ETHICAL DILEMMAS IN FAMILY THERAPY

A review of the literature in the area of ethical dilemmas facing family therapists revealed that there were a number of issues facing family therapists which are not included in the Principles for Family Therapists (1984) of the American Association for Marriage and Family Therapy. Seventy-five family therapists from across the nation responded to a questionnaire which asked what ethical dilemmas they face and how helpful the ethical guidelines are with these dilemmas. Results indicate that family therapists are encountering dilemmas which are not included in the Principles, significantly more often than those that are included. The ethical principles were found to be helpful for those ethical dilemmas attended to by the Principles.     

LEARNING ABOUT GRIEF FROM NORMAL FAMILIES: SIDS,STILLBIRTH, AND MISCARRIAGE*

Family therapists can learn a great deal that would be of utility to them in their clinical work from normal families grieving over the death of an infant. When a baby dies, families begin a long and difficult journey, a search for security and meaning in a world that for them has gone insane. The researcher discusses 10 probing, extremely difficult questions family members commonly pose in the aftermath of an infant death and offers guidelines that could be helpful to family therapists hoping to be of service to families in the process of healing and growing through this tragedy.     

Family Support Groups for Family Members of Mentally Ill Offenders: Therapeutic Factors

This study investigates therapeutic factors of a Family Support Group (FSG) intervention for family members of mentally ill offenders. Seventeen family members completed the ‘Group Therapeutic Factors‐Client Questionnaire’ (GTF‐CQ‐28) during four sessions of two FSGs. Results indicate that family members experienced the following therapeutic factors over the course of treatment: the relational climate, interactional confirmation, expressing and experiencing mutual positive feelings, forgetting own problems, hope from seeing progress in others, guidance from therapists, and getting interpersonal feedback treatment. The therapeutic factors, including learning by observation, support from the group, and universality of problems, correlated with a decrease in self‐blame, improved emotional well‐being, and experiencing less loss of control over one's life, respectively. Further, family members were satisfied with what the FSG has provided for them personally and for the relation with their relative. Finally, clinical implications of the FSG are discussed. The study sheds light on valuable therapeutic factors within an FSG and the important role of therapists.     

Dsm-iii-R and the family therapist: ethical considerations

DSM-III-R has gained popularity in many segments of the mental health field. Family therapists have generally not found its approach to assessing problems to be helpful in the planning of therapy, yet, are often forced to use it due to the requirements of third-party payers. This raises several ethical and practical concerns, e.g., the incompatibility of orientations between DSM-III-R and family therapy, the stigma associated with diagnosing, being asked to misrepresent diagnoses to third-party payers, and the competency of some family therapists to make DSM-III-R diagnoses. Short- and long-term strategies to deal with these ethical dilemmas are also presented.     

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.     

THE MARGINALIZATION OF FAMILY THERAPY: A HISTORICAL AND CONTINUING PROBLEM

Family therapy, and marital and family problems, are mariginalized in the larger fields of mental and physical health care, which is a misfortune both for family therapy and for other mental health professions. The early family therapists, who had multidisciplinary backgrounds, attempted toestablish a new, nondisciplinary paradigm and also tried to expand the perspectives of the more traditional mental health disciplines. More recently, family therapists have exerted greater effortsto establish marriage and family therapy as a differentiated, autonomous profession. These alternatives each involve dilemmas for the family therapy field. The positive side of becoming a distinctive profession is greater internal strength and clear professional identy; the downside is the threat of increased marginalization in rlation to the other professions, a tendency toward intellectual isolation, and hence restricted opportunities for invigorating new challenges. Family therapy now needs to develop new modes of interchange, collaboration, and selective integration with otherhealth care professions. Such interchange will be beneficial both to family therapy and to other professions.     

Stages of Change Theory in Family Therapy for Sibling Sexual Assault

Family therapy understands the benefits of therapeutically supported dialogue amongst family members when there are challenging themes and topics that need to be discussed. This paper is an attempt to explore ways that family therapists can work with family members who are thrust into therapy rather than ‘voluntarily’ signing up for it. It applies ideas from the drug and alcohol field such as Stages of Change theory and Motivational Interviewing. The paper explores how these ideas and approaches might help family therapists to formulate a concept of resistance and to make helpful dialogue more likely. They are applied to families experiencing sibling sexual assault, where they become involved with a legal response that necessitates a therapeutic intervention.     

An Empirical Assessment of the Goals of Family Therapy*

This study is an empirical assessment of the goals of family therapists. A list of goals was developed based on a theoretical clustering of the family therapy literature into the dimensions of communication, cohesion, and adaptability. Three hundred ten clinical members of the American Association for Marriage and Family Therapy (AAMFT) responded to a questionnaire about their use of these goals in family therapy. The findings indicate that the goals employed by this sample seem to reflect ideas from the literature which are not the property of any one “school” of family therapy. The goals that were rated and ranked highest included encouraging family members to relate caringly, responsibly, and creatively in negotiating their differences. Goals that were rated and ranked lowest included the more advanced or technical communication skills and some cohesion goals that may be interpreted as related to institutional aspects of family life.     

Basic family therapy skills, I: conceptualization and initial findings

This is the first report on a program of research designed to identify the most important characteristics of the beginning marriage and family therapist. The paper first surveys the literature in family therapy, social work, and psychology and finds that, although these factors are discussed for beginning psychotherapists, no set of skills are derived empirically. This study recruited all available members of the American Family Therapy Association (AFTA) and Approved Supervisors of the American Association of Marriage and Family Therapy (AAMFT) who were experienced educators and trainers of family therapists. After nominating the most important generic-type characteristics for beginning family therapists, the participants rated the items, yielding a list of not only the most important skills, but also personal traits of beginners based on mean scores of the ratings. The final section of the paper discusses the implications of these findings and notes the current and future activities of the research program.     

Art,Science and Curiosity: Research and Research Methodologies in Australian Family Therapy 1979–2000

This article presents an historical analysis of the development of research and research methodologies in an Australian context. The Australian and New Zealand Journal of Family Therapy was chosen as the site of the analysis. The first section of data consists of the articles that represent themselves as ‘research’ in the period from 1979 (the journal's inception) to 2000. These texts have been analysed using bibliometric analysis. The second section of data consists of commentary articles about research in family therapy. This data has been analysed using discourse analysis. Overall, I have been interested in how family therapists have defined ‘research’; how family therapists have chosen to inquire; representations of the researcher in Australian family therapy; associations between theoretical or clinical developments and the methodologies that have been chosen for inquiries. Findings from the study reveal very limited representations of research in the journal for the period under review, and an apparent struggle for family therapists to undertake a discussion about what research actually is. Questions are raised around how this has occurred, and some ideas are presented as to how research knowledges can be included in debates around theory diversity in family therapy.     

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.     

FAMILY THERAPISTS' RESPONSE TO AIDS: AN EXAMINATION OF ATTITUDES,KNOWLEDGE, AND CONTACT*

As the number of individuals and families impacted by AIDS continue to multiply, family therapists will increasingly be asked to become engaged in the challenge of caring for those affected. To date, little has been written in family therpy journals regarding the response of family therapists to this crisis. This paper represents an initial attempt to examine the atitudes of clinical members of the American Association for Marriage and Family Therapy toward AIDS and persons with AIDS. Included in the study are data regarding the therapists' contact with persons with AIDS, gays, and lesbians, and the impact of such contact on attitudes. Implications for future research, training, and treatment of those affected by AIDS are also provided.     

Family therapist comfort with and willingness to discuss client sexuality

Limited empirical information exists on whether or not marriage and family therapists are having sexuality-related discussions with their clients. When helping professionals ignore client sexuality, the potential for unintended negative outcomes increases. The researchers surveyed 175 clinical members of the American Association for Marriage and Family Therapy to assess how their clinical training and education, their perceived sexual knowledge, and their comfort with sexual material influenced their willingness to engage in sexuality-related discussions with their clients. The results indicate that sexuality education and supervision experiences are the cornerstone for a therapist's base level of comfort. It is through sexuality education and supervision that sex knowledge is acquired and comfort levels are increased. Once comfort with sexual discussions increases, then therapists are more likely to engage in sexuality discussions with their clients.     

Trends in family therapy supervision: the past 25 years and into the future

This investigation repeats a survey of American Association for Marriage and Family Therapy (AAMFT) Approved Supervisors done in 1976 and 1986. Despite negative contemporary contextual influences, the AAMFT Approved Supervisor credential is still attractive to the same percentage of the AAMFT clinical membership as formerly and reflects in general the demographic characteristics of marriage and family therapists (MFTs) in clinical practice. Across the last quarter century there has been a steady increase in female AAMFT Approved Supervisors and those with terminal master's degrees. These and other trends are discussed with a view toward what supervision is becoming and what it needs to become.     

An Exploration of Family Therapists' Beliefs about the Ethics of Conversion Therapy: The Influence of Negative Beliefs and Clinical Competence With Lesbian,Gay, and Bisexual Clients

The majority of the literature on conversion therapy has focused on clients' experiences and rationales for seeking such therapy. This study sought to explore differences in the beliefs and clinical competence of therapists who practice and believe in the ethics of conversion therapy and those who do not. The sample for this study included 762 family therapists who were members of the American Association of Marriage and Family Therapy. Data were collected using electronic surveys that assessed participants' negative beliefs about and perceived clinical competence with lesbian, gay, and bisexual (LGB) individuals. Results indicate that those who believe in the ethics of and/or practice conversion therapy report statistically higher levels of negative beliefs about LGB individuals and lower levels of clinical competence working with LGB clients. Implications for clinical practice and organizational policy are discussed.     

DOES ACADEMIC TRAINING BACKGROUND MAKE A DIFFERENCE AMONG PRACTICING MARRIAGE AND FAMILY THERAPISTS?

Using a national sample of practicing marriage and family therapists (MFTs) and their clients, this study investigated whether academic training background is associated with differences in pracice patterns and client outcomes. Clinical members of the American Association for Marriage and Family Therapy with academic training in psychology, social work, counseling, and marriage and family therapy were compared on a wide range of clinical practice variables, and their clients were surveyed about thier satisfaction and outcomes. Results showed highly similar practice patterns and client outcomes across all four disciplinary groups. Although the findings showed little evidence for the uniqueness of academic marriage and family therapy training among experienced MFTs, they also refute the notion that therapists trained in MFT degree programs practice in unusual or inferior ways compared to MFTs trained originally in other mental health disciplines.     

BASIC FAMILY THERAPY SKILLS,II: STRUCTURAL FAMILY THERAPY1

The Basic Family Therapy Skills Project has yielded empirically derived skills important for beginning family therapists. This article reports the results of ratings from the 103-member panel of experts who practice and teach Structural Family Therapy. A total of 100 competencies of Structural Family Therapy were rated in terms of importance on a 5-point Likert scale by the panel. Panelists were also given alternative responses such as “appropriate as a generic skill,”“inappropriate for beginning therapists,” and “don't understand what this means.” Rationale for the approach and results are discussed in terms of the importance of empirically based competencies for the practice of Structural Family Therapy.     

Walk-in Together: A pilot study of a walk-in online family therapy intervention

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk-in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof-of-concept study investigating the acceptability and short-term effectiveness of an online walk-in family therapy service, Walk-in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk-in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre-session, post-session, and at 6 weeks follow-up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi-structured interview data. Post-session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post-session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well-received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk-in delivery model. This proof-of-concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk-in, telehealth model to meet the rising demand for therapeutic support for families in distress.