Significant Conversations or Reduced Relational Capacity? Exploring Couple and Family Therapists' Expectations for Including a Client Feedback Procedure

Little information exists on the specific reflective processes that precede therapists' choice of including or not including a structured feedback procedure in their established practice. In the present study, we aim to describe and explore experienced couple and family therapists' expectations for how the comprehensive therapy feedback procedure Systemic Therapy Inventory of Change might influence their practices. Through a thematic analysis of six focus group interviews, two main themes were elicited. The first main theme involved values embedded in current practice, with the following subthemes: (1) balance between the therapist's expert knowledge and the client's experience‐based knowledge; and (2) making time to build alliances. The second main theme concerned the presumed influence on current practice, with the following subthemes: (1) ‘Systemic Therapy Inventory of Change will disturb the therapist's capacity to stay present’; (2) ‘Systemic Therapy Inventory of Change will shape conversations’; and (3) ‘Systemic Therapy Inventory of Change will contribute to increased qualitative depth’. We discuss these results in relation to the notion of Systemic Therapy Invention of Change as a ‘third party in the room’. We also discuss the results in relation to implications for collaborative practices, and for client and therapist autonomy.     

Woman Abuse and Conjoint Therapy: Therapists' Experiences of Engagement

ABSTRACT

Treatment approaches with couples in which woman abuse is a factor have been the subject of much attention and concern in the therapeutic community. We used focus groups to examine therapists' experiences of what they see as impeding or facilitating their ability to engage therapeutically with heterosexual couples when a man has used violence. Results were coded along four categories: contextual issues, the person of the therapist, client characteristics, and strategies for enhancing engagement. Results point to the difficulties therapist participants experienced engaging with males who have been violent with their partner. Strategies which therapists used to enhance engagement are illuminated. We discuss differences between the experiences of male and female therapists, and implications for clinical work and future research.     

Predictors and Processes Associated with Home‐Based Family Therapists' Professional Quality of Life

This study examined whether home‐based family therapists' (HBFT) workload and clinical experience were associated with therapists' professional quality of life directly and indirectly through self‐care activities and frequency of clinical supervision. Hypotheses were tested using structural equation modeling with a sample of 225 home‐based therapists. Results suggested that therapists' workload and HBFT experience significantly predicted therapists' professional quality of life. These associations between therapists' workload and HBFT experience were partially mediated through participation in self‐care and frequency of clinical supervision. Implications for improving therapists' quality of life are discussed as a function of therapists' workload, clinical experience, self‐care, and supervision.     

Genre as Tool in the Transmission of Practice Over Time and Across Professional Boundaries

In this article, we are concerned with the processes through which a central activity in the natural sciences—classification—is instantiated in the writing practices of psychotherapists. We examined several psychotherapists' grammatical, lexical, and rhetorical strategies for writing their initial evaluations of their clients' problems. Using membership categorization device analysis from ethnomethodology, we examined several therapists' written initial evaluations for their use of microlevel categories and categorizations derived both from clients' own (oral) representations and the therapists' professional repertoire. The resulting analysis suggests that clients' emic, contextually grounded expressions are absorbed into a monological account reflecting the therapist' s professional interpretive framework. The therapist thus translates the client' s concerns into a set of meanings compatible with the classifications of psychopathology of the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The resulting written account supports a billable diagnosis thereby fulfilling its institutional purpose. It fails, however, to serve another important purpose to many therapists, which is helping the therapist to guide the therapy process by providing a record of the client's perspective of his or her lifeworld.     

Borderline Personality Disorder and Adolescence

SUMMARY

This chapter addresses many of the potential challenges clinicians face when working with adolescents with BPD. First, we present the diagnostic issues related to an adolescent population. Second, we review issues related to the families, peers, and larger systems (e.g., schools) that reciprocally influence the adolescent and the treatment. Third, we discuss specific treatment concerns and propose solutions, including how to effectively manage therapists' own reactions to working with this population. Many of the clinical vignettes and suggested interventions in this chapter derive from our experience working in an outpatient adolescent Dialectical Behavior Therapy (DBT) program. As described later in this book, DBT is an evidence-based treatment effective for suicidal multi-problem individuals with promising data published with suicidal adolescents diagnosed with borderline features (Rathus & Miller, 2002).     

Does the Therapeutic Relationship Matter? A Follow-up Study of Adherence and Improvement in Family Therapy

A follow-up study of 83 families treated by family therapy at a child guidance clinic was conducted and the relation of client/therapist interaction to (i) drop out from therapy and (ii) improvement was examined. Early terminators were found to differ significantly from continuers as to their ratings of their relationship with the therapist, and trends were found for therapists' feelings to be associated with adherence to therapy. Early terminators were not distinguished by diagnosis, severity of case, or improvement rating. Improvement, on the other hand, was not associated with therapists' or clients' attitudes to each other. It is suggested that these factors are of greater significance in “joining” therapy than in its course.     

Persons and Hypotheses: The Use of the Therapist in the Hypothesising Process

Although hypothesising has been strongly criticised by postmodern and narrative theorists, it plays a major role in any therapy. This article aims to investigate the hypothesising process, first revisiting the concept of hypothesis in semiotics and Schön's theory of the professions, then examining some features of hypothesising within systemic therapy. The article takes into account the relationship between hypotheses and therapists' basic theories, to arrive, finally, at an examination of the role of the person (both therapist and client) in shaping hypotheses within the therapeutic interaction.     

To Refer or Not to Refer: Exploring Family Therapists' Beliefs and Practices Related to the Referral of Lesbian,Gay, and Bisexual Clients

This study explored how negative beliefs toward lesbian, gay, and bisexual (LGB) individuals and LGB clinical competence influenced family therapists' beliefs and practices regarding referring based on the sexual orientation of the client. The sample consisted of 741 experienced clinicians. The results of this study indicated that the majority of the participants believe it is ethical to refer LGB clients; however, most had never made such a referral. Furthermore, participants who had referred based solely on the client's sexual orientation reported higher levels of negative beliefs toward LGB individuals and lower levels of LGB clinical competence. Finally, negative beliefs toward LGB persons not only predicted the practice of referring, but also the belief that it is ethical to refer an LGB client.     

Reflections and Learning From an Agency‐Wide Implementation of Single Session Work in Family Therapy

In November 2009, the Bouverie Centre, a centre for training, research, and clinical family therapy in Melbourne, Australia, embarked on a 12‐month trial involving the implementation of single session work as our main model of service provision for all new family appointments. We were interested in evaluating clients' and therapists' experiences of this change in our clinical service delivery. This article discusses some clinical dilemmas that arose for staff in this process, and how they were addressed. Clients' responses to single session work are outlined, followed by a discussion of outcomes of the implementation for our organisation.     

Cut the Crap: Language — Risks and Relationships in Systemic Therapy and Supervision

This article concerns the use of language in both therapy and supervision, and how it contributes to the necessary risk‐taking that will be a part of therapists' and supervisors' repertoires. The focus will be on my own examples in both roles, and will refer to both successes and failures, while questioning the usefulness of either concept. Within a postmodern paradigm, and influenced by thinkers including Foucault and Bakhtin as well as systemic clinicians, I will examine the use of language (including in cross‐cultural settings where risks can sometimes be amplified) and of humour and self while exploring the meanings of identity. I contend that all relationships contain some element of risk and the ways in which we create a safe enough context, through the uses of language as well as nonlinguistic means, are the crucial elements in our endeavours as supervisors and therapists. I favour the idea that therapy is more of an art than a science and that this is most exemplified in the graceful use of language by which we strive to engage rather than alienate people. The article may be considered by some as being useful advice, and by others as a risk too far, such is the controversial nature of language, which highlights the importance of relationships and context.     

Life Course Analysis—The Courage to Search for Something More

Abstract

In this paper we discuss middle-to-late life issues of the transgender and intersex communities. We demonstrate that these mid-to-late life issues are richly complex, full of courage, coping, risk, and resilience, and are grounded in a socio-ecological landscape of systemic actual and perceived violence and abuse. We examine how this socio-ecological environment affects the “normative” mid-life cycle processes. Practical examples are drawn from the author's field interviews and survey research over the past decade. We close by examining the effects of such a landscape on the middle-age life stage and examine its potential ramifications for old age as well.     

Evaluation of Family Therapy: A Comparison of Therapists' and Clients' Views**

In this evaluation of therapy experience for 82 families by brief therapy at Bouverie Clinic to 1976–1977, therapists' and clients' rating of outcome were obtained. After termination of therapy both therapists and clients reported high improvement rates in the presenting problem(s) as well as in the quality of family relationships and in the family's ability to deal with further problems. High agreement was found between therapist’ and clients' ratings of outcomes. Therapists were more favorable than clients in their ratings of change in the presenting problem and in their ratings of change in the quality of family relationships, but not in assessing the change in family's further problem solving ability. At follow-up clients were predominantly satisfied with their therapy experience. In addition, therapists' ability to predict outcome accurately, after the second of therapy, was strongly supported by our finding.     

Group therapists' countertransference reactions to multiple deaths from aids

Group therapists for those with HIV Related Diseases are becoming the “professional” survivors of this world-wide epidemic. From their experiences we may learn a great deal more about the effects of multiple deaths on mental health care professionals. As therapists they are constantly eliciting and listening to the fears, hopes, agonies and terrors of those with this disease. They become the bereaved. Witnesses to the deaths of many of their group members, they struggle with a wide range of emotional responses while at the same time assisting surviving group members in their struggle to live with these deaths. Mourning reactions and countertransference phenomena are in abundance as these therapists grapple with these group processes. This article identifies and examines these therapists' responses by focusing on clinical illustrations drawn from their bi-weekly supervision sessions.     

MODES OF EXPRESSION IN FAMILY THERAPY: A PROCESS STUDY OF ROLES AND GENDER*

Twenty-two two-parent families with a referred adolescent were seen by 11 male and 11 female trainees in family therapy. Mothers, fathers, adolescents, and therapists were rated for verbal expression in affective, behavioral, and cognitive! attributional modes during the first session. Results clearly point to role and content difference in modes of expression. Of particular importance are differences by role which occured as a function of therapist gender. These differences suggest that therapist gender has an impact on family therapists' and family members' verbalizations in first sessions of family therapy.     

Therapists Working in New and Old Ways: An Integrative Ecological Framework for Non‐Familial Intergenerational Relationships

Non‐familial intergenerational (NFIG) relationships can complement conventional therapeutic interventions. We discuss the intergenerational gap and structural changes families have experienced over the last several decades. We advocate for an integrative framework combining non‐familial intergenerational opportunities with conventional therapeutic interventions. Finally, we address logistical and ethical dimensions of the integrative framework and participants' fitness, motivation, potential, and needs within non‐familial intergenerational programs/partnerships.     

Exploring Women's Retirement: Continuity,Context and Career Transition

This paper reports on an exploratory study examining women's views about and experiences of retirement. It has long been recognized that women's careers often follow a different path than men's due to the differential impact of family and domestic responsibilities and their relative underrepresentation at higher levels of organizations. However, many studies of retirement have implicitly assumed a conventional male career as the norm, where retirement is seen as marking a neat ending to continuous employment. This paper aims to present a richer understanding of women's retirement, utilizing contextual national data and qualitative analysis. The paper begins with a brief summary of literature looking at women's career development. We then explore the concept of retirement and consider current literature with regard to women's retirement. Following a brief discussion of our research approach, we provide some national context using quantitative data. We then discuss the qualitative findings, examining the areas of continuity and change that women experienced in retirement and exploring the factors that they felt enabled and constrained them.     

Union membership and perceived powerlessness in southern US textiles*

Using Marxist, mass society, organizational, and social movements literatures, we distinguish alternative accounts of the relationship between union membership and perceived powerlessness. Then, we illustrate the distinctions with survey data on southern US textile workers. Logistic and ordinary least squares regression analyses suggest two interpretations for this group of workers: union membership influences perceived powerlessness by providing members a responsive organization that contrasts with their lack of control in the workplace; and perceived powerlessness, when combined with endorsement of collective strategies for change, encourages union membership. In the southern textile case, we find that race is associated with specific ideological leanings regarding collective strategies. The location of our sample, its particular position in the political economy of the US, and the relative immaturity of its union allow for instructive comparisons with other sociological treatments of work attitudes and collective action.     

Experiences of Family Therapists Working with Families in a Transitional Homeless Community

The purpose of this study was to explore the experiences and observations of marriage and family therapists (MFTs) conducting an empirically supported parenting program at a transitional homeless community. A diary method was used in recording five MFTs' observations and reactions to implementing the psychoeducational groups. Fifty‐one recordings were collected from three different parenting groups over the course of 20 weeks. Constant comparative method was used to identify themes related to MFTs' experiences of conducting the parenting program. These themes included the needs of at‐risk families, confidentiality, and role ambivalence and boundary ambiguity. We provide recommendations for best practices and an example of therapists' decision‐making process using Kitchener's (1984) model.