Rating expressed emotion from initial family therapy sessions (a pilot study)

A small pilot study is described in which an attempt was made to rate expressed emotion (EE) from an initial family interview. It was found that ratings could be made and that all but one of the families were high EE. Both empirical and clinical implications are discussed.     

Group treatment for trichotillomania: behavior therapy versus supportive therapy

In this randomized controlled trial, group behavior therapy (BT; n = 12) was compared to group supportive therapy (ST; n = 12) in the treatment of trichotillomania (TTM). Both treatments were also compared to a naturally occurring waiting period, the time period that participants waited for groups to form. Participants completing group BT experienced significantly greater decreases in self-reported hair-pulling symptoms and clinician-rated hair loss severity than did those in group ST. Decreases were significantly greater after treatment than after the naturalistic waiting period. In addition, a significantly higher percentage of those in the BT than ST condition were rated as much improved or very much improved on the Clinical Global Impression scale at posttreatment. However, despite substantial symptom improvement, TTM severity remained problematic at posttreatment. Specifically, few participants in either treatment met criteria for clinically significant change at posttreatment. In addition, relapse of symptoms occurred over the 6-month follow-up period. Results provided partial support for the short-term efficacy of group BT. However, the group format may not maximize the efficacy of BT for TTM. Thus, it is recommended that future BT research test either individual therapy or a combination of group and individual formats for TTM.     

Using masks as therapeutic aids in family therapy

'Man is least himself when he talks in his own person, give him a mask and he will tell the truth' (Oscar Wilde).
This paper describes an innovative technique which uses masks as therapeutic aids in treating families in conflict. Structured within the framework of interpersonal perception, this technique uses play, humour, and the power and 'magic' of masks paradoxically to 'unmask' family members and facilitate reality-testing of perceptions distorted by the emotional masks individuals create and project onto each other. Mask usage is suggested as an adjunct to other therapeutic approaches currently used with families. Caveats and contradictions for the technique are presented. A case study illustrates the use of the technique with a reconstituted family.     

'Holding' as a therapeutic manoeuvre in family therapy

This paper describes the use of planned parental physical 'holding' as part of family therapy in a Child and Family Guidance Clinic. It is used when the child is overactive or out of parental control, or is not attached to its parents. Direct or indirect suggestions that parents hold their children are made by the therapist.     

Simulation as a tool in family therapy research

The efficacy and validity of simulation for purposes of training and evaluation are well established. Simulation has proven valuable in human behaviour research as well. However, based on the belief that families and other small groups behave differently, many family theorists have concluded that simulation may not be valid for family research despite the fact that some empirical studies showed little difference between simulated and actual families, suggesting that the disparity may not be as great as commonly believed. Ongoing and future studies controlling for 'time together', a dimension presumed to be critical in comparing simulated with actual families, may demonstrate that differences are not sufficiently large to preclude the use of simulated families in family research. Methodological problems are addressed and directions for future research proposed.     

The effect of affective bibliotherapy on clients' functioning in group therapy

Abstract The effect of affective group bibliotherapy (GB) was compared to affective group therapy (GT) on patients' functioning in therapy and their session impression. Three small groups totaling twenty-five in-patients in a hospital in Israel participated in the study. Clients concurrently participated in both group types, undergoing three sessions in each condition. In-therapy behaviors were assessed through the Client Behavior System (CBS; Hill & O'Brien, 1999). Results indicated that in the GB condition compared to the GT condition, clients showed less resistance, used simple responses less frequently, and expressed greater affective exploration. The Session Evaluation Questionnaire (SEQ; Stiles et al., 1994) was used to measure clients' impressions of the sessions. Results indicated that patients evaluated the two treatment conditions equally. Overall, the results support earlier findings, suggesting that affective bibliotherapy can be an effective method of treatment.     

Research as a family therapy intervention technique

The utilization of the research process as an intervention has recently been described in the family therapy literature. However, it is important to draw a distinction between research as intervention and research as a unique family therapy intervention technique. From a family systems perspective, research as an intervention technique may make therapy more palatable for some families. A case study is presented in which this technique created the context for change for a family involved in a chronic illness research project.The author would like to thank Dr. Wendy L. Watson for her participation as a member of the clinical team and Drs. Fabie Duhamel and Wendy L. Watson for their helpful critiques on earlier drafts of this paper.Supported by a grant from the Albert Foundation for Nursing Research.     

Cultural ruptures in short‐term therapy: Working alliance as a mediator between clients' perceptions of microaggressions and therapy outcomes

Aim: To determine whether or not clients' perceptions of microaggressions varied based on their own and the therapist's race/ethnicity and whether or not they would be negatively related to the effectiveness of therapy and if the working alliance would mediate this effect. Method: The study utilised a cross‐sectional, retrospective, methodology. Clients were recruited from a large university counselling centre in the United States (N=232 clients and 29 therapists). Results: Neither clients' race/ethnicity, therapists’ race/ethnicity, nor client‐therapist ethnic matching predicted perceptions of microaggressions. Clients' ratings of microaggressions were negatively associated with their psychological wellbeing; however, this effect was mediated by clients' ratings of the working alliance. Implications: Therapists should take into account the cultural messages they may be conveying to both white and racial/ethnic minority clients. Therapists should develop strategies that are consistent with a general therapeutic approach that promotes discussions about culture with their clients and, most importantly, should attend to the therapeutic relationship.     

Orthodoxy in family therapy practice as servant or tyrant

This paper considers some of the pitfalls of a single-model approach to family therapy. It does not argue a 'right' way of practising family therapy, but proposes that the therapist needs to have available a range of approaches on which to draw. This also raises certain problems for training in family therapy, which are highlighted. A case is discussed in the light of a number of perspectives, to demonstrate how approaches can be used in complementary fashion. Finally, reference is made to some of the agency constraints which also make it difficult to practise any one model in a 'pure' form.     

Preferences versus strategies as explanations for culture-specific behavior

In this article, we present a new framework for interpreting cultural differences in behavior -- what we call the institutional approach. In this framework, individuals' behaviors are conceptualized as strategies adapted to various incentive structures. Cultural differences in behavior are thus viewed as differences in the default adaptive strategies that individuals come to rely on in unclear situations. Through two studies, we demonstrate that the East Asian "preference" for conformity is actually a default strategy to avoid accrual of negative reputation. When the possibility for negative evaluations in a given situation was clearly defined, cultural differences in the tendency for uniqueness disappeared. This approach carries important implications to psychologists who interpret cultural differences in behavior in terms of preferences, and can serve as a common framework branching out toward other disciplines in the social sciences.     

One vs five sessions of exposure and five sessions of cognitive therapy in the treatment of claustrophobia

Forty-six patients fulfilling the DSM-IV criteria for claustrophobia were assessed with behavioral, physiological, and self-report measures. They were randomly assigned to four conditions: (1) one-session (E1); or (2) five-sessions of exposure (E5); (3) five-sessions of cognitive therapy (C5); and (4) Wait-list for 5 weeks. The first condition consisted of a single 3 h session of massed exposure, and condition 2 and 3 of 5 h of gradual treatment, which was done individually by very experienced therapists. The results showed that treatment was significantly better than the wait-list condition, and the three treatments did equally well with no differences between them. At post-treatment 79% of treatment patients vs 18% of the wait-list controls had improved to a clinically significant extent. When the three treatments were compared 80% in the E1-group, 81% in the E5-group, and 79% in the C5-group were clinically improved. At the 1 year follow-up the corresponding figures were 100%, 81%, and 93%, respectively. The implications of these results are discussed.     

The family as its own reflecting team: a family therapy method

Social research has suggested that people, in general, tend to overestimate their skills and abilities. Interestingly, research has found that peers are better predictors of a person's behaviour than self‐assessment, suggesting that others know us better than we know ourselves. Family therapists should be aware that family members might not give accurate accounts of themselves. In order to overcome this problem, therapists should incorporate peer assessments into therapy. Reflecting teams and videotaping do incorporate peer assessments, yet these methods can be impractical. This article describes a method of family therapy using enactments as a means of setting up the family as its own reflecting team. The method suggests that the family and therapist switch roles several times during the enactment, and then encourages a discussion on the peer observations on how each person addresses a problem in the family. Case examples illustrate how feedback from peers promotes insights.     

The real as illusion: deconstructing power in family therapy

This paper examines the current issue of power and intervention in family therapy from the perspective of Jacques Derrida's philosophy. In a deconstructive reading which presents power as both real and socially constructed, it negotiates the border between such dualities as knowing/ not-knowing, intervention/non-intervention, and power/non-power. The paper tracks Goolishian and Anderson's approach to therapy as deconstructive in practice, but not in theory, and discusses a double view of power in relation to both Bateson and Foucault. It suggests that power is both endemic to the context of family therapy and an illusion of epistemology. The paper concludes with a discussion of the wider question of ethics in relation to technology.     

Using relational reflexivity as a resource in teaching family therapy

In this paper we talk about creating coherence and transparency in the relationships between teacher, model of adult learning and subject taught. We describe how we have made connections between adult learning theory and family therapy to generate resources for action in teaching on the qualifying level course at Northumbria University. Using a recent teaching session and the voices of trainees, we illustrate these connections with an example of teaching about relational reflexivity, using methods which enabled us to generate reflexive ‘flow’ in the learning context.     

Countertransference as a corrective emotional experience in existential family therapy

An existential approach to family psychotherapy should be cognizant of both individual human development and family life cycle growth. In Existential Family Therapy a family developmental challenge often occurs when the developmental progression needs of one family member challenge the pace of total family developmental progression. In such a situation intervention by the therapist should occur in a way that facilitates both individual and family developmental growth. Such interventions often best occur through the creative and controlled use of the family therapist's countertransference feelings in a way that helps the family accept and master its developmental challenges. Case material is provided to illustrate the described intervention approach.     

Anxiety symptom focus in sessions of cognitive therapy for depression

The comorbid patient presents an especially difficult problem to a therapist who is attempting to implement a short-term, focused therapy. The current study investigates the effect of comorbid anxiety on cognitive therapy for depression. Participants were a subset of patients (N=24) assigned to the cognitive therapy arm of a large, randomized, controlled trial of treatment for depression. From intake assessments, patients were classified as having low or high levels of comorbid anxiety. Two videotapes of each patient's therapy sessions were coded. Irrespective of intake anxiety level, more time and effort spent addressing anxiety in session was found to predict less improvement in both depression and anxiety symptoms over the course of treatment.