The Debate: A Strategic Technique

This paper describes the work of a strategic team that came out from behind the one-way mirror. A debate among the team is enacted before the family as a strategy for change. The case of a family that refused to provide information illustrates an application of this method. The debate among the therapists represents a dilemma that is a strategically constructed isomorph of the family situation. From this position, therapists have the option of changing levels between themselves and the family, asking the family to help solve the therapists' dilemma so that they in turn can be free to help the family. The combination of the debate and the change of levels between the therapists and the family creates a therapeutic neutrality for the family. From their meta position, they observe the therapists' struggle to solve the family's problem, which is re-presented as a problem among the therapists. This perspective offers the family the choice of more adaptive solutions to their own dilemma.     

The Negotiation of Values in Therapy

Values are integral to all social systemic operations and therefore to the heart of the therapeutic process. For the therapist, values are an essential component in defining and assessing a problem, determining goals, and selecting therapeutic strategy. Therapists do not have a choice about whether they need to deal with values in therapy, only about how well. The training of therapists about their values needs to be integrated with the training about their own emotional and family issues. This training should be carried out in the context of treating families and have as its primary focus the relationship of the therapists' personal issues to the conduct of their therapy with families. Personal insight and mastery over handling their own values and family issues will maximize therapeutic effectiveness.     

Experiential Tasks and Therapist Bias Awareness

All therapists have values, assumptions, and beliefs about groups of people who are different from the dominant culture. How the therapeutic process is shadowed by therapists' assumptions and attitudes toward ethnic minorities is discussed. The author provides experiential techniques such as visualization, role playing, role reversal, family sculpturing, and a written assignment as a vehicle to heighten a family therapists' awareness of underlying assumptions and biases toward clients of an ethnic minority.     

'Good morning, Sir!'Axe handle.' Talking at cross-purposes in family therapy

This paper will examine how therapists can make sense of and use some of the incongruous and apparently absurd replies which clients sometimes make to their therapists' questions. It will be argued that the convention of relying on therapist questions can create its own problems, not least because clients often feel at a disadvantage. Careful attention to the question_answer process in therapy can play an essential part in the therapeutic alliance and can give us clues as to what may be some of the often unstated preoccupations of our clients.     

Walking in sacred spaces in the therapeutic bond: therapists' experiences of compassion satisfaction coupled with the potential for vicarious traumatization

The therapeutic bond is at the heart of effective therapy, yet few studies have examined therapists' experience of this bond. Using a qualitative study design, this exploratory study examines the experiences of couple and family therapists in relation to their perceptions of the satisfactions and risks involved in the therapeutic bond. The research was conducted using grounded theory methodology and eight in-depth interviews were conducted with therapists working in five counseling agencies in Sydney, Australia. Therapists described the importance of the 3 component parts of the therapeutic bond: the empathic connection between therapist and client; the role investment of the client; and the mutual affirmation experienced by both therapist and client in the therapeutic process. Walking in sacred spaces with the client was seen as both enriching and challenging for the therapist. The therapeutic bond gave therapists intense satisfaction and posed risks for them, especially when working with traumatic client experiences. However, the findings suggest that the experience of compassion satisfaction and the development of vicarious resilience counter-balanced the intense difficulty of bearing witness to clients' traumatic experiences and the potential for vicarious traumatization. The implications for sustaining couple and family therapists in their work are discussed.     

Sculpting Present and Future: A Systemic Intervention Model Applied to Psychosomatic Families

We present a therapeutic intervention model for use with psychosomatic families. This method, the result of our extensive research on various psychosomatic disorders, uses family sculptures of the "present" and "future": each family member is requested to represent the family as it now "is," and how it "will be" in the future. We discuss the theoretical reasons for our choice of this method: (a) the opportunity to use a therapeutic language that is similar to the nonverbal language of the psychosomatic symptom, and (b) the usefulness of reinserting temporal dimensions into family systems that seem to have lost their evolutionary potential and to be in a sort of "time lock." Two clinical cases are discussed (a child with chronic asthma and an anorexic adolescent); the use of sculptures in both cases revealed the underlying problems and made positive therapeutic interventions possible. Finally, we point out how the use of sculpture as a therapeutic technique enables therapists to deal with multiple systemic levels.     

My Family Made Me Do It: The Influence of Family Therapists'' Families of Origin on Their Occupational Choice

This study is an empirical test and exploration of the folklore about family life correlates of family therapists' occupational choice. The folklore is translated into systems concepts, including role complementarity and the mutually determining effect of process and roles. Fifty-nine family therapists, 49 siblings of the therapists, and 51 undifferentiated, non-helping professionals were compared on FACES (29), The Complementary Role Questionnaire, and on demographic data. Inconsistencies in the results led to a critique of the clinical faithfulness of current systems measures. Family therapists did not differ on FACES, but did differ in aspects of roles from their siblings and from the control professionals.     

Family therapy for childhood depression: researching significant moments

This paper is a qualitative family therapy process study which is part of a larger European-based outcome study comparing family therapy to child psychotherapy plus parent support for depressed children and their families. The family therapists and two clinical supervisors from the original study formed themselves into a research team to study the process of therapy with twelve families. Therapists selected the significant moments from fifty-nine sessions, and were then interviewed by the research team using a standard protocol to investigate the therapists' own thinking about the significant moments. Applying a thematic analysis, the significant moments were clustered into eleven themes. The paper discusses the rationale for this model of research, which is well suited for clinical teams, and the application of the themes to therapeutic work with depressed children and their families.     

Implementing Family-Based Musical Interventions in Family Therapy: A Mixed-Methods Research

Although rarely used by family therapists, musical interventions have the potential to become a more common technique in family therapy. Music’s unique therapeutic properties engage families, including young children and adolescents, in a meaningful, therapeutic, “here-and-now” creative process. Musical interventions act as catalysts, enable direct communication, and augment authentic communication patterns in a playful atmosphere. The purpose of this explanatory mixed-methods research was to obtain a greater understanding of the clinical applicability, therapeutic value and future implementation of a musical intervention carried out by family therapists in a family therapy context. The study explored the outcomes of 35 participating family therapists who attended a designated workshop on a structured family-based musical intervention, 18 of whom then applied 38 family-based musical sessions focused on family roles in their clinical work. The results illustrate the family-based musical intervention is a noteworthy tool for family clinical assessment and treatment, easily applicable in a variety of private and public settings with diverse populations. Musical instruments used as intermediary objects are potent vehicles for growing family awareness, functioning, and congruence, as well as inducing opportunities for change. The family-based musical intervention manifests the potential of an interdisciplinary, holistic, biopsychosocial approach to promoting individual and family wellbeing. The article also addresses ethical considerations and implications for family therapy training and education programs.     

Difficulty in implementing a family intervention for bipolar disorder: the predictive role of patient and family attributes

Family affect was examined as a predictor of difficulty implementing a 9-month, manual-based, psychoeducational family therapy for recently manic bipolar patients. Prior to therapy, family members were administered measures to assess both their expressed emotion and affective behavior during a family interaction task. Following family treatment, both therapists and independent observers rated the overall difficulty of treating the family, and therapists also rated each participant's problem behaviors during treatment, in the areas of affect, communication, and resistance. Therapists regarded affective problems among relatives and resistance among patients as central in determining the overall difficulty of treating the family. Relatives' critical behavior toward patients during the pretreatment interaction task predicted both independent observers' ratings of overall treatment difficulty and therapists' perceptions of relatives' affective problems during treatment. Moreover, patients' residual symptoms predicted independent observers' ratings of overall difficulty and therapists' perceptions of patients' resistance to the family intervention. Results suggest that difficulties in conducting a manual-based family intervention can be predicted from systematic, pretreatment family and clinical assessment.     

Working through: in-session processes that promote between-session thoughts and activities

This study examined whether clients' ratings of the working alliance as well as their perception of cognitive-behavioral (CB) and psychodynamic-interpersonal (PI) techniques (delivered by therapists who used both) were associated with clients' intersession processes (i.e., their thoughts about therapy and therapeutic activity between sessions). Seventy-five clients who were currently in therapy at a large university counseling center participated in the current study. Multilevel regression analyses demonstrated that alliance and clients' perceptions of their therapists' use of PI techniques were positively associated with clients' general thoughts about therapy between sessions. Also, stronger alliances were associated with more therapeutic activities between sessions and more positive (and less negative) thoughts about therapy between sessions. In addition, clients at later sessions who described their therapists as using more PI techniques also reported engaging in more therapeutic activities between sessions (after controlling for the variance in the other variables, such as use of CB techniques). Clients' perceptions of their therapists' use of CB techniques in the most recent session were not related to thinking about therapy or therapeutic activities after controlling for the variance in the other variables.     

Client and therapist variability in clients' perceptions of their therapists' multicultural competencies

This study examined therapist differences in their clients' ratings of their therapists' multicultural competencies (MCCs) as well as tested whether therapists' who were rated as exhibiting more MCCs also had clients who had better therapy outcomes (N = 143 clients and 31 therapists). All clients completed at least 3 sessions. Results demonstrated that therapists accounted for less than 1% of the variance in their clients' Cross-Cultural Counseling Inventory–Revised (CCCI-R; T. D. LaFromboise, H. L. K. Coleman, & A. Hernandez, 1991) scores, suggesting that therapists did not differ in terms of how clients rated their MCCs. Therapists accounted for approximately 8.5% of the variance in therapy outcomes. For each therapist, their clients' CCCI-R scores were aggregated to provide an estimate of therapists' MCCs. Therapists' MCCs, based on aggregate CCCI-R scores, did not account for the variability in therapy outcomes that were attributed to them. Additionally, clients' race/ethnicity, therapists' race/ethnicity, or the interaction of clients'–therapists' race/ethnicity were not significantly associated with clients' perceptions of their therapists' MCCs.     

Therapist Focus on Parent Involvement in Community-Based Youth Psychotherapy

Parent involvement in the treatment of childhood disruptive behavior problems is a critical component of effective care. Yet little is known about the amount of time therapists are involving parents in treatment and factors that predict therapists' efforts to involve parents in routine care. The purpose of this study is to examine therapists' within-session involvement of parents in community-based outpatient mental health treatment. The data are from a larger longitudinal observational study of psychotherapy for children ages 4-13 with disruptive behavior problems and include videotaped psychotherapy sessions coded for the therapeutic strategies delivered as well as measures of child, parent/family, and therapist characteristics at baseline. Parent involvement is defined as the proportion of time in the session that therapists direct treatment strategies towards parents. Results indicated that therapists directed treatment strategies towards parents an average of 44% of the time within a session. Multilevel modeling was used to examine client-level (child, parent, and family functioning) and provider-level (therapist experience and background) predictors of parent involvement. Therapists involved parents more when the child had higher levels of behavior problems, when the parent reported higher levels of internalized caregiver strain, and when the therapist was more experienced. The results highlight potential areas to target in efforts to increase parent involvement, including training less experienced therapists to increase their focus on directing strategies towards parents.     

Narrative Therapy Using a Reflecting Team: An Ethnographic Study of Therapists' Experiences

Narrative therapy in the last 15 years has been utilized by many clinicians and yet there is a lack of research on therapists' experience of this approach. This ethnographic research explores the views and perceptions of eight narrative therapists who belonged to a narrative team in an outpatient clinic. These therapists were observed and interviewed. Five themes emerge from the data. The themes include a sense of success in reducing the clients' problems as well as some limitations of narrative therapy. Two recommendations for research and practice involve the use of narrative therapy without a team and the use of narrative therapy in addressing issues of family violence.     

Critical incidents: Life events for experienced family therapists

Summary The results of this investigation suggest that therapists' professional style and clinical use of self patterns are impacted by critical life events occurring in their personal life. Many subjects reflected on how changes in their family constellations (both family of origin and family of procreation) were important to their professional development. They frequently mentioned that marriage, children, divorce, and illness or death of a loved one impacted their personal and, then, their professional lives. The important life events of becoming a parent or losing a significant loved one was specifically mentioned as strongly influencing changes in one's professional direction and therapeutic style.Becoming a parent caused the interviewees to reevaluate their expectations of their own parents, their client families and themselves. Changes in career aspirations, interactional patterns, and the capacity to be consistent and calm were explored and understood differently. Many subjects described how this transition in their own life shifted their primary focus and altered many of their existing relationships. In particular, female therapists with younger children related how their sense of being female changed. They sought out other women for intimate contact more frequently, they understood their own mothers better, and they frequently were less judgmental of mothers in their client families.Along with creating their own families, death of a parent was keynoted as having a strong impact on the subjects' personal and professional lives. They described questioning (and frequently changing) the amount of time they spent working and the type of work they did. Many began to push for more emotionally intense relationships personally and therapeutically. Detailing how their therapeutic goals for a family now included connection-making rather than just problem solving, they described being much more willing to share their vulnerabilities and personal needs with clients.     

Meditative Dialogue: Cultivating the Transformative Theater of Psychotherapy

This article offers a selective review of literature on the use of improvisation and play to promote “the bursting forth from the unknown in the moment” (Kindler, 2010, p. 224) in what I term the “theater of psychotherapy.” It presents an innovative Meditative Dialogue process through which clients and their therapists are able to cultivate and access this “theater” as they co-create creative spaces in which transformative experiences are accessible. A brief vignette offers an illustration of how the Meditative Dialogue process helps to develop intimacy, presence, and focus through a collaborative positioning of curiosity, openness, and enlivenment in the therapeutic relationship.     

The development of psychotherapists' theoretical orientation and clinical practice

There is a growing recognition on the part of psychotherapy researchers of the importance of studying therapist variables, recognising that they have a sizeable influence on both therapeutic process and outcome. A model of the development of therapists' theoretical orientation and clinical practice is outlined, based on the integration of data from 161 Portuguese therapists with the extant literature. The selection of initial orientation is addressed, showing that, regarding this choice, therapists from different persuasions appear to emphasise different variables. In terms of changes in the initial theoretical orientation, it seems not only that 'clinical experience' plays a central role, but also that therapists subscribing to different orientations may find different solutions to their theoretical development. Implications and suggestions for improving training are oudined.     

Family Secrecy in Family Therapy Practice: An Explorative Focus Group Study

The aim of this focus group study was to explore the experiences of family therapists working with family secrecy. Our study highlights that family secrets present important and compelling challenges for family therapists. Furthermore, our study reveals that there seem to be some basic strategies family therapists use in dealing with these challenges in therapy sessions. One basic strategy is that family therapists try to guard their position of being a trustworthy therapist for each family member by avoiding becoming stuck in family secrecy. Furthermore, therapists explore ways to guide the family toward the disclosure of the secret in order to alleviate the toxicity of the secrecy. This highlights the importance of the systemic model and how influential this perspective is in family therapy practice. Some participants, however, have in addition a second strategy they sometimes use: talking with the family about secrecy without aiming to disclose the secret. In the discussion section of the article we reflect on the possibility that in the strategic choices family therapists make conceptual issues might be involved. Furthermore, we stress the importance of further research.     

Micro‐analysis of a therapist‐generated metaphor referring to the position of a parentified child in the family

The purpose of this exploratory study is to develop a deeper understanding of the way in which the metaphorical language of therapists evolves in dialogue with a client over the course of a therapeutic session. We first briefly report on a study in which we categorized the metaphors used by therapists in twelve therapy sessions with a role‐played client. Then we focus on an intensive micro‐analysis of one particular metaphor that was introduced in the session by one particular therapist in the categorization study: the metaphor of a fireman in the family. Our analysis allowed us a detailed look at some of the ways in which metaphorical language opens dialogical space in the session to talk about the position of parentification of the client and about the price she has to pay for this position in terms of preoccupying worries and loneliness. Furthermore our analysis revealed the delicate dialogical nature of the therapeutic process in which, in talk, the therapist takes the client's experiencing into account all the time.