DEFINING WHO WE ARE AND WHAT WE DO: CLINICAL PRACTIVE PATTERNS OF MARRIAGE AND FAMILY THERAPISTS IN MINNESOTA

The clinical practice patterns of a representative sample of marriage and family therapists (MFTs) were studied. AAMFT clinical members from Minnesota ( N = 76 ) were surveyed for demographic characteristics, educational beckground, and practice-related issues. subjects also reported empirical data from 119 treatment cases involving 351 clients, a first in the MFT field. Among the major findings were: (a) MFTs practic relatively short-term therapy with the average case involving 11 sessions over a 4-month period; (b) therapy with families (average of 8 sessions) and couples (10 sessions) is briefer than individual therapy (14 sessions); and (c) NFTs treat a wide range of serious problems. Overall, MFT clinical practice patterns were comparable to those of other established mental health professions.     

ADVANCES IN COACHING: FAMILY THERAPY WITH ONE PERSON

This paper describes the process of "coaching" individuals in their efforts to change themselves in the context of their nuclear and parental family systems. Although this approach is regarded as one of the major modes of intervention in family therapy, the actual methods and techniques for intervention are not widely understood. Moreover, we have expanded the Bowen approach to address powerful cultural and family life cycle influences. The goal of coaching is to help clients define themselves proactively in relationship to others in their families without emotionally cutting off or giving in. Coaching begins by training clients to become observers and researchers of their own role in the family and of family patterns of behavior. Coaching then moves to help them bring their behavior more in line with their deepest beliefs, even if this means upsetting family members by disobeying family "rules."     

Are we there yet? Faculty Members’ Beliefs and Teaching Practices Related to the Ethical Treatment of Lesbian,Gay, and Bisexual Clients

The purpose of this study was to explore (a) faculty members' beliefs about the ethics of reparative therapy and referring lesbian, gay, and bisexual (LGB) clients, (b) course content related to reparative therapy and referral of LGB clients, and (c) positions taken by programs associated with reparative therapy and referral of LGB clients. A total of 117 faculty members from accredited family therapy programs completed an online survey for this study. While the vast majority of faculty members reported that reparative therapy is unethical, there was less agreement related to the ethics of referring LGB clients, which may highlight the need for clearer ethical guidelines to regulate this potentially harmful practice. Implications for clinical training and future research are discussed.     

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.     

SNARES IN FAMILY THERAPY

Telephone calls after therapy sessions, concurrent individual treatment of family members, the offer of secret revelations, and the use of psychoactive drugs all involve issues and events that can be insidious to effective family therapy. Various tactics are presented which not only succeed in controlling these incidents, but which also use them as important occasions for therapeutic intervention within the model of family therapy developed by Selvini Palazzoli and her colleagues in Milan.     

Assessing Lesbian,Gay, and Bisexual Affirmative Training in Couple and Family Therapy: Establishing the Validity of the Faculty Version of the Affirmative Training Inventory

This study established the validity and factor structure of the Faculty Version of the Affirmative Training Inventory (ATI‐F), which assesses faculty members’ perceptions of the level of lesbian, gay, and bisexual (LGB) affirmative training that occurs in clinical programs. Additionally, this study examined the latent associations among the subscales of the ATI‐F and three convergent validity items utilizing a sample of 117 faculty members from accredited family therapy programs. The findings provide empirical support for the relationship between including classroom content on LGB affirmative therapy and faculty members’ beliefs about LGB individuals and relationships. Specifically, faculty members who report more positive beliefs about LGB clients appear to be more likely to include LGB affirmative therapy content in the courses they teach.     

Marriage and family therapists and psychotropic medications: practice patterns from a national study

A national sample of marriage and family therapists (MFTs) was used to describe practice patterns of MFTs whose clients use psychotropics and to compare medicated and nonmedicated clients. Marriage and Family Therapists (n=283) reported on 195 medicated and 483 nonmedicated adult clients. Clients (n=375) rated their improvement and satisfaction with treatment. Results showed that 91% of MFTs treat medicated clients, and these clients accounted for 25% of MFT cases. Medicated clients were most often seen in individual therapy, had more serious medical problems, and showed greater cumulative improvement in relational functioning. Therapists from MFT educational backgrounds had fewer medicated clients than MFTs from other educational backgrounds.     

The Place of Single Session Family Consultations: Five Years’ Experience in Canberra

Open Day, in the form of two half day single session family clinics, has operated weekly in the ACT Child and Adolescent Mental Health Service since April 1993 and over a thousand families have been seen. Clinicians are often resistant to the concept of single sessions and frequently overestimate the amount of assistance that clients feel they require. However in an era of sharply increasing demand for services, selective use of single family sessions for milder problems, screened by a telephone intake process, has value to both families and workers. Telephone follow-ups of 100 families in 1994 and 70 families in 1996 found that single session family interviews were well accepted by the large majority of families seen. Clinicians see the program as reducing pressure from clients for early attention, enhancing client motivation when seen at crisis times, providing readily available consultation support from peers, increasing learning opportunities and building inter-disciplinary team work.     

Walk-in clinic counselling for emotional regulation with low-needs youth on the autism spectrum

A single-session consultation model for low-needs youth on the autism spectrum is presented with the mental health concern of emotional self-regulation, a common issue in family psychotherapy. This research is contextualised within the growing field of short-term therapy as it intersects the growing demand to therapeutically address clients on the autism spectrum. The treatment intervention is delineated through five sequential phases within the walk-in clinic setting for the practitioner clinician. A rationale, overview, and instruction for the practitioner clinician utilising this novel model is provided through a case study format. By using a more structured and integrated approach to treatment, organised through an externalised metaphor, it is suggested that the current model will be more effective for this specific clinical population. Additionally, a case illustration is provided that scaffolds the treatment model, which includes table formats and pictures. The case study illustrates the self-regulation map metaphor visually and interactively linking client challenges, strategies, and motivations simultaneously on multiple electronic devices in session. Relevant works were selected to explore the effectiveness of single-session consultation models for those presenting on the autism spectrum. Treatment interventions for specific clinical populations are recommended, especially within walk-in clinic therapy. This clinical research introduces a paradigm shift towards therapeutically addressing emotional self-regulation with low-needs youth on the spectrum through virtual, interactive technology.     

Triads in Equine-Assisted Social Work Enhance Therapeutic Relationships with Self-Harming Adolescents

Despite an increasing number of studies, there is still a lack of knowledge about the unique features that underlie the process in equine assisted social work (EASW). This study aimed to reveal, through qualitative methods, the dyads within the triad that become stronger during the process of EASW, as well as the effect of the participation of the horse on the relationship between the counselor and client. Data were collected through in-depth interviews with nine female self-harming clients aged 15–21 years and eight staff members. The interviews, together with video-recorded human–horse interactions with three staff members and four clients were analyzed, resulting in additional issues answered by these three staff members and four clients in a second interview. Critical dialogues between patterns and fragmentations in the narratives and video-recordings, as well as a dialogue with the participants while they were viewing videos of their own EASW sessions, led to the conclusion that adding a horse qualitatively changes therapeutic relationships in EASW. The different triads consist of different liaisons between actors in the triad, giving rise to unique combinations. The quality of the relationships depends on both the staff and the clients’ attachment orientations. Further research is needed to investigate how the degree of emotional connection to the horse affects the impact that horses have on triads in EASW.     

An Educational Model of Family Consultation*

This approach to working with families under stress recognizes the family as a system interacting via communication patterns among its own members and within a larger context of peers, neighbors, school, work, and community agencies. The goal is to help the family become a support system for all its members, more capable of meeting both adult and child needs for ongoing socialization and personal growth. The model is educational in that the focus is on teaching the family to identify strengths as well as dysfunctional behavior, and to acquire some basic communication and problem-solving skills. Methods are both cognitive and experiential. The approach is useful in short-term therapy with single families or groups of families.     

Theory and Practice of Systemic‐Dialogical Therapy

Systemic‐dialogical therapy originates from an evolution of Milan systemic therapy, through a reflection on Bakhtinian dialogue and on power and knowledge dynamics in therapeutic sessions. The model considers both emergent patterns in human interaction and the dialogical nature of human exchanges in which emotions play a relevant part. Such theoretical considerations prompted the creation of specific practices, such as emotional micro‐hypothesising, considering heteroglossia in the session, dialogue with the context, finding one's place in the relational network, and fostering relational responsibility in both therapist and clients. The practice of systemic‐dialogical therapy is illustrated by a clinical case study.     

A "READER'S THEATER" INTERVENTION TO MANAGING GRIEF: POSTTHERAPY REFLECTIONS BY A FAMILY AND CLINICAL TEAM

The sudden and accidental death of a child can be one of the most devastating events in the life of a family. This paper describes one couple's reflections of their grief and mourning following the death of their adolescent son as well as the clinical team's reflections of therapy. The uniqueness of this paper is that it offers a "reader's theater" intervention that enabled further change to occur. The clinical team used a belief model, emphasizing that altering constraining beliefs is at the heart of healing from such tragedies as sudden death (Wright, Watson, & Bell, 1996). This approach is operationalized through therapeutic conversations between family members, clinician, and clinical team. Interventions such as reflecting teams, therapeutic letters, and "homework tasks" were used to modify or challenge constraining beliefs of both the family members and the clinical team members. However, the intent to co-author a paper with this couple provided the serendipity intervention of a "reader's theater" that further served to identify, affirm, and solidify facilitating beliefs.     

The Devil is in the Detail: Clinicians,Academics and Researchers Resolving the Problems of Clinical Research

The difficulties associated with conducting valid family therapy research within a clinical practice discourage many potential researchers. This article will describe collaboration between a group of academics, researchers and clinicians who decided to explore the process and efficacy of systemic family therapy conducted within a working private practice. The specific questions we are addressing are, whether the requests clients bring to their first session of therapy can be reliably classified by practitioners, whether these requests change over time, and whether the nature of the request is associated with therapist and client ratings of therapeutic outcome. Additional questions about the form and nature of the therapeutic alliance as experienced by both client and practitioner are also being explored. This paper will map the passage of the work from inception to its current state where over 140 clients are active participants. In doing so attention will be paid to the obstacles encountered: practical, financial and ethical, and the solutions devised to address these.     

IN DEFENSE OF CASE CONSULTATION: MAYBE "DEAD" SUPERVISION ISN'T DEAD AFTER ALL

Clinical supervision based on "raw data"—the supervisor having direct access to the therapy session via tape or live observation—has become a hallmark of family therapy training. Despite the many advantages of such an approach, it also has limitations. The case consultation approach to supervision provides a different perspective which complements raw data supervision and remedies some of the limitations of the raw data approach. This paper proposes four specific tasks that are best undertaken in case consultation sessions: understanding the "architecture" of therapy, helping trainees build theoretical models of change, understanding the clients'broader context, and understanding the student's broader context.     

Family Constellation — A Therapy Beyond Words

Family Constellation, a psychotherapeutic approach associated with the name Bert Hellinger, has become a popular yet also controversial form of systemic therapy in the German‐speaking therapy community. ‘Family Constellation’ (Familienstellen) means the individual client's physical‐emotional positioning and re‐positioning of substitute family members in relation to each other, with help of a therapeutic group. Family Constellation is a one‐session approach that addresses family‐of‐origin issues. The therapeutic process is highly experiential, utilising multiple sensory modalities. Hellinger locates his model within phenomenology, and his practice has roots in several therapy schools. His model offers complementary therapeutic techniques in our ‘languaged’ world of family therapy.     

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.     

A MODEL FOR TRAINING PRACTICING PROFESSIONALS IN FAMILY THERAPY*

This paper offers a model for high quality training in family therapy. The unique aspects of the Family Consortium's model are that it: (a) is aimed at practicing professionals; (b) emphasizes structural family therapy principles with strategic and experiential elements; (c) is geared secondarily toward training members as effective peer consultants and trainers; and (d) uses an awareness of the isomorphic nature of training, therapy and family transactions. Part I describes the practical organization structure of the Consortium. Part II discusses the current theoretical philosophy and training approach of this evolving group. Examples are given of how the Consortium has dealt with specific training issues.     

‘My Child is Anxious Because We Might Get Deported’: Brief Therapy from MRI with an Immigrant Family in the United States

As we go to press in a COVID-19 world, the topic of anxiety is foremost on our minds. While each situation has to be considered in its own context, how to manage different anxieties has common denominators. There is currently a sharp increase in forced migration around the globe so mental health professionals must develop effective skills, like the ability to adapt services to different contexts and cultures, to manage the needs of immigrant people. Problem-Solving Brief Therapy, as developed at the Mental Research Institute in Palo Alto, is a systemic model of therapy, which aims at promoting change in the complaint the presenting client (the ‘talker’) cares about. The model’s roots in Constructivism foster integrating the clients’ beliefs and values into therapy to allow the therapists to adapt to the clients’ particular needs. This paper is the analysis of a single case where the therapist worked with an immigrant family because their child suffered from severe anxiety related to the parents’ threatened deportation. The paper focuses on premises and strategies that allowed minimising cultural barriers between therapists and family members, thus facilitating a strong therapeutic alliance conducive to improvement.