clients between sessions. It also incorporates methods for dealing with resistnace, for managing therapeutic crises, for convening indivudial sessions and borader network meetings, for disengaging from the consultation process, and for recontracting for further episodes of therapy. This evolving approach to practice draws on ideas from many traditions within the family therapy field and takes account of recent research relevent to the practice of family therapy.     

INTERVENTION STRATEGIES: PREDICTING FAMILY THERAPY OUTCOME*

A pre-defined list of family therapy intervention strategies was used to predict post-therapy perceived life happiness and marital happiness among husbands and wives. Clients presented with both child and marriage-focused problems. The data were analyzed separately for husbands and wives. In general, favorable outcome for husbands was associated with active restructuring operations on the part of the therapist. Prediction of outcome for wives was less clear. However, wives did appear to respond favorably to less active interventions such as actualizing transactional patterns and reframing.     

HOME-BASED MARITAL THERAPY FOR MULTIPROBLEM FAMILIES*

This paper describes a project designed to reach low-income, multiproblem families, utilizing couples therapy in the home. By targeting a population of young couples under the age of 30 and with children no older than 7 years, the project aimed at prevention of severe family dysfunctioning and child disturbances. The major characteristics noted in the literature on multiproblem families are reviewed here, as are the treatment goals and techniques with such families. Most programs working with multiproblem families have focused primarily on the parental functioning in family therapy, and little has been reported on work with the couple in multiproblem families. The project described here used home visits by a male-female therapist team, including frequent individual and couple sessions. Therapeutic techniques based on modeling, role playing and demonstration were emphasized. In addition, tasks which increased the individual and couple functioning of the spouses were designed and successful completion was reinforced. An attempt was made to integrate the couple into the community and to create a network of support outside of the family, including friends and community services.     

AN EXPERIENTIAL APPROACH TO FAMILY-OF-ORIGIN WORK WITH MARITAL AND FAMILY THERAPY TRAINEES

An experiential approach to family-of-origin work with marital and family therapy students is offered as a complement to didactic study. Recommendations are made for structuring courses to include family-of-origin work without blurring the roles of instructor and therapist.     

AN ETHNOGRAPHIC STUDY OF CLIENT AND THERAPIST PERCEPTIONS OF THERAPY EFFECTIVENESS IN A UNIVERSITY-BASED TRAINING CLINIC

The purpose of this study was to explor client and therapist evaluations of direct practice in a university-based training center using an ethnographic research methodology. Client and therapist perceptions about the strengths and limitations of ethnographic practice evaluation were also analyzed. A domain analysis was performed on postsession interviews with both clients and practitioners over a 4- month period. Six core categories of client and therapist perceptions of therapy effectiveness emerged from a domain analysis: (a) changes associated with counseling, (b) important practitioner qualities, (c) effective interventions or techniques, (d) ineffective interventions or techniques, (e) recommendations for future sessions, and (f) strengths and limitations of ethnographic practice evaluation. Implications of this study for clinical practice, training, and future research are discussed.