The feminist/emotionally focused therapy practice model: an integrated approach for couple therapy

Emotionally focused therapy (EFT) is a well-developed, empirically tested practice model for couple therapy that integrates systems, experiential, and attachment theories. Feminist family therapy theory has provided a critique of biased assumptions about gender at play in traditional family therapy practice and the historical absence of discussions of power in family therapy theory. This article presents an integrated feminist/EFT practice model for use in couple therapy, using a case from practice to illustrate key concepts. Broadly, the integrated model addresses gender roles and individual emotional experience using a systemic framework for understanding couple interaction. The model provides practitioners with a sophisticated, comprehensive, and relevant practice approach for working with the issues and challenges emerging for contemporary heterosexual couples.     

Harnessing the Power of Play in Emotionally Focused Family Therapy With Preschool Children

Emotionally focused family therapy (EFFT) is an attachment‐based therapy model that has been used with older children and adolescents. More recently, it has been suggested for use with young children. EFFT holds promise as a clinical treatment for young children coping with attachment problems, but more detailed guidelines are needed for implementing the model with this age‐group. Whereas preschool and kindergarten age children are less able to participate in talk therapy than older children, accommodations need to be made to this approach when the identified patient is a young child. This article offers a variety of play therapy activities that may be incorporated within an EFFT framework to strengthen the emotional bonds in families with children ages four to six.     

A BLUEPRINT FOR INCREASING THE RELEVANCE OF FAMILY THERAPY RESEARCH

Family therapy research and psychotherapy research in general have been criticized for their lack of relevance to clinical practice. This paper presents a fivestage model that family therapy researchers can follow to increase the relevance of their work for clinicians and other consumers of family therapy research. Using lessons derived from private industry, the research model is based on a marketing and developmental perspective.     

The Therapeutic Pyramid: A Common Factors Synthesis of Techniques,Alliance, and Way of Being

Common factors in therapy such as the therapeutic alliance and client motivation have been found to account for more change than therapy models. But common factors have been critiqued as only lists of variables that provide little practical guidance. Some researchers have demonstrated that certain common elements (e.g., the therapeutic alliance) account for more variance than others (e.g., techniques), suggesting that some factors should be emphasized over others. Such findings suggest the need for alternatives to model‐based therapy, with one alternative being meta‐models, or “models of models,” that focus on how therapeutic factors interact with each other to produce change. The purpose of this article is to propose a meta‐model describing the relationship between two specific common factors—the therapeutic alliance and interventions. We also propose a new factor—a therapist's way of being—that we believe is foundational to effective therapy. The model is proposed in pyramid format, with techniques on top, the therapeutic alliance in the middle, and therapist way of being as the foundation. The hierarchical relationships between these three concepts are discussed, along with implications for training, research, and therapy.     

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.     

The Maudsley Model of Family Therapy for Children and Adolescents with Anorexia Nervosa: Theory,Clinical Practice,and Empirical Support

The aim of this paper is to present the Maudsley model of family therapy for children and adolescents with anorexia nervosa, one that integrates principles and skills from a variety of models. The Maudsley model is of prime importance because of its non‐pathologising approach to families, because its techniques have been published in sufficient detail for standardised application by clinicians, and because of its strong history of empirical support. It is also a model that integrates both modernist and constructivist influences from the history of family therapy.     

Financial therapy in foster care

The introduction of prevention-oriented financial therapy in foster care is presented. Consideration of emotional demands in financial literacy and therapy is examined and remedies provided that address them. Revisions to the five-step model of financial therapy are considered in terms of the needs of foster care client populations. A pared down prevention model provides aging out foster children with a means of successfully navigating lifestyle challenges. The need to empirically evaluate the prevention model is advised to demonstrate its value with this population.     

What clients of couple therapy model developers and their former students say about change, part II: model-independent common factors and an integrative framework

Proponents of the common factors movement in marriage and family therapy (MFT) suggest that, rather than specific models of therapy, elements common across models of therapy and common to the process of therapy itself are responsible for therapeutic change. This article-the second of two companion articles-reports on a study designed to further investigate common factors in couple therapy. We used grounded theory techniques to analyze data from interviews with MFT model developers Dr. Susan M. Johnson, Dr. Frank M. Dattilio, Dr. Richard C. Schwartz, former students of Dr. Johnson and Dr. Schwartz, and each of their clients who had been successful in couple therapy. This article reports model-independent variables, that is, general aspects of therapy that are not directly related to the therapist's model. Model-independent categories include client variables, therapist variables, the therapeutic alliance, therapeutic process, and expectancy and motivational factors, each with several subcategories. We also present a conceptual framework that outlines how model-dependent and model-independent common factors may interact to produce change. We discuss our findings and proposed framework in relation to the current common factors literature in psychology and MFT. We also discuss clinical, training, and research implications.     

Endothelial progenitor cell therapy for atherosclerosis: the philosopher's stone for an aging population?

Much of the increased risk for atherosclerosis progression with age may be a result of age-related declines in the capacity of precursor cells to repair damage in the arterial endothelium. To estimate the impact of progenitor cell therapy for atherosclerosis on cardiovascular disease (CVD) mortality, life expectancy, and survival, as compared with the lifetime control of conventional risk factors, we modeled the health effects of bone marrow-derived endothelial progenitor cell therapy using data from the 1950 to 1996 follow-up of the Framingham Heart Study. To model cardiovascular disease mortality, we assumed that progenitor cell therapy was applied at age 30, with the effect assumed to be a 10-year delay in atherosclerosis progression. Age projections were constructed analytically using the stochastic process model for risk factor dynamics and mortality and microsimulation techniques. We considered three types of interventions: (i) keeping risk factors within selected limits to model current clinical recommendations; (ii) an age shift of 10 years to model the effects of progenitor cell therapy; and (iii) elimination of a competing risk (such as cancer). Our study suggests that progenitor cell therapy might increase life expectancy in the population as much as the complete elimination of cancer (in females, an additional 3.67 versus 3.37 years; in males, an additional 5.94 versus 2.86 years, respectively).     

Impact Evaluation of a Cognitive Behavioral Group Therapy Model in Brazilian Sexually Abused Girls

This study evaluated the impact of a cognitive behavioral group therapy model in Brazilian girls who had experienced sexual abuse. The effect of the waiting period before treatment and the enduring effectiveness of the treatment after six and 12 months were also evaluated. Forty-nine female sexual abuse victims between the ages of 9 and 16 completed instruments measuring depression, anxiety, stress, and post-traumatic stress disorder before, during, and after the group therapy. The group therapy had a positive impact on their psychological functioning, significantly reducing symptoms of anxiety, stress, and post-traumatic stress disorder. The therapeutic effects lasted six to 12 months after the treatment ended. The model proved effective for treating young female victims of sexual abuse.     

PREDICTING MARITAL THERAPY DROPOUTS*

The purpose of this study was to predict therapy dropouts using data gathered at marital therpay intake. Intake data included standardized assessments and demographic information. The sample consisted of 474 couples who were seeking marital therapy and who attended at least one therapy session. Seventy-two couples met the dropout criteria, and a random sample of equal size was drawn from the rest of the couples for the analyses. Data from these two groups of couples were analyzed with multiple regression and discriminant analysis formulas. Three variables-having less than two children, having a male intake clinician, and a presenting problem relating only to one spouse-were significant predictors in accounting for couples who would drop out of therapy. In the best model, high phobic anxiety scores for husbands and a presenting problem relating to parenting, along with the other three variables, produced a model that accurately classified 82% of the couples who dropped out of therapy.     

Towards the Incorporation of Forgiveness Therapy in Healing the Complex Trauma of Parental Incarceration

This paper explores the potential contribution of forgiveness therapy to the treatment of minor children who have experienced the adversities associated with parental incarceration. Theoretical perspectives on the imprisonment of parents and on forgiveness, and a survey of existing forgiveness therapy (FT) models points to the utility of this therapeutic modality. DiBlasio’s family based conjoint model of forgiveness therapy is delineated and case illustrations of its application with children of incarcerated parents are presented. The possibility of forgiveness therapy facilitating successful family reentry is discussed, along with important limitations and contraindications of FT with youngsters whose parents are involved in the criminal justice system. Implications of forgiveness therapy for the field of practice of child and adolescent social work are considered.     

System Therapy: Epistemology, Paradigm and Pragmatics

In this paper the author presents a model of therapy which he proposes to call 'system therapy.' Episteme, some basic concepts, stages of the therapeutic process and the training of system therapists are discussed. This paper is meant to be an introduction into system therapy and does not claim to attempt an exhaustive presentation of a complex subject.     

Family Therapy—Review of Outcome Research

This paper presents an overview of the literature on outcome research in the field of family therapy, examines the conclusions reached by researchers and reviewers and comments on the adequacy of such a model of research for evaluation of family therapy as a method.     

Family Therapy in Child and Adolescent Mental Health Practice: Integrating Family Therapy in Child and Adolescent Mental Health Practice: An Ethic of Hospitality

This article integrates family therapy in contemporary child and adolescent mental health services as an evidence‐based practice. An integrative practice model is proposed where contextual approaches like systemic and narrative therapy complement and enrich individual problem‐focused models such as biological psychiatry and cognitive therapy. This is based on an ethic of hospitality towards all therapy discourses and the following best practice guideline: ‘To make optimum space for a systemic and narrative understanding contributes to evidence‐based practice in a contemporary mental health service.’ After discussing some dilemmas of integrative practice, I illustrate the therapeutic process by a detailed example of integrative family therapy with a depressed suicidal adolescent.     

Predicting Change in Marital Satisfaction Throughout Emotionally Focused Couple Therapy

Emotionally focused couple therapy (EFT) is an empirically validated approach to couple therapy that uses attachment theory to understand the needs and emotions of romantic partners. EFT is recognized as one of the most effective approaches to couple therapy, but to guide therapists in their use of EFT, a theoretically based model to predict change is needed. This study tested such a model by recruiting 32 couples, and 14 therapists who provided approximately 21 sessions of EFT. Couples completed self‐report measures of marital satisfaction, attachment security, relationship trust, and emotional control at pre‐ and posttherapy and after each therapy session. Results of hierarchical linear modeling suggested that individuals higher on self‐report attachment anxiety and higher levels of emotional control had greater change in marital satisfaction across EFT sessions. Assessing attachment security at the start of therapy will inform therapists of the emotion regulating strategies used by couples and may help couples achieve positive outcomes from EFT.     

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     

BOOK REVIEWS

Book reviewed in this article:
Hoffman, Lynn. Foundations of family therapy: A conceptual model for systems change.
Zeig, Jeffrey K. (Ed.). Ericksonian approaches to hypnosis and therapy .
Humphrey, Frederick, G. Marital therapy .
L'Abate, Luciano (Ed.). Values, ethics, legalities and the family therapist .
Visher, Emily and Visher, John. How to win as a stepfamily .
Araoz, Daniel. Hypnosis and sex therapy .