WHY FAMILY THERAPY SHOULD GO BEYOND HOMEOSTASIS: A KUHNIAN REPLY TO ARIEL,CAREL AND TYANO

The thesis of “Beyond Homeostasis” is (a) that the discourse of family therapists unquestionably shows that family therapists have tended to see homeostasis as a trait of families; and (b) that such a view of homeostasis is inconsistent with the systemic paradigm. Therefore, family therapy should go beyond such an understanding of homeostasis. Ariel et al. may have failed to grasp this argument; they have certainly chosen to ignore it. Ariel et al. have provided a logical empiricist explication of the nonsystemic version of homeostasis which is portrayed in the discourse of family therapists. I still argue that family therapy should go beyond such an understanding of homeostasis.     

Family Therapy with Substance Abusers: Legal Considerations Regarding Confidentiality*

This paper explores various problems in the area of confidentiality often confronted by family therapists working with substance abusers. The scope and intent of the Federal Regulations controlling the release of all alcohol and drug abuse patient records and information are examined. Also, the rules regarding the release of confidential information by family therapists to attorneys, other family members and third-party funding sources are explained. Suggestions regarding the release of information in questionable cases are made. Finally, the growing use of family therapy in treating substance abusers, and its impact on confidentiality law and policy, is noted.     

THE FAMILY THERAPIST'S GUIDE TO PSYCHOPHARMACOLOGY: A GRADUATE LEVEL COURSE

Although medication has not traditionally been part of the family therapist's venue, family therapists have recently begun to consider medication as a treatment option. The increasing success of pharmacologic interventions and the widespread use of the biopsychosocial model have resulted in a new openness to the possibility of psychopharmacology although significant controversy still remains. A curriculum for a graduate level course in pharmacology for family therapists is outlines. The three components of the course are (a) specific pharmacology content; (b) the context of psychopharmacology, including how to access psychiatric resources; and (c) meta-isssues dealing primarily with political and economic concerns.     

Family Law and Family Systems: Multidisciplinary Training for Professionals

The Family Court in New Zealand has become the crucible for the mixing of legal and mental health professionals. Low key workshops convened by family therapists for multidisciplinary groups have made successful use of family therapy models and expertise to provide a base for the conciliation and mediation alternative to the adversary system so common in law and in earlier family litigation. Enhanced cross-disciplinary understanding and morale appear to have accompanied the more formal learnings in family therapy, and the programme as detailed is included as one possible structure on which such experiences might be offered by other therapists in other places.     

Are the Children Playing Quietly? Integrating Child Psychotherapy and Family Therapy

Over many years, family therapy training programs have not included the engagement of children under seven. John Byng-Hall wrote in 1986 that family therapists could learn about understanding young children from child psychotherapists. It has long been my practice to include young children when working with families. This article describe ways of working that include young children's play as relevant information. I hope to encourage other child psychotherapists and family therapists to find better ways of integrating skills.     

A graduate course in marriage and family enrichment

Legislation aimed at decreasing the divorce rate and the resurgence of interest in marriage and family enrichment have propelled educators to consider how well they are training new therapists in the preventive approaches to therapy. In this article, we present a graduate course to educate students about the enrichment movement and skill- and competency-based approaches to family intervention. We provide a general outline for teaching the course as well as specific resources and guidelines that can be of value to all marriage and family therapy practitioners.     

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.     

TEACHING PROFESSIONAL WRITING TO FAMILY THERAPISTS: THREE APPROACHES

The authors present three educational approaches designed to demystify the writing process and to support better writing skills among family therapists. One framework is an academic course in professional writing, another is a writing seminar for family therapy and physician trainees within a medical school setting, and the third is a 2-hour continuing education writing workshop for family therapists. Each is replicable within a variety of settings.     

EXPOSURE TO MARITAL AND FAMILY THERAPY IN MEDICAL SCHOOL: A STUDENT PERSPECTIVE

Most marital and family therapists, both medically and nonmedically trained, regularly interact with physicians on a professional basis. Though some physicians receive specific training in marital and family therapy in their postgraduate residency programs, (notably those in psychiatry and family medicine), for many, the only academic exposure they receive to this field comes during a 6- to 10-week clinical clerkship in psychiatry during their third or fourth year of medical school. No study could be located which examined marital and family therapy training in undergraduate medical education. The purpose of this study was to gain a better understanding of the level of marital and family therapy training in medical school and to provide information concerning physicians who are not family therapists, and how much knowledge about the field they can be expected to have.     

Improving Functioning of the Remarried Family System

This report presents salient issues for therapists in understanding and treating the remarried (Rem, second, blended, reconstituted or step) family. The structure of the remarried family is differentiated from that of the intact family. Specific treatment goals for Rem families are elaborated and various treatment modalities advocated. The need to include former spouses and to consider the meta family system are discussed. Common reactions and difficulties engendered in therapists when working with Rem systems are explicated.     

Expanding Systems Thinking: Incorporating Tools from Medical Sociology into MFT Education and Research

The field of marriage and family therapy has historically focused on dynamics within family systems, and at times the role of social and cultural factors external to the family. To date, however, little scholarship has examined how therapists themselves are embedded within a mental healthcare system. The purpose of this article is to demonstrate how structural components of the mental healthcare system shape the practice of therapy. We draw from the field of medical sociology to illustrate how three dominant structures—managed care, diagnosis, and evidence‐based models—are intertwining and mutually reinforcing systems that have significant and long‐term implications for systemic therapists and researchers. We recommend incorporating a sociological understanding of such structures into MFT education and research.     

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.     

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.     

Cybersex and the E‐teen: What Marriage and Family Therapists Should Know

Adolescents who use the Internet regularly (the “e‐teen”) present a new set of challenges for marriage and family therapists. This article introduces marriage and family therapists to (a) the basic technological concepts and unique psychological characteristics of the Internet important in understanding and addressing adolescent online sexual behavior, (b) the appropriate developmental expectations for teens online, including risk‐taking behaviors and critical decision‐making skills, and (c) suggested strategies for assessment, prevention, and intervention when dealing with problematic online sexual behavior in adolescents. Marriage and family therapists cannot ignore the role the Internet plays in adolescent sexual development and its implication for the family. This article will serve as a primer for the marriage and family therapist when presented with adolescents who engage in online sexual behaviors.     

THE INTERPERSONAL CONTEXT OF OBJECT RELATIONS: IMPLICATIONS FOR FAMILY THERAPY*

Psychodynamic theory and family systems theories have come to represent competing orientations in the understanding of human behavior. This paper extends the quest for an integration of these perspectives. This is done by mapping ideas from one orientation onto constructs from the other. Case examples illustrate the ideas and demonstrate how inner dynamics and interactional behavior dovetail to create systemic and personal crises. Clinical implications highlight the need (a) for psychodynamic therapists to recognize the contextual forces that activate personality structures and (b) for systems therapists to recognize the idiosyncratic meanings of interactional behaviors.     

Measuring the Effect of Sexual Health Education Training in Professionals: Structure of the Sexual Health Education for Professionals Scale (SHEPS) Among Marriage and Family Therapy Graduate Students

Marriage and family therapists and sexual health therapists are likely to receive training in graduate school that prepares them to encounter sexual concerns among clients, but there are few standard ways to assess the efficacy of this training. The Sexual Health Education for Professionals Scale (SHEPS) was developed to address this deficit. In this preliminary study, 163 marriage and family therapy graduate students completed the SHEPS prior to starting a graduate course in assessing and treating sexual concerns. Exploratory factor analyses indicate that the SHEPS subscales have good psychometric properties. The Skills and Knowledge subscales have factors labeled Typical Clients, Special Clients, Conservative Clients, and Ethically Complicated Clients. The Attitudes subscale had factors called General Sexual Attitudes, Valuing Sexual Health Training, Open to Providing Sexual Help, and Conservatism. This new instrument may be used to assess education and training of sexual health and marriage and family therapists. Larger sample sizes and longitudinal studies are needed in future.     

Integrating Reflective Practice in Family Therapy Supervision

This paper discusses how to integrate reflective practice in the family therapy supervisory relationship. This enables family therapists to think creatively, be insightful, and develop a range of perspectives regarding systemic formulation and practice. It encourages review of the past and promotes understanding in the present with the aim to improve therapists work with families in the future. Reflective practice encourages independent thinking and learning and helps therapists to develop a systemic process of critical enquiry to investigate and critique their own practice. It encourages therapists to be self‐reflective and develop confidence to think hypothetically regarding change. This allows them to pose questions for exploration, construct a new lens to conceptualise therapy and the therapeutic relationship and develop awareness of the personal as well as the professional self.     

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.     

SEXISM IN FAMILY THERAPY: DOES TRAINING IN GENDER MAKE A DIFFERENCE?

The purpose of this study was to investigate the clinical decision making of marriage and family therapists who had no training in gender compared to those who had such training, either through a separate course or by having gender issues integrated throughout the curriculum. Specifically, levels of feminism and sexism in the clinical assumptions and interventions of therapists were evaluated using clinical vignettes. Participants for this study included 150 beginning or entry-level therapists from marriage and family therapy training programs in academic settings. Of the 102 participants with some training in gender isues, 64% reported having received gender training from a faeminist perspective. contrary to expectations, a multivariate analyssis of variance revealed that training in gender issues alone did not significantly influence levels of feminism and sexism in clinical decision making. However, the levels of sexism in clinical interventions were significantly lower if therapists had received gender coursework from a feminist perspective, whether in a separate course or integrated throughout the curriculuim. These findings raise a question as to the wtility of teaching gender issues if what is taught and how it is taught are not also considered.