Multi‐Family Therapy with a Reflecting Team: A Preliminary Study on Efficacy among Opiate Addicts in Methadone Maintenance Treatment

In this study, we evaluate the efficacy of multi‐family therapy at reducing the addiction severity and at improving the psychological and family dynamics of opiate addicts receiving methadone treatment at a public treatment center. The study compares multi‐family therapy with a reflecting team (MFT‐RT) and a standard treatment following a methadone maintenance treatment program. The results show that multi‐family therapy with a reflecting team effectively reduces the addiction severity in several of the areas evaluated and noted that this effect is superior to standard treatment. The psychotherapy patients showed improvement in the areas of employment and social support; their drug use diminished and their psychiatric condition improved. At the same time, they needed a lower daily dose of methadone. In addition, the group undergoing standard treatment showed a noteworthy deterioration in their medical condition. Both groups showed a significant increase in their alcohol use. When applied to family treatments, the systemic‐constructivist approach by the reflecting team offers combined techniques that can help improve care for the families of patients with addiction problems.     

‘Somebody Watching You’: Impact of Reflecting Teams on Hope in Couple Relationships

Reflecting teams (RTs) represent both an epistemological stance and a therapeutic technique. Most commonly associated with narrative and systemic approaches to therapy, RTs offer an outsider perspective that can bring hope and alternative narratives and perspectives for therapists and clients to explore. Relational hope is a little researched concept in the field of couple therapy research. This study explores the experience of RTs in couple relationships and the aspects of the experience that couples describe as connected to a sense of hope for their relationship. The study also considers whether difference in attachment style shows any relationship with hope in couple relationships before and after the clients’ session with a reflecting team. Couples completed questionnaires about their attachment style, demographics, and relational hope and were given the option to complete an interview about their experience with the reflecting team within 1 month of their therapy session. Our findings suggest that RTs contribute positively to hope in couple relationships particularly for clients who present with an anxious attachment style. This direction for research is important because there is very little research about hope in couple relationships despite its importance (Merolla, 2014; Snyder, 2002) and there is no research about what aspects of a reflecting team contribute to hope in couple relationships. Analysis of interviews indicates a number of features of the reflecting team feedback that were valued by clients.     

AN ETHNOGRAPHY OF COUPLE AND THERAPIST EXPERIENCES IN REFLECTING TEAM PRACTICE

Couple and therapist perspectives about the use and process of reflecting team practice were analyzed using ethnographic research. A domain analysis was performed on postession interviews from both couples and therapists, and on field notes from each therapist. Seven couples and five therapists were interviewed at least twice over a 4-month period concerning their reactions to and perceptions of reflecting team practice. Six domains concerning reflecting team practice emerged from the analysis: (a)benefits of its use, (b) effects of gender, (c)recommended use, (d) contraindicated use, (e) the importance of creating spatial separateness between couple and team members, and (f) sequences of communication between the couple and team members that elicit change. The latter two domains described the process of reflecting team practice (i.e., steps in how it is used and how it is implemented). The role of ethnog rahy in reflecting team practice and in family therapy research is discussed.     

The reflecting team as a reflection of second order therapeutic ideals

The reflecting (R.T.) team is examined within its theoretical, therapeutic and training contexts. A distinction is made between the reflecting team technique (R.T.T.) and the reflecting team process (R.T.P.), in order to explore whether or not the practice of team reflection is consistent with the requirements of the second order family therapies, the theoretical development which supported the R.T.'s emergence and subsequent popularity. The critique of the R.T.P. suggests that although this therapeutic process does represent attempts towards increasing acceptance of complexity, reduced attempts to control, collaboration, interconnectedness and contextual respect, there is little room for complacency either theoretically or practically.     

A REFLECTING TEAM APPROACH TO FAMILY THERAPY: A DELPHI STUDY

Due to different conceptualizations and unclear theoretical guidelines, a reflecting team approach to family therapy has lacked conceptual and practical clarity. The purpose of this exploratory study was to outline the theory and practice of a reflecting team approach to family therapy. A Delphi technique was employed for panelists to consider the theoretical assumptions, techniques, how change occurs, major goals, when to use, and contraindications of a reflecting team approach. Analysis of data revealed where consensus was reached and a profile was formed to aid in further clarifying this approach.     

The Reflecting Team Model Used for Clinical Group Supervision Without Clients Present

An approach to group supervision, applying reflecting team, is described. Interview data showing how the approach is practiced recently are presented and analyzed qualitatively, and the results are discussed in relation to the original approach. The conclusion is that there are many pitfalls in using reflecting teams in supervision, and that following the original approach may guard against these pitfalls, but that some revisions may be needed. Supervisors, supervisees, and reflecting team members are all generally satisfied with the approach, but it remains to be established to what extent it contributes to therapist development.     

Three Journeys Toward The Reflecting Team

The experience of familiestrainee and supervisory therapists involved in reflecting team work are explored through the metaphor of ‘journey’ and by asking a small number of our colleagues and clients about their experiences. Ideas gained from this approach are tentatively used to raise some questions about the reflecting team specifically and the current direction of family therapy. More rigorous research into this area is invited.     

BOOK REVIEWS

Book reviewed in this article:
Rugel, R. P. (1977). Husband-ocused marital therapy: An approach to dealing with marital distress .
Selekman, Mathew D. (1997). Solution-focused therapy with children: Harnessing family strengths for systemic Change .
Taibbi, R. (1996). Doing amily therapy: Crat and creativity in clinical practice .
Bagarozzi, D. A. (1996). The couple and family in managed care: Assessment, evaluation, and treatment .
Friedman, S. (Ed.). (1995). The reflecting team in action: Collaborative practice in amily therapy .     

Reflections on the intersection of power and competition in reflecting teams as applied to academic settings

This article explores the author's experiences with the concepts of power and competition as they intersect with aspects of reflecting team practices in academic settings. It draws upon Bishop's (2002) work, the elements of which are based on Starhawk's (1987) ideas of power with and power over. The article describes how competition and other power over practices of domination might unfold and intersect with reflecting-team practices. It is proposed that a power over practice, such as competition, which is prevalent in our society and universities, can be incompatible with the collaborative nature of reflecting teams. Suggestions for addressing the dissonance between the environment and reflecting team practice are offered.     

Back and Forth and Beyond

The Journal invited Tom Andersen, author of major pioneering work on the reflecting team, and his colleagues, to offer comment on The Reflecting Team Process in Training. We thought such a north-south dialogue was in keeping with the spirit of reflecting teams, and the team members in Melbourne and Tromsø agree — Editor.     

“THE FLY ON THE WALL” REFLECTING TEAM SUPERVISION*1

The reflecting team concept, a practical application of constructivist ideas, is adapted for use in group supervision. The evolving model includes a focus on the unique “fly on the wall” perspective of the reflecting team. In addition to case supervision, the benefits of the model include: (a) the supervisee's ability to be at the meta-level of his or her own process; (b) the presentation of feedback in a less threatening manner; and (c) dramatic insight regarding the process, which enhances work with clients. Not only are trainees introduced to a multiverse of new ideas and perspectives, it is done in a refreshing context which integrates some of the most challenging ideas in the field.     

Outside Expert Knowledge; An interview with Michael White

Michael White is an internationally renowned family therapist from Dulwich Centre in South Australia. In this interview, Michael discusses his ideas and experiences covering a wide range of topics including the re-authoring process, changing roles of therapists and persons in therapy, the reflecting team, training, and the future of family therapy.     

Creating Dialogic Contexts for Multidisciplinary Clinical Reviews: The Reflecting Team Process

When multidisciplinary teams review their work, it is common for clinicians to hypothesise about their clients from the perspective of their role or theoretical model. The outcome of this review process may depend on the team's views. Here the epistemological position taken by team members about reality and objectivity can lead to starkly different pathways. There can either be a dialogue about different hypotheses, with the team jointly constructing new meanings; or, conversely, there can be a monologic exchange based on competition between different hypotheses. This paper explores why teams may struggle with coordinating different theoretical approaches and models. It suggests the dialogic nature of a reflecting team process offers one approach for helping teams to find ways of ‘putting their differences to work’. Ideas for implementing this process within multidisciplinary teams are illustrated with comments provided by teams who have begun to experiment with this approach.     

ETHNOGRAPHIC CONTENT ANALYSIS OF COUPLE AND THERAPIST PERCEPTIONS IN A REFLECTING TEAM SETTING*

An ethnographic content analysis was used to examine couple and therapist perspectives about the use and value of reflecting team practice. Postsession ethnographic interviews form both couples and therapists were examined for the frequency of themes in seven categories that emerged form a previous ethnographic study of reflecting teams (Sells, Smith, Coe, Yoshioka, & Robbins, 1994). The study demonstrated that quantitative numerical data and qualitiative narrative data can examine the same phenomenon from multiple perspecrives and allow for greater accuracy and stability in study findings. Ethnographic content analysis is briefly cosntrasted with conventional modes of quantitative cosntent analysis to illustrate its usefulness and rationale for discovering emergent patterns, themes, emphases, and process using both inductive and deductive methods of inquiry.     

The influence of the Milan approach—Part 2. The legacy of Boscolo and Cecchin and their Paduan connection: A conversation with Andrea Mosconi

The Milan approach, pioneered by Selvini-Palazzoli, Boscolo, Cecchin, and Prata, has significantly contributed to the field of psychotherapy, particularly in the realm of systemic and family psychotherapy. While rooted in systemic principles and concepts, over time the original Milan group demonstrated differences in their clinical orientations and practices which led to their regrouping into two teams. The paper explores the divergences in their views and directions on family dynamics and the role of symptoms within the system. It delves into the influence of Boscolo and Cecchin, two of the ‘Milan Four’ on the Centro Padovano di Terapia della Famiglia. Drawing from a conversation with Andrea Mosconi, a mentee and collaborator of Boscolo and Cecchin, the paper examines the reconfiguration of the original ‘Milan Four’ team and its impact on their clinical approach. Key Milan principles and concepts such as hypothesising, circularity, and neutrality are examined with particular emphasis on the work of Boscolo and Cecchin's systemic work. These principles, intertwined and interconnected, provide a fertile ground for the construction of multiple hypotheses and circular questioning. The paper also highlights the concept of reflexivity, which originates from Bateson's work and plays a crucial role in family relations and communication while explaining the birthplace of paradox taking place when two levels of meaning are ‘confused.’ The Milan approach continues to be highly regarded, as its early concepts and ideas have evolved and left a lasting impact on the field of family therapy. By reflecting on the distinct contributions of Boscolo and Cecchin, and using examples, Mosconi offers valuable insights into the rich legacy and ongoing relevance of the Milan approach to contemporary therapeutic practice.     

A "READER'S THEATER" INTERVENTION TO MANAGING GRIEF: POSTTHERAPY REFLECTIONS BY A FAMILY AND CLINICAL TEAM

The sudden and accidental death of a child can be one of the most devastating events in the life of a family. This paper describes one couple's reflections of their grief and mourning following the death of their adolescent son as well as the clinical team's reflections of therapy. The uniqueness of this paper is that it offers a "reader's theater" intervention that enabled further change to occur. The clinical team used a belief model, emphasizing that altering constraining beliefs is at the heart of healing from such tragedies as sudden death (Wright, Watson, & Bell, 1996). This approach is operationalized through therapeutic conversations between family members, clinician, and clinical team. Interventions such as reflecting teams, therapeutic letters, and "homework tasks" were used to modify or challenge constraining beliefs of both the family members and the clinical team members. However, the intent to co-author a paper with this couple provided the serendipity intervention of a "reader's theater" that further served to identify, affirm, and solidify facilitating beliefs.     

The Theory Behind the Traps — Considerations for the Practice of Family Therapy in a Multi-frame Work Team*

Family systems theory as an approach to problem generation and change is practiced in many settings where other theoretical stances are also held. The issue of successful team work within a clinic where other therapists work from psychoanalytic and behavioural models is addressed. Structural, strategic and systemic approaches are compared with the psychoanalytic and behavioural. Particular attention is paid to apparent similarities between psychoanalytic and systemic family therapy theory. It is concluded that basic differences exist which make successful merging of the two views impossible. Practical examples of difficulties and attempted solutions are offered.     

Inspiration Across Cultures: Reflecting Teams among the Métis in Canada

Métis Community Services on Vancouver Island exists to serve the Métis, one of Canada's three aboriginal peoples. I went there, hoping for an exchange of thoughts and ideas that I could apply to my work back home in Sweden. I was welcome to observe and participate in the work. I was asked to talk about something that I wanted to share with them. The result was a workshop about how to apply the reflecting team mode of working when counselling aboriginal families. The outcome of our exchange was a blend of the ethics and rules of behaviour among aboriginal people and the Scandinavian reflecting team mode of working.     

Amplifying Deviations in Family Interactions: Guidelines For Trainees in Post‐Milan Family Therapy

Amplifying deviations in family interactions is a critical skill in family therapy, and one that can be implemented following the first reflecting team intervention. This paper will provide trainees with a series of practical guidelines for amplifying deviations, derived from an integration of several models of family therapy. Solution‐focused and narrative questions are employed systemically, with the aim of magnifying virtuous, rather than vicious cycles of interaction. A theoretical rationale for deviation amplifying and a brief case vignette will also be presented.     

FAMILY ASSESSMENT IN CHILD CUSTODY DISPUTES*

This paper has operationalized family systems theory to explicate the interfacing dynamics between family dissolution and child custody disputes. The authors suggest that clinical assessment and intervention in these matters which focus solely on individual and marital, or child dimensions, fail to recognize the powerful influences of systemic family process. A family assessment model, evolved from clinical work with over 200 court-referred custody cases, is described. The model involves a cross-sex therapy team with each member responsible for a specific family subsystem. The role of each therapist and the functioning of the team is outlined. Specific criteria for determining custody recommendations are identified based on patterns of family process and dissolution.