A CHILD PSYCHOTHERAPIST IN PRIMARY MENTAL HEALTH

This paper outlines the author's application of psychodynamic thinking and approaches to brief therapeutic work with children, adolescents and their families in community mental health settings. It is the author's belief that systemic and narrative therapy insights and techniques combine well with psychoanalysis in the assessment and treatment of many concerns felt and expressed by parents and young people. The therapist's tasks are to listen empathically to clients who are in distress and to explore the clients' beliefs about the origins of their problems, as well as their previously attempted solutions. In proceeding at the family's pace, opportunities arise for facilitating more effective ways of resolving conflict. Clients are often more free than they realise to change their interpretation of their experience, and this has important consequences for the maintenance and solution of problems. Brief therapy seeks to remind clients of their strengths and resources and to share ways to encourage clients to resume effective ways of learning about themselves.     

Does the Therapeutic Relationship Matter? A Follow-up Study of Adherence and Improvement in Family Therapy

A follow-up study of 83 families treated by family therapy at a child guidance clinic was conducted and the relation of client/therapist interaction to (i) drop out from therapy and (ii) improvement was examined. Early terminators were found to differ significantly from continuers as to their ratings of their relationship with the therapist, and trends were found for therapists' feelings to be associated with adherence to therapy. Early terminators were not distinguished by diagnosis, severity of case, or improvement rating. Improvement, on the other hand, was not associated with therapists' or clients' attitudes to each other. It is suggested that these factors are of greater significance in “joining” therapy than in its course.     

Which therapist perceptions best predict client outcomes? A naturalistic examination

Examining associations between therapists' perceptions of therapy sessions and client-reported outcomes in naturalistic settings (real-life therapy settings) can provide valuable guidance for the assessment, treatment, and monitoring of clients. This study included data of 1334 sessions from 127 clients (86 individual and 41 couple cases) and 15 therapists, collected at a therapy training center. Clients reported their personal functioning and individual symptoms before each session. Therapists rated clients' participation, receptivity, session progress, goal progress, and therapeutic alliance at the end of each therapy session. Multilevel Structural Equation Modeling analyses revealed that therapist-rated client participation and goal progress predicted better personal functioning, beyond clients' previous personal functioning scores. In contrast, none of therapist-rated session variables predicted clients' individual symptoms, beyond previous symptom scores. Power analyses suggested sufficient statistical power to detect small effect sizes. Findings of the current study have clinical implications for treatment planning and progress monitoring.     

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.     

Genre as Tool in the Transmission of Practice Over Time and Across Professional Boundaries

In this article, we are concerned with the processes through which a central activity in the natural sciences—classification—is instantiated in the writing practices of psychotherapists. We examined several psychotherapists' grammatical, lexical, and rhetorical strategies for writing their initial evaluations of their clients' problems. Using membership categorization device analysis from ethnomethodology, we examined several therapists' written initial evaluations for their use of microlevel categories and categorizations derived both from clients' own (oral) representations and the therapists' professional repertoire. The resulting analysis suggests that clients' emic, contextually grounded expressions are absorbed into a monological account reflecting the therapist' s professional interpretive framework. The therapist thus translates the client' s concerns into a set of meanings compatible with the classifications of psychopathology of the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The resulting written account supports a billable diagnosis thereby fulfilling its institutional purpose. It fails, however, to serve another important purpose to many therapists, which is helping the therapist to guide the therapy process by providing a record of the client's perspective of his or her lifeworld.     

Therapist Differentiation and Couple Clients' Perceptions of Therapeutic Alliance

Therapeutic alliance has been acknowledged as one of the catalysts for change within a therapeutic relationship. The contributions of therapists' characteristics to alliance are not often studied. From a Bowen System's Theory perspective, the therapist's level of differentiation would be highly relevant to the development of a therapeutic alliance. The hypothesis for this study was that therapists who are able to take a more differentiated stance in therapy will build a stronger therapeutic alliance. To test this hypothesis, multilevel modeling procedures were performed, using data from nine therapists and 93 couple cases collected at a large, Midwestern university. Therapist differentiation of self was found to be weakly associated with the clients' perception of therapeutic alliance across the early sessions of therapy, but not in the expected direction. Although the results were unexpected, this study provides an example of the potential of examining therapist characteristics from within one model of therapy, that can be applied across various clients and various models of therapy.     

Reflections and Learning From an Agency‐Wide Implementation of Single Session Work in Family Therapy

In November 2009, the Bouverie Centre, a centre for training, research, and clinical family therapy in Melbourne, Australia, embarked on a 12‐month trial involving the implementation of single session work as our main model of service provision for all new family appointments. We were interested in evaluating clients' and therapists' experiences of this change in our clinical service delivery. This article discusses some clinical dilemmas that arose for staff in this process, and how they were addressed. Clients' responses to single session work are outlined, followed by a discussion of outcomes of the implementation for our organisation.     

Clients' relational conceptions of conjoint couple and family therapy quality: a grounded formal theory

Based upon a qualitative metasynthesis of 49 articles centered on clients' experiences of their conjoint couple and family therapy, the investigators constructed a grounded formal theory of Clients' Relational Conceptions of Conjoint Couple and Family Therapy Quality. The theory suggests from pretherapy conceptions to posttherapy reflections, clients' perceptions of conjoint couple and family therapy quality appear to consist of clients' constructed meanings regarding a series of interrelated relationships between clients and their therapists and therapy environments, between clients and themselves, between clients and other family members, and between process and outcome both inside and outside therapy. Within and across these relationships, clients appear to focus on expectations, connections, balance, and change when evaluating the quality of their clinical experiences. Based upon this theory, the investigators recommend that researchers continue to explore this clinical phenomenon and that therapists regularly seek clients' conceptions of quality in therapy.     

Predictors and Processes Associated with Home‐Based Family Therapists' Professional Quality of Life

This study examined whether home‐based family therapists' (HBFT) workload and clinical experience were associated with therapists' professional quality of life directly and indirectly through self‐care activities and frequency of clinical supervision. Hypotheses were tested using structural equation modeling with a sample of 225 home‐based therapists. Results suggested that therapists' workload and HBFT experience significantly predicted therapists' professional quality of life. These associations between therapists' workload and HBFT experience were partially mediated through participation in self‐care and frequency of clinical supervision. Implications for improving therapists' quality of life are discussed as a function of therapists' workload, clinical experience, self‐care, and supervision.     

Producing Family Problems: Organization and Uses of the Family Perspective and Rhetoric in Family Therapy

This article applies and extends literature on the micropolitics of trouble and family rhetoric perspectives by analyzing how therapists in a family therapy agency practicing the brief model used family rhetoric in defining and responding to client problems. Family rhetoric is the use of images of family (the family perspective) to (1) persuade others to one's preferred orientation to issues of mutual concern and (2) attribute identities to one's self and others. The article focuses on how the therapists rhetorically enacted and applied the family perspective in interactions with colleagues and clients to define and remedy client troubles. In general, troubles were defined and remedied by treating them as products of clients' family systems, defined as enduring roles, relationships, and perspectives. The therapists sought to remedy client troubles by initiating changes assessed as appropriate for their troubles and family systems. The article concludes by considering some of the implications of the findings and analysis for the sociological study of human service work.     

“Basically it's the Usual Whole Teen Girl Thing”: Stage‐of‐Life Categories on a Children and Young People's Helpline

This article explores the practices of membership categorization in the interactions of clients and counselors on a national Australian helpline (Kids Helpline [KHL]) for children and young persons. Our focus is on membership categories drawn from three membership category devices (MCDs): stage‐of‐life (SOL), age, and family. Analysis draws on data across different contact modalities—email and web‐counseling sessions—to examine how category‐generated features are relevantly occasioned, attended to, and managed by the parties in the course of interaction. This shows clients' use of MCDs in presenting their trouble and building a relevant case for their grievance. By examining counselors' subsequent receipts of the clients' complaints, we are able to trace some of the cultural knowledge that the clients' categorizations make relevant to the counselors. Moreover, the analysis demonstrates how the inherent flexibility of MCDs allows counselors to exploit these same categorial resources and to re‐specify the clients' trouble in a more positive fashion to accomplish counseling work. In explicating how taken‐for‐granted notions of the lifespan as well as of family relations are mobilized by participants in KHL's sessions, the findings contribute to previous studies of social interaction in counseling, and to research on social identity and categorization more broadly.     

A STRUCTURAL APPROACH TO UNRESOLVED MOURNING IN SINGLE PARENT FAMILY SYSTEMS*

The mother's depression is considered as a special problem in the family therapy of single parent families. It is seen as resulting from unresolved mourning that is maintained by the family system. Several reasons why the single parent family's structure seems inherently vulnerable to unresolved mourning are offered. Some techniques of Structural Family Therapy are proposed in a specific order to facilitate mourning in such families. A successful mourning experience requires a restructuring of the family that provides energy for the remainder of the therapy.     

Giving Clients a Backstage Experience: A Case of Dramaturgical Trouble in the Professional Performance of Drug Treatment

Professionals who provide drug treatment to young people seek to approach clients as agents of change, i.e., highlight clients' agency and ownership of treatment plans. On the basis of ethnographic data from two treatment institutions in Denmark, this article investigates how everyday interaction organizes clients' experiences in ways that alternately support and contradict this professional ambition. Notably, findings indicate that talk and material arrangements “backstage” make professionals, not clients, appear as the real agents of change. Clients are increasingly encouraged to participate in meetings “backstage,” where treatment is organized, but, contrary to intentions, clients may experience participation as debasing rather than empowering.     

Critical factors of intensive family work connected with positive outcomes for child welfare clients

Mechanisms producing positive change in troubled families were analysed. The study aimed to answer the questions: What kind of case and client outcomes does intensive family work (IFW) produce for child welfare clients? From the perspective of family workers, what kind of critical factors for positive child, parent and family outcomes can be identified? The study used child welfare case files of 35 families with 93 children from one social office and interviews with 20 family workers and IFW managers in 5 municipalities in Finland. The shades of worries scale was used in evaluating the change in each family's situation. The case outcome measures for children included changes in the child's status in open care, short-term placement or foster care. During IFW, positive changes took place in 23 families out of 35 (66%). Twenty-seven children from 16 families did not continue as child welfare clients. Eleven children were placed into foster care during IFW and two years after it. The critical processes for outcomes included time, trust building and engagement, practical help, facilitating communication and guaranteeing the best interest of the child. IFW was considered effective for positive outcomes for the majority of families with complex needs.     

Therapeutic Change and Anorexia Nervosa: Views of a Family and a Therapist

Answers to the question ‘Why do people change in family therapy?’ remain somewhat elusive and may to some extent always remain partial. However, the perceptions of important participants in the therapeutic system, namely family members themselves, seem somewhat under-utilised. A regular examination and integration of the families' views may lead to enrichment of our understanding of this complex area. In this paper the therapist's (and therapy team's) views of the possible catalysts of change in therapy are compared with one family's ideas twelve months after termination of treatment. The family had attended for family therapy because the middle daughter had been suffering from anorexia nervosa.     

Perceived Family Climate of Students Deciding to Pursue Counseling

Abstract

It was hypothesized that perceived family-climate factors would differentiate between students who applied for therapy help and those who had not. Further, within the applied-for-therapy group, it was hypothesized that perceived family-climate would be related to therapy outcome. It was predicted and found that the students applying for therapy were lower on the relationship and personal growth dimensions, but higher on the control dimension of family climate, than college students in general. Within the students applying for therapy it was found that perceived higher relationship and higher control dimension scores were related to longer time spent in therapy and to therapists' more favorable evaluation of the therapy experience. Suggestions were made for practical application of family-climate information to therapy.     

The Family in the Light of a New Relational Theory of Primary,Secondary and Generalized Social Capital

The aim of this article is to pinpoint the relevance of family relationships in the studies on ‘social capital’. In order to clarify this perspective, Pierpaolo Donati outlines a new approach called ‘relational approach’. According to it, social capital is a property and a quality of social relationships, not an attribute of individuals or social structures as such. This theory has two major advantages: first, it leads to differentiate those components of social capital which are usually conflated; second, it permits to identify various forms of social capital (primary, secondary-communitarian and civic or generalized). Riccardo Prandini criticizes the sociological prejudices which consider the family mainly as an obstacle for the full deployment of ‘liquid’ and ‘modern’ social relations. The family's social capital is defined as the reciprocal orientations of the family's members which are able to generate trust and therefore cooperative actions. Empirical evidence shows that the family's social capital is strictly connected to the emergence of pro-social attitudes in individuals, particularly in terms of social trust and participation in civil associations.