Internship training in marriage and family therapy: a survey of doctoral program objectives and implementation

This article presents the results of a survey that examined the implementation of the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) internship requirement by accredited doctoral Marriage and Family Therapy (MFT) programs. Representatives from each of 10 doctoral MFT programs provided responses to questions regarding program objectives for internship training. Respondents also provided subjective impressions regarding the effectiveness with which established internship goals are accomplished, associated benefits and difficulties, and adequacy of the standards. Results suggest that although most programs perceive the internship requirement as beneficial, many express concern regarding the effects of the internship requirement on other aspects of training and in relationship to the overall goals for doctoral MFT education. Conclusions and recommendations are offered based on the mixed findings.     

The Digital Divide: Couple and Family Therapy Programs’ Integration of Teletherapy Training and Education

The mental health field is increasingly integrating and growing a teletherapy presence, and couple and family therapists are uniquely situated to offer these services based on our history of innovative approaches to therapeutic services. To do so successfully, careful consideration of training and education must occur. To evaluate current teletherapy training and education opportunities of COAMFTE accredited couple, marriage, and family therapy programs, an inductive qualitative content analysis was conducted on the responses of 95 faculty at COAMFTE accredited programs. Findings indicate that more than two thirds of the participants were in favor of teletherapy integration in training programs; however, most programs currently do not offer such opportunities. Barriers that prevent such integration were highlighted as well as existing concerns to training graduate students in teletherapy. Implications for training programs, policies, and regulations are discussed.     

Evaluating Scholarship Productivity in COAMFTE‐Accredited Doctoral Programs: An Update

Scholarly productivity continues to be used as a significant factor when universities make decisions about granting tenure to faculty, allocating resources, and supporting program goals. In 2009, DuPree, White, Meredith, Ruddick, and Anderson reviewed research productivity in faculty from COAMFTE‐accredited PhD programs. As an update, the purpose of this article is to re‐examine scholarly productivity trends among COAMFTE‐accredited doctoral programs through the use of several evaluation methods. Specifically, productivity was examined in the following areas: (a) family therapy journal publications; (b) publications in any type of peer‐reviewed journal; (c) h‐factor index scores; and (d) historic and recent journal publication trends.     

Textual representations of diversity in COAMFTE accredited doctoral programs

The use of the Internet is growing at a staggering pace. One significant use of the Internet is for potential students and the parents of potential students to explore educational possibilities. Along these lines potential marriage and family therapy students may have many questions that include a program's commitment to cultural diversity. This study utilized qualitative content analysis methodology in combination with critical race theory to examine how Commission On Accreditation for Marriage and Family Therapy Education (COAMFTE) accredited doctoral programs represented cultural text on their World Wide Web pages. Findings indicate that many COAMFTE-accredited doctoral programs re-present programmatic information about diversity that appear to be incongruent with cultural sensitivity. These apparent incongruities are highlighted by the codification, inconsistent, and isolated use of cultural text. In addition, cultural text related to social justice was absent. Implications and suggestions are discussed.     

Family therapy trainees' evaluations of their best and worst supervision experiences

Supervisees in Commission on Accreditation for Marriage and Family Therapy Education-(COAMFTE) accredited and candidacy training programs were asked to describe their best and worst supervision experiences in terms of the context of training and supervision, the perceived personal attributes of the supervisor, and specific behaviors perceived to be enacted by the supervisor during supervision. Contextual factors such as supervision modality, frequency and duration of supervisory contacts, and sources of supervisory data appeared to distinguish between supervisees' perceptions of their best and worst experiences. These experiences were further distinguished by the supervisees' perceptions regarding the supervisor's level of interpersonal attractiveness, trustworthiness, and expertise. Key behaviors perceived to be enacted by supervisors during best and worst experiences clustered into several dimensions that included creating an open supervisory environment, communication and encouragement, attending to personal growth, and providing conceptual and technical guidance and direction.     

Career Aspirations and Perceived Level of Preparedness Among Marriage and Family Therapy Doctoral Students

The authors conducted a survey of marriage and family therapy (MFT) doctoral students in programs accredited by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE). MFT doctoral students ( N  = 82) from across the United States responded to a web-based survey that focused on career aspirations, training opportunities, and the level of preparedness they experienced during their doctoral education. Results of this survey indicated that students felt they were well prepared for many aspects of their chosen career path. Some respondents desired more training to prepare them for careers in academia. More men than women indicated a career in academia as their primary career aspiration. While most of the respondents perceived that their internship experiences were beneficial, some expressed the desire for more opportunities to supervise master's-level students, to write grants, and to teach graduate-level MFT courses. The authors conclude with a discussion of how these findings may influence the development of core competencies specific to doctoral education in MFT.     

Social Class in Family Therapy Education: Experiences of Low SES Students

In this article, we report the results of a national survey of students in COAMFTE‐accredited family therapy programs who self‐identify as coming from lower‐ or working‐class backgrounds. Results of the study reveal opportunity and tension relative to family, friends, and community because of social mobility associated with graduate education. Participants describe family therapy education as middle‐class centered, pointing to lack of attention to social class, marginalization, classism, and unacknowledged class barriers as salient experiences in their graduate programs. Finally, participants share a number of suggestions for program improvement.     

COAMFTE accreditation and California MFT licensing exam success

Professional accreditation of graduate programs in marital and family therapy (MFT) is intended to ensure the strength of the education students receive. However, there is great difficulty in assessing the real-world impact of accreditation on students. Only one measure is applied consistently to graduates of all MFT programs, regardless of accreditation status: licensure examinations. Within California, COAMFTE-accredited, regionally (WASC) accredited, and state-approved programs all may offer degrees qualifying for licensure. Exam data from 2004, 2005, and 2006 (n = 5,646 examinees on the Written Clinical Vignette exam and n = 3,408 first-time examinees on the Standard Written Exam) were reviewed to determine the differences in exam success among graduates of programs at varying levels of accreditation. Students from COAMFTE-accredited programs were more successful on both California exams than were students from other WASC-accredited or state-approved universities. There were no significant differences between (non-COAMFTE) WASC-accredited universities and state-approved programs. Differences could be related to selection effects, if COAMFTE programs initially accept students of higher quality. Implications for therapist education and training are discussed.     

Incorporating sexual orientation into MFT training programs: infusion and inclusion

Many authors have questioned the preparedness of family therapists to deal with sexual minority clients. Even though the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) has called for the integration of sexual orientation into the curriculum of marriage and family therapy training programs, the subject continues to be marginalized. The purpose of this article is to encourage trainers to examine their programs' curricula for evidence of heterosexist bias and introduce ways that they might integrate issues related to same-sex affectional and sexual orientations into their programs via the classroom and the clinic.     

A Primer for the Use of Multilevel Models in Couple and Family Therapy Research

This article serves as a primer for understanding how to use multilevel modeling (MLM) techniques in couple and family therapy outcome and process research. It outlines the use of HLM and Mplus—two of many software programs that can perform multilevel modeling—and provides an applied example of using MLM to investigate the use of postsession feedback on couple satisfaction and change, as well as the influence of trauma on the use of postsession feedback. Two graduate students in COAMFTE accredited PhD programs read the primer and provided questions to the first author that arose. Answers to these questions have been incorporated throughout the explanation of this methodological approach in hopes of addressing common stuck points for those using MLM.     

Common Factors' Role in Accredited MFT Training Programs

Common factors proponents discuss the benefits and methods of including common factors in marriage and family therapy (MFT) training; yet there are no empirical investigations of how common factors are incorporated into MFT curricula. The purpose of this study was to obtain a baseline understanding of common factors' role in MFT training. Thirty‐one directors of COAMFTE‐ and CACREP‐accredited MFT training programs responded to a survey about the inclusion of common factors in their training program, as well as the benefits, challenges, and students' reactions to common factors training. Findings show that common factors are regularly included in MFT training programs and have garnered largely positive responses. Additional results are discussed regarding the implications of common factors in MFT training.     

Common pitfalls of beginning therapists utilizing enactments

Empirical data, clinical observation, and theoretical rationales support use of enactments as a fundamental mechanism of change in relationship therapies. Yet beginning therapists may lack an adequate conceptual framework and operational training essential to effectively utilize enactments. Inadequate training may contribute to ineffective execution, and in turn to negative results, which could lead to abandonment of enactments. This study sought to identify proficiencies and nonproficiencies of beginning therapists in conducting enactments. Twenty beginning therapists from three Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE)-accredited programs were briefly trained in an indirect therapy style that incorporates enactments. Twenty-six therapist enactments were coded using a comprehensive observational measure designed to assess proficiencies and nonproficiencies in executing enactment phases, component tasks, and subcomponent operations. Results suggest that beginning therapists struggle with numerous clinical operations conceptually linked to the successful engagement of relationships in marriage and family therapy. In light of these findings, specific recommendations for additional enactment training in COAMFTE-accredited programs are offered.     

Publication patterns of faculty in commision on accreditation for marriage and family therapy education programs

Journal articles published by faculty in Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) programs from 1998 to 2002 were analyzed to determine patterns regarding the amount and type of research conducted by this group. Fifty-eight percent of the articles were identified as research. Slightly more than 10% of these dealt with clinical processes and outcomes. Forty percent of studies reported a specific source of funding. Twenty-nine percent of research articles used qualitative methods, with percentages rising over the course of time. Results suggest the average number of publications per faculty member was relatively low, particularly for senior faculty. Implications for these findings are discussed.     

COMMON FACTORS ACROSS THEORIES OF MARRIAGE AND FAMILY THERAPY: A MODIFIED DELPHI STUDY

The Delphi methodology was used to explore common factors across theories of marriage and family therapy (MFT). Leading clinicians and researchers from the American Family Therapy Academy and select faculty members from MFT training programs accredited by the Commission on Accreditation for Marriage and Family Therapy Education were asked to achieve consensus regarding common factors. Respondents were asked to report on commonalities across the various MFT theories, as well as what they personally considered to be the core ingredients of change. A final profile of items was created from the responses. Qualitative interviews were conducted with selected panelists to clarify discrepancies as well as to add meaning to the data. Implications for the training and practice of MFTs as well as direction for future research are discussed.     

Responding to remediation and gatekeeping challenges in supervision

Thirty faculty in randomly selected Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) programs representing four geographical regions of the United States were asked to respond to a survey that included seven brief vignettes depicting gatekeeping and remediation challenges supervisors may face when working with therapists-in-training. Research participants were asked to select from among a range of 17 response options and were also asked to provide a rationale for the selection of their responses. The response rate for the mailed survey was 34%. Telephone interviews were conducted with three respondents who had provided especially detailed responses to the open-ended portions of the mailed survey and who also volunteered to be questioned regarding how supervision decisions are made. Results support the conclusion that COAMFTE faculty take their gatekeeping function seriously as they balance commitments to multiple stakeholders. When presented with hypothetical "bare-bones" vignettes, the supervisors in our study consistently recommended talking with the student in order to more fully understand the context of the student's performance problem before deciding how to proceed. Supervisors recommended a variety of remediation efforts, but reserved the most severe consequences, such as probation, dismissal, and filing an ethics complaint, for the vignette involving dishonesty and lack of personal integrity.     

Getting Comfortable as “Fish Out of Water”: Using Qualitative Research Methods Training to Enhance the Technical Capacity of Family Therapy Trainees

This article describes a qualitative research methods training project undertaken in a COAMFTE‐accredited family therapy master’s‐level program. Graduate students were trained to collect research data for a qualitative study on the resilience of families displaced to the United States because of war and politically motivated violence in their country of origin. By involving trainees in a research project with refugees, the project was intended to address a gap in clinicians’ training, specific to the refugee population (Miller, Muzurovic, Worthington, Tipping, and Goldman, American Journal of Orthopsychiatry 2002; 72 : 341). However, the training process was also a way to increase the students’ skills at interviewing in complex situations, develop their cultural sensitivity beyond awareness, enhance their capacity for routine self‐reflection, and introduce them to basic practices of qualitative research methodology. In this article, we focus on the students’ experience of the training and discuss the potential implications of their feedback for family therapy training.     

Integrative Systemic Therapy: Lessons on Collaboration and Training for the 21st Century

The field of couple, marital, and family therapy (CMFT) is at an important juncture of identity development and synthesis. Integrative Systemic Therapy (IST) is a problem‐centered metaframeworks approach that meets the growing needs of family therapists working with diverse and complex family systems and restores the field to its original focus on collaboration. This paper describes the process by which IST developed featuring anecdotes from live interviews with the founders. We briefly outline IST's theoretical pillars and the essential way IST practitioners deliver treatment including a blueprint for therapy. Finally, we propose that IST is a comprehensive, systemic guide uniquely beneficial to CMFT training and discuss our approach to integrating IST into our training of students in a COAMFTE accredited program.     

Integrating Spirituality into MFT Training: A Reflexive Curriculum and Qualitative Evaluation

When clients enter the therapy room they bring unique spiritual beliefs and values in with them; however, marital and family therapists (MFTs) often lack training to assist in this important area of diversity. Current training recommendations encourage therapists to explore their own spirituality to identify personal limitations that may occlude positive client outcomes; however very little information exists on the implementation and usefulness of this type of training. This article will describe a curriculum and report results from a qualitative study of students who participated in a reflexive spirituality practicum course offered in a COAMFTE accredited doctoral program at a private, religious institution. Through this, we hope to provide a training model to further spiritual integration activities in MFT.