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.     

Therapist effects on dropout in couple therapy

Marriage and family therapy scholars have argued that therapists play a crucial role in successful couple therapy, yet little research has empirically documented that the therapist in couple therapy has a significant impact on outcomes. Known as the study of therapist effects, this study sought to assess the amount of variance attributed to the therapist in couple therapy outcomes. Using dropout as the outcome variable, this study analyzed data from 1,192 couples treated by 90 masters and doctoral student therapists at a university‐based training clinic. Results from multilevel analysis indicated that therapists in the sample accounted for 9.4% of the variance in couple dropout while controlling for initial couple impairment. Therapist gender and therapist experience did not significantly predict variability in therapist effects. These findings give promise to future research on therapist effects in couple therapy and encourage exploration into which therapist characteristics and behaviors contribute to successful clinical outcome.     

Seeing Ourselves as Others See Us: Using Video Feedback in Family Therapy

Video recordings have been used for many years in family therapy for supervisory or therapist review purposes, but have usually had little direct relevance for clients. This article describes how video recordings can be used jointly by therapist and family to discuss episodes and themes in the sessions, rather like the current use of reflecting teams. The danger of the abuse of power in video feedback is also discussed — a danger which is present in all forms of therapy, however ‘user friendly’ they aim to be.     

A Pilot Use of Letters to Clients before the Initial Session

This paper explores the nature of engagement in the therapy process, and proposes that engagement may be facilitated when both client and therapist are able to develop an appreciation of each other's position within the therapeutic relationship. Some ways that a therapist can assist in this process are explored. An experiment is described in which information letters are sent to clients before the initial therapy session, as a possible way to enhance the engagement process.     

Prescribing the Families Own Dysfunctional Rules as a Therapeutic Strategy*

The use of paradox-strategy in therapy is motivated by the fact that many families request help but at the same time seem to reject all offers of help. The therapist may be drawn into a game in which every effort on his part to act as an agent of change is nullified by the family group. In systemic terms these contradictory attitudes derive from the dynamic equilibrium existing between the tendency toward change, which is implicit in the request for help at one level, and the tendency toward homeostasis which at another level imposes the repetition of the family's habitual rules of interaction. The coexistence of these forces can entangle the therapist in the family's paradoxical logic of “help me to change, but without changing anything.” By accepting the contradiction facing him and by “uniting” himself with this within the family, the therapist puts himself into a position opposite to that which the family expects. His response to the family's paradoxical request is a paradox, or counterparadox, because it creates the contradictory communication typical of rigid family systems. By prescribing its own dysfunctional rules to the family, the therapist can stimulate the tendencies toward change present in the family system.     

An Insight Approach to Marital Therapy

The trend in marital therapy has traditionally been away from insight approaches and toward action-oriented methods, such as manipulating the couple system or teaching partners to negotiate. This paper presents a form of insight therapy based upon systems theory and suggests that this orientation has much to offer. The first part describes general categories of relationship problems with which a couples therapist must deal. The second part takes each of these problem types and suggests how a therapist with the present systems-interpretive approach might proceed. The goal is a shared understanding by partners of their marital system.     

Systemic alliance in individual therapy: factor analysis of the ITAS-SF and the relationship with therapy outcomes and termination status

Clients providing systematic feedback to therapists via self-report measures of psychological distress and working alliance have been shown to increase therapy outcomes. However, there are few systemic-based measures that are feasible for therapists to use. Recently, Pinsof et al. (Family Process, 2008, 47, 281) developed a brief systemic alliance measure (ITAS-SF) for individual therapy. The current study tested the factor structure of this measure and examined whether the subscales related to clients' therapy outcomes and termination status (N = 570). The results demonstrated supported a 3-factor model for the ITAS-SF (as compared to the seven factors proposed by Pinsof et al.). In the first factor, content combined the goals for therapy, the tasks or methods to reach those goals and bond between the client and therapist. The second factor reflected how clients perceive the relationship with the therapist (i.e., interpersonal dimension-self/therapist), and the third factor reflected how clients perceive the alliance between their social network and the therapist (i.e., interpersonal dimension others/therapist). The two interpersonal factors were related to therapy outcome and termination status.     

Multiple Family Therapy Systems

This paper investigates multiple family therapy (MFT), a treatment method which includes several families in a series of sessions with the therapist(s). A brief historical development of MFT is included as well as reports of multiple family therapy groups found in the literature. The characteristics of this treatment method are delineated with special attention to the elements of change attributed to MFT and the stages of development in MFT groups. The role of the therapist and special problems in MFT are also explored. Some implications for research are outlined, indicating that MFT is lacking adequate validation as a treatment modality. Possible advantages inherent in multiple family therapy systems, which have been suggested by therapists' clinical findings, are also reported.     

Insider/Outsider: A Muslim Woman's Adventure Practicing ‘Alongside’ Narrative Therapy

The following paper centres on my unique experience as a white Australian therapist who is able to sympathise with a Western world view while being immersed in an Islamic world view. The goal is to share my journey as a Muslim Australian via an auto‐ethnography reflexive method. Using diaries, intentional reflexive positioning, and multiple modes of supervision, I contemplate an Islamic identity and value system while negotiating poststructural therapies such as solution‐focused collaborative, and in particular, narrative therapy as viable approaches to working with the Muslim community. There are two inquiries which are of interest. The first is to reflexively describe the experience of being a Muslim practitioner and wondering whether core differences in epistemological views between social constructionism and Islamic doctrine can be overcome. Secondly, this enquiry explores Quranic guidelines about how to perceive ‘problems’ in life, based on the premise that understanding how an Islamic world view addresses life's troubles may add to deeper conceptions of the role of difficulties. I propose that adherent Muslims have a natural metaphorical way of thinking that connects with some of the poststructural therapeutic skills and techniques and at the same time draw on past Quranic solutions for contemporary problems. Little has been written on narrative therapy as a suitable approach to working with Muslim clients. In the current paper I review my personal experience as a veiled Muslim therapist striving to implement narrative therapy alongside an Islamic epistemology.     

Breaking the race barrier

Through the reflective process of analyzing one's own feelings and reactions to the ethnic minority patient, the white therapist develops an inner clarity that serves as a resource to cope with the unique conflicts one must confront in interracial practice. Only when the therapist has come to some resolution of his or her own feelings about the plight of ethnic minorities in this country can this acumen develop. Although the therapeutic skills applied in psychotherapy with ethnic minorities are in no way different from overall therapeutic skills, certain techniques may be especially useful in interracial practice. For instance, a discussion of the meaning of race and ethnicity in the relationship may curtail racial distortion, prevent stereotyping, and lead to the creation of a therapeutic alliance. When dealing with transference and countertransference issues, the therapist must be particularly attentive to the representation of these same distortions and stereotypes. Formulating clinical problems from dual perspectives, theoretical and sociocultural, is an arduous, but necessary task. Finally, the white therapist must be able to view ethnic minority patients as individuals. Although these patients cope with special problems which must be acknowledged and dealt with in therapy, the therapist must realize there is a common ground on which to communicate. On this common ground, therapists discover the foundation of interracial clinical practice is the ability to accept and respect their patients and themselves as individuals who may have similar anxieties, problems, experiences, and goals. It is through the recognition and sharing of the fundamental human bond that ethnic and racial differences, which may have detrimental effects on interpersonal relationships, are transcended.     

Relationships,Reconciliation and Children: Giving Young People a Say

I have realised how central my therapy background and skills have been in my current job. Without being conscious of it, I use much of my background as a therapist in my role as Commissioner for Children and Young People. I probably spend more of my time advocating for children and young people as a group because they are excluded or disregarded on the basis of their status as children.     

Family Therapy with the Learning Disabled Child and His/Her Family

No therapist can come in contact with and treat children with minimal brain damage or specific learning disabilities without being struck by the fact that there are numerous intertwined factors that have contributed to and continue to perpetuate the problems. In addition to the helping approaches which have been utilized in recent years, such as tutoring, special education, and child therapy, this article elaborates the importance of utilizing family therapy as the treatment of choice sometime during the course of treating the child and helping the parents to understand and deal with their handicapped youngster.     

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.     

Responsive Persistence Part I: Therapist Influence in Postmodern Practice

Feminist and social constructionist developments in family therapy highlighted the importance of attending to therapist–client power relations and incorporating clients' understandings and preferences as a part of therapy. Significantly, less attention has been given to how postmodern therapists do use their power and influence. This is an important topic because it is therapists who have the major responsibility for guiding the interaction with clients and persisting in this so that change is facilitated. Therapist persistence in various forms and across dimensions of therapy process is examined to expand understanding of therapist influence in postmodern and collaborative work. An analysis of responsive persistence in a session with Karl Tomm as the therapist is presented to illustrate this conceptual framing.     

Countertransference with adolescent clients of the same ethnicity

This article addresses countertransference in therapeutic relationships involving therapist and client from the same ethnicity. A case illustration of a Japanese adolescent and a Japanese therapist is used to develop the thesis that obvious similarities in race, or culture may lead to invalid assumptions about shared beliefs and values and subtle countertransference manifestations which have the potential to disrupt or prevent the development of a working relationship.in private practice.     

Issues in Psychotherapy with Clients Affiliated with the Opposing Side in a Violent Political Conflict

The therapeutic dyad of clinician and client affiliated with rival groups in a violent conflict shares many features that complicate psychotherapy with persons of different ethnic, racial, and cultural groups, including lack of knowledge, negative stereotyping, differences in fundamental values and world views, and power differentials. Although a great deal has been written about these matters, very little has been written about the therapeutic dynamic where therapist and client are affiliated with different sides of a violent political conflict. Based on the sparse literature on the subject and on the clinical experiences of the author and her colleagues, this paper discusses three features that characterize this dynamic, which do not appear in the same way in therapy involving dyads of different races, ethnic groups, or cultures. These are the presence of the “enemy” in the consulting room, the therapist’s feelings of mistrust towards the client as a representative of the opposing group, and the client’s feelings of guilt towards the therapist as a representative of the injured group. The impacts of each feature on the therapist, client, and the therapeutic encounter are explored and suggestions are made for dealing with them. The hope is that professionals’ awareness of these issues will help improve the quality of psychotherapy with persons on the rival side of a violent political conflict.     

Thinking About the Emotional Interaction of Therapist and Family

The emotional interaction of therapist and family has been difficult to explore within the field of systemic family therapy. This paper looks at ways of thinking about this process. As a starting point, I take some feelings I had with three families in the course of therapy. These are used to illustrate some concepts from analytic therapy which address the emotional interaction of therapist and family. The kind of theoretical space and guidance offered within systemic family therapy is then explored, and it seems that the Milan frame gives some space for thinking about the process but offers little guidance as to exactly how this might be done. This is a paper about practice, though it's primarily a theoretical discussion. There is no aim of establishing a ‘correct’ way of understanding the emotional interaction of therapist and family.     

A Longitudinal View of the Association Between Therapist Warmth and Couples' In‐Session Process: An Observational Pilot Study of Emotionally Focused Couples Therapy

This longitudinal dyadic clinical process study used coded data from eleven couples to determine the influence of therapist warmth behaviors on couples' warmth behaviors over time in therapy. A mixed effects model was used to examine within‐ and between‐individual variability. Men and women were modeled separately. A series of two‐level multilevel models of change were examined, where Time is Level 1 and Individual is Level 2. Findings were mixed. There was no significant relationship between therapist warmth toward wife and wife warmth toward husband; however, there was a significant relationship between therapist warmth toward husband and husband warmth toward wife. Findings demonstrated that 62.9% of the variance in husband warmth toward wife was accounted for by therapist warmth to husband across time in therapy. Specifically, therapist warmth toward husband was significantly and positively related to husband warmth toward wife over time in therapy. Clinical implications and directions for future research are discussed.