Spiritual assessment in marital and family therapy: a methodological framework for selecting from among six qualitative assessment tools

Emerging professional and cultural developments underscore the importance of spiritual assessment. Most marriage and family therapists, however, appear to have received little training on the topic. Consequently, this article overviews a complementary family of six recently developed qualitative assessment approaches or tools, an initial brief assessment tool and five comprehensive assessment tools, and presents a methodological framework for using the six tools. To help decide whether or not a comprehensive assessment is warranted after conducting an initial brief assessment, two general guidelines are offered. Suggestions for selecting the appropriate comprehensive assessment tool are also presented, and summarized graphically in the form of a decision tree. The overall methodological framework is designed to be congruent with the recent spiritual assessments recommendations issued by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the largest healthcare accrediting organization in the United States.     

Spiritual issues in family therapy: a graduate-level course

With the advent of the biopsychosocial approach in family therapy, the domain of spiritual issues is increasingly being recognized as important to families. This article will describe a graduate-level seminar on Spiritual Issues in Family Therapy at the University of San Diego that offers family therapy students the opportunity to examine issues of spirituality, religion, and meaning and their place in therapy. One premise of the course is that research has demonstrated that most clients consider their spiritual life to be relevant to personal problems and would prefer a therapist who is comfortable with such topics. The goals of the course include (1) training in opening a dialogue with individuals and families about spiritual issues and discerning when referral may be appropriate; (2) expanding an awareness of wisdom traditions through use of comparative religions material; and (3) identifying from current practice many of the spiritual issues that may arise in the clinical setting.     

Changing marital and family patterns: a test of the post-modern perspective

"Four central constructs of the post-modern perspective are extended and tested using secondary analysis of [U.S.] Census data and the NORC General Social Survey: 1972-94 data sets. The modified postmodern themes of: (1) the decline of a single universal family organizational standard, and (2) growing cultural diversity...were supported by examining changes in American family structure, attitudes toward such structural changes, and changing attitudes toward marital and family patterns over the last quarter century. However, little support was found for the greater use of, and reliance on, (3) the mass media. Mixed results were found on the fourth construct, greater variance in, and/or loss of, personal happiness or personal or family life satisfaction."     

Boundaries and family practices: implications for assessing child abuse

Family practices related to hygiene, affection behavior, and privacy were studied using a sample of mental health and child welfare professionals. The professionals were asked to use their own experience to state up to what age it was acceptable for parents and children of the same gender and mixed gender to engage in certain family practices. For virtually all family practices, respondents reported lower appropriate ages for mixed gender pairs. Family practices were acceptable for mothers with their daughters up to older ages than fathers with their sons. Results indicate high variability in the responses regarding appropriate ages, as well as whether the behavior was ever acceptable. The implications of these substantial differences among professionals who often assess these practices as "soft signs" related to abuse are discussed.     

The evaluation ranking scale: a new methodology for assessing satisfaction

Most patient satisfaction scales produce high, undifferentiated levels of reported satisfaction that fail to detect program areas that consumers do not like. Methodological problems apparently contribute to these results. An alternative procedure, the Evaluation Ranking Scale (ERS), was formulated and tested. A 2 X 3 design was employed with 246 public health center patients randomly assigned to one of two measurement techniques (ERS vs. a global measure) and one of three informational sets. A secondary group of subjects was a convenience sample of 26 staff members, which allowed comparisons of staff evaluations of the health center to patients' evaluations of the health center. Compared to the global measure, the ERS provided more specific information about particular program components, was more discriminating, and resulted in mean satisfaction scores that were significantly lower. This new approach may be a more effective technique for assessing the psychosocial effectiveness of human service programs.     

Aging issues: unanswered questions in marital and family therapy literature

Researchers have reviewed couple and family therapy journals to determine the extent to which issues concerning older populations are addressed. In an effort to extend previous work, we conducted content analyses of 957 articles published in three of the leading marital and family therapy journals between 1997 and 2006. From the articles, 27 (2.8%) mentioned aging or included older adults in their sample. Results indicate that the number of articles emphasizing older adults has not substantially increased. While this result has been substantiated by other researchers in previous years, a new finding in this study concerns the quality of articles on aging issues. The articles reviewed in this study indicated a greater focus on aging issues and addressing issues during this life cycle stage.     

Interpersonal relatedness and psychological functioning following traumatic brain injury: implications for marital and family therapists

Recovery from a mild-to-moderate traumatic brain injury (TBI) is a challenging process for injured persons and their families. Guided by attachment theory, we investigated whether relationship conflict, social support, or sense of belonging were associated with psychological functioning. Community-dwelling persons with TBI (N = 75) and their relatives/significant others (N = 74) were surveyed on relationship variables, functional status, and TBI symptom severity. Results from this cross-sectional study revealed that only sense of belonging was a significant predictor of postinjury psychological functioning, although interpersonal conflict approached significance. No relevant preinjury or injury-related variables impacted these relationships, except marital status. Our findings suggest that interventions targeting strengthening the injured persons' sense of belonging and lowering interpersonal conflict may benefit those living with TBI.     

The Lichtenberg Financial Decision Screening Scale (LFDSS): A new tool for assessing financial decision making and preventing financial exploitation

ABSTRACT

One of the challenges in preventing the financial exploitation of older adults is that neither criminal justice nor noncriminal justice professionals are equipped to detect capacity deficits. Because decision-making capacity is a cornerstone assessment in cases of financial exploitation, effective instruments for measuring this capacity are essential. We introduce a new screening scale for financial decision making that can be administered to older adults. To explore the scale’s implementation and assess construct validity, we conducted a pilot study of 29 older adults seen by APS (Adult Protective Services) workers and 79 seen by other professionals. Case examples are included.     

Review of outcome research on marital and family therapy in treatment for alcoholism

This review of controlled studies of marital and family therapy (MFT) in alcoholism treatment updates the earlier review by O'Farrell and Fals-Stewart (2003). We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, both Al-Anon facilitation and referral and spouse coping skills training (based on new findings) help family members cope better, and CRAFT promotes treatment entry and was successfully transported to a community clinic in a new study. Once the alcoholic enters treatment, MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. New BCT studies showed efficacy with women alcoholics and with gay and lesbian alcoholics, and BCT was successfully transported to a community clinic, a brief BCT version was tested, and BCT was adapted for family members other than spouses. Future studies should evaluate the following: MFT with couples where both members have a current alcohol problem and with minority patients, mechanisms of change, transportability of evidence-based MFT approaches to clinical practice settings, and replication of MFT outcomes of reduced partner violence and improved child functioning.     

View_net: A new tool for network analysis

Evidence from a variety of sources suggests that visual representations can facilitate the analysis of complex relational data, stimulate theoretical insights, and help to convey the results of research to relevant audiences. Advances in computer graphics technology in the last decade have made it possible to create and manipulate complex visual images in real time and these advances provide the basis for developing new tools for network analysis. This paper describes the present state of the art of interactive computer graphics, and a graphics package for interactive visually-assisted network analysis — VIEW_NET — is discussed and illustrated.     

Love attitude and marital adjustment in the family life cycle

The present study examines husband and wife perceptions of attitude toward love and marital satisfaction through seven family life cycle stages. A significant relationship was determined between husbands’ and wives’ attitude toward love and marital satisfaction for couples in the early years of marriage with no children, and for couples with children in the preschool years. Marital satisfaction and attitude toward love seem to function more independently of one another in the other family life stages. Overall, husbands vary slightly more than wives on marital satisfaction and attitude toward love, but the pattern for both is similar in that each relationship is curvilinear.     

The treatment of sexual problems in marital and family therapy

With the proliferation of new research data and clinical practice techniques for dealing with sexual dysfunction, many family and marital therapists whose patients express sexual complaints experience the need to integrate this knowledge into their practice. For many couples and therapists, the rapid treatment approaches to sexual difficulties are inappropriate or ineffectual, yet the current literature addresses itself to either sex therapyper se or marital therapy and rarely deals with an integration of the two. This paper presents guidelines for assessing the sexual difficulties in the context of the relationship and outlines techniques for addressing the sexual difficulties directly while maintaining a more traditional marital therapy approach.     

The truth and lie story: developing a tool for assessing child witnesses' ability to differentiate between truth and lies

Within the court arena, the credibility and competency of child witnesses often comes under scrutiny and the decision whether a child is considered to be credible or not strongly in?uences whether their evidence will be heard by the court. A child's ability to demonstrate that they understand the difference between truth and lies and the importance of telling the truth is synonymous with competency. Research suggests that many professionals undertaking the task of establishing competency ?nd it very dif?cult, especially with younger children (Aldridge and Wood, 1997, cited in Aldridge and Wood, 1998). This paper describes the process involved in developing an innovative tool for helping professionals assess whether a child understands the difference between truth and lies. The development of the tool arose from the concerns of of?cers from Northumbria Police Force (in the UK) relating to interviews following the protocol of the government's Memorandum of Good Practice (Home Of?ce and Department of Health, 1992) on interviewing child witnesses, and the need to establish whether child witnesses can differentiate between truth and lies. As an example of good practice, The Truth and Lie Story described here has now been included in the Home Of?ce (2002) guidance Achieving Best Evidence in Criminal Proceedings, which is a revision of the 1992 Memorandum of Good Practice. Copyright © 2004 John Wiley & Sons, Ltd.     

Becoming: Identity and spirituality

An individual’s identity answers the questions of who, what, where, and why the individual is. An overall identity is made up of multiple constituent identities. These identities may not be fixed over the life course, but may change as a result of conscious choices as well as serendipity or calamity—life transforming events which cannot be anticipated, which remove what had been the certainties and norms of life, and which can leave the individual disconnected from what had been her past and from her hoped for future. In this paper we develop a two-period behavioral model of an individual whose personal identity is an amalgam of N identities, one or more of which may be spiritual in nature. Some identities are actualized at a point in time and some remain latent. We model how individuals allocate resources among current and hoped for future identities, and how these resource allocation decisions and identity actualizations are affected by the interaction of choices and unanticipated external events. We argue why a spiritual identity may be actualized, how it interacts with other identities, and why, in giving context to an individual’s life, it enables her to define and to strive toward her overall identity—to become.     

Defining the psychomedical and systemic paradigms in marital and family therapy

A framework for defining paradigms within the field of marital and family therapy is presented. The term "paradigm" is critically analyzed as applied to mental health services. Paradigm crisis in marital and family therapy is described as resulting primarily from practical-theoretical, professional, andpolitical concerns rather than scientific anomaly. Subsequently, two paradigms are defined as related to marital and family therapy: the psychomedical and the social systems (systemic) paradigms. Both paradigms are defined according to basic propositions and methodological tenets. The need for, and the design of, critical paradigmatic experiments of the psychomedical paradigm against the systemic paradigm are addressed. Critical paradigmatic experiments are viewed as an offshoot of a postpositivistic empiricism in keeping with a contextual view of knowledge.     

The influence of marital and family therapy on health care utilization in a health-maintenance organization

Research has shown that people reduce their use of health care after individual psychotherapy. However, little research has been done to learn if marital and family therapy has a similar effect. Subjects (n = 292) from a health-maintenance organization were randomly selected according to the type of therapy they had received. Subjects' medical records were examined for 6 months before, during, and after therapy. Those who received marital and family therapy significantly reduced their use of health care services by 21.5%. These results show an "offset effect" for marriage and family therapy.