Training family therapists to work with children and families: a modified Delphi study

This study examined child inclusion issues and training marriage and family therapists (MFTs) to treat children. This modified Delphi study utilized a panel of experts, and gathered data through questionnaires and qualitative interviews. Panelists believe children should participate in family therapy sessions for both child and adult problems, except when parents are discussing sex or sensitive issues. Child-focused courses should emphasize developmental issues, engaging techniques, theoretical issues, play therapy theory, MFT treatment for child disorders, and specific child/family problems. Panelists suggest numerous child-focused references, but reached consensus for only one. Key therapist attributes and skills were identified. Deductive and inductive training methods and the role of supervision were highlighted. Although therapist playfulness and creativity were emphasized, few play techniques were included in the final profile.     

Creating Culturally Responsive Family Therapy Models and Research: Introducing the Use of Responsive Evaluation as a Method

Models of marriage and family therapy (MFT) typically reflect Western values and norms, and although cultural adaptations are made, many models/frameworks continue to be inappropriate or inadequate for use with non‐Western cultures. Worldwide, therapists are examining ways of using MFT models in a culturally sensitive manner, especially when working with clients who are seen as having minority status or perceived as “other” by the dominant group. This essay suggests the use of responsive evaluation as a theoretically consistent methodology for creating and evaluating culturally responsive therapies. This approach rigorously evaluates each unique client/therapist context, culture, power, needs, and beliefs. We describe responsive evaluation and discuss how each component addresses the research needs of examining culturally responsive family therapies. A case illustration is offered delineating the process of conducting culturally responsive therapy with a Cambodian sample using solution‐focused and narrative therapy.     

EXAMINING THE MULTIFACETED NOTION OF ISOMORPHISM IN MARRIAGE AND FAMILY THERAPY SUPERVISION: A QUEST FOR CONCEPTUAL CLARITY

The notion of isomorphism has been recommended as a comceptual framework to guide the practice of marrige and family therapy (MFT) supervision. The term is frequently cited in the MFT training literature but is often used in different ways. A panel of MFT supervirors rated the impotance and relevance to both therapy and supervision of a large pool of variables. The majority of variables were found to be a equally relevant or isomorphic to the domains of MFT and MFT supervisoin. A qualitative interview with a small subset of the panelists suggested that the concept, to varying degrees, has influenced their work as supervisors. The implications of the results for theory development, research, and supervisory practices are discussed.     

Alcohol abuse

We reviewed 38 controlled studies of marital and family therapy (MFT) in alcoholism treatment. We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, (a) Al-Anon facilitation and referral help family members cope better; (b) Community Reinforcement and Family Training promotes treatment entry; and (c) the popular Johnson intervention apparently does not effectively promote treatment entry. Once the alcoholic enters treatment. MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. BCT also reduces social costs, domestic violence, and emotional problems of the couple's children. Future studies need to specifically evaluate: MFT with women and with minority patients, mechanisms and processes of change, and transportability of evidence-based MFT approaches to clinical practice settings.     

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.     

Review of outcome research on marital and family therapy in treatment for alcoholism

This review of controlled studies of marital and family therapy (MFT) in alcoholism treatment updates the earlier review by O'Farrell and Fals-Stewart (2003). We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, both Al-Anon facilitation and referral and spouse coping skills training (based on new findings) help family members cope better, and CRAFT promotes treatment entry and was successfully transported to a community clinic in a new study. Once the alcoholic enters treatment, MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. New BCT studies showed efficacy with women alcoholics and with gay and lesbian alcoholics, and BCT was successfully transported to a community clinic, a brief BCT version was tested, and BCT was adapted for family members other than spouses. Future studies should evaluate the following: MFT with couples where both members have a current alcohol problem and with minority patients, mechanisms of change, transportability of evidence-based MFT approaches to clinical practice settings, and replication of MFT outcomes of reduced partner violence and improved child functioning.     

What clients of couple therapy model developers and their former students say about change, part II: model-independent common factors and an integrative framework

Proponents of the common factors movement in marriage and family therapy (MFT) suggest that, rather than specific models of therapy, elements common across models of therapy and common to the process of therapy itself are responsible for therapeutic change. This article-the second of two companion articles-reports on a study designed to further investigate common factors in couple therapy. We used grounded theory techniques to analyze data from interviews with MFT model developers Dr. Susan M. Johnson, Dr. Frank M. Dattilio, Dr. Richard C. Schwartz, former students of Dr. Johnson and Dr. Schwartz, and each of their clients who had been successful in couple therapy. This article reports model-independent variables, that is, general aspects of therapy that are not directly related to the therapist's model. Model-independent categories include client variables, therapist variables, the therapeutic alliance, therapeutic process, and expectancy and motivational factors, each with several subcategories. We also present a conceptual framework that outlines how model-dependent and model-independent common factors may interact to produce change. We discuss our findings and proposed framework in relation to the current common factors literature in psychology and MFT. We also discuss clinical, training, and research implications.     

Clinical and Supervisory Considerations for Transgender Therapists: Implications for Working with Clients

Transgender therapists have unique and valuable perspectives into how gender organizes the therapeutic process. Currently, in the MFT field, there is discussion of the cisgender therapist's experience in the therapy room, but no known articles on the transgender therapist's experience. This article provides insight into the experiences of transgender therapists around issues of self‐disclosure, social locations of both therapist and client, and clinical supervision. Drawing from our clinical experiences as transmen, we highlight special considerations for working with cisgender, queer, and transgender clients. Implications for supervision of transgender therapists are also discussed. As more gender diverse students seek MFT training, there is an urgent need to acknowledge their perspectives. This article is a call for beginning conversations in this direction.     

Therapist Personal Agency: a model for examining the training context

This study reviews the creation and testing of a model of Therapist Personal Agency during MFT training. A model including self-efficacy, trainee developmental level, supervisor working alliance, family of origin relationships, and psychological states was supported by data collected from a national sample of MFT students. The model supported by the data was consistent with much of the previous research regarding the correlates of therapist self-efficacy. Furthermore, the model accounted for 20% of the variance in therapist performance as measured by therapist reports of the working alliance. The results also highlighted the importance of attending to the relationships, interactions, and experiences that take place within the training environment and secondly, the added value that may accrue from focusing on the trainee's extended network of family relationships. A brief case example serves to illustrate the importance of tending to Therapist Personal Agency. In sum, this study provides preliminary support for holistic training methods that focus upon the whole person of the therapist.     

Nurturing Nature: Exploring Ecological Self‐of‐the‐Therapist Issues

Much has been written about the systemic effects of families and culture on individual well‐being. Seldom discussed, however, are the systemic effects of our relationship with the larger ecological system in which all families and cultures are embedded. A case is made for the importance of nature in family therapy. Furthermore, before therapists can effectively address ecological issues in therapy, they need to address various ecological self‐of‐the‐therapist issues that will influence their clinical practice. A series of questions are asked to help guide therapists in this exploration, and practical suggestions for incorporating nature into MFT clinical practice, training, and research are made.     

Multifamily therapy in the community mental health network: A pragmatic randomized and controlled study

Multifamily therapy (MFT) is a psychotherapeutic group intervention for patients with severe mental disorders (SMDs) and their families. The present study is a multicenter, randomized, and controlled trial that analyzes the benefit of MFT during outpatient treatment. The recruited patients were randomly assigned to the experimental group (n = 26), which received 24 MFT sessions in addition to their treatment as usual (TAU), or to the control group (n = 29), which received only TAU (individual and family sessions). Six months after the inclusion in the MFT, the experimental group showed a significant decrease in number of visits to the psychiatric emergency services, number of psychiatric admissions, and the days of admission. The need for hospital care 6 months after recruitment was also lower in the experimental group compared to the control group. These results suggest that the implementation of MFT during outpatient treatment facilitates community management of people diagnosed with mental health problems.     

Family Therapy is Just One Option

I trace my development as a family therapist from being a single model worker in systemic family therapy to a more eclectic approach. The context of my work is children's services and private practice. Failure to appreciate when one method of therapy is more suitable than another can lead to family therapy being applied when it is not indicated. The dangers in such mistakes and a lack of careful assessment that includes the ‘feeling state’ of the therapist are illustrated by case vignettes. A possible effect of some therapy techniques is to create a ‘distance’ from clients and to shield the therapist from their emotional distress. I outline situations where I would not use family therapy.     

Internships for Future Faculty: Meeting the Career Goals of the Next Generation of Educators in Marriage and Family Therapy

A key component of a doctoral education in marriage and family therapy (MFT) is the completion of an internship. Virtually all MFT doctoral internships are focused on advanced clinical practice and often are located in agencies unconnected with an academic setting. This article describes an MFT doctoral internship specifically designed to foster the skills needed as a faculty member. The primary purpose of this "future faculty" internship is to expose doctoral interns to faculty life, including participation in graduate teaching, clinical supervision, research, and faculty service—while still meeting typical clinical requirements. Results of semistructured qualitative interviews with five doctoral interns associated with the site are reported. Guidelines for the development of other doctoral internships designed for future MFT faculty members are discussed.     

Competency-Based Training: Objective Structured Clinical Exercises (OSCE) in Marriage and Family Therapy

The field of marriage and family therapy (MFT) has recently engaged in the process of defining core competencies for the profession. Many MFT training programs are adapting their curriculum to develop more competency-based training strategies. The Objective Structured Clinical Examination (OSCE) is widely used in the medical profession to assess clinical competence. These examinations involve using simulated clinical situations as a tool in conducting summative evaluations of trainee competence. This article describes an adaptation of the OSCE procedures for competency-based training of MFT students. Instead of using the procedures as a summative examination as is typical in medical education, this article proposes how to use them as formative exercises in the development of student competence. The development of the OSCE is discussed, including “blueprinting,” focused competencies, procedures, and feedback protocols. The article concludes with suggestions of how to continue the development of the OSCE for evaluation in MFT education.     

Multi‐Family Therapy with a Reflecting Team: A Preliminary Study on Efficacy among Opiate Addicts in Methadone Maintenance Treatment

In this study, we evaluate the efficacy of multi‐family therapy at reducing the addiction severity and at improving the psychological and family dynamics of opiate addicts receiving methadone treatment at a public treatment center. The study compares multi‐family therapy with a reflecting team (MFT‐RT) and a standard treatment following a methadone maintenance treatment program. The results show that multi‐family therapy with a reflecting team effectively reduces the addiction severity in several of the areas evaluated and noted that this effect is superior to standard treatment. The psychotherapy patients showed improvement in the areas of employment and social support; their drug use diminished and their psychiatric condition improved. At the same time, they needed a lower daily dose of methadone. In addition, the group undergoing standard treatment showed a noteworthy deterioration in their medical condition. Both groups showed a significant increase in their alcohol use. When applied to family treatments, the systemic‐constructivist approach by the reflecting team offers combined techniques that can help improve care for the families of patients with addiction problems.     

The Doctoral Education of Professional Marriage and Family Therapists

The professional practice of marriage and family therapy (MFT) scholarship is regulated at the master’s level in the United States. Consequently, contemporary curricular issues have largely been focused on what is to be achieved within the master’s degree, with an emphasis on clinical practice. We consider here what value may and should be added through the doctoral degree in marriage and family therapy. Doctoral programs are the developmental stage wherein we should seek to transmit the specialized knowledge and skills germane to MFT scholarship and practice in diverse settings, e.g., clinical and research intensive university, family law, health care, child development and education, child welfare, juvenile justice, faith based, and business. However, underlying this specialty education are three transcendental goals: sophistication of family systems scholarship, socialization into the profession of MFT, and cultivation of professional maturity.     

Integrative module-based family therapy: a model for training and treatment in a multidisciplinary mental health setting

Thirty years ago, leaders in psychiatry expressed hope for more interdisciplinary collaboration with family therapy. Since then marriage and family therapy (MFT) has entered the mainstream of clinical practice in psychiatry and psychology. It is mandated for training in psychiatry and psychology. We propose a model for collaboration, training, and treatment in interdisciplinary mental health settings that strives to integrate empirical bodies of knowledge in MFT, psychiatry, and psychology and to provide a usable and testable clinical approach to treatment. It can be taught to trainees with various or limited training in MFT This model delineates nine critical domains that guide treatment. Flexibility is central to this model, focusing on techniques and clinical methods based on empirically supported treatments, when available, and best-practice standards.     

From Private Practice to Academia: Integrating social and political advocacy into every MFT Identity

While advocacy was essential to establishing the field of marriage and family therapy, at present a social and political advocacy skill set is lacking for the typical marriage and family therapist (MFT). This article reviews the importance of being active in social and political advocacy and highlights the attributes of MFTs’ professional identity that uniquely position us for success in these areas. Other mental health fields’ pedagogical approaches to training and education are explored, and recommendations are made for how MFTs can begin to increase their competency in advocacy. Ideas for incorporating advocacy into a professional identity are presented for MFTs at every level of professional experience. Finally, the concept self‐of‐the‐advocate is introduced and discussed.     

The State of Sex Research in MFT and Family Studies Literature: A Seventeen‐Year Content Analysis

The ability to conceptualize and treat sexual problems has been widely accepted as a crucial skill to master the MFT training. However, clients’ sexual relationships are often ignored by clinicians because of a lack of experience or training, or personal discomfort. In this content analysis, we review sex and sex therapy research within MFT and family studies journals since the turn of the century. Of the 13,919 articles published within the 15 journals, 137 focused on sexuality or sex therapy. The articles were divided into five themes: sexual and relational health, sexual diversity, treatment and contributors of sexual dysfunction, sex therapy practices, and sexual education and development. Implications for clinical practices, sex therapy integration, and future research are discussed.     

Common factors and our sacred models

In this article we argue that much of what makes one treatment effective is common to other forms of effective treatment--both in psychotherapy generally and in marital and family therapy (MFT) specifically. Yet MFT has largely ignored the research on common factors. In this article we present a moderate view of common factors that, while repudiating the extreme position that there is no difference among treatment models, stresses that there are common factors and mechanisms of change that undergird most forms of successful treatment. These common mechanisms of change should be given more attention in our field, which has tended to emphasize the uniqueness of our sacred models. We delineate some of the major common factors, review the empirical evidence for them, and discuss implications of adapting a common factors informed approach to family therapy.