Reliability and Validity of the Global Assessment of Relational Functioning (GARF) in a Psychiatric Family Therapy Clinic

The reliability and validity of the Diagnostic and Statistical Manual of Mental Disorders-IV Global Assessment of Relational Functioning (GARF) was evaluated in consenting participants presenting to a family therapy training clinic. The purpose of this study was to (a) assess whether the GARF could be administered quickly in a marriage and family therapy training clinic, (b) assess the inter-rater and internal reliability of GARF ratings of intake sessions, (c) examine the relationship of GARF ratings to established measures of relationship functioning, and (d) compare GARF ratings to a measure of depressive symptoms. Study participants completed the General Functioning Subscale of the Family Assessment Device (GFS/FAD), the Quality of Marriage Index (QMI), and the Center for Epidemiologic Studies–Depression Scale (CES-D). After intake sessions were conducted with study participants, GARF ratings were made by an American Association for Marriage and Family Therapy Approved Supervisor or Supervisor-in-Training, a therapist trainee, and two observing trainees who had observed the session from behind a one-way mirror. Cronbach’s coefficient alphas and the average intraclass correlation coefficients were both .82 when ratings of the supervisor and two observers were compared and .78 and .79, respectively, when ratings of the supervisor, two observers, and therapist were evaluated. There was significant agreement between GARF ratings made by the supervisor and therapist (but not observers) and scores on the GFS/FAD, QMI, and CES-D. Results suggest that GARF ratings can be made quickly and reliably, especially among raters with greater clinical experience, and are related to measures of relational functioning and depression. Implications for research and marriage and family therapy training are discussed.     

Nurturing Nature: Exploring Ecological Self‐of‐the‐Therapist Issues

Much has been written about the systemic effects of families and culture on individual well‐being. Seldom discussed, however, are the systemic effects of our relationship with the larger ecological system in which all families and cultures are embedded. A case is made for the importance of nature in family therapy. Furthermore, before therapists can effectively address ecological issues in therapy, they need to address various ecological self‐of‐the‐therapist issues that will influence their clinical practice. A series of questions are asked to help guide therapists in this exploration, and practical suggestions for incorporating nature into MFT clinical practice, training, and research are made.     

Constructing the ‘ideal’ family for family‐centred practice: challenges for delivery

Family‐centred practice positions families as the key decision‐makers, central to and experts in the wants and needs of their child. This paper discusses how families interviewed for a Western Australian study describe their relationships with a range of allied health professionals in the paediatric disability sector. The allied health professionals, in turn, describe how they characterize the role of families caring for children with disabilities. We argue that the successful implementation of family‐ centred principles in service delivery need to move beyond the individualizing of responsibility and acknowledge the structural and systemic limits to family‐centred practice, as well as the social complexity within which diverse families live.     

Parent‐Child Value Similarity: The Role of Zeitgeist

Reporting a study of German 2‐child families, the article focuses on a neglected issue in value transmission studies: contemporaneous societal context. Parent‐child value similarity depends not only on family characteristics but also on zeitgeist, the modal value climate of a society. To evaluate the role of zeitgeist in value transmission, differences in parent‐child value similarity between families agreeing and disagreeing with the zeitgeist are studied, focusing on a core value of modern societies: hierarchic self‐interest. Results show a weak general zeitgeist effect. A family’s relative position vis‐à‐vis the societal value climate, however, is shown to strongly influence intergenerational similarity in hierarchic self‐interest, families distant from the zeitgeist showing a much higher intergenerational value similarity than families close to the zeitgeist.     

Video Game Use as a Tool for Assessing and Intervening with Identity Formation and Social Development in Family Therapy

Because video games are becoming such an integral part of our culture, modern family therapists are more likely than ever to encounter families with members who play them. It is easy to overlook video game use in terms of its potential as a therapeutic tool, particularly if a therapist possesses only limited knowledge of the medium. Using existing literature and my experience as a lifelong gamer, I provide family therapists with a background of the major video game genres and explain how video games can aid in the assessment of factors such as identity formation and social development. I also provide a systemic case example, recommendations for practice, and a table for quick reference to highlight potential videogame‐based family therapy interventions.     

Parent‐to‐Child Aggression Among Asian American Parents: Culture,Context, and Vulnerability

We examined correlates of lifetime parent‐to‐child aggression in a representative sample of 1,293 Asian American parents. Correlates examined included nativity, indicators of acculturation, socioeconomic status, family climate, and stressors associated with minority status. Results revealed that Asian Americans of Chinese descent and those who immigrated as youth were more likely to report minor parental aggression; ethnicity and nativity were not associated with severe aggression. Indices of acculturation did not predict risk, but minority status stressors (perceived discrimination, low social standing) predicted risk of both minor and severe aggression. Affective climate differed markedly in families with minor versus severe aggression. Parental aggression in Asian American families may not be cultural per se, but stress associated with immigrant family context may heighten vulnerability.     

Consejos as a Family Process in Transnational and Mixed‐Status Mayan Families

This article describes a constructivist grounded theory study about cross‐border relationships within Mayan families divided between the United States and Guatemala. Nine families participated, and each included a U.S.‐based undocumented migrant parent and a Guatemala‐based adolescent and caregiver. Findings pertaining to the family process of consejos—defined as a communication practice in Latino families wherein older family members pass on conventional wisdom to younger family members—are discussed. Although consejos has been identified as an important cultural practice in Latino families, it has rarely been examined in Mayan families or explored as an important aspect of transnational family relationships. Findings suggest that for some transnational and mixed‐status Mayan families, consejos has become an important family process and a way in which migrant parents maintain a presence in their children's lives despite being physically separated. Implications for future research with transnational migrant families, and Mayan families in particular, are discussed.     

Mitigating the effect of family poverty on academic and behavioral outcomes: The role of school climate in middle and high school

The persistent achievement gap between students from poor families and their peers calls for research that examines risk factors associated with poverty and strategies for promoting resilience. Research demonstrates the impact of school climate on behavior and academic achievement, especially in high-poverty schools. The present study examines associations between family poverty, social supports, students' perceptions of school climate, behavior, and grades. Poverty is associated with poor grades and behavior, while positive perceptions of school climate are associated with positive grades and behavior. Perceptions of school climate moderate the association between poverty and behavior, such that students from poor families who perceive a positive school climate exhibit similar behaviors to their peers from higher income families. Implications for practice, policy, and research are discussed.     

Love in Times of Cholera: Systemic Reflections on Supporting Families Through the Journey(s) of Illness

This paper is the result of our increasing interest in the experience of illness in families and the concomitant reflections on how best to therapeutically support these families through this process. This interest led us to reflect on the nuanced way in which language establishes a play with the experience of illness, a play that can amplify or reduce its effects. Such an interplay in turn led us to consider the valuable role that family therapists have in helping families and treating practitioners to create a safe space for conversation about illness. Further questions are also explored in relation to whether there is a role for family therapists in facilitating the interface between our clinical practice with clients and the wider treating medical community. And, if so, what shape would such an interface take? Considerations at this level would include the anticipation of psychological reactions to diagnosis of chronic and life‐threatening illnesses, in particular the importance of ‘normalisation’ of the psychological reactions to such chronic and/or life threatening diagnoses; the complex dynamics emerging from the interface between the effects of illness in the subjectivity of the ill person and the grief experienced by the other family members; different family members’ narratives of the illness; relevant community contexts; and, lastly, ways to help the family members and/or the ill person navigate the medical system including the use of second opinions, cyberspace information, and other systems in their ecology, such as the spiritual dimension. Some aspects of children's narratives of illness are also identified. The paper has been organised around the dialogue that the authors had around one of their clinical cases.     

Social Work Student Learning Experiences of Family Therapy: Improving Competency in Pedagogy Through Qualitative Research

The purpose of this qualitative study is to evaluate graduate social work student experiences of pedagogy intended to improve competency in family therapy practice. Students from two classes (N = 37) completed open‐ended surveys assessing: perceptions of most helpful pedagogical practices; understanding of needed competencies; and perceived opportunities offered to them during their graduate training for learning about work with couples and families. Results, analysed using grounded theory methodology, revealed that students: (1) believed that experiential activities were especially critical for learning how to do clinical practice with couples and families; (2) understood important competencies related to professional development, therapeutic engagement with the family, and how to approach family practice; and (3) believed they were ‘somewhat prepared’ for practice. Implications include improving understanding of abstract skills in practice with couples and families, and emphasising relationship dynamics more in graduate social work education and training.     

Questioning the Suitability of Traditional Self-Report Family Functioning Measures for Single-Parent Families with Young Children

Family functioning is a common interest of social science and health researchers. Most often, well-established self-report instruments are used to measure family functioning. Although these instruments have been used with families of diverse compositions, our experiences using one of the commonly used instruments, the McMaster Family Assessment Device (FAD), suggest that it is not appropriate for single-parent families with young children. In addition to describing the difficulties we encountered with the FAD, we discuss our experiences in relation to current research findings about the processes and effectiveness of family functioning in single-parent families. As well, we examine other frequently used self-report family functioning instruments, the results of which lead us to question the suitability of any of the commonly used self-report family functioning instruments for single-parent families with young children. We conclude by arguing for the development of family functioning instruments that are appropriate for diverse family structures and compositions.     

How do cohabiting couples with children spend their money?

Increasing rates of cohabitation in the United States raise important questions about how cohabitation fits in with the definition of family. Answers to this question depend in part upon the extent to which cohabitors’ behavior differs from that of other family types. Using data from the Consumer Expenditure Survey, we compare the expenditure patterns of cohabiting‐parent (n = 1,804), married‐parent (n = 33,159), divorced single‐parent (n = 7,641), and never‐married single‐parent (n = 2,893) families. We find that cohabiting‐parent families, compared to married‐parent families, spend a greater amount on 2 adult goods (alcohol and tobacco) and a smaller amount on education. Cohabiting‐parent families also differ in their spending patterns from divorced single‐parent families and from never‐married single‐parent families. Overall, our results show that cohabiting‐parent families allocate their budgets differently than do other families.     

Family Work and Acquired Brain Damage

Acquired Brain Damage (ABD) causes immense difficulties for individuals and families and is increasingly recognised as a serious community issue. This paper focuses on the burden placed on family members with a head injured relative. The authors propose that when working with families with a member with a neuropsychological condition, the family therapist may be required to embrace a more flexible role. Depending on the developmental needs of the family, the family therapist may at times: provide educational information about brain damage and its effects arrange family support groups or wider network meetings be the family's advocate in the context of complex legal and financial bureaucracies or undertake marital, sexual or family therapy when required. Whatever the role played, a ‘family sensitive practice’ approach by family therapists is advocated. It is also deemed useful to develop a theoretical assessment model which helps the therapist locate where individual family members are in their negotiation of the tasks of grieving, restructuring, identity reformation and achieving a sense of growth after head injury. Further implications for clinical practice are outlined.     

Using an Anti-racist Framework for Assessment and Intervention in Clinical Practice with Families from Diverse Ethno-racial backgrounds

Cultural competency and cultural sensitivity are now widely considered to be essential for clinical social work practice with individuals and families from diverse cultural, racial, and ethnic backgrounds. Failing to incorporate these concepts into clinical services can be harmful to clients, can fail to meet the needs of members of diverse ethnoracial communities, and can result in inappropriate services. Yet a sole focus on culture can obliterate our understanding of the consequences of race and racism on individuals and families. The use of a discursive anti-racist framework for assessment and intervention in practice with members of diverse ethnoracial communities is suggested and explained through the use of a case example.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

Multidimensional Family Resilience Assessment: The Individual,Family, and Community Resilience (IFCR) Profile

The goal of this study was to develop a broad, multidimensional assessment of individual, family, and community resilience for use in evaluating socioeconomic mobility programs. The Individual, Family, and Community Resilience Profile (IFCR) is a broad, multidimensional measure that evaluates multiple ecological levels of resilience. Based on a sample of 650 low-income families, this study demonstrates the initial reliability of the 75-item IFCR. This evaluation tool assesses 20 separate dimensions of constructs often associated with resilience. The IFCR provided strong reliability with interitem reliability coefficients ranging from α = .71 to.93. The IFCR also showed strong predictive abilities for education levels, employment, and mental health. We also present benchmark scaling of the IFCR for use in practice and future research.     

The Effect of Family Communication Patterns on Adopted Adolescent Adjustment

Adoption and family communication both affect adolescent adjustment. We proposed that adoption status and family communication interact such that adopted adolescents in families with certain communication patterns are at greater risk for adjustment problems. We tested this hypothesis using a community‐based sample of 384 adoptive and 208 nonadoptive families. Adolescents in these families were, on average, 16 years of age. The results supported our hypothesis. Adopted adolescents were at significantly greater risk for adjustment problems compared to nonadopted adolescents in families that emphasized conformity orientation without conversation orientation and in families that emphasized neither conformity nor conversation orientation. Adolescents in families emphasizing conversation orientation were at lower risk for adjustment problems, regardless of adoption status.     

Community Context,Social Integration Into Family,and Youth Violence

The purpose of this study is to analyze the extent to which neighborhood‐level family structure and feelings of family integration are associated with acts of violence among 16,910 adolescents from the National Longitudinal Study of Adolescent Health. The results from our hierarchical linear models indicate that adolescents who live in neighborhoods with lower proportions of single‐parent families and who report higher levels of family integration commit less violence. We also find that neighborhood‐level family structure shapes the extent to which social integration into family matters: In neighborhoods that are considered higher risk environments (i.e., contain greater proportions of single‐parent families), family integration is often less effective in deterring youth violence than it is in lower risk environments.     

Strengthening Clinical Research in Marriage and Family Therapy: Challenges and Multilevel Solutions

There is a critical need for high‐quality and accessible treatments to improve mental health. Yet, there are indications that the research being conducted by contemporary marriage and family therapy (MFT) scholars focuses less on advancing and disseminating clinical interventions than in previous decades. In this article, we describe challenges to increasing rigorous clinical research in MFT. We use systems mapping and the intervention‐level framework to identify strategic goals designed to drive innovation in clinical research in the field. It is our hope this article encourages dialog and action among MFT stakeholder groups to support clinical science that will improve the health and functioning of families.     

Lesbian,gay, bisexual,and transgender families and health

Research consistently demonstrates that family relationships are key determinants of health, but most research on health and families focuses on a heterosexual and cisgender context. Sexual and gender identities often are overlooked or erased in family and health research. We present an overview of the current state of research on LGBT families and health, using a life course approach and pointing to the ways that LGBT people's experiences of families occur within a broader social structural context, with implications for their health and the health of their family members. We focus on parenthood, parent–child ties, intimate relationships, and caregiving. We also identify two theoretical obstacles for studies of LGBT families and health as well as important research areas for moving forward, such as the inclusion of non‐binary and queer identities in our studies of family and health. Incorporation of LGBT and other queer families and family forms into our health research interrogates assumptions within family and health research and offers insight into how to move the field forward.