What clients of couple therapy model developers and their former students say about change, part II: model-independent common factors and an integrative framework

Proponents of the common factors movement in marriage and family therapy (MFT) suggest that, rather than specific models of therapy, elements common across models of therapy and common to the process of therapy itself are responsible for therapeutic change. This article-the second of two companion articles-reports on a study designed to further investigate common factors in couple therapy. We used grounded theory techniques to analyze data from interviews with MFT model developers Dr. Susan M. Johnson, Dr. Frank M. Dattilio, Dr. Richard C. Schwartz, former students of Dr. Johnson and Dr. Schwartz, and each of their clients who had been successful in couple therapy. This article reports model-independent variables, that is, general aspects of therapy that are not directly related to the therapist's model. Model-independent categories include client variables, therapist variables, the therapeutic alliance, therapeutic process, and expectancy and motivational factors, each with several subcategories. We also present a conceptual framework that outlines how model-dependent and model-independent common factors may interact to produce change. We discuss our findings and proposed framework in relation to the current common factors literature in psychology and MFT. We also discuss clinical, training, and research implications.     

Beyond common factors: multilevel-process models of therapeutic change in marriage and family therapy

A number of scholars have proposed the common factors perspective as the future direction of marriage and family therapy (MFT). Although intuitively appealing, the case for the common factors perspective is not as clear-cut as proponents portray. In its current form, the common factors perspective overlooks the multilevel nature of practice, the diversity of clients and settings, and the complexity of therapeutic change. In contrast, comprehensive process-based change models are an alternative to the limitations of common factors. In this article, we consider the limitations of the common factors perspective and propose the necessary and sufficient components and processes that might comprise comprehensive, multilevel, process-based therapeutic change models in MFT.     

The mental health recovery movement and family therapy, part I: consumer-led reform of services to persons diagnosed with severe mental illness

In 2004, the U.S. Department of Health and Human Services issued a consensus statement on mental health recovery based on the New Freedom Commission's recommendation that public mental health organizations adopt a "recovery" approach to severe and persistent mental illness, including services to those dually diagnosed with mental health and substance abuse issues. By formally adopting and promoting a recovery orientation to severe mental illness, the United States followed suit with other first-world nations that have also adopted this approach based on two decades of research by the World Health Organization. This movement represents a significant paradigm shift in the treatment of severe mental health, a shift that is more closely aligned with the nonpathologizing and strength-based traditions in marriage and family therapy. Furthermore, the recovery movement is the first consumer-led movement to have a transformational effect on professional practice, thus a watershed moment for the field. Part I of this article introduces family therapists to the concept of mental health recovery, providing an overview of its history, key concepts, and practice implications. Part II of this article outlines a collaborative, appreciative approach for working in recovery-oriented contexts.     

How parents suspected of child maltreatment change their cognition and behavior: A process model of outreach and child protection,generated via grounded theory

AimAlthough considerable efforts have been made to improve relationships between professionals and parents suspected of child maltreatment, little research has been conducted to examine the ways in which parents escalate their negative cognition and behavior involving professionals. This study developed a model of parents' negative reinforcement of their cognitive behavior and the factors influencing reductions in this reinforcement.MethodInterview data were collected from 21 parents, who had experienced outreach and child protection issues, and analyzed using the grounded theory approach.ResultIn the outreach phase, the analysis initially produced the negative image of help-seeking behavior category, followed by the dissatisfaction with outreach and reinforcement of negative cognition categories. In this phase, the analysis also identified the social support and support groups step as a means of reducing negative cognition. In contrast, in the child protection phase, the analysis produced the anger and psychological conflict with child protection services and unwilling consent categories. In this phase, the analysis also identified the psychoeducation and timely feedback step as an acceptable means of minimizing the escalation of negative cognition.ConclusionThe hypothetical model revealed the ways in which parents changed their cognition and behavior and demonstrated the factors influencing reductions in the reinforcement of negative cognition and behavior. These results could be useful for practice in child maltreatment cases.