AN ETHNOGRAPHY OF COUPLE AND THERAPIST EXPERIENCES IN REFLECTING TEAM PRACTICE

Couple and therapist perspectives about the use and process of reflecting team practice were analyzed using ethnographic research. A domain analysis was performed on postession interviews from both couples and therapists, and on field notes from each therapist. Seven couples and five therapists were interviewed at least twice over a 4-month period concerning their reactions to and perceptions of reflecting team practice. Six domains concerning reflecting team practice emerged from the analysis: (a)benefits of its use, (b) effects of gender, (c)recommended use, (d) contraindicated use, (e) the importance of creating spatial separateness between couple and team members, and (f) sequences of communication between the couple and team members that elicit change. The latter two domains described the process of reflecting team practice (i.e., steps in how it is used and how it is implemented). The role of ethnog rahy in reflecting team practice and in family therapy research is discussed.     

A qualitative study of intimate partner violence universal screening by family therapy interns: implications for practice, research, training, and supervision

Although a few family therapy researchers and clinicians have urged universal screening for intimate partner violence (IPV), how screening is implemented-and, in particular, client and therapist response to screening-is vaguely defined and largely untested. This qualitative study examined the dilemmas experienced by couples and family therapy interns when implementing universal screening for IPV in an outpatient clinic setting. Twenty-two graduate students in a COAMFTE-accredited program were interviewed using qualitative research methods grounded in phenomenology. Three domains, 7 main themes, and 26 subthemes were identified. The three domains that emerged in this study include (a) therapist practice of universal screening, (b) client response to universal screening, and (c) therapist response to universal screening. Implications for practice, research, training, and supervision are discussed.     

Is Who Delivers the Treatment More Important than the Treatment Itself? The Role of The Therapist in Common Factors

In this article, we discuss the role of the therapist in change in couple and family therapy. We argue that the therapist is a key change ingredient in most successful therapy. We situate our discussion in the common factors debate and show how both broad and narrow common factor views involve the therapist as a central force. We review the research findings on the role of the therapist, highlight the strengths and weaknesses of this literature, and provide directions for future research. We then use this review as a foundation for our recommendations for theory integration, training, and practice.     

The RELATionship Evaluation (RELATE) with therapist-assisted interpretation: short-term effects on premarital relationships

This study assessed participant satisfaction with two interpretation formats and the effects of taking the RELATionship Evaluation (RELATE) on single young adults' premarital relationships. Thirty-nine engaged or seriously dating couples were assigned to one of three groups: (a) those who took RELATE and interpreted the results themselves, (b) those who took RELATE and participated in an interpretation session with a therapist, or (c) a control group. Results showed that taking RELATE with therapist assistance had a significant positive effect on perceived relationship satisfaction, commitment, opinions about marriage, feelings about marriage, and readiness for marriage. Positive effects also included increased awareness of strengths and challenges, improved couple communication, and the expectation of the prevention of future relationship problems. Taking RELATE without therapist assistance produced a small initial drop in relationship satisfaction followed by a marked improvement over time. Both genders approved of two interpretation formats-self-interpretation and therapist-assisted interpretation-with males slightly preferring therapist assistance. These results add to the literature on the usefulness of brief assessment techniques as effective interventions with premarital couples.     

Individual Therapy for Couple Problems: Perspectives and Pitfalls

Despite the demonstrated efficacy of conjoint couple therapy, many clients seeking help for couple problems ultimately find themselves in individual therapy for these concerns. Individual therapy for couple problems (ITCP) may evolve from a partner's refusal of conjoint therapy or from the treatment format preferences of either the client or therapist. Having acknowledged the role of partner refusals, we offer some perspectives about the idiosyncratic personal factors and professional background factors that may lead therapists to provide ITCP and discuss the significant pitfalls in its practice. We emphasize five central areas of concern in the ongoing practice of ITCP: structural constraints on change; therapist side‐taking and the therapeutic alliance; inaccurate assessments based on individual client reports; therapeutic focus; and ethical issues relevant to both attending and nonattending partners. We conclude by urging that this very important but largely neglected topic be paid greater attention in psychotherapy research, training and continuing education.     

Effects of a video feedback parent training program during child welfare visitation

Behavioral parent training programs have documented efficacy for improving behaviors among parents and their children and are frequently used by child welfare agencies to prevent removal of a child from the parental home or to facilitate reunification. Although an ideal time for parent training might be during supervised visits where parents may practice skills with their children under the guidance and support of a therapist or caseworker, this is not typically the case. Most often, parents within the child welfare system receive parent training in small groups without their children present, and to date, few studies have examined effects of behavioral parent training interventions during supervised visitation. In this study, concurrent multiple baseline across behaviors design was used to examine effects of a behavioral parent training program, Filming Interactions to Nurture Development (FIND), on parental skill acquisition with four mothers who had lost custody of their children but were being considered for reunification. Children emitted little or no problem behaviors during baseline or intervention, so parenting behavior was the primary dependent variable. Results obtained across participants documented a clear functional relation between implementation of the FIND intervention and increases in developmentally supportive parenting behaviors. Results of social validity and contextual fit measures suggest the intervention was perceived by mothers to be positive, feasible, and appropriate within the child welfare context. Practical and conceptual implications, limitations of this study, and directions for future research are discussed.     

Toward a mini-theory of the blamer softening event: tracking the moment-by-moment process

In this article we present the results of a discovery-oriented task analysis research study identifying specific therapist behaviors that facilitate softening events in emotionally focused therapy (EFT) for couples. Therapy sessions conducted by an expert EFT therapist were examined. Six therapist content theme shifts were identified and specific interventions were delineated within each using an EFT coding scheme (EFT-CS) created for this study. This study extends the theoretical understanding of the softening process--a key change event in an empirically validated couples therapy approach--and provides a detailed clinical map for the training of therapists.     

Change Processes in Couple Therapy: An Intensive Case Analysis of One Couple Using a Common Factors Lens

The article describes a research study that explored the process of how change occurred for one distressed couple and a specific therapist in a naturalistic setting. Quantitative and qualitative data were collected on the couple at multiple points in the therapy. A research team comprised of five members met regularly to analyze the data and collectively they arrived at a theory of change for the couple posttherapy. Conclusions are made related to how change occurred for the couple with an emphasis on the role of extratherapeutic events, client motivational factors, the therapeutic alliance, hope and expectancy factors, therapist factors, specific techniques and interventions, and other surprise factors that contributed to change.     

ETHNOGRAPHIC CONTENT ANALYSIS OF COUPLE AND THERAPIST PERCEPTIONS IN A REFLECTING TEAM SETTING*

An ethnographic content analysis was used to examine couple and therapist perspectives about the use and value of reflecting team practice. Postsession ethnographic interviews form both couples and therapists were examined for the frequency of themes in seven categories that emerged form a previous ethnographic study of reflecting teams (Sells, Smith, Coe, Yoshioka, & Robbins, 1994). The study demonstrated that quantitative numerical data and qualitiative narrative data can examine the same phenomenon from multiple perspecrives and allow for greater accuracy and stability in study findings. Ethnographic content analysis is briefly cosntrasted with conventional modes of quantitative cosntent analysis to illustrate its usefulness and rationale for discovering emergent patterns, themes, emphases, and process using both inductive and deductive methods of inquiry.     

THE CLIENT'S INTERVIEW OF THE THERAPIST

This paper presents a framework for thinking about interactions between client and therapist systems in terms of the participants' personal explanatory systems and models of reality. The therapist's contribution to forming structures throughout the therapy is examined. The elements of a covert interview of the therapist performed by the client system are described. A model is presented for training therapists to think systemically about client/therapist fit in the context of the client's interview. A case presentation illustrates the value of the interview.     

Targeting Threats to the Therapeutic Alliance: A Primer for Marriage and Family Therapy Training

Although theory and research highlight the importance of the client–therapist relationship, marriage and family therapy (MFT) training has historically centered on specific models, consisting of proprietary language and techniques, instead of common factors like the therapeutic alliance. In this article, we begin by making an argument for explicitly focusing on the therapeutic alliance in MFT training programs. Next, we highlight common alliance threats experienced by both faculty members and student therapists. We then integrate research‐informed principles with clinical wisdom to outline specific recommendations and concrete skill‐building exercises for MFT educators and supervisors to use with their students to address these threats and advance training on the therapeutic alliance.     

BASIC FAMILY THERAPY SKILLS, IV: TRANSGENERATIONAL THEORIES OF FAMILY THERAPY

This pape focuses on the basic skills and compentencies of transgenerational approaches to family therapy, the fourth report of a program of research surveys by the Basic Family Therapy Skills Project. In the first survey, a panel of family therapy educators listed the most critical or basic skills or compentencies of beginning family therapist with a transgenerational orientation. In the third survey, self-selected respondents rated these items according to degree of importance for beginning family therapists. Rankings of the items according to mean scores of the Likert responses indicate that transgenerational family therapy skills are founded in theory and can be identified behaviorally. The most important skills are those that use the self of the therapist to understand and utilize transgenerational family therapy skills for both therapist and client. Also listed are skills that many raters deemed "generic" rather than specifically related to transgenerational family therapy. Other findings and their implications for the future training of family therapists are discusses. Although the paper is intended for family therapy educators interested in their colleagues' ideas about critical skills in trans-generational family therapy, theorists and clinicians may also find it useful.     

Clients’ perceptions of marriage and family therapists’ way‐of‐being: a phenomenological analysis

Previous research highlights the influence of therapist factors on treatment outcomes. One therapist factor proposed as fundamental to the process of therapy is the therapist's way‐of‐being, a relational concept that refers to how the therapist regards a client—either as a person or object (Fife et al., [2014] Journal of Marital and Family Therapy, 40, 20–33). Although this case has been made conceptually, there is little empirical research on therapists’ way‐of‐being with clients. The primary purpose of this research is to investigate clients’ perceptions of their therapists’ way‐of‐being. Utilizing a common factors perspective, the study seeks to explore: (a) how clients experience their therapists’ way‐of‐being and (b) the influence therapists’ way‐of‐being has on clients’ engagement. Phenomenological methods were used to gain a nuanced understanding of the phenomenon. Qualitative data were collected through semi‐structured face‐to‐face interviews with clients (N = 10) who received individual therapy from a marriage and family therapist. Results were organized into two main themes: core tenets (attunement, congruency, and aligning with clients) and operational tenets (providing affirmation and validation, balancing flexibility and structure, and accomplishing goals). Findings are used to make a case for adding the concept of way‐of‐being as an overarching construct for several well‐established therapist factors. Clinical and training implications are discussed.     

The Therapeutic Pyramid: A Common Factors Synthesis of Techniques,Alliance, and Way of Being

Common factors in therapy such as the therapeutic alliance and client motivation have been found to account for more change than therapy models. But common factors have been critiqued as only lists of variables that provide little practical guidance. Some researchers have demonstrated that certain common elements (e.g., the therapeutic alliance) account for more variance than others (e.g., techniques), suggesting that some factors should be emphasized over others. Such findings suggest the need for alternatives to model‐based therapy, with one alternative being meta‐models, or “models of models,” that focus on how therapeutic factors interact with each other to produce change. The purpose of this article is to propose a meta‐model describing the relationship between two specific common factors—the therapeutic alliance and interventions. We also propose a new factor—a therapist's way of being—that we believe is foundational to effective therapy. The model is proposed in pyramid format, with techniques on top, the therapeutic alliance in the middle, and therapist way of being as the foundation. The hierarchical relationships between these three concepts are discussed, along with implications for training, research, and therapy.     

THE EFFECTIVENESS OF FAMILY THERAPIES FOR SELECTED BEHAVIORAL DISORDERS OF CHILDHOOD

This article reviews the scientific evidence for the effectiveness of family-based aproaches in the treatment of selected childhood behavioral disorders. Although limitations certainly exist, family interventions have consitently improved child and, in some cases, parent functioning in families with children presenting with conduct disorder (CD) and autism. Parents and other family members also directly benefit from child-focused interventions, gaining in knowledge, child management skills, and attitudinal improvements. Longh-term follow-ups indicate that CD and autistic children achieved lasting gains. Similarly, the research on attention-deficit/hyperactivity disorder (ADHD) indicates that parent training improves child noncompliance and aggression yet does not consistently affect core symptoms of ADHD. There is no evidence that adding short-term family interventions improves ADHD child functioning beyond improvements from the use of psychostimulant medications. Some tentative support for family involvement in the treatment of childhood anxieties and fears is reviewed, but clear conclusions await future investigations. Finally, several methodological limitations and needed areas of research are discussed.     

Therapist effects on dropout in couple therapy

Marriage and family therapy scholars have argued that therapists play a crucial role in successful couple therapy, yet little research has empirically documented that the therapist in couple therapy has a significant impact on outcomes. Known as the study of therapist effects, this study sought to assess the amount of variance attributed to the therapist in couple therapy outcomes. Using dropout as the outcome variable, this study analyzed data from 1,192 couples treated by 90 masters and doctoral student therapists at a university‐based training clinic. Results from multilevel analysis indicated that therapists in the sample accounted for 9.4% of the variance in couple dropout while controlling for initial couple impairment. Therapist gender and therapist experience did not significantly predict variability in therapist effects. These findings give promise to future research on therapist effects in couple therapy and encourage exploration into which therapist characteristics and behaviors contribute to successful clinical outcome.     

Teaching Note—Implementation of Online Client Simulation to Train and Assess Screening and Brief Intervention Skills

Given the workforce shortage of adequately trained behavioral health professionals, schools of social work are ideally positioned to teach empirically supported treatments for preventing and reducing substance use, specifically, screening and brief interventions. Traditionally, opportunities to practice screening and brief intervention skills occur in classes and field placements; however, these opportunities are limited by class time, placement setting, and multiple demands placed on field instructors. Online client simulation has potential to address these limitations as an asynchronous training and assessment tool. This article details the integration of online interactive client simulation technology in advanced-level master of social work curricula. Drawing on longitudinal pre- and postdata, we present a preliminary analysis of changes in students’ screening and brief intervention skills.     

Conduct problems in children. Characteristics of families recruited for a clinical outcome trial as compared to families in an implementation study

The implementation of empirically supported treatments (EST) is recommended as a way to transfer knowledge from research to clinical practice and to improve service quality. One area of concern has been client representativeness, that is to which degree participants in EST studies resembles the target group in usual care settings. For children with conduct problems the recommended ESTs have been parent training or parent mediated programs. The aim of this article is to explore and describe central parent and family characteristics of families with conduct disordered children recruited from ordinary clinical practice in connection with the evaluation of the Parent Management Training — Oregon (PMTO) model in Norway, and to see whether the families recruited to a randomized control trial (RCT) differ from families recruited to a large scale implementation study in routine practice. Data from 376 families indicated that there were few differences between the two samples and thus that the parent and family characteristics found in the RCT study were representative of help-seeking families with conduct disordered children in Norway.Perhaps an even better treatment result could be achieved by tailoring PMTO to better suit the characteristics of Norwegian parents and families. Mothers (regardless of marital status) seem to be especially vulnerable to caregiver strain and suggested interventions should take this into consideration.