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.     

Action-oriented evaluation of an in-home family therapy program for families at risk for foster care placement

The purpose of this study was to conduct an action-oriented evaluation of an in-home family therapy program serving families deemed at risk for the placement of children in foster care. In this study, feedback was solicited from both clients and therapists. Results indicate "duality" associated with several aspects of in-home family therapy, including the opportunity to observe families in their own homes versus the vulnerability some families feel when therapy is conducted in-home; therapists suggesting that sufficient training is required for in-home family therapy to be effective versus clients' opinions that therapists' lived experiences are more relevant; and the importance of the therapeutic alliance versus feelings of abandonment upon termination. Implications for researchers and practitioners are discussed.     

Exploring the influence of the attachment organizations of novice therapists on their delivery of emotionally focused therapy for couples

Clinicians' own internal resources for understanding relationships--that is, their attachment organizations--have been found to influence the process and outcome of treatment. The current study addressed whether the attachment organizations of novice couple and family therapists were associated with couples' experiences of their therapists, therapeutic alliance, session impact, and emotionally focused couple therapy (EFT) fidelity (i.e., especially as related to targeting and working with attachment needs and overt and underlying emotions). Novice couple and family therapists delivered EFT, an attachment-based approach, to couples in a simulated session and an embedded multicase study design guided a cross-case analysis. Findings indicated that secure therapists, when compared to their insecure peers, were more competent at working with attachment needs, as well as the overt and underlying emotions of their clients. Secure therapists perceived themselves as being more skilled in emotion regulation, which may have contributed to their abilities to remain attuned to their clients' attachment needs and emotional expression, even in the face of emotional arousal in session. Couples of insecure therapists also reported greater alliance splits. Future research is needed to further explore the dyadic influences of both therapists' and clients' attachment organizations, as well as the training and supervision practices these findings implicate.     

Supervising emotionally focused therapists: a systematic research-based model

Emotionally Focused Therapy (EFT) is an empirically validated relational therapy that recognizes the complexity of couple's therapy and supports the need for specialized training of therapists. Until now, there has been little research on effective methods for EFT supervision and no systematic model for conducting EFT supervision. The findings of a qualitative study of certified EFT therapists' experiences with EFT supervision and training are presented in this study, along with a systematic model of EFT supervision. The model of EFT supervision is based on the findings of this study, relevant research regarding effective clinical supervision, and the authors' experiences with EFT supervision. This model of EFT supervision is isomorphic to the clinical practice of EFT, in that it is theoretically grounded in attachment theory and emphasizes experiential and emotionally based processes.     

Use of simulated clients in marriage and family therapy education

Knowledge of how one should manage suicidal, homicidal, child maltreatment, and domestic violence situations is paramount in the training of marriage and family therapists (MFTs). Simulated patient modules were created to help clinical faculty address these crisis situations in a protected learning environment. The modules were implemented by the MFT faculty in collaboration with the Office of Clinical Skills Assessment and Education at East Carolina University's Brody School of Medicine. Qualitative data over the course of 2 years revealed six thematic domains regarding therapists' performance, therapists' emotions, the simulation experiences, and lessons learned. Educational, clinical, and research recommendations include tools to implement simulation exercises into marriage and family therapy programs as well as suggestions to assess for teaching effectiveness.     

Enhancing Family Therapy's Relationships With Research

The contention of this article is that systemic family therapy has much to gain from a realistic appraisal of its research base, which is as positive as possible. And that through such an appraisal we can find ways of developing the scope of family therapy to the benefit of the profession and thereby, of our clients. Family therapy will benefit if practitioners can present an informed view of research. As a preliminary approach to this objective, I review reasons why perceptions of family therapy underestimate its research base, and why therapists might resist involvement with research. The article then explores the reasons for regarding randomised controlled trials as a ‘gold standard’, and why they are not well fitted for the purpose of evaluating or developing a relational therapy. Next is a consideration of alternative approaches to research, including a consideration of what clients actually want from their therapy, then a brief review of the positive findings of outcome research. Greater emphasis on researching processes in therapy is proposed, and consideration of the ‘common factors’ debate is shown to support priorities that are specific to systemic therapies. The article concludes with suggestions for increasing the involvement of family therapists with research, both as consumers and as research practitioners.     

The impact on the family therapist of a focus on death, dying, and bereavement

Recognizing the growing numbers of family therapists who are choosing a focus on death, dying, and bereavement, this article addresses the nature of the commitment required--as well as the gifts and challenges presented by work in this area. Particular attention is given to therapists' vulnerability to compassion fatigue and/or vicarious traumatization, both of which are described and discussed. A variety of strategies for individuals and institutions, aimed at supporting professionals and preventing problems, are considered. It is concluded that as family therapists focus on self-care as well as client care, they have the potential to increase not only their effectiveness but also to enhance their own well-being. Implications for training and for research on this topic also are considered.     

How Do the Professional Lives of Family Therapists Affect their Private Relationships: A Qualitative Study

This article is based on a qualitative research project about how the professional lives of family therapists affect their private relationships. The overarching research question was: How does your professional work as a family therapist affect your private relationships? To answer this question, semi‐structured qualitative interviews were conducted with four therapists from two different Family Counseling Services. Through the use of interpretative phenomenological analysis, three main findings were identified: (1) family therapists’ knowledge and values are a basis for interpersonal encounters; (2) participants describe resonance in relation to clients’ stories; and (3) therapists can be challenged in managing confidential knowledge particularly where they belong to the same communities as clients. The study also explores societal expectations and discourses that accompany the role of therapist, which can affect therapists’ freedom of movement in their private lives. These issues are discussed in relation to family therapy theory and relevant research.     

Sex and sexual orientation as variables in therapists' biases and therapy outcomes

The extent to which the variables of sex and sexual orientation are factors in therapy efficacy and therapist bias are examined through an extensive review of the literature. Data analysis based on a large sample of lesbian women indicate that female therapists, either heterosexual or lesbian, were assessed to be more beneficial than male therapists. However, the author suggests that therapists' sex role ideology may be a more salient factor than sex or sexual orientation in positive therapy outcomes with lesbian women.     

INFLUENCES ON THEf INCLUSION OF CHILDREN IN FAMILY THERAPY BRIEF REPORT

This study examined factors that influence family therapists to include children in or exclude them from therapy sessions. We hypothesized that therapist comfort, child problem type (internalizing vs. externalizing), family composition (one- vs two-parent families), and presenting problem (child-oriented problem vs. adult-oriented problem) affect therapists' inclusion of children. A survey of clinical members of AAMFT found that half of the therapists excluded children on the basis of their comfort and that those who felt more comfortable were more likely to include children in sessions. Therapists included children more frequently in cases of an internalizing vs. an externalizing child, more with single-parent than two- parent families, and more often when the presenting problem focused on a child than on an adult. Implications of the findings are discussed.     

Understanding the experience of Black clients in marriage and family therapy

Past research on Black clients' utilization of therapy focused on the barriers that prevent Black clients from attending therapy and the reasons for these barriers. However, few studies have been conducted that focus on how Black clients attending therapy actually experience these barriers. This study utilized both Likert and open-ended questions to examine the obstacles 16 Black clients face in their attempts to attend family therapy. The most frequently identified obstacles were related to concerns over family member response and cultural barriers to therapy. Participants also reported concerns about racial and/or cultural differences and a lack of understanding by non-Black therapists. The implications of this study addressed how to effectively meet the therapeutic needs of Black clients.     

CORRESPONDENCE OF FAMILY THERAPISTS' PERCEPTIONS WITH FRCCCS CODING RULES FOR TRIADIC INTERACTIONS

Family therapy theory, practice, and research across many orientations are concerned with multiperson interactional phenomena such as intercepts, disconfirmations, and indirect communications. This study reports a successful criterion validity test of the rules for coding these triadic features in the Family Relational Communication Control Coding System (FRCCCS) (Friedlander & Heatherington, 1989). Thirty-five experienced family therapists observed two videotaped family therapy interactions and reported their perceptions of each of 25 communications. These perceptions-the criterion-significantly corresponded with the FRCCCS coding rules about the relational control aspects of triadic communications. Discussion focuses on the future use of the FRCCCS in research on family therapy.     

Integrating Reflective Practice in Family Therapy Supervision

This paper discusses how to integrate reflective practice in the family therapy supervisory relationship. This enables family therapists to think creatively, be insightful, and develop a range of perspectives regarding systemic formulation and practice. It encourages review of the past and promotes understanding in the present with the aim to improve therapists work with families in the future. Reflective practice encourages independent thinking and learning and helps therapists to develop a systemic process of critical enquiry to investigate and critique their own practice. It encourages therapists to be self‐reflective and develop confidence to think hypothetically regarding change. This allows them to pose questions for exploration, construct a new lens to conceptualise therapy and the therapeutic relationship and develop awareness of the personal as well as the professional self.     

DIFFERENT LENSES: VARIATIONS IN CLIENTS' PERCEPTION OF FAMILY THERAPY BY RACE AND GENDER

Race and gender have been given extensive theoretical and clinical attention in family therapy in the last decade. However, little empirical work has focused on their effect on therapy. The present study examines the effect of clients' race and therapists' race and gender on male and female partners' assessments of an initial and subsequent family/marital therapy session. One hundred twenty-six individuals, comprising 63 heterosexual adult couples, evaluated both the first and the fourth therapy session using the Session Evaluation Questionnaire (Stiles, 1980). Results indicated a strong effect for race, with black females rating initial sessions more negatively than white females when seeing a white therapist. Black men, however, had a more positive response than white men to the initial session, regardless of the race of the therapist. Over time, these differences decreased. The results suggest not only that race and gender may contribute to differences in partners' perceptions of the same session, but also that these differences are not static.     

The Marriage and Family Therapy Practice Research Network (MFT‐PRN): Creating a More Perfect Union Between Practice and Research

This article describes the Marriage and Family Therapy Practice Research Network (MFT‐PRN). The MFT‐PRN is designed to build a professional community based on practice‐informed research and research‐informed practice, increase the diversity of participants in MFT research, and unify researchers and clinicians. Clinics choose measures from a list that best represent their clinic needs. Clients' outcomes are assessed regularly, and therapists receive immediate graphical feedback on how clients are progressing or digressing. Data are pooled to create a large and diverse database, while improving client outcomes. We will discuss advantages of the MFT‐PRN for researchers, therapists, clients, and agencies, and provide one model that we hope will inform other collaborative clinical‐research models in the field of marriage and family therapy. Video Abstract is found in the online version of the article .